Respiratory Rehab: Step-by-Step Guide(PS 2~3)
PS2~3
This applies to each step – you never need to overexert yourself. Please do the movements that you can do within your comfort zone. The goal of positions 0-2 is to allow you to naturally deepen by 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. It is also advised to do 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. If you would like to prevent yourself from developing post exertional malaise (PEM), it is good to mainly focus on positions 0-2 after doing daily activities, and rest intentionally.
No. 0 0:00~
Lie on your back. Try your 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 according 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, but you do not need to intentionally breathe deeply. The 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 either one of your shoulder blades 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-degrees 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.)
If it is difficult 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 let them get tired from having to manually hold them up. While holding this position, do each side for 3 to 5 minutes.
No.1 4:49~
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 7:02~
Continuing from position one, bend your top leg towards the floor and push it forward. This is a position 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.4 for PS2-3 9:00～
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 stomach. If this is hard for you, you can put your hands down. Position 4 is divided into 3 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 duration 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. Next, you will breathe in just like you did before, but this time you will purse your lips lightly and exhale a long, thin breath. Perform this breathing for about 1 to 2 minutes while being careful not to strain yourself.
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. Next, breathe in just as you did before so that your chest and belly will expand. When you breathe out this time, lightly purse your lips and exhale a long thin breath. Perform this breathing for about 1 to 2 minutes while being careful not to strain yourself.
No.5 14:37~
You can do this in position number 0. Place your palm on the soft area below your ribcage on the side of your abdomen. The direction of your hands can be thumbs up or down, whichever easier for you to do. First, when you inhale lightly, feel that your fingers are pressed against the side of your abdomen. You will do this for about 1 ½ minutes. Next, inhale while focusing on the air that fills the side of your abdomen (so that your fingers feel pressed against your abdomen). When you exhale, do so normally. You will do this exercise for 2 to 3 minutes.
No. 6 17:02~
Grab your arms by folding them. You will reduce any possible burden by doing this. Raise your folded arms towards your head as you breathe. It is easier if you place your arms on your forehead like in the picture. Basically, while breathing in, move your arms towards your head. After catching your breath several times, bring your arms down to the original position. If you have the energy, you can do this in one breath. Adjust your pace to avoid fatigue. The recommended frequency is 5 to 8 times, but please adjust it by yourself to avoid fatigue. You can do it one arm at a time if you find this difficult.
No.9 19:29~
Here, you will do this exercise while lying down on your side. Now, you will do the movements while breathing out. Next, you will move your arm back and forth in sync with the breath that you exhale; extend your arm forward, and then while squeezing your shoulder blades together, bring your arm back. Inhale, and then release the tension and extend your arm forward in sync with the breath that you exhale. After catching your breath, this time retract your shoulder blades together and pull your arm back in sync with the breath that you exhale. It is recommended to do this 5 to 10 times. Do the movements slowly at your own pace, at a frequency within your comfort zone.
No. 10 22:12~
You will start in a position of lying on your side with your arm extended forward. While exhaling, move your arm towards your head in a big, circular windmill motion. If this is hard for you, you can stop part way through and rest while breathing. After catching your breath, slowly start rotating your arm in the same motion again. It is fine to let your arm glide across the floor, when possible, instead of causing fatigue by holding your arm manually. While letting your arm glide across the floor try to reach your arm out as far from yourself as possible. The general rule is to do this movement while your arm is stretched, but you can bend your elbow if this is too difficult. The purppose of this movement is to move your shoulder blade. While releasing the tension, move your arm in a relaxed way. For those who have shoulder pain due to symptoms from conditions such as frozen shoulder, never raise your arm beyond your comfort zone. Just moving your shoulder blade is enough.
No.11 25:07~
While sitting on something, like a chair, you will synchronize your breathing while rounding and straightening your back. The straightening and rounding the spine should be in sync with your breathing. Your hands should rest on your thighs as you breathe out, and they will glide forward as you round your back. While breathing in, make your pelvis upright and straighten your back. Focus on where your hands are, and straighten the spine. It is recommended to do this exercise 5 to 10 times.
To improve the movement of your rib cage, you will do side flexion stretches in sync with your breathing. While breathing out, bend sideways with the help of gravity in a relaxed way. While maintaining the position, continue breathing, feeling air coming in and out of the ribs and the sides of your chest where your hand is touching like in the picture. You will do this on the other side as well. For those who find this exercise hard, please create support by using a cushion. It is recommended to do this 5 to 10 times. Do it at your own pace, at a frequency within your comfort zone.
© 2022 Shinji Nozaki, Koichi Hirahata
Respiratory Rehab Video for PS2~3 (for Long COVID, LPCVS, ME/CFS)
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