Physiotherapy Provision Only

Physiotherapy and
COVID-19

Physiotherapy Booklet For

Booklet provided by PT Name __________________________ DATE______________________

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Physiotherapy can help with several things:

- Provide advice and education about your illness
- Help you to keep mobile and independent
- Set exercises to prevent deconditioning
- Help you to managing shortness of breath
- Help you to maintain good lung volumes and clear phlegm
- Support energy conservation when breathless

Engaging with physiotherapy

Covid-19 is a contagious airborne virus; all hospital staff are advised
to limit contact. For this reason, you may be given advice by a
physiotherapist over the phone and provided with information
leaflets. Alternatively, you may require face to face contact and can
therefore expect to see a physiotherapist dressed in protective
clothing which is normal practice for this condition.

Your physiotherapy treatment will be individually designed to

support your recovery, it is likely that you will be asked to wear a
mask during physiotherapy treatment; this is to reduce the risk of
droplet transmission.

Your physiotherapist will select and guide you through treatment

strategies from this booklet.

Whilst in hospital, your treatments will be progressed by your

physiotherapist; please just complete the specific tasks that are
selected for you.

If you feel worse whilst completing any of these tasks please STOP,
until reviewed by your physiotherapist.

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Breathing support devices:

Whilst you are in hospital you may require breathing support. This
can be provided in several ways:

Oxygen via mask/nasal prongs

Extra oxygen is provided via nasal

prongs/mask which can help increase
your oxygen levels. It is important
that you keep these devices closely
attached to your face, not blowing in
the room.

High Flow Nasal Prongs (“Airvo”)

This device provides warm,

humidified air supplemented
with oxygen. It provides air at a
higher flow rate (pushing air
into lungs) and can help loosen
phlegm. It is designed to make
breathing easier for you and
help you to feel more
comfortable. It is always important to keep the mask or nasal prongs
on (including when going to the bathroom). This is to ensure the
benefits from the device are maintained.

Why am I breathless?
Breathlessness is a key feature for many people with this condition
and you are not alone if you feel this way too.

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Some people do not have this problem at all; if you are admitted to
hospital it is likely that you may become short of breath as your lungs
work harder to provide oxygen to your body. This may mean that you
breathe faster and shallower. Some people feel anxious as simple
daily tasks become harder. Being breathless can make you panic or
feel frightened.

What can I do when I feel breathless?

☐ Relaxed breathing control PT initial ______ ; Date:______

Breathing control starts with noticing how you are breathing and
how you feel about it. Choosing a comfortable position and
becoming aware of your pattern of breathing will help minimise
feelings of stress associated with shortness of breath. Try to avoid
holding your breath and making sudden rushed movements.

Adopt a posture that is supportive and comfortable (see below) then

try to breath in and out of your nose at a slowed pace- this warms
and filters the air; if this is too hard and makes you feel more anxious
or breathless, use your relaxed open mouth as well.

Try to notice areas of muscle tension in your body, start from the
feet and work your way to the top of your head- gradually let go of
any tension in your body as you breathe out. Maybe you can try to
make your breaths slower, do not force your breath, take comfort in
the depth and volume of air you are moving and enjoy the relaxation
from fear that it brings. Some people like to close their eyes as they
focus on the task.

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☐ Resting positions PT initial ______ ; Date:______

These positions are helpful to reduce breathlessness and work of

breathing.
High side lying:
 Lie on your side
 Use multiple pillows, or lift the head of the
bed up on your bed controls
 Make sure the head pillow supports your
☐ head and neck fully
 Bend your knees a little

Supported forward sitting:

 Sitting on a chair, lean forward on a table
 Pillows may be added, for some this is a
comfortable position to sleep in

Forward sitting:
 Sit leaning forward
 Rest your forearms on your knees
 Relax your chest and shoulders

Supported standing
 Stand leaning forward on a chair, bench or
against a wall
 Let your chest and shoulders relax

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Pursed lip breathing (PLB) PT initial ______ ; Date:______

This technique helps to keep your airways open during expiration

(breathing out) you can use PLB whilst you’re doing something that
makes you breathless (like showering or dressing) and it will help you
to feel more in control. Some people do this naturally in their
everyday activities, but if you are struggling with PLB- talk to your
therapist about it.

1. Breathe in normally
2. Breathe out through pursed lips (like you are
about to whistle or blowing out a candle)

☐ Blow- as- you- Go PT initial ______ ; Date:______

This technique helps to make tasks easier

1. Breathe in before you make the effort (like

lifting a weight)
2. Breathe out as you do the task.
This can help functionally:

 As you get out of bed

 As you bend over to reach for your shoes

Blow- as- you- go is also helpful when doing your exercises.

 As you reach and stretch a band (blow out on the stretching

part)
 As you stand or step up (blow out as you strain or take weight)

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☐ Diaphragmatic breathing control PT initial ____ ; Date:___

This technique stretches the diaphragm and fills the bases of your
lungs; it is another relaxed breathing strategy. If you find it does not
work for you, stop and talk to your therapist.

1. Be in a comfortable upright seated position

2. Place a hand on your stomach
3. Breathe in, feel your stomach gently move out
4. Breathe out, feel your stomach relax and move in

Repeat _______

☐ Lying prone (on your front) on

the ward PT initial _____ ; Date:______
You may be asked to lie on your tummy for
certain times in the day- this will depend on
your levels of oxygen and your physiotherapist will discuss this with
you. It is done to help the long-term recovery of lung tissue and can
greatly improve your oxygen levels, and for some people, secretions
are easier to clear with this change in position.

We may need to use a few pillows to help you find a position that’s
comfortable; particularly for your neck and shoulder position to
avoid a stretch and to support your ankles and feet. Some people like
to sleep in these positions.

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Why do I have phlegm?

Most people have phlegm or mucous and it is normal to cough some
up and swallow during our day. You may have a dry cough, but some
people develop phlegm as the course of their illness progresses. This
can depend on current and previous health conditions, or it may just
be how you are being affected by the virus.

Clearing this phlegm is important as it will improve your oxygen

levels and help make breathing easier.

What can I do to help clear this phlegm?

Breathing Exercises
Breathing exercises can help your lung recovery, improve oxygen
levels and clear phlegm. There are many different routines; your
physiotherapist will select one which is right for you.

☐ Autogenic Drainage PT initial ______ ; Date:______

Do this sitting or lying down on your side; begin by clearing your

upper airways by huffing or blowing your nose.

1. Low lung volume breathing (unsticking) - small airways

Take a small breath in slowly through your nose, keeping your upper
airways open and hold your breath for a few seconds.

Breathe out through your mouth as far as you can, allow your tummy
(abdominal) muscles to tense. This will take you down to low lung
volume. Take a partial breath in slowly (resist the urge to take a big
breath in). Repeat this until you feel the secretions moving up in your
airways (aim for 10 breaths)

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2. Middle lung volume breathing (collecting) - middle/large airways

Take a normal sized breath in and hold your breath for a few seconds
then breathe partially out (not all the way out) through your mouth.
Keep breathing this way until you can hear/feel the sputum moving
(aim for 10 breaths)

3. High lung volumes (evacuating) - large airways

Breathe in slowly through your nose as far as you can, keeping your
upper airways open. Hold your breath for a few seconds. Only
breathe part of the way out to keep you at high Lung volume. Take a
big breath in again, slowly and repeat the same type of breath out.
Keep breathing this way until you feel/hear the sputum is ready to be
cleared.

4 Clearing secretions

Do 1 or 2 huffs or an effective cough to clear the sputum.

Try not to cough until the mucus is in the larger airways. You have
now completed one cycle.

Use breathing control for one to two minutes. Repeat the cycle until
the mucus is cleared.

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☐ Active Cycle Of Breathing Technique (ACBT)

PT initial ______ ; Date:______

1. ____ Deep breaths

2. Rest (normal breathing)

3. ____ Deep breaths

4. Rest (normal breathing)

5. ____ Huffs (like fogging up a mirror) Small-long

or Big-short.

6. Cough if you need to

Repeat this cycle of breathing ___ times and ___times

a day.

Try not to miss a stage as it works best as a full cycle.

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Mobility
☐ Walking and moving
Walking can help to clear phlegm by encouraging deeper breaths.
Walking or transferring from bed to chair may make you
short of breath. Mobility aids may be given by your
physiotherapist to make the work of walking easier

Try frequent short walks, this may be on the spot and

timed, or around your room. You can mark your
achievement off in your exercise diary. If this is hard for
you, assistance may be provided by your physiotherapist
or nurse.

☐ Sit out in a chair

Sitting upright helps you take deeper breaths which can
move phlegm. Sit out of bed in a chair for all meals and
throughout the day.

☐ Positioning In Bed
Lying flat on your back or slumped in bed is
not a helpful position for your lungs. It can
make breathing difficult, make your cough
weaker and limit the air in your lungs. Try sitting upright in bed, use
the bed controls and pillows to find a comfortable position. If you are
lying down, your physiotherapist or nurse will help you find a
position that allows your body to gain the oxygen it needs.
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What are reduced lung volumes? The Lungs

Being less mobile and unwell can

contribute to reduced lung volumes
and that can affect your oxygen
levels.
Having reduced lung volumes means
that there is less air going in and out
of your lungs. This is partly due to
small air sacs (called alveoli) that
have semi- collapsed or fully closed.
This can happen for many other
reasons such as having an
anaesthetic.

Normal Reduced

What can I do to increase lung volumes?

Performing regular breathing exercises, changing your posture and
moving can improve reduced lung volumes.

Breathing exercises like those mentioned previously, and getting up,

trying to be active and mobile will help to increase lung volumes.
This is another exercise that is right for some people and should only
be used when selected by your physiotherapist.

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☐ Thoracic Expansion Exercises (TEE)

PT initial ______ ; Date:______

1. ____ Normal relaxed and controlled breaths

2. ____ Slow, deep breaths
Glottis open/shut: Hold □ ___ secs Sniff □
3. ____ Normal relaxed and controlled breaths
4. ____ Slow, deep breaths
Glottis open /shut: Hold □ ___ secs Sniff □
Repeat: _______

The importance of exercise

Whilst in hospital, it is important to try to be mobile and complete
some form of exercise each day as you will be limited to a room
space. This will maintain your strength, prevent deconditioning and
help you recover more easily so that your discharge home will not be
delayed. Physiotherapists are part of a team dedicated to help you
get through this and will support you through each stage.

On the next page there are some generalised exercises, please follow
the exercises that are ticked only. Your physiotherapist will likely
progress these exercises throughout your time in hospital.

If you are breathless remember the Blow-as-you-go technique.

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Sit to Stand
When seated in a chair, have your feet hip-
☐ width apart. Stand up, and slowly sit down
onto the chair.
Repeat ______

Leg Extension
☐ When seated in a chair, straighten your leg
as far as you can, hold for 2-3sec.
Repeat ______

Seated Marching
When seated in a chair, lift each leg
☐ alternately. Like you are marching.
Repeat ______

Straight Leg Raise

☐ Whilst lying down. Squeeze your thigh
muscles, keeping your leg straight lift it off
the bed about 10cm. Slowly lower to the
bed.
Repeat ______

Bridge
☐ Lie on your back. Bend both knees and lift
your bottom of the bed. Hold for 2-3sec,
slowly lower your hips.
Repeat ______
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Chest press with band

☐ Whilst seated, hold the band in both hands,
keep hands in line with shoulders. Push your
arms away and then bring back to your chest.
Repeat ______

Bicep curl with band

☐ Whilst seated, loop the band under your feet.
Hold the end of the band in both hands. Bend
your elbows and slowly straighten your arms.
Repeat ______

Banded pulls
☐ Whilst seated, loop the band under your feet.
Hold the end of the band in both hands with
your arms straight. Pull the band towards you
and slowly straighten your arms.
Repeat ______

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☐ Exercise Diary PT initial ______ ; Date:______

Theraband colour:______

Record how many you do and how often e.g. 10x3

Exercises Mon Tue Wed Thurs Fri Sat Sun

Sit to Stand

Leg
Extension
Seated
Marching
Straight Leg
Raise
Bottom Lifts
(Bridge)
Chest Press
with Band
Bicep Curl
with Band
Banded
Pulls

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Exercise Routine: (Respiratory Focus) PT initial ___ ; Date:___

O2 therapy______________Mode_____________

Exercises Mon Tue Wed Thurs Fri Sat Sun

Relaxn. Brthg.

Posture

Posture

Endurance

Endurance

Endurance

Strength

Strength

Strength

IMT

Stretch UL

Stretch LL

BORG
FATIGUE
F.I.T.T.
PACING
BORG SCALE 0_______________________________10
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☐ Why do I need to use a walking aid?

You may be assessed by your physiotherapist for a walking aid; this
may be given to you if you are unsteady on your feet due to this
illness. Wheeled Frames like gutter frames or super strollers are
often provided to relieve shortness of breath and can significantly
reduce how hard you must work in order to move.

If you have been advised to use an aid, it is important that you use
that aid for all walking and transfers. The aid will help to control your
breathing, allowing your body to conserve precious oxygen and
energy. Once you are better you can leave it behind!

If your physiotherapist has determined that you need help when

mobilising it is important that your call bell is always close to you.
This will be explained by your physiotherapist.

AID PROVISION_____________________ PT initial ______ ; Date:______

☐ Keeping a routine
When in hospital try to maintain as much routine and structure to
your day. It helps to have some normal activities and a routine which
can reduce the risk of deconditioning. Some elements that can be a
part of this routine are:

- Getting up at a normal hour

- Complete morning tasks i.e. brushing teeth
- Morning wash/shower
- Getting dressed in your own clothing if available
- Sitting in the chair for all meals
- Walking up to the toilet

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- Tick off your Exercise diary - given by your physiotherapist

- Use the free hospital Wi-Fi
- Find music that helps you relax or encourages you to exercise
- Follow your passion- What do you like to do, what is your
hobby? Puzzles or Sudoku, handcrafts or reading, tell us and we
will try to help you navigate this journey.
- Some people like to have a diary, noting down the events of
their stay in hospital and celebrate their stages of recovery
- Stay in touch with the world; don’t be frightened by it- you
have a large team of support behind you and people get better!

Space That You Can Use For YOU!

_____________________________________________
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