What To Do When Long COVID Recovery Stalls

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 by David Deppeler, PT, DSc


At the age of 78, Tim was healthy until COVID-19 landed him in the ICU for a week. Three months later he still struggled with activity and sleep – functioning at half his pre-COVID activities. He was not able to walk more than a half-mile or work in the woods without shortness of breath. Two blood clots in his lungs made him feel even more uneasy. He felt stuck and wondered if this would be his life going forward. Like many who have or have not been to the ICU with COVID-19, Tim had unnecessarily plateaued in his recovery and was simply encouraged to stay home, rest, and recover.


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The Nature of COVID-19 Symptoms

Medication and rest alone may not be enough to recover from Long COVID-9. Symptoms get wrapped up in our physical body, chemistry, and psychology. COVID-19 has obvious effects on the lungs. The less obvious effects are breathing behavior changes that disrupt health – further magnifying systemic inflammation. Restoring healthy breathing patterns improves the physical, chemical, and psychological wellness. 

Improving the breath literally improves heart, digestive, circulatory, and nervous system activity. These changes are solid and long lasting. And unlike pharmaceuticals, there are no side effects.
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Finding Help is Not Easy

Most people with Long COVID-19 are prescribed some type of medication and sent home to rest and recover – with little additional guidance. For many, this is not enough.    

If you have Long COVID-19 symptoms or know someone who does, you know how difficult it is to get help. Ongoing symptoms and conditions can include pericarditis (inflammation around the heart), bradycardia (slow heart rate), tachycardia (fast heart rate), blood clots, shortness of breath, labored and fast breathing, fatigue, headaches, dizziness, digestive problems, disturbed sleep, anxiety, and general feelings of being unwell. Long COVID-19 symptoms can be very different from person to person, but we see common themes in recovery.

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The Power of Breathwork

Back to Tim. Tim returned to his full, pre-COVID function after one month of breath work. He worked to improve diaphragm function with nose breathing and lower rib resistance work. He did breath-pattern retraining during light activities and learned to slow his exhale to better control his nervous system. He used capnography biofeedback to learn how to improve carbon dioxide levels for better blood acid-base balance.

With minimal intervention, Tim got unstuck and improved the physical, chemical, and psychological aspects of his breathing. His sleep improved, and he was able to return to walking and working in the woods. He got his life back.

Improving our connection to the breath can literally improve heart, digestive, circulatory, and nervous system function. Sometimes slow and sometimes fast, the changes are solid and long-lasting. And unlike pharmaceuticals, there are no bad side effects.

Humans have long known the healing power of breath. Google search “breath work” and you’ll find hundreds, if not thousands of ways to work with the breath – many of them seeming to contradict each other. Looking through the lens of science, technology, and ancient wisdom teachings, we can find successful common themes.

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Getting the BIOMECHANICS Right

Improving the mechanical or physical part of breathing (diaphragm and rib cage movement) improves lung volume and postural/spine stability.

Try one of these activities

  • Breathing low and slow – allow expansion of the lowest ribs out to the sides (not just belly breathing).
  • Stretch the rib cage in all directions while maintaining steady breathing.
  • Add resistance to diaphragm movement – sort of like taking your diaphragm to the gym. Try lying on your stomach with the head resting on the back of the hands and breathing into the back lower ribs for a few minutes. There are many other ways to add resistance to the diaphragm if this is not comfortable.
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Getting the CHEMISTRY Right

Capnography (study of CO2) biofeedback helps us see the effect of breathing on the acid-base balance of the blood (an important part of breathing). It allows us to see if current breathing patterns improve or impair good gas exchange. Believe it or not, most people actually over breathe while working to correct the breath. This disrupts the acid-base balance of the blood, trapping oxygen in the blood and not allowing it to get into the cells of the body. Ironically, this leaves us feeling short of breath – causing us to breathe even more. You get the problem. Bad breathing behavior promotes more bad breathing behavior, without us even knowing it. The trick is to break the cycle – comfortably.

Try one of these activities.

  • Slow the First Part of the Exhale. Allow the rest of the exhale and the inhale to be what it wants to be. Simply savor, or slow begging of the exhale.
  • Feather Breathing. Allow the breath to become subtle enough to not move a feather if placed under the nose.

We understand these may not feel intuitive. That’s where the capnography biofeedback can help. There is something about seeing CO2 in real-time that makes all the difference.

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Science seems to be showing us what ancient wisdom teachings have long understood. Where the mind goes, the breath follows. And where the breath goes, the mind follows. We can use the breath to excite, steady, or calm the mind and body. Changing the time-ratio of the breath in (inhale) and the breath out (exhale) changes nervous system activity by way of the Vagus nerve and the autonomic nervous system (ANS). Slowing the exhale increases Vagus nerve tone and calms the body – helping us rest, repair, and regenerate.

Try one of these activities.

  • Paced Breathing. Breathe in for a count of 4 and out for a count of 6. Try this for 10 -30 minutes a day to make breathing pattern, blood chemistry, and nervous system changes.
  • Self-compassion. Allow the breath to be steady and subtle, calling up memories of self-compassion.

Note: Guided breath holding (hypoxia) and hyper ventilation (hypocapnia) practices, when done skillfully, can have significant positive effects on the mind, nervous system, and immune system. We recommend these practices only after baseline is corrected.

Click here for more recorded guidance on these activities.

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It’s Not About Working Harder

This approach is effective because it includes multiple aspects and puts control in your hands.  We see “breathing well” improve movement, sleep, digestion, headaches, and overall energy. While it often takes practice and patience, the effects are yours to keep.

Lastly, the trick to breathing better is not to work harder. In fact, it’s closer to letting go. Let go of physical tension that restricts the diaphragm, let go of fast chest breathing that makes it hard for oxygen to get out of the blood. And let go of thinking that blocks our naturally programed self-compassion. It’s all about getting back to the way we used to breathe, the way we’re meant to breathe, the way our body wants to breathe. This is what we mean by “Breathe Your Truth.”

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Reach out for a free 30-minute conversation about Long COVID Recovery and what it’s like to work with a BYT coach.

email [email protected]

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 David Deppeler, PT, DSc, is the founder of Breathe Your Truth, a project dedicated to helping people breathe better for health and performance. He lives in Cocoa Beach, Florida and works with people in person and remotely online.




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