Integrating Manual Therapy Techniques in the Treatment of Long COVID: A Case Report

Purpose: Growing evidence suggests long COVID in some can result in nervous system dysfunction, which translates to difficulty completing daily activities. Physical therapists play an important role in regulating the autonomic system through the use of manual techniques that can decrease sympathetic tone. The purpose of this case report was to outline the physical therapy management of a person with long COVID and associated autonomic nervous system dysfunction. This case report discusses a patient who is a 70-year-old man referred to physical therapy for fatigue and shortness of breath related to physician-diagnosed long COVID. Methods: The following manual therapy techniques were applied at each treatment session to address rib cage dysfunctions, muscle hypertonicity, and sympathetic tone for improved breathing: suboccipital release, cervical paraspinal release, and rib raising. Concurrently, the patient was instructed and prescribed a diaphragmatic breathing home exercise program. Results: After 11 physical therapy visits over 20 weeks, the patient demonstrated functional improvement with an associated decrease in symptoms. Conclusions: Manual therapy techniques, in combination with other physical therapy interventions, may be a first-line, less invasive means of addressing sympathetic tone and the downstream effects of nervous system dysfunction on daily living.