Yoga & Long Covid – Part 1

By Imogen North for Om Yoga & Lifestyle Magazine.

Can yoga help relieve the symptoms of Long Covid? The respiratory system: part one of a three-part series.

Eighteen months into this pandemic and many of us may know someone who has contracted Covid-19. Some people have suffered with the virus; some people have developed what is now known as Long Covid.

Perhaps you are someone struggling with the symptoms of Long Covid? I have had numerous friends and students ask me over the last 18 months if yoga can help support sufferers and the simple answer is yes! In this three-part article series I aim to unravel a little bit about Long Covid and how yoga can help to relieve the symptoms.

So, what is Long Covid? This is the term that is being used to describe the effects of Covid-19 that continue for some people for weeks and/or months after they have contracted the virus. The National Institute for Health and Care Excellence (NICE) in the UK defines Long Covid sufferers as people who have had symptoms lasting for more than 12 weeks.

Research published in June 2021 by Imperial College London identified two groups of Long Covid symptoms. The first being mainly respiratory coughs, breathlessness, but also including fatigue and headaches. The second affecting many other parts of the body including heart, brain and gut (increased heartbeat, pins and needles, palpitations, numbness and ‘brain fog’).

Another study published in the Lancet’s journal EClinicalMedicine, surveyed 3,762 people with confirmed or suspected Long Covid from 56 countries around the world. It identified 203 symptoms, of which 66 were tracked for seven months. The most common three symptoms reported were fatigue, post-exertional malaise (where people’s health worsens after physical or mental exertion) and brain fog. Other symptoms from this study included visual hallucinations, tremors, itchy skin, changes to the menstrual cycle, sexual dysfunction, heart palpitations, bladder control issues, shingles, memory loss, blurred vision, diarrhoea and tinnitus.

In this first article we are going to look at Long Covid and the respiratory system because first and foremost, Covid-19 is a respiratory illness and some of the main Long Covid symptoms being reported are things like shortness of breath, persistent coughs and chest tightness.
But how does Covid-19 actually affect the respiratory system? In simple terms, the Covid-19 virus infects the respiratory tract in the body. It travels down your airways and the lining of your lungs becomes irritated and inflamed. The lung’s air sacs fill with fluid, limiting their ability to take in oxygen.

The lungs are made of elastin, fibers that allow the lungs to expand and contract while we breathe. Covid, like many other respiratory illnesses, prevents these elastic fibers from assembling properly, losing some of the important elasticity of the connective tissue. Without the elastic fibers, we lose some of our breathing capacity (the volume of air we can take in). Regaining elastin in the lungs is tricky, but working with certain simple breathing techniques can help people suffering with Long Covid to work towards a more easeful, deeper breath, allowing them to slowly regain control of their respiratory function.

So, what breathing techniques are useful?

Diaphragmatic Breathing

This is a breathing technique we call ‘belly breathing’. I love this as it’s easy and can be done sitting, standing or lying down. Place your hands on your belly and close your mouth. Then allow your breath to travel down into your belly on your inhale, feeling the belly expand under your hands like a balloon. As you exhale allow the belly to contract (the balloon shrinks), allow the air to leave the body through your nose. Repeat this over a number of times gently and slowly for a few minutes.

Try and find a few minutes to work with this technique every day. Remember the diaphragm is a muscle, and like all muscles it needs to be worked in order to create change.

There are two other reasons this breath technique is great. Firstly, it stimulates the vagus nerve. The vagus nerve travels through the diaphragm, regulating what is called vagal tone (vagal tone is a measure of the resiliency of our system) and has a parasympathetic influence on the heart (helping those Long Covid heart symptoms such as increased heart beats and palpitations). The other great reason to use this breath technique is that the diaphragm acts as a pump for the deeper lymphatics in the body. Remember the lymphatic system plays a vital role in our immune response.

More about Long Covid, the nervous system and the immune system in Part 2 and Part 3 of this article series.

Shitali Breathing

I think this technique is best used sitting, aligning the neck, head and spine.
Breathe using the diaphragmatic technique for a few minutes then create an O shape with the tongue and the lips (curling the sides of the tongue up like a straw). Inhale drawing the breath across the tongue, sense the cool air travelling across it. Close the mouth and exhale through the nose. Continue repeating slowly (don’t rush it!) for 2-3 minutes. Remember we are trying to encourage building longer, deeper breaths.

This breath is a not only a great recovery technique, but it also cools the body and helps regulate fluctuating body temperature that many Long Covid sufferers have reported. If you are someone suffering with Long Covid you may also be suffering with bouts of anxiety or you may be feeling agitated (these symptoms have also been recorded). When we are in a heightened state of anxiety, the mind is active and it creates more heat in the system. So, while practicing this Shitali technique, focus on the cooling sensation of the breath, the felt experience happening in your body. Visualise the breath washing the body with a cool air. This visualisation will help to take you into the rest (parasympathetic) state of your nervous system, calming the mind, and as well, calming and cooling the body.

Long Exhalation Breath

Another of my favorites, which is a simple technique perfect for Long Covid sufferers trying to build breath capacity. You can use this sitting, standing or lying.

Once you are settled, start follow your breath for a minute or so and then begin to count your breath, inhale slowly for 4 counts, exhale slowly for 4 counts. After a minute or so of repeating this over and over, extend the count of your exhalation. First work to 5 counts for a minute or so, then increase to 6, maybe you can even extend to 7 or 8 after a few minutes.

These long exhales will deepen your breath, helping to restore diaphragm function and increase lung capacity. Simultaneously, the long exhales will have a double whammy effect of lessening feelings of stress and anxiety and improving the quality of sleep as (similar to the other two techniques I have described above) the parasympathetic nervous system is encouraged to switch on.

If you are someone who is struggling with Long Covid, commit to putting one of these techniques into your day, every day for the next few weeks. It won’t take more than five minutes. Monitor how you feel before and after each day in a journal and see if they make a difference to the quality of your breath. Also monitor if regularly practicing these techniques eases any other symptoms you are experiencing.

Having drilled into the detail of the respiratory system here, you can see how interconnected we are as humans. You can see how the respiratory system affects the nervous system, the immune system and the circulatory system. In the next article in this series, we will drill into a different system, the nervous system, and see how from that view point we can use the practices of yoga to relieve Long Covid symptoms.