At our hospital sites our physiotherapists have formed part of the team of frontline workers treating COVID positive patients. We are approaching the peak of the second wave of infections in South Africa and, with hospital beds hard to come by, many people are managing milder cases of COVID at home. We wanted to put together this document with some physio tips that may help you in doing so.
A really useful, safe and easily accessible home therapy is positioning. Many COVID positive patients (but not all) see an immediate response in their oxygen levels (sats) with positioning in prone lying (lying on your stomach). If this position is uncomfortable for your lower back, try doing it with a pillow under your pelvis and keep your head resting on your hands and turned to the side so you can still breathe freely. For people who do respond well to prone lying (either with decreased breathlessness or an improvement in sats) it’s recommended that you spend at least 20minutes in this position every hour.
Our physiotherapists encourage regular position changes. By turning and changing your position you can;
(1) use gravity to help drain secretions and move them to the bigger airways for easier clearance and
(2) move and direct airflow in your lungs.
The greatest blood flow, and thus biggest surface area for oxygen exchange, is at the base of your lung. Tummy lying is the best position to take pressure off your bases allowing them to expand fully and maximize oxygen intake. Lying alternately on each side is the next best position if prone lying isn’t manageable.
A good idea would be to move between these 4 positions every 20 to 30 minutes;
Tummy lying – Left side lying – Sitting upright – Right side lying
When you are feeling acutely short of breath you may get some relief with tummy lying. Other positions that can help to ease shortness of breath are positions that take the weight of your shoulder girdle off your chest and include;
- sitting in a chair, leaning forward with the full length of your forearm supported on your thigh and trying to breathe deep into your lungs
- Standing at a counter height, resting the length of your forearms parallel to each other and resting your head on your arms while deep breathing
Diaphragmatic or “belly breathing” is the gold standard to aim for, mindful of the fact that it can be hard to achieve when you are feeling acutely short of breath. You may not be able to breathe like this with every breath, but it is helpful to perform hourly as a breathing exercise.
Put your hand on your stomach, just below your sternum and breathe in deeply through the nose aiming to get your tummy to rise with each breath. This means you are pulling air down to the bases where your blood can draw the most oxygen into it. If as you breathe in deeply you get a big, barrel chest and your tummy falls away under your hand, your are just drawing air into the top of your lungs.
The co-ordination can be awkward in the beginning but it’s worth persevering until you get it right. If you battle to achieve this in sitting, try it in lying on your back with knees bent and feet resting on the bed. As always, keep one hand on your chest and one on your stomach so you can feel where the airflow is going.
Pursed lip breathing can help to slow down your respiratory rate. Take a deep breath in through the nose and then blow out slowly through pursed lips. Repeat a few times taking normal breathss in between so it doesn’t worsen shortness of breath and become “breath holding”.
There are a few things you can monitor to measure improvement in your condition or pick up a deterioration quickly
It may be useful to track your perceived effort in breathing as well as your respiratory rate as a means of quantifying your shortness of breath. Set a timer for 30 seconds and have someone count the number of breaths you take in that time, doubling it to get your number of breaths per minute. This should ideally be below 25.
A pulse oximeter is a useful tool if you need to closely monitor oxygen levels. It measures the saturation of oxygen in your blood and these figures are useful to feedback to your healthcare provider if you feel you may need admission for oxygen support.
Be mindful of the fact that nail polish can affect these readings. Poor perfusion in your fingers, as in the case of someone with clubbing from cardiac disease or something similar, can also result in inaccurate readings.
A normal sats reading is usually between 97-100%. Someone saturating at 92% and below may need supportive oxygen therapy. These baseline figures would be a bit lower in slightly older patients, heavy smokers or someone with chronic obstructive pulmonary disease, in which case their body may be quite used to functioning with saturation levels in the low 90s. For this reason sats need to be considered in context, and in relation to other symptoms like shortness of breath.
Keep well Hydrated
Staying well hydrated is a very important when you aren’t well. Anyone 60kgs and over should drink a minimum of 2l of water a day, even more when you are feverish.
Keep in touch with your doctor
If you are managing your COVID-19 symptoms at home we highly encourage reaching out to your GP over the phone (not going into their rooms!). Keep them abreast of your symptoms, give them information about your oxygen levels etc if you are monitoring them at home and, in doing so, share the burden of having to make decisions about escalating intervention, admission to hospital etc. It can feel like a tremendous responsibility having a sick loved one at home so it’s important to share the burden with your healthcare provider.
Our physiotherapists are available for telehealth consults if you would like more input. Please don’t hesitate to get in touch.