At One 2 One Physical Therapy our Doctors of Physical Therapy are specialists in posture and breathing through the Postural Restoration Institute. We created this video and accompanying blog article to teach you what we consider to be one the most important exercises you can do right now to improve lung health and potentially help prevent and manage the breathing and respiratory issues related to COVID-19.

As many of you know, COVID-19 primarily infects the lungs and if it progresses far enough can result in pneumonia where there is increased fluid and scar tissue. This reduces our ability to obtain oxygen and ultimately breathe.

According to this source, it appears that this pattern of edema and fibrosis can be present in the lungs even before symptoms appear. (https://www.genengnews.com/news/coronavirus-early-pathology-examined-in-lung-tissue-of-symptomless-patients/.

The increased fluid and scar tissue are a result of the body’s immune system trying to fight off the virus. However, problems arise when the debris created from the immune response is not being cleared out effectively and efficiently. This is what causes the congestion and fibrosis in the lung tissue.

When dealing with an infection in the lungs we need to not only have a strong enough immune system to kill the virus but we also need to be able to clear away the debris. This occurs primarily through our lymphatic system.

Our Lung Lymphatic System

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We have lymphatic channels and nodes throughout our lungs to filter and clear away the waste created by an immune response. Just like our heart powers our circulatory system, our lymphatic system also requires a power generator. This power generator is our breathing and movement.

Therefore, in order to power your lymphatic system pump to keep your lungs clear it is imperative that you optimize your breathing and movement.

Did you know that most likely your baseline breathing is not sufficient to accomplish this?

This is especially true if you are under stress, have asthma, allergies, or any other baseline respiratory condition. We find that the majority of our patients are shallow breathers, when in fact our diaphragm needs to fully contract and relax in order to be an efficient pump. When we breathe too shallow, our diaphragm becomes too tight.

In order to relax the diaphragm, you must first learn how to exhale completely. After a complete exhale, you can then take a large inhale. These excursions of inhales and exhales create the pressure differentials needed in the lungs for efficient lymphatic drainage and clearance of respiratory debris.

However, we can't forget the other driver of lymphatic flow which is the 3-dimensional movement that should normally occur through our pelvis and rib cage during breathing and walking. This also serves to pump our lymphatic system. It is ultimately the combination of our breathing coupled with the alternating rotation of our bodies during walking that drives this mechanism.

Body Rotation During Walking

Used with permission. Copyright © 2020 Postural Restoration Institute®, www.posturalrestoration.com

We have adapted a Postural Restoration Institute based breathing and movement technique that accomplishes these goals. We believe if everyone could perform this exercise a couple times per day it could significantly help prevent and minimize the respiratory complications related to covid-19.

Seated Alternating Reach, Breathe, and Tone Technique

Depending on your physical ability, sit on either a low step stool/stack of books in a squat position or a regular chair facing sideways. The lower the chair the better. If in a regular chair you can try placing a footrest/books under your feet. Round out your low back and roll your pelvis back so you can feel your sit bones. Reach forward with your right arm (thumb up) and backwards with your left arm (thumb down) while keeping your back rounded and weight through your sit bones. Inhale through your nose as you reach backwards with your left arm. You should feel your front left chest opening. Do NOT inhale too aggressively so that your neck muscles engage. Inhale enough so that your neck muscles stay relaxed. As you exhale create a low toned vowel sound such as "uh", "oh," or "ah." Try to maintain the tone as long as you can get ALL of the air out of your lungs. You will feel your abdominals engage during this and maybe some vibration in your body. You may notice that your next inhalation feels deeper and more opening in your chest. Repeat this for 4 toning/breath cycles on one side and then switch to the other side (L arm forward/R arm backwards) for 4 cycles. Perform 3-4 cycles each side, ideally 2x day to optimize your lung lymphatic flow.

We also suggest incorporating this breathing technique at times when you are walking. You can substitute the exhale toning with a prolonged pursed lip exhale if you think you might intimidate nearby passerby.

If you experience any discomfort during this exercise we do not recommend you continue.