Long COVID Rehab: Physiotherapy Approaches for Persistent Fatigue and Breathlessness

If you’re reading this, chances are you — or someone close to you — is still battling the lingering shadow of COVID-19. That bone-deep fatigue that hits even after a short walk to the kitchen. The breathlessness that creeps in when you climb the stairs at home in Fourways. The frustration of feeling like your body has forgotten how to be “normal” again.

You’re not alone, and more importantly — you’re not stuck.

Here at Broadacres Physio in Broadacres, Fourways, we’ve been walking alongside dozens of Johannesburg locals through Long COVID recovery since 2021. I’ve sat across from strong, active people — runners, golfers, busy parents, CEOs — who suddenly couldn’t get through a grocery shop without needing to sit down. The good news? With the right physiotherapy approach, most of them are now back to living full lives. And the two cornerstones that make the biggest difference are breathing retraining and graded activity.

Let’s talk openly about what works, why it works, and how you can start feeling like yourself again.

First, a Bit of Real Talk About Long COVID

Long COVID (or post-COVID syndrome) isn’t just “being a bit tired.” It can involve dysregulated breathing patterns, profound muscle deconditioning, postural issues from weeks in bed, and even changes in how your nervous system manages energy. The two symptoms we see most often at the clinic are:

• Persistent fatigue that doesn’t improve with rest
• Breathlessness out of proportion to activity (sometimes even at rest)

These can feel terrifying and isolating. But physiotherapy has solid, evidence-based tools to tackle both — gently, progressively, and without pushing you into a crash.

Breathing Retraining: Teaching Your Body to Breathe Easy Again

One of the sneaky effects of COVID is that it can disrupt your normal breathing pattern. Many people shift to shallow, upper-chest breathing — fast, inefficient, and exhausting. Over time, this creates a vicious cycle: you feel short of breath → you panic a little → you breathe even faster → you feel more tired.

Breathing retraining is about breaking that cycle and restoring calm, efficient diaphragmatic breathing.

Here’s what we do at Broadacres Physio:

1. Positioning for comfort We start with you lying down or half-sitting with support so your body feels safe. Forward-leaning sitting (elbows on knees or a table) often helps reduce breathlessness instantly.
2. Diaphragmatic breathing practice Hand on belly, hand on chest. The goal: belly rises first, chest barely moves. Slow inhale through the nose (count 3-4), gentle exhale through pursed lips (count 5-6). We aim for 6-8 breaths per minute.
3. Paced breathing We teach techniques like the “3-3-6” method: inhale 3 seconds, hold 3, exhale 6. It activates your parasympathetic nervous system and lowers heart rate.
4. Breath-hold and recovery drills Once you’re comfortable, we gently introduce short breath-holds to improve CO₂ tolerance — a game-changer for that “air hunger” feeling.

One of our patients, Claire — a 42-year-old teacher from Fourways — described her breathlessness as “trying to breathe through a straw.” After six weeks of focused breathing retraining twice a week, she was walking her dogs again without stopping. She told me, “It’s like someone finally turned the tap back on.”

Graded Activity: Rebuilding Energy Without the Boom-and-Bust Cycle

The biggest trap with Long COVID fatigue is the boom-and-bust pattern: feel okay one day → overdo it → crash for three days → feel guilty → repeat.

Graded activity (sometimes called pacing) is the antidote. It’s not about “pushing through” — it’s about steady, sustainable progress.

How we structure it at Broadacres Physio:

• Baseline setting We find your current sustainable activity level (e.g., you can walk 5 minutes without a crash). That becomes your starting point.
• Tiny increments Increase by 5–10 % every week or two — only if you’re recovering well. Example: Week 1 = 5 min walk daily → Week 3 = 7 min → Week 6 = 12 min.
• Activity cycling Alternate higher-energy days with lower-energy days. We use simple diaries to track symptoms and energy.
• Incorporating strength and balance Once walking is stable, we add gentle resistance (bodyweight squats, wall push-ups) and balance work to rebuild muscle you may have lost during illness.
• Post-exertional monitoring We teach you to recognise early warning signs and pull back before a crash — this is the skill that prevents setbacks.

Mark, a 55-year-old accountant who commutes through Fourways, came to us barely able to climb one flight of stairs. Eight months later — after consistent graded walking, pool-based exercise, and breathing work — he completed the 94.7 cycle challenge (the 40 km route). He still messages me every year on the anniversary: “Never thought I’d get here.”

Other Tools We Use Alongside Breathing and Graded Activity

While breathing retraining and pacing are the stars, we often layer in:

• Gentle manual therapy for tight chest muscles or postural issues
• Postural education (especially for those working from home in Fourways)
• Simple mindfulness or relaxation to manage anxiety around symptoms
• Advice on sleep positioning and energy conservation in daily tasks

When Should You Start Physio for Long COVID?

The sooner, the better — but it’s never too late. If you’re still experiencing significant fatigue or breathlessness three months after your initial infection, it’s worth getting assessed.

At Broadacres Physio in Broadacres, Fourways, we offer specialised Long COVID rehabilitation packages that include an initial 60-minute assessment, personalised breathing and pacing plans, and ongoing support. We work closely with GPs and pulmonologists when needed.

Final Thought: There Is a Way Forward

Long COVID can feel like a life sentence, but with the right guidance, most people improve — often dramatically. Breathing retraining calms the storm inside your chest. Graded activity rebuilds your energy bank, one small deposit at a time.

You don’t have to figure this out alone.

If you’re in Fourways, Johannesburg or nearby and ready to take the next step, reach out. Book online at www.baphysio.co.za or give us a call — we’d love to help you breathe easier and live fuller again.

You’ve already survived the worst part. Now let’s get you thriving.

With hope and high-fives, The team at Broadacres Physio — supporting Fourways through recovery, one breath at a time.

Take Control of Your Pain Today

Don’t let pain or stiffness hold you back. Heat and cold therapy at Broadacres Physio in Broadacres, Fourways can help you manage discomfort, recover faster, and live an active life. Our expert physiotherapists are ready to guide you with personalized, science-backed care.

Ready to feel the difference? Visit www.baphysio.co.za to book your appointment today. Let Broadacres Physio help you thrive in Fourways, Johannesburg!

📍 Visit us at Broadacres Physio in Fourways
📞 Call us on 011 467 8300
📧 Email us at admin@baphysio.co.za
🌐 www.baphysio.co.za

Let’s get you moving, healing, and thriving — the way your body was designed to.

Broadacres Physio – Where Healing Starts With Understanding

At Broadacres Physio, we believe that healing starts by understanding you. By treating the underlying causes — not just the symptoms — we give you the tools, knowledge, and support to reclaim your health and stay pain-free for the long run.

Let’s keep you moving. Book your session today at www.baphysio.co.za.