Long Covid, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a condition that affects people who have recovered from Covid-19 but continue to experience symptoms for a prolonged period of time. These symptoms can include fatigue, shortness of breath, joint pain, and cognitive difficulties. Physiotherapy can play an important role in the management of Long Covid symptoms.

Before starting physiotherapy, a thorough assessment is required to determine the patient’s physical status, functional abilities, and limitations. This assessment can include:

• Measurement of lung function: This includes spirometry, which measures the amount and speed of air that a patient can exhale.
• Assessment of breathing pattern: This can be done by observing the patient’s breathing rate and pattern, and assessing their use of accessory muscles.
• Assessment of exercise capacity: This can be done through walking tests or cycle ergometry.
• Assessment of strength: This can be done through muscle strength testing.
• Assessment of balance and coordination: This can be done through functional tests, such as the timed up and go test.

Physiotherapy treatments for Long Covid

Breathing exercises – Breathing exercises can help improve the function of the respiratory muscles and increase oxygen intake. The following types of breathing exercises may be used:

• Diaphragmatic breathing: This involves breathing from the diaphragm instead of the chest, which can help improve the efficiency of breathing.
• Pursed lip breathing: This involves exhaling through pursed lips, which can help slow down breathing and reduce breathlessness.
• Deep breathing exercises: This involves taking deep breaths to increase oxygen intake and improve lung function.

Cardiovascular exercise – Cardiovascular exercise can help improve endurance and reduce fatigue. The following types of exercise can be useful:

• Walking: This can be done on a treadmill or outside and can be gradually increased in intensity and duration.
• Cycling: This can be done on a stationary bike or outside and can also be gradually increased in intensity and duration.
• Swimming: This can be a low-impact option for patients who have joint pain.

Resistance training – Resistance training can help improve strength and reduce muscle weakness. The following types of exercises may be used:

• Weight training: This can involve using weights or resistance bands to target specific muscle groups.
• Bodyweight exercises: This can involve using the patient’s own body weight to perform exercises such as squats, lunges, and push-ups.

Balance and coordination exercises – Balance and coordination exercises can help improve balance and reduce the risk of falls. The following types of exercises may be useful:

• Tai chi: This involves slow, flowing movements that can improve balance and reduce stress.
• Yoga: This can improve flexibility, balance, and strength.
• Functional exercises: This can involve exercises such as standing on one leg or walking heel-to-toe to improve balance and coordination.

Education and self-management – Education and self-management are important components of the treatment of Long Covid. Patients can learn techniques to manage their symptoms and improve their quality of life. This can include:

• Understanding the condition and its potential long-term effects
• Learning how to manage fatigue and conserve energy
• Understanding the importance of breathing exercises and cardiovascular exercise and how to perform them correctly
• Learning how to manage joint pain and muscle weakness
• Understanding the importance of a healthy diet and sleep hygiene