The detrimental respiratory effects of Covid are well-known to those who have been infected and suffered. They can include difficulty of breathing, tightness in the chest, and a general feeling of being ‘ill.’ These symptoms are debilitating and limit what the person can do physically. What is less well-known and harder to ‘feel’ are the muscle weaknesses that occur after an illness. Although you might feel better and want to return to training and competition, you could be at risk of suffering a muscle strain that will then keep you out of your sport even longer.

A recent study of professional soccer players in Belgian found that they had a five times higher risk of developing a muscle strain after a SARS-CoV-2 infection than those uninfected. The effects were noticeable for a month after infection and were higher in those that had been isolated for longer than their peers.

The worse their symptoms, the higher the chance of them suffering a muscle strain.

So, while it might be okay to return to work for the normal population, the athletic population should take care in building up their fitness before trying to compete. It is not a good idea to immediately return to the training levels that you had before Covid. It is a good idea to have a ‘ramp-up’ process that allows you to return safely, just as if you were returning from a musculoskeletal injury.

A suggested ramp-up program for soccer players

The exact amount of work will depend on the severity of your illness. The rule of thumb is to take your time and allow your body to recover. Do little and often rather than trying ‘intense’. Think about your own body rather than trying to emulate what someone has posted on social media. It will take weeks to get back to full fitness rather than day.

If you are experiencing Covid symptoms, then you should not train. Seek advice from a medical professional.

Week 1: Movement and skills

Individual skill work with the ball is good for your soul. You feel like a soccer player again. It also allows you to pace yourself rather than trying to keep up with the team. If you feel tired, you can sit down, rest, and then practice again when you are ready.

The movement should start with walking rather than jogging or running. You have been inactive and the respiratory illness could still be lingering in your system. You may be surprised how tiring going for a 30-minute walk is. If you feel ok the next day, you can add brisk walking. Easy cycling is also useful if you have access to a bicycle: forget about distances and just go for an ‘easy ride’ of less than 30 minutes.

Structural Integrity (basic strength exercises) work can be started with micro-dosing throughout the day rather than trying to do everything in one session.

My ‘go-to’ exercises include:

Hip series 1

Lunge and reach

Hanging sequence.

Squat Matrix

These can be done before or after your football skills.

Towards the end of your first week of recovery, you can start to do speed technical drills (without the speed work). This prepares your body for sprinting in week 2.

Week 2: Speed and strength with small area skill work.

Again, depending on how you feel, you can start to do more specific work in a limited fashion. Speed work over 10-20 meters, combined with change of direction exercises. Allow longer recovery than usual.

You can start to add external resistance to your training: dumbbells and barbell movements (if you did them before the illness) but limit the loading to 50% of your previous work for this week.

Having a discussion with your coach is vital to help plan your return. If you are thrown straight back into full team training sessions, you are more likely to get injured than if you gradually return. Try to limit the space that you work in and the duration of the session. For example, working in a 10-meter by 10-meter area will prevent you from running at top speed. Working for a limited time will allow you to recover better. This can be either a time of 2-3 minutes and then stop, or by sitting out every other set that the rest of the team is doing.

At the end of week 2, you might be okay to play for a limited time in a match: like the last 10 minutes. But this must be done in consultation with your coach and any medical staff.

Weeks 3-4: Return to normal training.

In these weeks, you can gradually increase the load that you use in the gym and the amount of team training that you do. This might mean sitting out a middle portion of training for 10 minutes or only playing on one-third of the pitch.

You can increase your playing time in matches with the aim to play a full match by the end of the four weeks: if you are symptom-free and feel good.

Remember that the Belgian soccer players were experiencing a higher risk of muscle strains for a month after suffering from Covid. If you feel tired or have a muscle ache, stop and allow yourself to recover. That way, you can reduce the chance of injury and be ready to play properly rather than rushing back and suffering a setback.