Recover From Long COVID: A Free Guide
I’m Marianne Svanevik, a private practicing physiotherapist with 20 years of clinical experience treating patients with ME/CFS and for the last 4 years Long COVID too. I’ve helped hundreds of patients recover. In this guide I’ll show you how.
Three Steps to Recover
There are three steps you have to go through to recover from Long COVID:​
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Rest: Reduce your activity level and avoid stress.
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Rebuild: Increase your activity level gradually.
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Solidify: Build robustness to avoid relapse.
In the Rest phase, we stop you from having crashes/symptom increases and make your body ready for growth. You achieve this by reducing your activity level dramatically and avoiding stress.
In the Rebuild phase, we gradually increase your activity level by 10-20% every two weeks. When your body responds well to the increase, we keep increasing every two weeks, when it doesn’t, we reduce the activity level a bit and increase it a bit less two weeks later.
In the Solidify phase, we make your body robust so that you don’t relapse. We achieve this by making sure you avoid big negative stressors and don’t ramp up exercise too quickly.
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While some people eventually recover without professional help, it's hard to find the right activity level and execute the plan on your own. In our Long COVID Recovery Program, we show you exactly what to do and not to do every step of the way, give you detailed feedback every two weeks, and we provide support whenever you need it.
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1. Rest: Reduce your activity level and avoid stress
The first phase of the recovery process is named Rest. At the start of this phase, you typically experience frequent crashes/symptom increases and you struggle to manage the situation.
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Your body is out of control
Having Long COVID means that your body’s central regulation mechanisms, like sleep-, temperature-, and blood-pressure regulation have broken down. This causes a wide range of symptoms, like fatigue, mind fog, headaches, dizziness, high pulse, body pains, sleep disturbances, temperature swings etc.
At the start of the Rest phase, you’re no longer in control of your body. One day you feel somewhat okay, the next you crash and can’t get out of bed for days. These crashes happen seemingly without warning and for no particular reason, and it can feel frustrating and scary.
But don’t despair, there’s hope! 🙂
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To regain control, rest
To regain control you need rest for several weeks/months. This means that you have to reduce your activity level significantly and avoid all stressful situations.
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It sounds simple, but it’s not.
In the beginning of this phase, patients are typically so fatigued that resting comes natural to them. But when they rest well, they get more energy, do more, and crash.
Don’t make that mistake. The key to regain control of your body is to not do more on the days you feel better. Over time, such discipline stops the body from crashing and prepares it for phase 2: Rebuild.
7 top non-obvious tips for how to rest
In the first step of our Long COVID Recovery Program, we analyze each patient’s life and provide a daily plan with exactly what they can and cannot do in this phase of the recovery.
When they see the plan, the patients almost always react in the same way: “Wow, it’s going to be hard to do so little, I had no idea I had to rest this much!”.
Every patient’s life is different and it’s impossible for me to tell you exactly what to do if you’re not part of our program. Some things are obvious though, like stop exercising and working for example.
Below are the 7 most important, non-obvious things you need to do to rest well:
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Don’t do anything for the first two hours after waking up.
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Don’t shower early in the day, often, or for a long time.
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Minimize walking.
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Stop doing chores.
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Avoid driving, flights, buses, and trains.
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Avoid all stressful situations, fights, problems, etc.
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Use headphones with silencers anywhere it’s not peaceful.
In the Long COVID Recovery Program, we work with you to understand your unique situation (for example what are the stressors in your life) and make sure your plan is optimal for you. We also provide support whenever you have a question or want to share something.​​​​​​​​​​​
Check in with us every two weeks
The checkin is an essential part of the recovery process. In our Long COVID Recovery Program, you check in with us every two weeks and tell us how the last 14 days went. In turn, we tweak your plan to make sure it’s perfect for the upcoming 14 days.
This feedback loop is essential. Your daily plan needs to change as you or your circumstances change. If you are not part of the program this becomes more challenging.
The Rest phase is tough but enormously rewarding
The Rest phase is by far the toughest part of the recovery process. It’s hard to implement all the above when you are weak, and doing so little feels boring and sad. However, if you stick with it, the rewards are enormous.
In the Long COVID Recovery Program, we provide ongoing support to help patients implement the plan well. The sooner you get the execution right, the faster you will recover.
You don’t have to wait for weeks or months to feel better - your health will improve throughout the Rest phase. For example, if you currently experience frequent crashes, it typically takes just a few weeks to reduce those.
You can expect to feel better and better throughout this phase, however it’s normal for improvements to follow the ketchup effect: nothing happens, then all at once.
The Rest phase typically takes a few weeks to a few months
When you’ve had 14-days straight without any crashes or symptom increases, you have completed the Rest phase and are ready to start rebuilding your body.
From when patients truly understand what they have to do day-to-day to rest well, it typically takes a few weeks to a few months to complete this step of the recovery process. However, every patient's situation is different, so it is impossible to say for sure. ​​​​​​​​​
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​​2. Rebuild: Gradually increase your activity level
The second phase of the program is called Rebuild. You have now begun to feel better and are hungry for more. Your body is ready to be rebuilt, one step at the time.
Not too little, not too much
The key to success in this phase is to not do too much too soon, but not do too little too late either. It’s a fine balance. If we do too much we crash and have many bad days. If we do too little we don’t get better.
Some people get so happy at the end of the Rest phase that they are afraid to start doing more out of fear of relapse. This is understandable - if you do too much you will crash. However, if you don’t increase your activity level, you will not recover. The body needs the extra stimuli to understand that it needs to become stronger. If it doesn’t get it, the body thinks it’s ok to remain weak.
Other people overestimate how strong they have become when they’ve completed the Rest phase. “I feel better, now I can start living my life again!” Such patients do more than their body can handle and crash. If they keep doing too much, their symptoms will worsen and they need to return to phase 1.
Our Long COVID Recovery Program is designed to avoid these mistakes. The weekly check-ins with us ensures that you’ll find the right balance if you stick to your individual plan.
How to gradually increase your activity level and avoid relapsing
It’s almost impossible to provide general advice for how to rebuild your body as every patient’s situation is so different. The best I can do is to provide you with the following rules to know whether to increase, maintain, or reduce your activity level:
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When you haven’t experienced any crashes or symptom increases for the last 14 days
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Increase your activity level by about 10% (physical, chores, cognitive, social) for the next two weeks.
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When you have experienced slight symptom increase(s) during the last 14 days
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Maintain the same activity level for another two weeks.
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When you have experienced crashes or significant symptom increase(s) during the last 14 days
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Reduce your activity level by about 10% for the next two weeks.
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You evaluate your last 14 days during the bi-weekly check-in with us. It’s essential that you continue this practice throughout the recovery process.
The Rebuild phase has three sub-phases:
Slow:
Here we plan for a slightly higher activity level than in the Rest phase, but lower than the patient’s limit.
Speed up:
Here we speed up the activity increase, yet stay within the patient’s limits.
Experiment:
Here we allow you to reintroduce activities you have particularly missed in your life, and we gradually increase the activity level up towards normality. But we do not let you go off on your own yet.
When your daily plan is right and you execute well, you’ll get better and better
Although you have to be prepared for some setbacks (it’s impossible to have a perfect plan and execute it perfectly), you can expect to get better and better during this phase. Often improvements happen in shifts where suddenly you feel significantly better after weeks of no improvement - the ketchup effect.
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This phase of the recovery process typically takes 3-12 months, but every patient's situation is different, so it is impossible to say for sure.
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When you are able to live an almost normal life, this step of the recovery process is complete and you are ready for the final phase: Solidify.
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3. Solidify: Build robustness to avoid relapse
When you have completed the Rebuild phase your body has become normal again with one exception: It’s still vulnerable. This means that we have to avoid big energy thieves so that you don’t relapse.
In this phase we make you robust enough to live a normal life again. To do that you need some time where you get used to the activity level you achieved at the end of phase 2.
Do the following:
1. Avoid big energy thieves
Live your new life with happiness and inspiration, but wear your detective glasses. Perceive what you feel and avoid big energy thieves. This is very important. Your body is not yet robust enough to handle big fights with your partner, work or neighbor conflicts, severely negative people, too much physical activity, etc.
In our Long COVID Recovery Program, we help you map out these energy thieves and make a plan for how to avoid them.
2. Don’t do too much too fast
If you exercised a lot before you became ill, feel free to train again, but gradually and be sensitive to how much your body can handle. Rest actively after exercising and don’t do too much too fast.
Follow the rules from the Rebuild Phase to know whether to increase, maintain, or reduce your activity level. Continue to do the same check-in every two weeks as you did in the Rest Phase.
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3. Stay focused on making a full recovery
Your recovery journey isn’t over yet, take with you your strong focus on making a full recovery. Make sure you use the tools you’ve learnt, rest when you get tired, and look forward to soon being back at 100%!
The Solidify phase typically takes 1-3 months, but all patients and their circumstances are different so it’s impossible to say for sure.
When you have completed this phase you can live a normal life again. You have gone from not being able to do anything to living a normal life once again. What a journey that is!
You too can recover. 🙂🚀
Regards from Marianne & Bjarte