Still COVID after all these months?

If you’ve tested positive or suspect you may have had COVID-19, you may still have strange and unexpected symptoms weeks, even months later. This is called ‘long Covid’.

Long Covid is a new medical term and is defined as not recovering for several weeks or months following the start of symptoms that were suggestive of Covid.

What symptom is normally at the top of the list?

Extreme fatigue

It’s very debilitating, but it’s the most common symptom of Long COVID. Your physiotherapist can help you pace and manage life with fatigue.

Other symptoms which are high on the list?

Muscle or joint pain; body aches

Long COVID often causes pain which you can’t account for. Your physiotherapist knows a lot about managing pain, and can gently help you cope.

Chest pain

This pain could either be in the lungs or feel like it’s affecting the heart. Your physiotherapist knows how to assess if this is a Long COVID symptom, and help you understand, cope and get treatment.

Fatigue after exertion

If you crash after exerting yourself, even slightly, you may need help from your physiotherapist to help you pace and manage life with Long COVID ‘post-exertional malaise’.

Breathing difficulties

There is nothing worse than struggling to breathe, and it’s common in Long COVID. Your physiotherapist can teach you to breathe properly and help strengthen your breathing muscles.


Not surprising that someone with Long COVID feels anxious! Your physiotherapist can help you with relaxation techniques, breathing and very gentle, paced movement.

Other possible symptoms?

Irregular or rapid heartbeat

COVID-19 can attack the nervous system, and tachycardia (often on sitting or standing) may be a Long COVID symptom. Talk to your physiotherapist for advice and any necessary referrals.

Tummy troubles

COVID-19 can affect the autonomous nervous system, which may cause constipation or diarrhoea. Your physiotherapist can help you understand if this is part of Long COVID and refer you if necessary.

Brain fog

You can’t concentrate or focus. Your physiotherapist is your point-person; have a chat and ask if you need to see a specialist, and if so, who.

Dizziness, vertigo

Long COVID sufferers will testify it’s not easy to live with this symptom. Your physiotherapist can give you some essential tips that will keep it from taking over your life.

MBW Physios having been keeping up to date with the latest research on COVID. We can assist with your post COVID rehabilitation.

Credit to Paul Simon and the South African Society of Physiotherapy.


What is mental health?

Mental health is defined as a state of well-being in which every individual realises his or her own potential, can cope with the stress of life, can work fruitfully and productively, and is able to make a contribution to their community.

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Adequate and good mental health is essential to the well-being of individuals, families and communities. Poor mental health has been identified as one of the leading causes of poor quality of life, disability and reduced productivity. There is also a strong association between poor mental health status and individuals reporting multiple sites of pain.

It has been reported and documented that physical activity can improve quality of life for people with poor mental health status. As people with poor mental health status are also at an increased risk of a variety of physical health problems, including cardiovascular diseases, obesity and endocrine disorders, the benefits of physical activity not only reduce the risks of developing these types of diseases, but also improves mental health status.

The global Covid-19 pandemic has high-lighted and emphasised the importance of mental health awareness. Physiotherapists have an important role to play in the management of their patients’ mental health status.

Can regular physical activity improve your mental health?

The physical health and mental health benefits of regular physical activity or exercise include:

  • * Better sleep
  • * Improved cardiovascular fitness
  • * Better endurance
  • * A positive influence on diabetes presentation and metabolic syndrome
  • * Better mood
  • * Stress relief
  • * Less tiredness and increased energy levels
  • * Reduced symptoms associated with depression, negative mood, anxiety and social isolation
  • * Improved cognitive functions, self‐esteem and quality of life

What role can your physiotherapist play in improving your mental health?

Physiotherapists are deemed as experts in components of physical healthcare and can contribute to improving mental health status by offering:

  • * Pain management without the use of medication
  • * The development and delivery of patient-specific lifestyle and weight management advice and programmes, improving self-esteem and body image
  • * Expertise and knowledge in prescribing patient-specific exercise programmes, which can improve mood, address the risk factors of other diseases associated with poor mental health status and improve overall wellbeing
  • * Expertise and knowledge in motivating patients and promoting autonomy and self-management in the context of mental and physical health problems
  • * Interventions to address the physical problems of people with poor mental health status which limit recovery and social interaction and participation
  • * The management of falls, fear of falling and mobility problems for older people
  • * The management of developmental issues for children and young people


1.        World Health Organization. Media centre Mental health : strengthening our response. 2016.

2.        Mental Health, Physical Activity and Physical Therapy – Physiopedia [Internet]. [cited 2020 Oct 3]. Available from:,_Physical_Activity_and_Physical_Therapy?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal

3.        Vancampfort D, Stubbs B, Probst M, Mugisha J. Physiotherapy for people with mental health problems in Sub-Saharan African countries: a systematic review. Arch Physiother. 2018;8(1).


Do you feel out of breath after a flight of stairs although you consider yourself relatively fit?

Does your voice loose strength after a long sentence?

If the answer to the above questions is yes, you might have an incorrect breathing pattern.


Other incorrect breathing patters signs and symptoms may include:

  • * Neck and backpain
  • * Dizziness
  • * Anxiety
  • * Headaches
  • * Insomnia
  • * Concentration difficulties
  • * Pins and needles in hands and feet with exertion
  • * Cramps
  • * Exercise induced asthma
  • * Sleepiness
  • * Lot of yawning
  • * Pins and needles
  • * Tiredness
  • * Achy muscles and joints
  • * Irritability
  • * Upset gut

The diaphragm is your main respiratory muscle and should do 70-80 % of the breathing work. It is is a large sheet of muscle and is dome shaped. Together with the pelvic floor, as well as the abdominal and deep back extensor core muscles it co-contracts and work together via fascial connections to form a rigid cylinder that provides stability to the trunk and offers postural control. Furthermore, it divides you into a chest and abdominal cavity. One of the vital roles of the diaphragm is to produce and control intra-abdominal pressure, in conjunction with other muscles. Various muscles are attached to the diaphragm and it also attaches to your spine. During inspiration (breathing in), a correct breathing pattern sees the diaphragm descend, the abdomen bulge outwardly while the lower ribs swell sideways. This is logical as to increase lung volume, you need to increase the size of your lungs.

Below is a picture of the diaphragm. Have a look at the size and various attachments. This is a very important muscle.

Why or how is breathing patterns affected?

  • * Poor posture
  • * Cultural reasons- tight clothes around waist, trying to hold stomach in
  • * Athletes who have performed too many oblique sit-ups
  • * Congenital defects
  • * Overuse or misuse of musculoskeletal system
  • * Abnormal movement patterns
  • * Braced posture (after operations or with pain)
  • * Pain
  • * Occupational: divers, singers, swimmers
  • * Stress, anxiety, rushed life
  • * Poor bike set-up

In the general population hyperventilation predominates. 15% of the population is shallow, fast breathers and has an excessive use of accessory muscles and lack of sideways rib expansion.

How to practice the correct breathing pattern which is called diaphragmatic breathing:

In various positions:

  • * Place one hand on your diaphragm (just below the V formed by the bottom ribs), other hand over upper       chest.
  • * Breathe in: abdomen should rise, and the upper chest should remain still. Visualise that you have swallowed  an upside down umbrella. As you breathe in, the umbrella opens (i.e. the diaphragm descends), expanding to  the front, back and to the sides, resulting in swelling of the abdomen.
  • * Breathe out: abdomen should lower. As you breathe out, so the umbrella closes, and the diaphragm rises or  ascends to assist in removing the used air from your lungs.
  • * Relax the jaw, upper chest and shoulders.

Practice about 30 breaths at a time, twice daily. Remember, the body needs to reset its new normal. This might take up to 6-8 weeks to change. Initially this may feel unnatural (as if you are not getting enough air) but if you keep practising you will retrain your nervous system to recognise this as the correct breathing pattern.

Keep practicing until this breathing pattern becomes natural to you.

This is a simple way to reduce back and neck pain and also to improve oxygenation and therefore performance in sports.

Happy breathing!

(Gen 2:7 Then the Lord God formed man of dust from the ground, and BREATHED into his nostrils the BREATH OF LIFE, and man became a living being.)