April 12, 2021, Publisher: Breath Hub
As the world is trying to end the acute phase of the pandemic with vaccination and quarantine practices, doctors strive to treat patients and understand the damage left behind by the virus. The latest information shows that some patients' complaints continue to intensify, even in mild cases, although months have passed since their recovery. In this article, we take a look at post-Covid syndrome and how breathing exercises may help these patients.
An article published in The Atlantic, "Unlocking the Mysteries of Long Covid," features the story of doctors struggling to diagnose and treat the long-term effects of the virus and patients waiting to get their health back. Endocrinologist Zijian Chen, Medical Director Center for Post-Covid Care at Mount Sinai Hospital in New York, says they didn't expect this from a virus thought to cause a two-week-long respiratory illness at the beginning. He notes that some patients suffer post-intensive care syndrome, and that the extent of the damage Covid-19 creates is quite unusual and of great concern. Normal test results despite severe complaints in the vast majority of patients and diversity of symptoms leave doctors baffled about how to treat them.
David Putrino, a physiotherapist and neuroscientist and the director of rehab innovation at Mount Sinai, and his team have dedicated themselves to understanding and healing the post-Covid syndrome. Putrino notes that the symptoms are very different from acute Covid-19 and very diverse. The pandemic dramatically demonstrates the variability and complexity of human physiological response to a pathogen.
According to the article in The Atlantic, symptoms vary widely, and they are highly personal. Patients experience numerous persistent problems, including shortness of breath, congestion, difficulty swallowing even though months have passed since the infection. Many patients have severe fatigue and brain fog. Others complain about chest tightness and tachycardia. Some have terrible pain in their bones. In some patients, even mild rehabilitation worsens the symptoms, while in others, it only works up to a point, and the syndrome recurs even more severely.
Research shows the virus persists for weeks in immunocompromised patients. There is growing evidence that the virus infiltrates and damages not only the lungs, heart and vagus nerve but also the brain, vocal cords, oesophagus and more.
The symptoms of post-Covid syndrome are similar to dysautonomia (impaired functioning of the autonomic nervous system) and POTS (postural orthostatic tachycardia syndrome, a type of dysautonomia). They are also very similar to chronic fatigue syndrome, as people show exercise intolerance and severe fatigue. Symptoms also bring to mind autoimmune disorders. But post-Covid syndrome does not exactly meet any of these conditions. The common point is that they are all symptoms that can be triggered by the body's response to infections.
Putrino and his team soon found the missing piece of the puzzle. They noticed that breathing did not improve even months after the acute phase passed, including the mild cases. Patients were breathing shallowly from their mouths into the upper chest area. However, natural breathing is deep and takes place through the nose using the diaphragm. The natural movement of breathing helps regulate the heartbeat and nervous system by stimulating the vagus nerve. Although most of us have abandoned deep belly breathing and become shallow chest-breathers, in patients with the post-Covid syndrome, lung inflammation or another trigger seemed to have profoundly affected this process. Thanks to this discovery, breathwork became the starting point of the post-Covid treatment process.
The Atlantic article notes that the patients participating in breathing exercises begun to recover remarkably. They report an improvement in symptoms such as shortness of breath, brain fog and fatigue, even after a week. After about a month of regular practice, breathwork leads to significant improvements and allows them to recover from debilitating symptoms such as dizziness. Patients who can sit without experiencing dizziness are ready to start physical therapy.
Although patients still face unpredictable symptoms, breathing exercises help take them "to the point where recovery can begin." Putrino calls this an unprecedented recovery.
Regular breathing exercises help restore natural breathing patterns, strengthen the respiratory muscles, improve the function of the diaphragm, increase the capacity of the lungs, and enhance oxygen absorption in all cells. We are familiar with the importance of oxygen, but carbon dioxide plays an equally vital role by balancing the pH level of the blood. Natural respiration keeps the ratio of these two vital compounds in balance. Starting the treatment with breathwork primarily helps restore the regulatory effects of natural breathing.
Studies also show that high levels of stress can lead to chronic inflammation. Breathing exercises support the regulation of the nervous system's acute stress response and help eliminate inflammation in the body. Experts emphasize that it is possible to reduce inflammation in all organs, not just the airways and lungs, by reducing the effort to breathe and the anxiety associated with shortness of breath.
You can find more on breathing exercises that may help during and post-Covid here.
Recovery from the long-term effects of Covid-19 is a gradual process. A very slow rehabilitation process, including breathing exercises, supports physical and mental recovery. Just as it is necessary to progress slowly with breathing exercises, it is crucial to take it slow during physical exercises such as walking. The exercises must be stopped well before the need to stop arises.
Doctors caution against the risk of overexertion and emphasize that excess physical effort sometimes takes the patient back to the start. The researchers observe that exercises work effectively, albeit slowly, and they believe in the possibility of full recovery.