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Latest on Long Covid 19

By Michael Nicolaou, osteopath

The following information is collected from a webinar hosted by the Institute of osteopathy (Io) in association with the National Council for Osteopathic Research (NCOR) which took place on 24th March 2021.

How common is Long Covid 19?

Around 1 in 5 people testing positive for Covid 19 exhibit symptoms for a period of 5 weeks or longer, and around 1 in 10 exhibit symptoms for a period of 12 weeks or longer. That equates to approximately 420,000 (and rising) people in the UK presenting with long Covid.

What are the risk factors?

Increasing age, higher BMI and being a female. There is also emerging evidence that, like adults, children are at risk from persisting symptoms – in other words, long covid.

The severity of Covid in the first instance does not predict long Covid 19.

How does it present?

Long Covid sufferers usually present with clusters of symptoms, which can fluctuate and change over time and can affect any system in the body. 86% reported relapses, irregular symptom patterns, multiple triggers.

Commonest symptoms: a persistent cough, low grade fever and fatigue which is often be disabling . 
Less common symptoms : shortness of breath, chest pain, muscle pains and muscle weakness, headaches, neurocognitive difficulties, GI upset, metabolic disruption, thromboembolic conditions, depression and other mental health conditions as well as skin rashes.

What are the causes of long covid?

Causes are : post viral fatigue, the immune response itself rather than the virus (aftermath of cytokine storm), viral persistence, organ impairment, thrombosis, embolism risk increase, biological sex different responses to the virus, neurological changes such as damaged nerve cells and psychological overlay affecting recovery.

How to best assess someone with long Covid ?

An osteopath will systematically organise a first pre-session screening of potential covid infected patients. It is the right place to find out if the patient has had Covid in the past, or is still suffering from post-covid issues.

Firstly, any acute or life threatening complications need to be ruled out, and symptoms need to be evaluated to ascertain if they are likely to be caused by ongoing symptomatic covid, long covid or a new unrelated issue.

Potentially life threatening signs and symptoms for immediate referral are :

  • severe hypoxaemia or oxygen desaturation on exercise,
  • signs of severe lung disease,
  • cardiac chest pain,
  • multisystem inflammatory syndrome (especially children).

How can someone with long Covid be treated osteopathically ?

A holistic assessment for a bespoke care management plan is needed first, including a physical, cognitive and a psychological assessment.

Care might involve referral to common specialist routes of care including : lung disease services, sleep clinics, cardiac services, rehabilitation services, psychological care such as CBT and other mental health services.

Managing long covid will entail:

  • The use a holistic, person-centred approach,
  • Refraining from prognosing the severity and trajectory of long Covid: we have lots to learn,
  • There is no ‘one standard approach’ to assessment,
  • Recommending using an integrated approach rather than a symptom by symptom management approach.

Take home message :

There is very little or no research, specific to care and management of long Covid 19. What is advised so far:

  1. The use physical care and touch, 
  2. Activity/ rehabilitation advice and tailor made exercises within the patients activity level capacity,
  3. Advice guidance on self management and care,
  4. Well being promotion, 
  5. Monitoring and support.  

Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity, according to the American Family Physician Journal, with an article by Trisha Greenhalgh and Matthew Knight.

Addition to Michael Nicolaou’s article: in parallel to osteopathic treatment, long covid sufferers can also get “everyday life” support from the youtube channel of fellow long covid sufferer Gez Medinger, “Pre-Covid, film producer and director. Now, an investigative science journalist travelling down the rabbit hole of Long Covid

On-line Art Workshops with Shelley

Weekly on-line 1 hour art workshops with practical group activities such as drawing, painting, clay sculptures, collage.

Art has the potential to inspire, promote wellbeing and team building. Working in a group, even though online can bring a feeling of being connected, learning from others and exploring individual creativity.

The emphasis will be placed on simple, fun projects with the scope for individual flair, broken down into easy to follow steps. Aimed at all levels of ability.
Art/ craft material requirements to be emailed to participants beforehand with links to online shops. The materials will be easy to find and safe to use.
Examples –

Example 1 : Two-Weeks Vase/ Plant Pot Making Workshop – using air drying modelling clay and acrylic paint
Week 1 – participants will use clay to model a small vase or plant pot after visual examples and a demonstration, to be made in the workshop with advice from Shelley and feedback from the group. The objects will be left to dry thoroughly until the following week.
Week 2 – we will paint/ decorate the vases/ pots and have a finished piece.

Example 2 : One-Week Group Collage Workshop to encourage team bonding
A picture is broken down into squares of the number of participants and emailed to each person to print beforehand. In the workshop participants colour in/ paint their individual square with ideas and advice on how to use the materials from Shelley. The squares will then be photographed and
placed together to reveal the bigger picture.

The sessions will be led by Shelley Hopkins.

From 2000 to 2013, Shelley was a Support Worker, Activity Development Worker, Craft Group Volunteer and Art Teacher.
These various roles in social care environments involved working with clients holistically and delivering quality activities to clients. Shelley ran various groups including art, creative writing, filmmaking and photography and coordinated many projects which led to exhibitions, spoken word/ art events, a performance at the Old Vic and the publication of an art/ poetry magazine which is still running today. Shelley linked in with major galleries and their Education Department at the Tate Modern, V & A, ICA and the Soane’s Museum etc.Shelley also continues to enjoy life drawing, model making and photography.

In parallel, Shelley is also a filmmaker and video editor, specialising in experimental films, art videos and music videos. She has collaborated with musicians including The Heavy North, The Cheating Hearts and Carly Paradis.

Her Qualifications
BA (Hons) Fine Art (Sculpture)
MA Psychoanalytic Studies. The emphasis on this degree was on ‘the gaze’ and the relation of theory to film and fine art

Training and CPD courses : Various courses in :

  • Pottery, model making, life drawing, filmmaking,
  • Art and meditation and mindfulness,
  • Health and Safety, Risk Assessment, Equality at Work, First Aid,
  • Specialist training in Mental Health and Substance Use,
  • Training the Trainer, Motivational Interviewing, Assertiveness Skills.

On-line Mindfulness Meditation

Image par John Hain de Pixabay

What is Mindfulness?

The word Mindfulness means COMPASSIONATE and LUCID AWARENESS, a sense of knowing what is happening in the external and internal world, as it is happening.

Most of us are more used to its opposite: “mindlessness” –when we are not really conscious of what is going on, and liable to make mistakes.

In the Buddhist tradition, Mindfulness is explained as a momentary sense and impression of how past, present and future moments arise and cease.

And in practice, Mindfulness purposely brings one’s attention in the present moment without judgment, and has two main parts: attention and acceptance.

  • Attention typically involves directing one’s awareness to breath, thoughts, physical sensations in the body and the feelings experienced on the moment.
  • Acceptance involves observing those feelings and sensations without judgment. Instead of responding or reacting to those thoughts or feelings, one aims at acknowledging them and letting them go, the result being an increased ability to manage them.

The scientific back-up of Mindfulness

In the 1970’s, the professor Jon Kabat-Zinn and colleagues at the University of Massachusetts Medical Centre researched thoroughly Mindfulness and gathered evidence for its effects on focus, anxiety, stress, depression, chronic pain and general health.

As a result, a growing awareness of the importance of our emotional fitness through Mindfulness has risen, in a very similar way to the journey of acceptance of physical exercise in the 20th century. Early on, sports were not recognised for their physical and mental positive effect, and somebody going to jog would be labelled as a lunatic!. But after a large body of scientific evidence was gathered, sports became identified as a powerful tool to regulate health.

The introduction of Mindfulness in UK and USA institutions

Mindfulness meditation benefits now from a general acceptance, and the Pr Jon Kabat-Zinn is one of the Patrons of the UK Mindfulness Initiative which has led the Mindfulness programme in the British Parliament.

Mindfulness is recommended by the UK National Institute for Health and Care Excellence (NICE) as a way to prevent depression in people who have had 3 or more bouts of depression in the past.

Mindfulness has also entered the corporate work environment, for instance at the Californian Company Google where meetings are used to start with a Mindfulness intro.

Chade-Meng Tan, head of Mindfulness training up to 2015 at Google states:

 “If you are a company leader who says employees should be encouraged to exercise, nobody looks at you funny, the same thing is happening to meditation and mindfulness, because now that it’s become scientific, it has been demystified. It’s going to be seen as fitness for the mind.”

Tan also says that mindfulness opens the doorway to loving kindness, which is at the heart of business success.

«In many situations, goodness is good for business, if you, as the boss, are nice to your employees, they are happy, they treat their customers well, the customers are happy to spend more money, and so everybody wins.”

The On-Line Mindfulness session

A 20 min seated session, with a few gentle twists and breathing techniques, bringing the feeling of grounding and clarity into our daily lives.

The session teacher: Aneta Grabiec

Aneta Grabiec is already providing the same format session to many UK companies very successfully.

Author of 3 Well-being eBooks and numbers of wellness articles published nationwide, Aneta Grabiec has always been passionate about the science of wellness through her studies of psychology (BA), NLP (MA), Nutritional Therapy (Nutritional Therapist Diploma ), Detox  and Toxicology (The Detox Specialist and Toxicology Expert Diploma), the Science of Yoga (BWY, Yoga Alliance). With over fifteen years of experience and care for the others, Aneta helps people reach a healthy mind-body connection, with exercise and nutrition as the recipe for longevity and happy, healthy living.

Her Website:

Image par Okan Caliskan de Pixabay

On-line mental support for expectant and new parents

By Laura Hayward White, recognised birth and postnatal Doula

Due to the severe reduction of external sources of support for parenthood, it is accepted that tragically there has been a sharp increase in Mental Health issues for expectant and new parents over the last twelve months. Covid-19 aside, there is also a National Campaign to raise awareness of Postnatal Depression in Fathers. Face-to-face support,  whether this be health checks, support groups or simply those visits from friends and family is no longer accessible. And we do not appreciate how important that sense of community is, that sense of ‘being seen’, both literally and metaphorically, how important it is for mums to get out and go to appointments, breastfeeding groups, play areas and to mix with and observe other mothers.

A Doula provides emotional and physical comfort and ongoing support for the whole family through pregnancy, birth and in the early days of parenthood.
A Doula can also provide information and guidance regarding pregnancy, birth and postnatal period, and if she can’t help the parent, she can help find someone who can. The point of which is for the parents to be able to make informed decisions and choices and understand their changing environment.
If it is deemed that the parents need further support in the form of counselling then the Doula can signpost them accordingly.

However, Doulas do neither offer medical advice, nor provide medical care, nor speak for the mother or family on any medical matters.

The continuity of care with a Doula lowers not only the risk of Mental Health issues for both Mother and Father in the form of Postnatal Depression or Post Traumatic Stress Disorder, it increases breastfeeding success rates and reduces intervention during labour.
It is important for parents to interact with other parents but also for everyone be heard and to find the right place to ask the questions relevant to their family, as the Doula is there to listen, give confidence and not judge.

During confinement, video-conferencing services such as Webex, Zoom and Teams have been invaluable in facilitating communication with health professionals, family, and support groups. On-line Doula sessions will be general practical fact sharing sessions where expectant mothers and new parents will be invited to raise any issues no matter how trivial that they may be struggling with.
Aspects of informational support include suggesting techniques for labour, such as breathing and relaxation techniques, helping find evidence-based information about different options in pregnancy and childbirth, helping explain medical procedures beforehand, and any post birth advice and support for breast feeding issues, sleep quality, nappies, etc.

The content of the session remains strictly private and confidential, as well as independent from the corporate environment.

Laura is registered to the Doula UK association, and officially recognised as a birth and post natal Doula. She is a baby massage instructor (MSCM Holistic Massage) , a specialist in Pregnancy & Postnatal Bodywork including Massage and Scarwork.

Past Doula/Pregnancy courses
Well Mother Bristol (WMB) – Massage in Pregnancy and Labour part 1 & 2 –
WMB Workshops – Pelvic Pain Management & Postnatal Depression
Nurturing Project seminars -The State of the Art Breastfeeding & Breastfeeding with Jack Newman
Patrick Houser – Nurturing Birth Fathers To-Be-Study-Day
Middlesex School Complementary Medicine – Baby Massage in Pregnancy
Diploma Body Realignment with Body in Harmony 2017
Sharon Wheeler Scarwork courses
ITEC Holistic Massage Training – Anatomy & Physiology
Early Nurture – Breastfeeding workshop by Pam Lacey
Chelsea & Westminster hospital – Antenatal course & their Birthing Class.
Hypno Birthing Course by Julie Alexander

Currently training in:
TMJ Disorder with Blend Therapy Training
Three Step Rewind with Birthing Awareness
Holistic Sleep Revolution by Holistic Sleep Coaching Program
Understanding and Supporting PND by “Traumatic Birth Recovery” which specialises in working with Parents post traumatic Births.

Michael Nicolaou: on-line osteopathic consultation

What to expect from an on-line video consultation

An online video consultation is ideal for people who :

  • are working from home with no time to travel around,
  • live rurally far from osteopathic practices,
  • want to have the peace of mind that the session is 100% sterile,
  • are too incapacitated/in pain to travel to an osteopathic practice,
  • do not like physical touch,
  • want some more clarity/ a second opinion about a previous diagnosis.

Firstly, the video call shall established in a well-lit room with good Internet Connection.

I will then take a case history where I will be asking questions about the problem/issue that is concerning you and about your past medical history. As with a face to face consultation, the information you provide is confidential, and the video call is not recorded. 

I will then need to analyse your posture. I will be looking for any misalignments in your body that may cause/contribute to the problem, so please wear a pair of shorts and a bikini top or vest top.

I will then ask you to perform certain movements and some orthopaedic tests which will help me understand what is going on. Sometimes it is helpful if another person is also present at your residence to help with the tests although this is not a must. 

After that, I will explain to you what I believe the problem is, I will give advice accordingly and will go through with you a tailor made exercise program to help your body heal/recover. I will then ask you to perform the exercises yourself to make sure you are doing them correctly.

It will be helpful if you have an extra recording device so you can record me while doing the exercises so it will be easier for you to remember. You can otherwise take notes.

I will then answer any questions you might have.
Session length : 1 hour
24 cancellation notice.

Michael Nicolaou: Simple stretching exercises at your desk

Simple stretching exercises at your desk to relieve pain

In this video I am showing you simple stretching exercises you can do at your desk to relieve pressure or strain from the most commonly affected areas.
Sitting in-front of computers for hours or working on laptops puts extra strain on our muscles and joints, which can cause neck stiffness, headaches, lower back pain, shoulder ache, and forearm, elbow or wrist problems.
Please watch my previous video on how to achieve correct posture at the desk.
Michael is a registered Osteopath and has over 20 years of experience in the field.


Shelley Hopkins: tools for a moment of calm

Tools for a moment of calm when you cannot get a massage

Are you finding it difficult to relax or meditate?

The global pandemic has well…. I don’t even know where to begin…

During this time I’m sharing some relaxation videos to support my massage clients (and anyone else who’s finding it difficult to relax or meditate) with their health and wellbeing. I think at the moment a “one step at a time” approach is helpful and relaxation is a great place to start.

These 1 to 3 minute relaxation videos can be watched on their own or combined with some simple breathing techniques or body scans. They are designed to relax body and mind with beautiful soothing colours and a range of natural sounds, binaural and ambient music. They could be used before a longer meditation. I always found meditation difficult until a teacher said you have to learn to actively relax first and then something clicked.

You can find more of these on my YouTube channel (hopkinsholistic), any feedback is welcome as this is a new thing I’m trying. I might include a guided breathing session or short body scan in the future.

Laura Hayward: the power of massage in pregnancy

Podcast hosted by Delia Muhammad on her website “Pregnancy without fear”.:

“The power of massage in pregnancy: interview with Laura Hayward”

The Power of Massage in Pregnancy: Interview with Laura Hayward

Laura Hayward White is a UK based Pregnancy Massage Therapist and Doula. Since qualifying in pregnancy massage in 2002, Laura’s passion has been to truly accompany mothers on the whole of their birthing journey, a passion re-enforced by becoming a Doula ten years ago.

In this interview, Laura shares her experiences of working with expectant and new mothers, and how by having a continuous sense of support, skill and understanding; women can develop and discover the inner confidence, power and strength they need to carry them through the birthing process and into motherhood.

Laura also runs a home visit service for Pregnancy, Postnatal and Baby Massage throughout Surrey and South West London.

Michael Nicolaou : optimal home desk set up

How to set up optimally your desk at home

More people than ever before are working from home at the moment. Not having the right chair, table and/or using a lap top compromises our posture and puts extra strain on our joints and muscles, resulting in pain and discomfort.
In this video I will show you how to properly set up your home work space and how to overcome most problems arising from not having the ideal work station.


In addition, if you need specific help tailored to your own home work space and/or if you suffer from any back/musculoskeletal issue, I would suggest that you book a video session with me.

Conditions required for the session:

The room where the desk assessment is to be performed shall be well-lit.The video call shall be established with a good Internet connection,  preferably from a different computer than the desk computer to be assessed. 

Session length : 1/2h
24 cancellation notice.
Michael is a registered Osteopath and ergonomics expert and has over 20 years of experience in the field.