Respiratory Rehab: Step-by-Step Guide (PS8~9)
PS8~9
This applies to each step – you never need to overexert yourself. Please do the exercises that you can do within your comfort zone. If you push yourself, you can cause your symptoms to worsen. The goal of positions 0-2 is to allow you to naturally deepen your breathing just by simply maintaining a comfortable position. The recommended duration is from 5 to 10 minutes, but feel free to do it for longer. We also recommend doing this frequently about once per hour. Since this makes the parasympathetic nervous system dominant, you may become sleepy. Falling asleep while doing this exercise over and over again is actually recommended for recovery. In order for you to recover, it is important to increase the duration of time when the parasympathetic nervous system is dominant. For those of you at PS9, positions 0-2 should be your main focus during the respiratory rehab.
No.0 0:00~
Lie on your back. Try best to place your legs on a platform or chair so that your hip joints and knees form 90-degree angles. You can use a lower angle if it is too difficult, or you can bend your knees to your comfort. This position is ideal for allowing air to enter the belly naturally, as it makes it easier for the diaphragm to move. Maintain this position, you do not need to intentionally breathe deeply. This position itself will naturally make your breath deeper, and it leads to parasympathetic dominance. If lying on your back is difficult, putting a cushion under your shoulder blade may help. As a general rule, breathing should be done through your nose.
Gradually spread your arms into a T-pose, until your armpits form 90-degree angles. This makes it easier for air to flow into the sides of the chest. If you spread your arms into a Y-pose, air will flow into the upper chest, so maintain the position. Do not push yourself. Only those who find it easy should continue doing the exercise. Manually holding up your arms will get tiresome, so it is recommended to support the elbows or arms with cushions.
While putting your arms down, stretching your neck lightly is recommended.
(Stretching the Sternocleidomastoid and Scalene Muscles -- They assist in breathing.)
No.0 Bending Knees
If it is difficult for you to lift your legs, bend your knees and then lay your legs to the side. You can get into this position effortlessly if you try to stretch your oblique. It is best to support your legs with cushions, rather than get them tired from having to manually hold them up. While holding this position, do each side for three to five minutes.
No.1 4:47~
Lie on your side, and hold a cushion. Round your back a little, allowing air to flow into the lower lungs. First, remain in this position as you feel air coming in and out throughout your back. You will hold this position for 5 to 6 minutes. If it makes you feel good, you can do this position for longer. If it is hard for you to round your back, you can relax it a little and extend your legs. If you have the energy, take deeper breaths to allow air to flow into your mid-back. When you exhale, do so naturally. Breathe through your nose.
No.2 7:00～
Continuing from position one, bend your top leg towards the floor and push it forward. This is the position of lying partially on your stomach. Feel the air coming into the sides of your abdomen and around the pelvis. Breathe naturally, feeling the air coming in and out of your lungs. Hold this for 2 to 3 minutes. Next, breathe in so that the air flows into the sides of your abdomen and pelvis. Hold this for 2 to 3 minutes as well. If you have the energy, you can raise your arms such as above your head. This opens the sides of your ribs and abdomen. Feel air flow into your ribs as you maintain this position. Breathe in deeply to draw air into the area. This movement should only be done by those who are capable of doing this within their comfort zone.
No.3 (Only if you have someone to assist you) 8:56~
You can do this if you are at PS 8 or 9, and if there is someone who can assist you. While maintaining position 0, the patient is merely lying down. Whoever is assisting will aid in breathing. From the sides, they will hold the lower part of the ribs lightly, and when you breathe out they will pull towards your legs. When you breathe in, they will loosen their hold. You can do this for as long as the assistant is comfortable with helping (The recommended duration is about five minutes).
No.4 for PS8-9 11:32～
You can do this with position 0, or you can bend your knees. Putting pillows or cushions under the arms will help avoid any arm fatigue. Put one hand on your chest and the other on your belly. If this is hard for you, you can put your hands down. Position 4 is divided into three phases: A, B, and C.
A. Feel the sensation of your hand on your chest. Feel the air coming in and out of your chest from the movement of your hands. It is alright even if you cannot feel it. If that is the case, try to focus on the sensation of your hands for about 1 to 2 minutes. Next, inhale by drawing air into your chest so that the hand on your chest will rise. You will do this for the same amount of time. When you exhale, do so naturally. Breathe through your nose. You should do this as long as you can keep your neck and shoulders relaxed.
B. Next, switch your focus to your hand on your belly. Feel the air flow in and out of your belly through the movement of your hand. It is alright even if you cannot feel it. If that is the case, try to feel the sensation of your hand for about 1 to 2 minutes. Next, inhale by drawing air into your belly so that your hand will rise. You will do this for the same amount of time. When you exhale, do so naturally. Breathe through your nose. You should do this as long as you can keep your neck and shoulders relaxed.
C. Switch your focus to both the hand on your chest and the one on your belly. Feel the air flow in and out of your belly through the movement of your hand. It is alright even if you cannot feel it. If that is the case, try to feel the sensation of your hand for about 1 to 2 minutes. Next, inhale by drawing air into your chest and belly so that they will expand simultaneously. When you exhale, do so naturally. Breathe through your nose. Do this for the same amount of time. You should do this as long as you can keep your neck and shoulders relaxed.
No.7 15:18~
Lie on your side. Hold this position using pillows or cushions in a comfortable posture. Keeping your elbow at your side, extend your arm forward as you exhale. Extend your arm as far as you can, but keep your arm muscles relaxed. You should lose tension rather than tense them up. Imagine moving your arm under its own weight, while your arm is slowly gliding across the floor. When you pull your arm back, let it glide across the floor as if the arm were a rope that lost tension. It may be good to keep the arm extended forward as you maintain your breathing for a while, and feel the stretch in your shoulder blade. It is fine to take a comfortable approach, such as: If you are lying on a bed, let your arm hang. If you are lying on a mattress, you should glide your arm forward. It is recommended to do this position 5 to 8 times, but it is not a strict rule. Also, it is good to do this movement slowly only once, taking about 5 minutes. If you push yourself when doing the arm movements, your symptoms will worsen, so never do more than your comfort level.
© 2022 Shinji Nozaki, Koichi Hirahata
Respiratory Rehab Video for PS8~9 (for Long COVID, LPCVS, ME/CFS)
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