The British Association of Sports Rehabilitators (BASRaT) hosted a brilliant webinar last week on Long COVID in elite athletes, giving some really valuable & concise information on the patterns they’ve seen in this population & how to manage it. This treatment strategy can be applied to everyone suffering with Long COVID.
Here are my key take home points:
In all populations the vaccine has shown a decreased risk of hospitalisation.
Being physically fit & healthy reduces risk of hospitalisation. Younger age groups are less likely to be admitted to hospital in the acute phase BUT there are many more cases - not being admitted to hospital doesn’t mean you can’t get very ill!
Average duration of symptoms 10- 11 days. But of those athletes studied with longer duration 27% (!!!) were still not training at 28 days. To put this in context, the normal common cold most of us may be out of action for 1-2 days, but as long as 28 days? Only 4%.
The symptoms that correlated with those suffering symptoms for longer initially suffered with symptoms of lower respiratory tract infection, such as fatigue, chest pain & shortness of breath, rather than upper tract infections like a cough & loss of smell/taste. There has also been some concern raised about cardiac issues post COVID. Cardiac inflammation was only seen in <1%.
The most typical ongoing symptoms were excessive fatigue, breathlessness, joint pain & chest pain. Athletes demonstrated altered breathing patterns typical to a Sympathetic nervous system response (‘Fight or flight’), using more of the upper chest rather than the diaphragm. This then causes a cascade of issues as it is a highly inefficient way of breathing.
Our body needs a balance of fight/flight and rest/recover - known as the Parasympathetic nervous system. We get most of this when we sleep. Athletes with Long COVID were still in fight/flight while they were trying to sleep! Not only does this lead to lack of quality sleep, but also muscle tension, increased heart rate & fatigue. If athletes are unable to rest, they are unable to recover from a training session in time for the next.
(My favourite bit of info:)
Biomechanically an upper chest breathing pattern can affect the ribcage mobility which means the diaphragm can’t function correctly and can fatigue. The diaphragm trumps the limbs in terms of the body’s priorities for blood supply as it is essential for getting oxygen into the body (& part of your #core)! If running, you might notice this as to fatigue of the legs so you’d need even more effort/exertion to keep going. This isn’t exclusive to athletes - For normal people this could just be felt as trying to do day to day tasks like housework or running around after the kids! So although the presentation was showing research on athletes, when it comes to looking at energy expenditure for day to day tasks these findings can be transposed to the non-athlete population
Treatment aims to balance the Sympathetic & Parasympathetic nervous systems by:
Optimal breathing is:
Through the nose
Relaxed upper chest
80% diaphragm 20% intercostals
Quiet
8-12 Breaths per minute
Doesn’t have to be big ones, a normal breath is only 500ml
As your energy systems can be drained by things other than exercise including socialising, cognitive activities & emotional stress relaxation is NOT:
being on social media
Watching TV
talking /socialising with friends or family
So, how to put this into practise?
wait for 72 hrs after exertion- whether that’s exercise or something other type, to see your body’s response & avoid a boom/bust cycle,
improve your sleep hygiene- such as switching of from blue light & winding down 1-2 hours before bed, having a routine bedtime/waking time,
doing your breathing exercises.
Other excellent resources supplied:
The CSP Covid Rehabilitation standards are available to view here: https://www.csp.org.uk/publications/covid-19-community-rehabilitation-physiotherapy-service-delivery
More information about the Institute of Sport Exercise and health: https://www.iseh.co.uk/
Dr Hull’s recent publication in BJSM: Clinical patterns, recovery time and prolonged impact of COVID-19 illness in international athletes: the UK experience: https://bjsm.bmj.com/content/bjsports/early/2021/08/01/bjsports-2021-104392.full.pdf
Resources on breathing: “Physiotherapy for Breathing Disorders”: www.physiotherapyforbpd.org.uk and The physiological effects of slow breathing: https://drive.google.com/file/d/1OdApRAJtf-b1-w38NOatjOObKf1VUrki/view?usp=sharing
#breathing #recovery #longcovid #health #rehabilitation #fitness #returntohealth #breathingpattern #diaphragm #breathebetter #ribmobility #corefoundations #exercise #bodyawareness
Your posts are always a good read. Luiz Antonio Duarte Ferreira
This post really resonated with me. Luiz Gustavo Mori
Loved the insights, thank you! Veronica Dantas