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We may have hoped that COVID would be a fading memory by now, but it has proven to be more than just a thorn in our side or an inconvenience. For some, it has been mild and uneventful but for others it has been associated with a number of symptoms that they are having a difficult time shaking. Long COVID has now entered our vocabulary.

WHAT IS LONG COVID AND IS IT THAT COMMON? A positive COVID diagnosis with symptoms lasting longer than 4 weeks is defined as Long Covid, according to The National Institute of Health (NIH) and the Centers for Disease Control and Prevention (CDC). Our best idea of how common long Covid is comes from the UK office of National Statistics which found an incidence rate of 13.7% among 20,000 people that tested positive for COVID in 2020 (Nature June 2021). If that was extrapolated out across the world population it would suggest that there over 38 million people with Long Covid in the world.


If you are experiencing fatigue and shortness of breath, physical therapy may be a great intervention. Oxygen is a key ingredient for cell energy and if you aren’t getting enough of it, it stands to reason that you will be fatigued. If you decide to try it, we have some suggestions for you and your physical therapist.

1. Be objective as possible about your progress.

a. Subjective feelings of fatigue and lack of energy are difficult to quantify. Have your therapist examine your Oxygen saturation with a Pulse Oximeter and purchase one for home to monitor

b. Monitor your respiratory rate at rest. Count how many breaths you take in a minute and work on effectively reducing that number with your therapist.

2. Work on diaphragmatic breathing with your therapist.

a. Many non-COVID diagnosed patients have what we call an inverted breathing pattern and if you have it with Long COVID, you are not setting yourself up for a successful recovery.

b. This can be challenging for many patients so don’t get discouraged when you have a difficult time, at first.

3. Receive manual therapy to improve rib movements.

a. A normal breath in (inhale), causes the ribs to move up and a breath out (exhale) reverses the movement.

b. A physical therapist can mobilize your rib cage so that it starts to move more effectively.

4. Correct exercise dosing.

a. Many people come back too fast and overexert themselves, leading to a relapse. Let a trained

professional guide you back gradually until you feel confident you can progress on your own.

b. Stick with Zone 2 (Heart Rate) training and limit volume increases of no more than 10% or prior week’s volume. Your therapist can help with this.


The symptom presentation of long COVID varies but typical symptoms include fatigue, headaches, dyspnea (shortness of breath), and cognitive dysfunction (brain fog, for example). Fatigue, by far, is the most common symptom. In data that analyzed 4,182 cases of Long COVID, 97.7% reported fatigue at 4 weeks post diagnosis. Many in this situation worry that they will not regain their previous level of function or fully shake their symptoms.


Very few have analyzed those with Long COVID but a UK/US group collaborated to conduct a survey among 3,762 participants (eclinical medicine 38 (2021) 101019 Davis et al.). They found that after 7 months, only 45% were completely recovered. Among the 55% unrecovered, 22% of those were not working and 45% required a reduced workload. Many respondents claimed that relapses were triggered by exercise, stress, physical and mental activity. This study did not assess whether anyone received treatment and, if they did, what that treatment included. This may have been able to shed some light on how the 45% recovered. Admittedly, there are some very inherent difficulties in using a survey model for research.


Physical therapy may not be the first thing you think of to treat Long COVID but you might be surprised. Based on your current level of fatigue and breathing difficulty, they can prescribe a program that is right for you. GREATER THERAPY CENTERS and EDGE PT have physical therapists that can provide the treatment you need. If you or someone you know is dealing with Long COVID, contact your physician about starting a physical therapy program soon and work toward getting your life and energy back!


--Shane Hernandez, PT, DPT, ASTYM Certified, Advanced Dry Needling Certified

A member of the Therapy Partners Group family of brands.
GTC strives to be the premier provider of physical and occupational therapy in the DFW area. Our therapists apply professional techniques and utilize state of the art tools to ensure that patients recover function and receive relief from pain as quickly and efficiently as possible.
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