Most people who get sick with COVID-19 recover in about two weeks, but for others the impact is far longer lasting. No one knows exactly how many people end up with long COVID; estimates suggest that anywhere from 7.7 million to 23 million Americans might have it. This wide range reflects that fact that there’s no universally accepted definition of long COVID, though the World Health Organization defines it as a condition that “occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19 with symptoms and that last for at least two months and cannot be explained by an alternative diagnosis.”
What is clear is that an awfully large number of people are suffering with symptoms that linger or arise well after the virus should have cleared their system. Shortness of breath, brain fog, fatigue, and an elevated heart rate or heart palpitations are among the most common problems, though insomnia, depression, dizziness, muscle pain, and digestive distress are also on the list, says Naomi Bauer, physical therapist and program director of the COVID-19 Recovery Program at Raleigh WakeMed/UNC.
The extent of such symptoms also varies significantly. Bauer herself has been dealing with long COVID since she contracted the virus nearly a year ago. “I used to be a runner; now I can’t even walk fast. I used to do 40-mile bike rides on weekends; now if I do that I’m on the couch the rest of the day,” she says. Still, she describes her issues as mild to moderate, noting that some people with long COVID don’t have enough stamina to get out of bed, and others have developed serious heart or lung problems.
Given the wide range of symptoms and severity, there’s no one-size-fits-all fix. What’s more, many people also have other health conditions, such as high blood pressure, diabetes, or chronic obstructive pulmonary disease (COPD) that worsened in the wake of COVID, says Monique Caruth, a physical therapist who runs a Maryland-based home health staffing agency. For these reasons, it’s wise to see your primary-care provider or a long COVID specialist before attempting to self-treat in any way.
Once a doctor has evaluated you, it may also be worth seeking out an evaluation from a physical therapist, who can devise a plan aimed to improve strength, mobility, endurance, and even certain breathing issues, says Brianne Mooney, an advanced clinician and physical therapist at Hospital for Special Surgery (HSS) in New York. “When addressing long COVID, a person must have a comprehensive management plan from their medical provider focusing on improving physical, mental, and social well-being,” she says. For some patients, “physical therapy can be a vital part of that recovery plan.”
Ideally, physical therapy should be tailored to your specific issues. (You can find a physical therapist near you or one that conducts telehealth visits at choosept.com.) But if you prefer to go the DIY route or are waiting to snag an appointment, here are some physical therapy strategies that you can try at home to combat common long COVID symptoms.
Combat shortness of breath and anxiety
Two different breathing techniques may help. To try pursed lip breathing, inhale slowly through your nose, then form a tight “o” shape with your lips and blow out forcefully through your mouth. “Pretend you’re smelling roses or bacon cooking, then blowing out a birthday candle,” says Caruth. “The long inhalation brings rich oxygen into the lungs, and then the exhale forces out carbon dioxide.” Repeat five times.
Diaphragmatic breathing, also called belly breathing, is worth a try. Place your hands on your stomach, breathe in through your nose for a count of four, pause for a count of two, then slowly out through your mouth for another count of six. You should feel your stomach pushing against your hand as you inhale. Repeat five to 10 times.
To support the muscles that assist in breathing, Mooney recommends scapular retraction: Sit tall and engage your core while your arms are outstretched in front of you or bent at your waist. Pull your elbows toward your sides and squeeze your shoulder blades together. Hold for five seconds, then slowly relax. Repeat five to 10 times. This exercise also helps promote better posture.
Improve balance
While holding onto a supportive surface (like furniture), try a single leg stance, suggests Mooney: Stand on one leg and try to maintain your balance, ideally holding for 15 to 30 seconds before putting your foot down and switching sides. “As your balance improves, you may lessen the support of your hand on the surface in front of you,” she says.
Sit to stand is another technique that helps build balance. Sit toward the edge of a chair, hold onto the armrest with both hands or just one hand, and then slowly stand up while maintaining good posture and engaging your leg muscles. Repeat 10 to 15 times if you can.
Increase range of motion
If you’re not having any dizziness or shortness of breath but you are feeling muscle tightness in your shoulders, back, hips, or thighs, Caruth suggests trying a chair forward fold: While seated (ideally in a stable chair without wheels) with feet flat on the floor, slowly bend forward and reach your hands down between your legs as you bend toward the floor or, if you can, under and toward the back of the chair. You should feel this stretch—which is good for anyone who spends too much time hunched over a computer—in your lower back and shoulders. Get up slowly to avoid dizziness; repeat about four times.
Build strength needed for daily activities
Seated knee extensions focus on the muscles needed for walking, stair climbing, sitting, and standing, says Mooney. Start seated in a chair with knees bent and feet flat on the floor. Slowly raise one foot and straighten your knee as you engage your thigh muscles. Hold for a few seconds, then slowly lower your foot back to starting position. Switch sides and repeat a few times.
Manage fatigue
Severe fatigue is one of the most common long COVID symptoms. Slowly pushing yourself to build endurance—perhaps by walking a little further or doing other physical activity a little longer each day—works for some people with long COVID. Others, however, have “post-exertional malaise” (also known as exercise intolerance), meaning that exercise makes them feel even more drained rather than energized. Sometimes the impact isn’t apparent for several hours or even days after exercise, but keeping a diary or log can help you sort it out, says Bauer.
If you have exercise intolerance, you’re better off practicing energy conservation. In short, this entails modifying what you’re doing throughout your day to save energy when possible. “Find ways to save energy on your ‘have to do activities’ so you have more energy for your ‘want to do’ activities,” says Bauer. For example, try sitting on a stool in the kitchen while cooking or using a robot vacuum (like a Roomba) to clean your floor, and you might find that you have a little extra energy to stay up and chat with your family after dinner.
“It is important to listen to your body,” says Mooney. If any of the above strategies make you feel worse, stop and tell your health care provider.
