If you had COVID and never quite got back to yourself, you're not making it up. We see this several times a month. The pattern is consistent: an acute illness in 2020-2023, then a tail of symptoms that drags on for months or years afterward.
What patients actually present with
The most common symptoms we see:
- Breathlessness — disproportionate to the activity, sometimes at rest
- Fatigue — particularly post-exertional, the day-after slump
- Dysfunctional breathing patterns — apical, chest-led, often unconscious
- Dizziness on standing
- Brain fog and reduced concentration
- Chronic cough
- Joint pain and muscle weakness
- Sleep that doesn't restore
Most patients have already seen a GP, sometimes a respiratory or cardiology specialist, before they reach us. The bloods are usually normal. The scans are usually normal. The patient is told they're "fine," which they very obviously aren't.
Why this is different from regular post-viral recovery
The single most important concept in Long COVID rehab is Post-Exertional Symptom Exacerbation (PESE), sometimes called Post-Exertional Malaise (PEM).
In normal recovery, doing more makes you better. In Long COVID, doing more often makes you measurably worse — not just tired, actually worse, for hours or days afterward. The standard "graded exercise" approach that works for most post-viral fatigue can make Long COVID significantly worse if applied without screening first.
Pushing through is the wrong instruction. Most patients have been given exactly that instruction by well-meaning trainers, partners, and clinicians. Undoing that mindset is often half the work.
What our first session looks like
Different from a standard physio assessment. We're not testing ranges of motion in the first ten minutes. We're screening for three specific things:
1. PESE screening
We use a validated questionnaire to gauge whether you have PESE, and how reactive your system is. This sets the ceiling for what we can prescribe. Some patients can handle modest aerobic work from the start. Others can't, and pushing them is malpractice.
2. POTS screening
Postural Orthostatic Tachycardia Syndrome — your heart rate jumps more than 30 beats per minute when you go from lying to standing. Common in Long COVID, often missed. If you have it, the rehabilitation approach is specific (recumbent exercise first, compression, salt and fluid loading, gradual progression to upright).
3. Cardiac involvement check
Less common but serious if present. Resting tachycardia, exertional chest discomfort, syncope on exertion are all flags for a cardiology referral before we do anything physical.
What treatment actually looks like
Slow. The instinct from previous physiotherapy experiences is "give me exercises to do." Resist it. The first phase is usually:
- Pacing. Learning your envelope — how much you can do without triggering a crash — and operating safely within it.
- Breathing retraining. Most Long COVID patients have shifted to apical (chest) breathing without realising. Restoring diaphragmatic breathing reduces breathlessness and improves nervous system regulation.
- Sleep optimisation. Sleep is where recovery happens. If yours isn't restorative, nothing else matters as much.
- Carefully graded movement. Often starting recumbent or seated, very gradually adding load only when previous load is being tolerated without symptom spike.
The team approach
Long COVID rehab works best when everyone's on the same page. We'll often coordinate with:
- Your GP, for ongoing investigations and medication review
- Any specialist you're seeing (cardiology, respiratory, ME/CFS specialist)
- Your personal trainer or class instructor, so they know not to push you
- Family, who often need help understanding why "just doing a bit more" isn't the answer
If you arrive at our clinic and want us to coordinate this, we will. It's part of the work.
If you're not sure whether what you have is Long COVID
Bring whatever your GP has told you so far. Bring any blood results, scans, specialist letters. We'll talk through it on session one and tell you whether you fit the pattern, and whether what we offer is the right next step. If it isn't, we'll point you at who is.
Ring 07 394 4227 and ask to talk about Long COVID specifically. We'll book you with whoever in the team has the best fit for your case.
