Understanding Long Covid April 2021 Information and Guidance for Soft Tissue Therapists

by Anna Maria Mazzieri - Jan 13th, 2022

This document has been written as guidance for Soft Tissue Therapists on how to support and potentially treat clients who continue to suffer from the effects of COVID after the acute stage of the infection. The guidance has been developed by the ISRM via a Working Group of Soft Tissue Therapist members. The document will be updated from time to time as new information around COVID becomes available.

Sufferers of Long-COVID symptoms should be identified through a thorough consultation process. The usual red flags and contraindications apply, of course.
In addition, the following symptoms require referral to the GP before any treatment of any nature can commence:

  • Acute breathlessness

  • Chest pain

Hands-on work should proceed with appropriate considerations, for example:

  • Positioning to improve their comfort and ease of breathing.

  • Reducing treatment time to avoid exacerbating some symptoms.

  • Allowing additional time for getting dressed.

  • Extra support when getting off the couch to keep the client safe in the event of dizziness or weakness.

Hands-on treatment should be seen as one tool, used judiciously, during a session of person- centred support, rather than the sole objective.

The complexity and unknown nature of many of the conditions should be borne in mind, and we should not mistakenly associate familiar symptoms with known musculoskeletal conditions. We should be looking to support and reassure the client if appropriate and relieve the symptoms.

Where our role involves supporting a client through exercise, we should be aware that the rehabilitative pathway is unknown and unpredictable. Standard repetitions and sets, even when graded, may not be desirable, and progress may be non-linear with relapse and remission being common. Let the treatment be led by the client.

Finally, we should bear in mind our scope of practice as Soft Tissue Therapists which involves the assessment, treatment and rehabilitation of minor and chronic MSK injuries and pain. Where we are unsure, we should refer back to the GP or a qualified medical professional. Where the GP cannot offer further support, this is the opportunity for Soft Tissue Therapists to utilise their own networks of healthcare practitioners (physiotherapists, osteopaths, etc.).

Through adherence to this guidance, the community of Soft Tissue Therapists will not only ensure it supports those in need effectively and safely, but also shows itself to be a trustworthy and dependable ally in the provision of healthcare.

This guidance has been developed from a review of current literature and research undertaken by the ISRM Long-COVID working group. Due to the nature of COVID and the unknown nature of Long-COVID progression, the longer-term response of the NHS, we will continue to monitor developments closely to ensure that Soft Tissue Therapy will continue to play a role in supporting people with Long-COVID.

Emerging evidence will be reviewed and any new evidence that influences our practice as Soft Tissue Therapists supporting people with Long-COVID symptoms will be reflected in updated guidance.


For other symptoms, or where a client has been seen by the GP and no objection to treatment has been raised, the following key considerations apply:

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