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A Practical Approach to Long COVID

First, I want to preface this article by saying I am not a doctor and these are my thoughts alone based upon my own physical experience and empirical evidence with clients.

I want to write this article because there are millions of people suffering from what has come to be known as “Long COVID” and I feel this could be of particular harm to Vocalists.

My goal is to explain my take on Long COVID, what I feel it is and is not and some practical solutions to end the symptoms associated with this horrible malady and come back better than you were before.

In order to do this, we have to understand a bit more about how COVID operates.

When COVID comes in your body, it meets the mucous membranes that line your nose, mouth, and eyes. The virus enters a healthy cell and uses the cell to make new virus parts. It multiplies, and the new viruses infect nearby cells.





Think of your respiratory tract as an upside-down tree. The trunk is your trachea, or windpipe. It splits into smaller and smaller branches in your lungs. At the end of each branch are tiny air sacs called alveoli. This is where oxygen goes into your blood and carbon dioxide comes out.

The new coronavirus can infect the upper or lower part of your respiratory tract. It travels down your airways.

The lining can become irritated and inflamed. In some cases, the infection can reach all the way down into your alveoli.

Knowing this, we can extrapolate that chronic inflammation and infection of the airway can result in less overall space for air to travel in and out of the lungs.


The knock on effects on this are as follows:

  • A heightened stress breathing pattern. When less space exists for air to travel, breathing rate accelerates to accumulate more air. This potentially results in hyperinflation (or too much stale air) being trapped in the lungs and an inability to full exhale.

  • Reduced CO2 tolerance. CO2 is the waste product produced by exhalation. In the presence of hyper-ventilation or a stress breathing pattern, the body becomes less effective at extracting oxygen from the blood due to an off-loading of CO2 from the lungs. This article goes more in to this topic.

  • Diaphragmatic and Pelvic Floor imbalances. The Diaphragm contracts and descends as we inhale and ascends as we exhale. An inability to fully exhale (as a result of hyperinflation) and hyper ventilation (excessive breathing) results in excess downward pressure on the pelvic floor (doe to a diaphragm that is overstimulated) and a reduction in overall diaphragmatic range of motion.





The overall consequence of the above, I feel, is a permanently heighten sense of threat and a “new normal” of reduced breathing capabilities.



So how does this effect long COVID?

According to the CDC, Long COVID (symptoms longer than 30 days) can have a wide range of symptoms that can last more than four weeks or even months after infection. Sometimes the symptoms can even go away or come back again.

Post-COVID conditions may not affect everyone the same way. People with post-COVID conditions may experience health problems from different types and combinations of symptoms happening over different lengths of time.

Most patients’ symptoms slowly improve with time. However, for some people, post-COVID conditions may last months, and potentially years, after COVID-19 illness and may sometimes result in disability.

This article describes the result of long COVID as an immune system gone haywire, small blood clots which disrupt breathing and heart rate and more.

But in all cases, it would seem we are dealing with a condition which disrupts the ability of the autonomic nervous system to regulate homeostasis.

I feel that this is due, in part, to a heightened threat response (prolonged fight or flight) level in the body which would explain the anxiety and depression also experienced by those reporting this issue.

Importantly, inhalation and exhalation act as conscious regulators of vagal tone (see more info below) and an inability to fully exhale could potentially lead to such a prolonged state of fight or flight.

Consequently, I feel that one major contributor to the symptoms of Long COVID is Vagus Nerve compression and dysregulation.

The Vagus nerve is responsible for the regulation of internal organ functions, such as digestion, heart rate, and respiratory rate, as well as vasomotor activity, and certain reflex actions, such as coughing, sneezing, swallowing, and vomiting.





To illustrate it’s importance, this study reported that Vagus nerve stimulation led to significantly improvements in cognition, learning and memory.


This study indicates that the Vagus nerve affects appetite while this study indicates Vagus nerve stimulation affects heart rate.


Importantly, the Vagus nerve passes directly through Trachea and chest wall—areas whose space is often reduced and in which inflammation is present during COVID—and is affected by the rate at which you breathing. Deep breathing stimulates the vagus nerve and slows heart rate as indicated by this article.

I am sure researchers have pondered this connection in relation to COVID, but it would stand to reason that post COVID treatment should revolve heavily around re-establishing the capability to take a full deep breath and an even longer exhalation.



A practical approach to long COVID:

The frustration I feel for long COVID sufferers is that while there is ongoing research, no one seems willing to recommend anything beyond very general breathing exercises and medications.


This, frankly, is not good enough and I hope to offer a more specific plan in this section that will help on your road to recovery.


First, I encourage you to check your BOLT score. BOLT is a blood oxygen utilization level test which gives us a good idea of how well your body is currently utilizing oxygen.


From my perspective, a BOLT score of over 30 seconds is an absolute essential as a marker of breathing health. If you are under this number, improving it should be the first step in your post COVID rehab.


This is done, in the beginning, by improving the cadence at which you breath and attempting to lengthen your exhales with a pause at the end. Here is a guided circuit to get you started on that.


From here, we want to cultivate an awareness of your breathing pattern and offer practical tools to improve it. When we inhale, we want the thorax to expand in a 360 degree manner in which the ribs laterally expand, the chest wall opens and even the back ribs receive some degree of expansion.


My question for you is how are you breathing right now? Are you able to fully expand these areas or is all the air coming in your belly alone?


I filmed this daily 15 minute breathing awareness segment to give you an idea of how you are breathing right now and a few exercises to specifically improve the expansion of each of these areas.


I highly highly recommend performing the 1st breathing cadence circuit and the 2nd breathing awareness circuit back to back on a daily basis as a great place to start re-building your breathing pattern in order to lower your body’s sense of threat and give your vagus nerve a chance to recover.



Wrap up:

I want to emphasize that this article only scratches the surface of recovering from long COVID, but I do believe that taking 15-20 minutes twice per day to cultivate your breathing either via the routine above or a guided program is absolutely essential to recovering from long COVID.


The other incredibly important factor in this recovery is aerobic fitness. Quite simply, the adaptations achieved through aerobic fitness amount to the body’s ability to stay open and utilize oxygen well.


This means walking or performing aerobic cardio initially for 30-45 minutes daily while breathing through the nose only.


Practicing the last habit of nasal breathing throughout the day would round out what I consider to be a comprehensive physical approach to recovering from long COVID. Pay attention to your breathing and, when it becomes shallow, take time to slow down and cultivate it through awareness.

If you are reading this article, I truly hope it provides some hope and a basis to begin getting better.

If it resonates, I urge you to contact us about our Breathe 360 program and/or a consultation on how we may help in your fitness and/or recovery journey!


Until next week,

Coach Chris


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