Yoga therapy and COVID-19 recovery
By Ingrid Yang, with Laurie Hyland Robertson
Give Back Yoga University and the International Association of Yoga Therapists have partnered on an initiative to support patients as well as healthcare and yoga professionals dealing with the effects of long COVID. This post was developed based on my programs in this series and offers starting points for those in any of these groups and for people recovering from the acute phase of COVID-19.
For some people, COVID-19 infection is a nonevent that produces no symptoms. Others experience mild discomfort that feels like a common cold, some have more moderate illness, and still others—about 15% of cases—have severe illness from the virus.
In my experience as a hospitalist physician on COVID-19 wards and an IAYT-certified yoga therapist, targeted yogic practices are uniquely suited to help with recovery from COVID-19—whether the illness was mild, severe, or in between—for several reasons:
- In yoga we focus on linking breath with movement, an approach that can be beneficial for reducing the physical, mental, and emotional stresses of illness; these exercises can also be as gentle as needed—and they can even be done mentally rather than physically.
- The inherently mindful techniques of yoga have been shown to decrease stress and anxiety generally and also the stresses related to COVID-19 illness.
- Yoga has also been shown to decrease inflammation, a key factor behind COVID-19’s wide-ranging effects in the body.
- Because breathing is often negatively affected by this disease, the techniques of yogic breathwork (pranayama) are a natural fit for support.
- The practices are infinitely adaptable to individual capabilities and to inevitable variations in daily energy levels.
Based on recently published scientific literature, the overall COVID-19 disease process occurs in three distinct and potentially overlapping phases that result in respiratory, inflammatory, and thrombotic (blood-clotting) effects. Basically, the virus causes a reaction in your body that is actually an overreaction. This exaggerated response is the origin of the lasting symptoms seen in long COVID and the cause of the high mortality rates with this disease. The heightened inflammatory process is also why yoga therapy—especially a practice that incorporates asana (physical postures), breathwork, and meditation—is uniquely suited to assist with COVID-19 recovery.
As noted above, research shows that yoga can decrease levels of proinflammatory cells in the blood.* Decreasing inflammation generally can help to decrease one’s reaction to COVID-19 once contracted. But most importantly, if we can prevent an overexaggerated inflammatory response, we may be able to prevent the long-term damage from this disease.
The studies cited below, and others, imply that yoga may be a useful complementary intervention for those at risk of or already suffering from diseases with an inflammatory component. Yoga practice may also enhance immunity. Just a little bit of yoga can go a long way in decreasing general inflammation in our bodies. This is important because we have found that people with chronic conditions tend to become sicker when they contract COVID-19—they are already in a state of increased inflammation.
Decreased anxiety and stress
Becoming ill with COVID-19 can cause significant anxiety, especially because the inability to breathe comfortably will almost inevitably make us anxious. A number of studies have demonstrated the benefits of yoga in decreasing stress and anxiety, particularly when the practice includes a meditation component.† Mindfulness techniques may assist in decreasing long-lasting effects of COVID-19—inability to focus, brain fog, etc.—and the anxiety and stress that go along with a significant illness like this.
Sample practices‡ to support recovery
After illness or general deconditioning, breathing patterns may be altered, with reduced diaphragmatic movement—this causes us to overuse accessory breathing muscles in the neck and shoulders. Our breathing may become shallow, which will in turn increase fatigue and breathlessness. Breathwork aims to normalize breathing patterns and increase the efficiency of respiratory muscles (especially the diaphragm), resulting in less energy expenditure, less airway irritation, reduced fatigue, and improvement in breathlessness.
Someone recovering from COVID will perform diaphragmatic breathing exercises a bit differently than traditional techniques. Breathing through the nose as much as possible, as is often done in pranayama, is helpful here, too. In this case, though, we can add gentle breath holds at the end of the inhalations and abdominal muscle contraction at the end of the exhalations. These techniques work to improve elasticity and strength of the diaphragm and to improve oxygen exchange in the alveoli. (Alveoli are the tiny air sacs at the end of your respiratory tract that enable the exchange of oxygen and carbon dioxide; COVID’s effects on the lungs, as well as the inflammation, can cause poor utilization of the alveoli.)
Breathwork I like to offer those recovering from COVID-19
• Sit with your back against a wall and let the back of your head also gently touch the wall. Place one hand on your belly and the other on your chest. As you practice this technique, feel the entire torso expanding in all directions, including into the wall—that will give you sensory feedback that you are really taking in a deep breath.
• Breathe in slowly through your nose so that the flow of air is even throughout the entire length of your breath. As you inhale, feel the hand on your belly move as the area expands. Try to keep the hand on your chest as still as possible.
• Hold in the breath at the top of your inhale for about 2–5 seconds, as long as that’s comfortable.
• Exhale slowly through pursed lips, gently contracting the abdominal muscles up and in. Try to release the air with the same cadence as your inhale.
• Repeat this cycle of inhaling through the nose, holding, and exhaling through pursed lips for 5–10 breath cycles (possibly more if you can tolerate it).
As you progress or on days when you have more energy, you can also coordinate the breath with gentle movements, for example, lifting the arms as you inhale and relaxing them down as you exhale.
Physical postures that may help
This asana routine includes gentle movement, proning (lying on the belly), side-lying, reversing a slumped-forward posture, and targeted stretching. Postures should be practiced in coordination with the breath and held as long as is comfortable. (Some days simply moving toward a pose is enough!)
• Locust pose (salabhasana) reproduces the belly-down position doctors recommend for COVID patients. Lying prone helps to recruit collapsed or poorly utilized alveoli that may not otherwise facilitate adequate oxygen exchange due to poor positioning and gravity. This technique works especially well for those who have been bedridden for several days or weeks. Repeat 3–5 times if you can, inhaling to lift the torso into extension and exhaling to relax back to the floor or bed.
• Vishnu’s couch (anantasana) is recommended for the same reasons as locust. Lying on the side, supported by the arm changes your positioning and helps to recruit otherwise sluggish alveoli. Hold for 3–5 breaths on each side, as tolerated.
• Cat-cow (marjaryasana bitilasana) is particularly helpful for those with long COVID because it can help to reprogram a healthy connection between breath and movement, a key goal in post-COVID rehab. Moving between spinal extension and flexion, as in this exercise, also stretches many of the back and chest muscles that may have become tight while being sedentary with the infection. Cat-cow also stretches the intercostals (important breathing muscles between the ribs) and tones the core muscles (also important to improve diaphragmatic control). Cycle through 3–5 rounds of breath, inhaling for cow and exhaling to cat.
• Staff pose (dandasana), sitting erect with the legs reaching long and active in front, teaches us to use our core muscles for upright posture. Posture plays an important role in respiratory function, and studies on COVID-19 recovery encourage erect head and neck positioning. Hold for 4–8 breaths, as tolerated.
The road to recovery from COVID-19 infection can be a long one. I recommend being extremely gentle with yourself and taking a step-by-step approach. If all you can do one day is a gentle breathing exercise or a visualization or mindfulness practice that day, that work can still be enormously helpful!
Remember, too, that just as each individual experiences COVID-19 differently, there is no one-size-fits-all for a yoga for COVID-19 recovery program. The most important component is that you be present with your client and listen to their concerns and symptoms to best assist in their resilience and recovery.
Ingrid Yang, MD, JD, E-RYT 500, C-IAYT, incorporates medicine into yoga and yoga into medicine. A hospitalist based in San Diego, she is also the author of Hatha Yoga Asanas and Adaptive Yoga. Find her on Instagram.
Laurie Hyland Robertson, MS, E-RYT 500, C-IAYT, manages communications and publications for the International Association of Yoga Therapists.
All photos of Dr. Ingrid Yang by Jeremy Schneider.
‡As with any yoga practice, remember that not every pose or exercise is suitable for everyone. Adjust poses as needed to accommodate your comfort and range of motion. Practice listening to your body rather than forcing or trying to achieve a particular shape.
(Articles referenced may require a subscription for full access.)
Like the other information provided on this site, this material is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You are encouraged to consult your personal physician with questions or concerns. If you are experiencing a medical emergency, please call 911 or the emergency services number in your area.