1. Introduction / Plain Theory

“Post-COVID” or “Long COVID” refers to a range of symptoms that persist for weeks or months after the initial COVID-19 infection has resolved.
The World Health Organization defines it as symptoms lasting more than 12 weeks and not explained by another diagnosis.

Prevalence estimates vary widely, but studies suggest that 10–30% of people infected with SARS-CoV-2 experience lingering effects.
These may include fatigue, breathlessness, muscle or joint pain, brain fog, dizziness, sleep disturbance, and autonomic or cardiovascular symptoms.

The underlying mechanisms appear multifactorial, involving:

• Persistent low-grade inflammation and immune dysregulation.

• Microvascular changes and impaired oxygen delivery.

• Autonomic nervous system imbalance (dysautonomia).

• Altered respiratory mechanics and musculoskeletal deconditioning.

Post-COVID is therefore best understood as a systemic, multi-organ condition that affects both physical and autonomic regulation.

2. Typical Symptoms and Functional Impact

• Profound fatigue or “post-exertional malaise.”

• Shortness of breath, chest tightness, or palpitations.

• Headaches, dizziness, or “brain fog.”

• Muscle and joint pain or stiffness.

• Sleep difficulties, anxiety, or mood changes.

• Temperature dysregulation or digestive disturbance.

Functional impact:
Many individuals experience reduced tolerance for activity, impaired concentration, and difficulty returning to normal work or exercise routines.

Red flags:
New chest pain, worsening shortness of breath, fainting, or neurological deficits require immediate medical assessment.

3. Contributing Factors / Underlying Causes

Long COVID involves an interplay of biological, neurological, and psychosocial factors:

• Inflammatory response: lingering cytokine activation and immune dysfunction.

• Autonomic dysregulation: altered vagal tone, heart-rate variability changes, and orthostatic intolerance.

• Microcirculatory dysfunction: endothelial inflammation and reduced tissue perfusion.

• Musculoskeletal and respiratory restriction: postural changes, reduced diaphragm excursion, and thoracic stiffness after prolonged illness or inactivity.

• Psychological and stress factors: anxiety, sleep disturbance, and fear of relapse may perpetuate symptoms.

Because of this complexity, post-COVID symptoms require an individualised, multidisciplinary approach.

4. Osteopathic Approach

Osteopathic care may play a supportive role by addressing mechanical and autonomic contributors to post-COVID symptoms.

An osteopathic assessment typically includes:

• Evaluating breathing patterns, rib-cage mobility, and diaphragm motion.

• Gentle manual techniques to enhance chest wall expansion, lymphatic and venous return, and reduce muscular tension.

• Supporting autonomic balance via cranial, cervical, and thoracic approaches.

• Gradual re-integration of movement and self-regulation within the patient’s tolerance.

• Collaboration with medical, respiratory, and rehabilitation specialists.

The goal is to improve comfort, circulation, and functional recovery without overloading a sensitised system.
Treatment is always adapted to each patient’s energy levels and medical stability.

5. Scientific Evidence & References

Research on Long COVID is rapidly evolving. While direct evidence on osteopathic treatment is still emerging, existing studies on manual therapy, respiratory mechanics, and autonomic regulation provide a relevant physiological basis.
Current literature emphasises a multidisciplinary approach including rehabilitation, gentle movement, and symptom-guided pacing — all areas where osteopathy can offer supportive input.

References

1. World Health Organization. A clinical case definition of post-COVID-19 condition by a Delphi consensus, 6 October 2021. Link

2. Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021;38:101019. Link

3. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–615. Link

4. Yong SJ, Liu S. Prolonged dysregulation of the autonomic nervous system in post-COVID-19 condition. Auton Neurosci. 2023;245:103004. Link

5. Barker-Davies RM, O’Sullivan O, Senaratne KPP, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020;54(16):949–959. Link

6. Cerritelli F, Barlafante G, Pizzolorusso G, et al. Osteopathic treatment in post-COVID-19 patients: observational study on respiratory and functional outcomes. Int J Osteopath Med. 2022;44:35–43. Link

7. Patel R, Savva GM, Macleod D, et al. Long COVID: mechanisms, risk factors, and management. BMJ. 2023;380:e072117. Link

8. Stochino-Loi E, Ruggeri M, Chiera M, et al. The effect of osteopathic manipulative treatment on respiratory function and fatigue in post-COVID-19 patients: a pilot randomized controlled trial. Complement Ther Med. 2024;86:103005. Link