Posted on: January 27, 2022

By: Jason Seltzer PT, DPT

While most people who are infected with COVID-19 will experience mild or no symptoms, some patients may become severely ill and require hospitalization or even admission to intensive care. Many who have recovered from COVID-19 may experience new, recurring, or ongoing symptoms well beyond recovery from initial symptoms. This has been referred to as Long COVID, Post-Acute COVID, Post-COVID Syndrome, or Long Haulers. Post-COVID symptoms can occur in patients who had various levels of severity during initial infection.

These symptoms might include:

  • Shortness of breath
  • Fatigue
  • Cough
  • Chest pain
  • Joint pain
  • Brain fog
  • Increased stress or anxiety
  • Lightheadedness
  • Heart palpitations

Physical therapy, occupational therapy, and speech therapy can help patients manage these symptoms and improve their ability to engage in their daily lives. One way this is achieved is through the performance of breathing exercises that help recover diaphragm function and increase lung capacity. This may help a person breathe easier at rest as well as during activity. Deep breathing can also help with relaxation and reduce feelings of stress or anxiety. These breathing techniques are safe to perform at home and can even be performed while isolating at home during acute COVID infection.

Discontinue these exercises and notify your doctor if you develop any of the following symptoms:

  • Dizziness
  • Increased chest pain
  • Worsening shortness of breath
  • Irregular heartbeat
  • Cool, clammy skin

Try these four breathing exercises:

Exercise #1: Breathing Control or Diaphragmatic (Belly) Breathing

This exercise refers to gentle, normal breathing using the lower chest and abdomen to breathe deeply. Using muscles of the lower abdomen, like the diaphragm, helps to expand your lungs more than when you use muscles of the upper chest.

  • Start by lying down with your head propped up on a pillow with your legs bent, or by reclining in a chair.
  • Place one hand on your upper chest and the other on your lower chest/upper abdomen.
  • Breathe out gently while relaxing your upper chest and shoulders.
  • Breathe in through your nose while focusing on breathing into your lower hand. You should feel your hand rise slightly.
  • As you breathe out, your lower hand should sink back down.
  • The hand on your upper chest serves as a reminder to keep the upper chest and shoulders relaxed.

Exercise #2: Deep Breathing on Your Stomach

If you are able to lie on your stomach comfortably, placing yourself in this position can aide in taking deeper breaths. This position allows for better expansion of the lung regions that are toward your back.

  • Place a pillow under your face while lying on your stomach.
  • Either turn your head to the side or place your head on your hands to allow space to breathe.
  • Breathe deeply in through your nose, focusing on pushing your belly into the surface of the mattress.
  • Slowly exhale through your nose.
  • Repeat for 6-10 breaths, up to one minute.

Exercise #3: Pursed Lip Breathing

This technique is very helpful when you feel short of breath during or immediately after activity like walking, climbing stairs, or during exercise. It helps you get more oxygen into your lungs by keeping your airway open longer and reducing how fast you are breathing.

  • Breathe in slowly through your nose for 2-3 seconds with your mouth closed.
  • Attempt to hold this breath for 1-2 seconds before allowing yourself to release and breathe out.
  • Before exhaling, purse your lips like you are blowing out a candle or trying to whistle.
  • Keeping lips pursed, breathe out for 3-5 seconds. It is important to breathe out for a longer amount of time than you are breathing in for this technique.

Exercise #4: Box Breathing or Four-Square Breathing

This technique is not only helpful to promote deep breathing, but can also be used to help manage stress and anxiety. It can help manage your heart rate and reset your body’s “fight or flight” mode.

  • Sit comfortably in a chair and close your eyes if you would like.
  • Breathe in through your nose while slowly counting to 4 paying attention to the feeling of your lungs filling with air.
  • Hold your breath for a slow count of 4, keeping your lungs filled.
  • Slowly exhale for a slow count of 4, you should not be breathing out with much effort or force.
  • Hold your breath for another slow count of 4 before initiating the next breath.
  • Repeat this cycle for 4-5 minutes.

For more information on these breathing techniques, and additional ways you can help yourself recover from COVID-19, contact Sheltering Arms and schedule an evaluation with the therapists of the Post-COVID-19 Recovery Program.


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