The AAO Journal, 2025/06, 35(2):17–18. doi: 10.53702/i2375-5717-35.2.13, type of study: ,cr,

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

autonomic nervous system [154]
case report [736]
long covid [26]
OMT [3924]
osteopathic manipulative treatment [3945]
running [19]

Abstract:

Introduction/Background: Adjacent to dysautonomia syndromes, long-COVID impacts autonomic functions within the body, presenting in patients as fatigue, digestive issues, tachycardia, and brain fog. Osteopathic manipulative treatment can impact the autonomic nervous system, and therefore is a reasonable approach to relieving dysautonomic symptoms associated with long-COVID. Case: This is a 25 year-old runner presenting with persisting symptoms of tachycardia, fatigue, gastrointestinal issues and exercise intolerance 15 months following COVID infection. Somatic dysfunctions noted on structural exam: - OA FRLSR and right occipitotemporal suture restriction - Restricted left thoracic levels 2-5 - Restricted sternum and underlying mediastinal fascia - Inhaled left ribs 5-7 - Thoracoabdominal diaphragm restriction bilaterally - Extended sacrum bilaterally. The patient underwent treatments focused on balancing autonomics through osteopathic cranial manipulative medicine and sacral balanced ligamentous tension; treating thoracic cage fascia and thoracoabdominal diaphragm through myofascial release; and treating rib and thoracic somatic dysfunction through balanced ligamentous tension. Results: Following sessions, the patient reported symptomatic improvement in ribs, thoracic cage and diaphragm, greater ease of participation in respiratory physical therapy exercises and less fatigue. They also reported their lowest heart rate recording since initial COVID infection. Discussion: Our patient’s symptoms and location of somatic dysfunction were related to possible autonomic impacts from long-COVID. The proximity of the sympathetic chain within the thoracic cage provided anatomical rationale for addressing autonomic symptoms with techniques directed to the thoracic fascia and articular dysfunction, and for using osteopathic cranial manipulative medicine to address autonomic imbalances. Symptomatic improvement in fatigue and improved ability to participate in physical therapy demonstrates the utility of using osteopathic manipulative treatment to decrease allostatic load in a patient’s recovery. Future research on OMT in long-COVID could focus on techniques that balance autonomics.