Brigitte: Post-Covid experience report (DE/EN)

Experience report (German)

Before her infection, Brigitte, in her mid-40s, was moderately active in sports and spent a lot of time sitting at work. She suffered from acute Covid-19 disease without hospitalization. Weeks later, however, there were persistent symptoms: severe fatigue, muscular pain, varying joint problems, the feeling of “cotton in the head” and a significantly reduced resilience - even small exertions led to regression the next day (post-exertional malaise, PEM).

• Deep exhaustion (fatigue) with a drop in performance
• Muscle pain and myofascial tension
• Alternating shoulder pain and knee pain
• Shortness of breath on exertion, shallow breathing
• Difficulty concentrating (“brain fog”)
• Sleep not restful

In everyday life this meant that climbing stairs became a hurdle, prolonged computer work led to shoulder and neck pain, walks had to be planned and breaks had to be strictly adhered to. Brigitte sought support from our practice in Hamburg to understand her orthopedic problems and to get moving again gently.

Diagnostics and classification

At the beginning, safety and classification were the top priority. Post-Covid is not a uniform clinical picture. First, we clarify warning signs together and take internal clarifications into account (family doctor, if necessary cardiology, pulmonology, neurology). From an orthopedic perspective, we check which structures actually hurt and how stress affects muscles, tendons and joints.

• Medical history with a focus on resilience and PEM (exercise intolerance)
• Physical examination: posture, joint function, muscle tone, pain points
• Functional tests (e.g. sit-to-stand, walking distance, balance), symptom-guided
• Digital posture and movement analysis (e.g. DIERS 4D, if useful) for objective follow-up control
• Breathing pattern check (diaphragm/chest breathing), ergonomic analysis from home office
• Coordination with previous findings (laboratory, ECG, lung function) – if available

Important: If PEM shows up, we plan exercise very carefully. Instead of forced endurance training, the focus is on pacing - i.e. the clever distribution of energy and stimuli in order to avoid relapses.

Therapy approach: conservative, individual, step by step

The goal is not “faster, higher, further”, but rather stability, pain reduction and sustainable use of energy. The plan was created individually for Brigitte - as an example it can provide guidance:

1. Pacing and energy management: Introduction of a traffic light system (green/yellow/red), activity diary, gentle daily structure with microbreaks.
2. Sleep and rhythm: sleep hygiene, fixed anchor times, relaxation exercises; If necessary, consult your family doctor.
3. Breathing and diaphragm training: slow, nasal breathing, prolonged exhalation, relaxed mobilization of the chest.
4. Physiotherapy/manual medical measures: myofascial treatment, gentle joint mobilization, stretching and sliding exercises.
5. Strength “in small doses”: isometric and very low-dose exercises (e.g. wall sit, Theraband), frequency and intensity depending on the progression of symptoms.
6. Ergonomics and everyday movement: workplace adjustment, walking breaks, stairs in stages, dynamic sitting.
7. Pain modulation (decided on a case-by-case basis): TCM acupuncture can help with myofascial pain; Axomera (peripheral neuromodulation) can be considered for clearly defined pain syndromes. Benefit-risk assessment and information are essential.
8. Supplementary procedures (outside guidelines, only after careful indication): IHHT (interval hypoxia-hyperoxia training) can be tried in selected patients to regulate resilience. Evidence in the Long/Post-Covid context is still in flux.
9. Self-exercise program: 10-15 minutes on “good days”, 5 minutes on “yellow days”, on “red days” just breathing and relaxation - no rigid guidelines.
10. Regular re-evaluation: Adjustment after 2-4 weeks, combining objective markers (e.g. sit-to-stand) and subjective well-being.

Important: Every therapy is symptom-related and without pressure. Not every measure is suitable for every person. We make decisions together – transparently and, above all, conservatively.

Course and results in Brigitte's case

There was a cautious but noticeable stabilization over 12 weeks. The shoulder pain and myofascial complaints subsided, sitting time at work became easier to manage, and short walks became possible again. Fatigue and cognitive fluctuations remained dependent on the day - on “red days” being consistent with breaks helped. There is no promise of healing; Progress can come in waves.

• Objectively: more repetitions of sit-to-stand without an increase in pain the following day.
• Movement pattern: fewer compensatory evasive movements in the 4D analysis.
• Subjective: better control over “good” and “difficult” days, less fear of relapse.
• What didn’t help: rigid training plans or “pushing through” despite warning signals.

The most important thing for Brigitte was to learn to read her body again. Small progress counts – sustainably and without pressure to compare.

Practical tips for those affected

• Symptom diary: 3-5 lines per day on energy, activity, sleep, triggers.
• Traffic light system: green = tolerable, yellow = cautious, red = break. Stop in time.
• 10% rule: Only increase progress in very small steps - not every day.
• Breathing First: 5 minutes of diaphragmatic breathing daily, especially before activity.
• Microbreaks: 3-5 minutes of exercise or relaxation for every 30-45 minutes of work.
• Ergonomics: monitor height, chair, footrest – relieve stress points.
• Social support: realistic communication with the environment and employer.
• Nutrition: drink enough, eat small meals regularly – tolerated by each individual.
• Acceptance of fluctuations: regression is part of the process, not defeat.

Warning signs that should be checked by a doctor:

• Chest pain, new or severe shortness of breath
• Heart palpitations, fainting, persistent attacks of dizziness
• Neurological deficits (e.g. paralysis, speech disorders)
• Leg swelling, calf pain (risk of thrombosis), high fever

Patient Story (English)

Brigitte (name changed), in her mid-40s, experienced a mild acute Covid-19 infection but struggled with ongoing symptoms weeks later: pronounced fatigue, muscle pain, shifting joint pain, breathlessness on exertion, and cognitive fog. Even small efforts could trigger next-day setbacks (post-exertional malaise, PEM).

• Fatigue with fluctuating capacity
• Myofascial pain and stiffness
• Shoulder and knee pain depending on load
• Shortness of breath and shallow breathing pattern
• Non-restorative sleep and brain fog

Her goals were simple: reduce pain, regain confidence in movement, and structure daily life without overdoing it. She sought conservative, stepwise care at our practice in Hamburg.

Assessment and care plan

• History with focus on PEM and energy pacing
• Orthopedic exam: joints, muscles, posture, pain mapping
• Functional tests adapted to symptoms; use of 4D motion analysis (e.g., DIERS) when helpful
• Coordination with primary care/cardiology/pulmonology as needed

1. Pacing: traffic-light system, activity diary, micro-breaks.
2. Sleep anchors and gentle relaxation techniques.
3. Breathing work: diaphragmatic, nasal breathing, rib mobility.
4. Physiotherapy: soft tissue and joint techniques, gentle mobility.
5. Low-dose strength work (mostly isometrics) guided by symptoms.
6. Ergonomics and graded daily movement within tolerance.
7. Pain modulation options in selected cases: TCM acupuncture; Axomera for focal pain syndromes after careful evaluation.
8. Adjunct option outside guidelines: IHHT in selected cases with transparent counseling; evidence is evolving.
9. Home program and regular re-evaluation; no rigid progression.

No guarantees are made. The approach is conservative, individualized, and symptom-led to avoid setbacks.

Progress and takeaways

• Reduced myofascial pain and better posture control over 12 weeks.
• Short walks and desk work became more manageable with pacing.
• Fatigue remained variable; respecting red days prevented crashes.
• Key takeaway: read your signals early; small, consistent steps matter.

Your contact point in Hamburg

Our practice at Dorotheenstrasse 48, 22301 Hamburg, supports those affected by post-/long-Covid with musculoskeletal complaints using a conservative, evidence-conscious approach. We work in an interdisciplinary manner and coordinate measures with family doctors and specialist disciplines. Appointments are possible in German and English.

Further content and videos

In-depth articles and tools from our practice – for classification, diagnosis and gentle treatment options:

• Prof. Citak Videos – Orthopedics understandable (DE/EN)
• Diers measuring systems – 4D analysis for back & gait (DE/EN)
• IHHT – Interval Hypoxia-Hyperoxia Training (DE/EN)
• Axomera – Neuromodulation for pain (DE/EN)
• TCM acupuncture in orthopedics (DE/EN)
• Storz Medical ESWT – Focused Shock Wave (DE/EN)
• RTL report: Shock wave & memory – classification (DE/EN)
• Orthopedist Hamburg Altona – The 5 most important selection criteria

The 5 tips at a glance

1. Deep exhaustion (fatigue) with a drop in performance
2. Muscle pain and myofascial tension
3. Alternating shoulder pain and knee pain
4. Shortness of breath on exertion, shallow breathing
5. Difficulty concentrating (“brain fog”)

Information does not replace an individual examination. If there are any warning signs, please seek medical advice.