I know someone (and you probably do too) who has post-acute COVID syndrome. She recovered from COVID last spring, but now struggles with fatigue, breathing, and brain fog. She used to be an avid hiker, but now she’s lucky if she can take a shower. She can’t work very much, and without her husband’s support, she doesn’t know how she would survive.
I’ve been writing, teaching, and speaking to health care professionals and policy makers about yoga for chronic conditions for a while now, so, if you are a regular reader you know how passionate I am about bringing yoga into the conversation, as an adjunctive/integrative therapy.
Before COVID-19, according to the CDC, 60% of Americans had at least one chronic condition and 40% had two or more. Chronic illnesses suck up 90% of all health care dollars and the medical community often is at a loss as to how to effectively address the roots of these health challenges.
While infectious diseases were the puzzle twentieth century medicine needed to solve, chronic diseases were the most pressing medical problem of the twenty-first century.
But, as it turns out, COVID-19, at least in some cases, appears to be both.
It’s not only a virus that causes acute and sometimes fatal symptoms, but it can also trigger a long-term, chronic response.
Estimates that those who contract COVID-19 will become long-haulers (most are 20-50 year-old women) range from 10-33%. These folks experience an array of symptoms including fatigue, shortness of breath, joint, muscle, and chest pain, brain fog, depression, headaches, fevers, heart palpitations, hair loss, rashes, smell and taste problems, insomnia, memory issues (here’s a comprehensive list from the CDC).
Most of these folks had only mild to moderate symptoms when they caught the virus, but the long term effects have been debilitating and in many cases, prove very difficult to treat.
The medical world uses the umbrella term “dysautonomia,” to describe what’s happening. It means that the autonomic nervous system (ANS) has gone awry – it’s confused and doesn’t respond properly to changes in position, exertion, temperature, or stress. It ramps itself up into an inappropriate fight-or-flight response and has trouble regulating heart and breathing rates.
Physicians at Mt. Sinai Hospital in New York have been trying to figure out what to do for long haulers who are exhibiting dysautonomia. One clue they discovered is that many of these folks seem to have shallow, dysregulated breathing, and because of this problem, the dorsal branch of the vagus nerve doesn’t get the stimulation it needs. So, they’ve determined that a first step needs to be addressing breathing.
Dr. David Putrino and his team piloted a program using simple ratios (4:6 in the morning 4:4:4:0 in the afternoon) to help patients get their breathing rate to a point that they could participate in rehab programs (here’s a long read about it from the Atlantic).
The results have been promising. After just one week, all the patients in the program reported improvement.
Since COVID-19 is a pandemic, these kinds of programs are going to be needed worldwide.
I can’t help but wonder if Dr. Putrino would be open to training some yoga professionals to help?
If you have been teaching breathing techniques and helping folks learn to tune into what’s going on in their respiratory and nervous system, you may very well have some important skills to share. If you’ve received training and have experience, you may have the capacity to gently guide someone into and help bring them out of ratios safely and effectively.
Frankly, I’m a little more conservative than the folks at Mt. Sinai when it comes to pranayama. I would never tell a long hauler to do a 4:6 ratio in the morning and a 4:4:4:0 ratio in the afternoon without teaching them how to gently get into and out of those ratios first and without watching them do it and giving them individualized guidance.
I started studying ratio breathing in the early 2000s – and it’s an fascinating, intricate, and nuanced science. Suffice it to say, someone who has been practicing and teaching ratios for many years most likely has a better grip on these practices than medical personnel who are simply handed a protocol and don’t practice pranayama themselves. That doesn’t mean that medical folks can’t teach ratios, what it means, in my mind, is that yoga professionals have a lot to offer to this conversation.
Here are 3 key reasons I believe yoga professionals should be trained, and then integrated into programs that address post-acute COVID syndrome:
- Person-Centered
Yoga professionals can learn protocols and also help tailor breathing practices to the needs of each individual.
- Low Risk
Yoga is not a drug and as for affecting the ANS, it does so endogenously. The client is always in control and can stop whenever they like. There are many nuanced, even-lower-risk-than-ratio techniques that could be helpful, particularly those that emphasize interoceptive awareness. (For more interoceptive breathing techniques, check out my free 30 day pranayama challenge on YouTube).
- Agency
These practices can help people learn how to participate in their own healing process – and that is something that is very empowering and can support mental health during recovery.
Also, there’s much more that yoga can offer the healing process including slow, simple, mindful movement that prepare the respiratory structures for breathing practices, and provide another way to help start regulating a dysfunctional nervous system. Yoga practices should also be accompanied by interoceptive pauses. And they should be shared with a trauma informed approach that empowers clients to tune into their own nervous system and make informed choices about how much or how little to do.
Yoga professionals can also share meditation techniques and help clients cope with the mental health stress of chronic illness via reflection upon the yamas and niyamas.
Let me be perfectly clear – I would never suggest that a yoga professional alone can solve the problem of post acute COVID syndrome. But if you are a practitioner and teacher, you have a lot to offer in this conversation and you could potentially be part of an integrated team working to help those struggling with these debilitating after-effects.
Key links for more long haul info (many thanks to Dr. Helen Machen Pearce for her help with references):
- https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00043-8/fulltext
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776560
- https://www.bmj.com/content/370/bmj.m3026
- https://www.webmd.com/lung/news/20210216/programs-help-covid-long-haulers-recover
- https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/
Please check out my FREE guide for yoga professionals: Get Healthcare on Your Side
CHAIR YOGA FOR YOUR BRAIN & NERVOUS SYSTEM
SUBTLE® YOGA FOR ENHANCING TRAUMA RECOVERY
Five Ways Yogic Meditation Benefits Your Brain – eBook
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Kristine,
I am a yoga instructor, and I am suffering from Long Covid. I have a number of the symptoms: loss of smell, variable heart rate, chest tightness, even my hair being greasier than normal. Fortunately these are (so far) mild compared to many who are afflicted. Of all, getting more easily out of breath is the most troublesome for my life. As a farmer there are times I need to be quite physically active, and becoming winded so quickly is a problem.
My own instructors and I have been reading the articles about breathing training for Long Covid relief, and found that the pranayama we were already doing was pretty much in alignment. Just within the last few days we decided to move on to being more mindful on data collection about my daily capabilities, watching heart rates, measuring lung capacity each morning through use of a spirometer. We have precedent, as last year I used yoga to recover from some major orthopedic trauma, a process that we also carefully documented.
It’s an interesting journey with an unknown ending.
Andy
Thanks Kristine, you are so right. Yoga teachers have so much to contribute to people’s health care, and especially post covid as you say.
I am excited for holistic health care, yoga, massage, reflexology etc to become more accepted and appreciated in Western medicine. And we find simple and free ” earthing ” so beneficial. Barefoot on grass, sand, earth or water.
Thank you for this insightful information about ratio breathing. I practice 4:7:8, a technique I learned in the 1990s from a Dr. Andrew Weil cassette tape on breathing. This 4:7:8 breathing ratio helps me when my mind is racing and I can’t go to sleep. In my yoga classes, I teach 4:4 because I teach at a fitness center in a conservative community where anything remotely spiritual is discouraged.
This is fascinating! I would love to learn more about this and would love to be involved. Thank you for sharing this information.
Thanks for sharing this Kristine. I totally agree that pranayama has so many benefits and works if you work it daily. Much appreciate all you do to uplift those who teach yogaand those who practice.
I agree Patti. This is a generous advice for many. Thanks Kristine.
Thank you for this! Not only am I trying to help students, I am a long hauler. I am struggling to find help and support.
Thank you for speaking to this. I have most of these post-covid symptoms, and to tell you the truth, yoga has helped me the most in my recovery. It has made a significant improvement in my symptoms. Playing piano, playing Lumosity games, chess and scrabble, resting way more than normal, and doing mathematics have also helped me, but it has been the daily yoga practice that has made the huge difference. Thank you again for thinking of us long-haulers. It’s been a hard road. Jenni
This is so very useful. Thanks as always for tracking and sharing the research and your expertise – and for keeping us posted in real time.
This article reflects so much of what i have experienced working with my brother who was severely sick with COVID. I was tentative to offer him direction in pranayama as i felt ‘i did not know what i was doing’ in relation to these new long-haul effects of this illness but i instinctively felt that mindful breathing had to offer some benefit. Although my brother lives in Africa i have been able to connect with him weekly and he is showing significant progress. I have done a yoga teacher training (Kundalini and Ashtanga) but i would love to find some instruction in specifically yoga-based therapeutic breathing.
Thank you for sharing your awesome knowledge & wisdom Kristine. My opinion is if our leaders REALLY cared about this situation (& our health); if they REALLY wanted to end this crisis, they would stop suppressing relevant info & discovery. They would stop working to instill chronic fear, which suppresses immunity. They would be teaching how we can self-regulate our immune system & the genomes responsible for producing proteins, that correlate with dysautonomia & disease, through Yogic Science. I’ve read & listened a great deal of PHD’s in this space, who are coming forward to reveal the truth & being threatened to lose their ability to practice if they continue speaking out. The good new for us who practice & teach (& bad new for those who conspire), is you cannot suppress the Light. Our time has come. We stand on the leading edge of collective enlightenment & Humanity’s development.
Keep Shining Brightly all you Beautiful Lights. Wishing you
constant & continuous Blessing & Well-Being.
Namaskar 🙏
Halotherapy helped me get my lung capacity back. It’s improved leaps and bounds in one month after 3-day/eek treatments. Maybe this info can help someone:)
Here is an article that just appeared in NPR. This long-haul Covid sufferer was diagnosed with POTS – Postural Orthostatic Tachycardia Syndrome, one of multiple forms of dysautonomia as mentioned in the article. I hope the diagnosis will help her find beneficial treatments. POTS is a very difficult syndrome and it can often take quite some time to find treatments that work. As someone with dysautonomia (not from Covid) I send my very best to all suffering from the long-term effects of this terrible virus.
https://www.npr.org/sections/health-shots/2021/05/22/996533041/after-months-of-a-racing-heart-and-burning-feet-a-covid-long-hauler-gets-a-diagn