Resolution of Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome symptoms following kanshoho, a low-pressure muscle relaxation technique: A case report

Post-COVID-19 condition (Long COVID) can cause persistent multi-system symptoms such as fatigue, pain, and cognitive dysfunction ("brain fog"), and a subset of patients meet diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Treatment options remain limited, particularly when post-exertional malaise (PEM) restricts exercise-based rehabilitation. A 41-year-old woman developed refractory symptoms after acute SARS-CoV-2 infection, including severe fatigue, posterior neck and shoulder pain, bilateral upper extremity numbness, brain fog, and insomnia. Despite up-titration of sertraline to 50 mg/day by a previous physician and trials of other symptomatic medications, her symptoms did not show meaningful improvement. After exclusion of alternative organic causes, she was diagnosed with Long COVID and met diagnostic criteria for ME/CFS. Kanshoho, a low-pressure muscle relaxation technique, was administered as the primary intervention, with brief advice on activity pacing; sertraline (50 mg/day) was continued initially and later tapered at the patient's request, without clear symptom worsening, and subsequently discontinued. After 10 sessions over 2.5 months, all symptoms resolved at the final assessment. Fatigue visual analog scale (VAS) improved from 79 mm to 0 mm, performance status improved from 7 to 0, and the Profile of Mood States, Second Edition Total Mood Disturbance raw score decreased from 136 to -19. Although causality cannot be inferred from a single case, this low-load approach may warrant evaluation in controlled studies, especially for patients in whom PEM limits conventional rehabilitation.