P220 Thoracic mobilisation techniques combined with stretches improves thoracic compliance and respiratory rate in long COVID

BackgroundA number of patients with COVID-19 experience prolonged symptoms, known as ‘Long COVID’. Fatigue, dyspnoea and chest wall tightness are common symptoms. These symptoms limit exercise tolerance and cause anxiety. They require thorough and costly investigations that do not always provide a pathway to traditional treatments. We present the impact of thoracic mobilisation, a combination of stretches and general advice on abdominal breathing on long COVID symptoms.MethodsConsecutive adult long COVID patients attending a general respiratory physiotherapy clinic with breathlessness and chest wall tightness were included. All patients were assessed for thoracic expansion using a cloth tape, measuring at T6 level from resting expiration to maximum inspiration. Resting respiratory rate (RR) was also measured as breaths per minute (bpm). All patients were then treated with a single application of thoracic mobilisation techniques (muscle energy techniques and/or rib stacking) and combinations of muscle stretches including serratus anterior, pectoralis minor and diaphragm stretches. General advice regarding abdominal breathing was also demonstrated.ResultsThirty four consecutive long COVID patients were included (mean age 52 y, 16♂). Nine patients (26%) had pre-existing respiratory co-morbidities including asthma, COPD and sleep-disordered breathing and 12 patients (35%) had no past medical history. Prior to intervention mean thoracic expansion was 1.92 cm (±1.15) and mean RR was 17.6 bpm (±5.1). After intervention, thoracic expansion improved to 3.89 cm (±1.32) and RR to 11.2 bpm (±4.6). There were significant improvements in both thoracic expansion and respiratory rate (p<0.0001).ConclusionNormal thoracic expansion is approximately 3.5 – 7 cm. This group of long COVID patients displayed suboptimal thoracic expansion at T6. This appears to have had an effect on resting respiratory rate. Post mobilisation both thoracic expansion and resting respiratory rate improved. This is likely due to improved thoracic compliance with mobilisations and stretches, reducing the work of breathing in these patients. The addition of simple breathing advice, rather than longer breathing re-education sessions helped to further reduce and correct respiratory rate.A single application of thoracic mobilisation techniques combined with stretches and simple advice on breathing can improve thoracic expansion and resting respiratory rate in long COVID.