Breathing Rehabilitation - Recovering after Covid-19
Tommy Conway - Chartered Physiotherapist and Director - OneHEALTH
Covid - 19 has affected me and my family personally, my mother unfortunately contracted the virus but luckily after spending 6 days on a ward in hospital she was able to return home. She is one of the lucky ones who got great medical assistance and is doing better now. It’s harrowing to leave someone at a door in a wheelchair and just look as they are wheeled in, not knowing will they be wheeled out or walk out. She is doing better now, thank god but there are after effects. She has a very painful chest due the constant coughing and also a heaviness around her ribcage and back which is weighing her down. She knows that she has lost a lot of her movement and still struggles to get a long, big, deep breath in. As I have explained to her, unfortunately this disease has left her at a deficit and we have to fight to get it back. The good news is, when you know how the body moves and works to take a long, big, deep breath in. I have figured out what it has lost and can restore it through specific movements and stretches. There are 5 key spaces you need to open to restore the movement of the “Cage” and then you need to train the diaphragm through breathing drills. I am using the word “Cage” instead of ribcage because it sums up the function of this structure better. What I want you to understand is that it physically is a “cage” that can restrict you and keep you locked in for a long time.
What happens when you take a breath?
One word expansion, you physically get bigger, your diaphragm muscle (See pic attached 1) descends and pulls air into your body. Your ribcage expands outwards from the sides and your chest bone tilts upwards to allow more air into your lungs.The air fills down into the middle part of your back and allows the lower “cage” to expand at the very bottom. It doesn't stop there, you also have a big space in between your shoulder blades where your lungs will expand after you take a long, big, deep breath. This shoulder blade space is valuable, it accounts for a lot of lung volume, hence why we have seen medics lying patients face down. This process is called proning and can be very beneficial to create the space for the lungs to expand into. These 5 key spaces are all equally important but some will close first and will take longer to open after, you need to work at it.
What happens with Covid-19?
You lose your ability to expand, this loss of expansion equals a loss of lung filling, a loss of air in. Due to the nature of the disease, shortness of breath or a cough limiting a full inhale, the lungs are unable to fully fill. This results in two important changes to the body:
1: The diaphragm muscle is underutilized as it is unable to fully lengthen and shorten.
2: The “Cage” begins to close in on the 5 key spaces.
These changes will close the 5 key spaces that allow you to take a big, deep, long breath in. The spaces that primarily close are at the chest, sides of the rib cage and in between the shoulder blades, but there are more. This closing of spaces will not only limit your breathing but cause a tightness, soreness and heaviness. Now if you have had a cough, your diaphragm and the external intercostal muscles have to work very hard to try and perform the action of coughing. The external intercostal muscles are the muscles that are in between each level of the “cage”. With high repetitions of coughing, these muscles become very tight and shortened, closing the space further. Unfortunately, we are unable to work on a diaphragm directly or even feel a stretch on it but we can stretch and work on the external intercostal muscles. After we open up the key spaces, breathing restoration activities will restore the diaphragm to its full function. If you suffered with Covid 19 and had a repetitive cough, you need to start stretching this muscle today. Believe me, it will not come back on it’s own, you are now at a deficit.
How to improve it?
The key to create more room for expansion is you need to first create space for the lungs to fill into. In other words you need to stretch 5 key spaces to fully open the ribcage and create space for your lungs to expand again. I have made a course specifically for rehabilitation of the lungs as I know everyone is going to need this to fully recover. One of the 5 key spaces is the space between your shoulder blades. Type this link into your web browser and try this exercise at home.
Also if you have any questions about restoring the lungs, just email me personally on