Medical Massage in Cases of Long COVID and Chronic Stress–Related Disorders – Part 2

MEDICAL AND SPORTS MASSAGE EDUCATION™ from Boris Prilutsky Educational system.

To read Part 1, please refer to the previously published article.

https://www.medicalmassage-edu.com/blog/medical-massage-in-cases-of-long-covid-and-chronic-stress-related-disorders.htm

Long COVID: Research Findings and Clinical Dialogue

Approximately one week ago, I received an email from a Doctor of Physical Therapy with whom I collaborate closely. She shared the following update:

“Researchers in Japan have identified a biological basis for Long COVID–related brain fog using advanced PET brain imaging. They discovered widespread increases in AMPA receptor density associated with cognitive impairment and inflammation. These findings confirm that brain fog is a measurable biological condition and may open the door to targeted diagnostics and therapies.”

My response was immediate: these findings help explain why my treatment approach has been effective in patients with Long COVID.

I then shared with her links to my earlier articles on the management of post-concussion symptoms and post-traumatic encephalopathy, originally published in the Journal of Massage Science, Issue #2, 2016. In those publications, I discussed the hypermetabolic and hypometabolic stages following brain injury, widespread increases in AMPA receptor density associated with cognitive impairment and inflammation, and emphasized the importance of restoring adequate blood supply to the brain and stimulate autonomic regulation.

Sometimes what appears “new” in research reflects mechanisms that have already been clinically observed. The concepts of metabolic imbalance, perfusion mismatch, and autonomic dysregulation are not unfamiliar in post-concussion rehabilitation.

I forwarded this correspondence to thirteen healthcare professionals with whom I regularly collaborate and invited them to a Zoom meeting, which we held last Thursday. During that discussion, I also referred participants to my article on pandemic stress and neurocognitive-somatic dysfunction, where I describe the cascade of chronic stress reactions—including increased intracranial pressure tendencies, compromised cerebral blood supply, and progressive functional decline.

https://www.medicalmassage-edu.com/blog/pandemic-stress-neurocognitive-somatic-dysfunction.htm

Chronic Stress vs. Viral Microvascular Injury: A False Separation?

One participant suggested that microvascular damage caused by the COVID-19 virus is a documented biological fact and perhaps should be considered separately from chronic stress mechanisms.

My response was framed as a question:

Do we remember the psychological climate during the height of the pandemic? Continuous media exposure and alarming messaging led many people to believe that infection was nearly a death sentence. The emotional trauma associated with diagnosis cannot be dismissed.

To separate Long COVID from chronic stress physiology may be an oversimplification. Many patients were already living under prolonged HPA-axis activation before infection. When viral insult occurred, it was layered onto an already dysregulated autonomic and vascular system.

Research supported by the National Institutes of Health confirms microvascular involvement in COVID-19. At the same time, extensive literature demonstrates that chronic stress independently impairs endothelial function and cerebral perfusion (Gianaros & Wager, 2015).

Clinically, what we may be observing is not an either–or phenomenon, but rather a cumulative effect:

• Chronic stress–induced autonomic and vascular dysregulation
• Viral-related microvascular injury
• Neuroinflammatory activation
• Emotional trauma
• Metabolic imbalance

The “Double-Hit” Hypothesis

If increased AMPA receptor density reflects heightened excitatory activity—as demonstrated in recent Japanese PET imaging studies—one critical question arises:

What happens if this receptor overactivity occurs simultaneously with compromised cerebral blood flow?

Such a situation would create a “double-hit” scenario:

1. Increased metabolic demand at the neuronal level
2. Reduced oxygen and nutrient delivery due to impaired perfusion

Under these conditions, neural tissue operates under high metabolic stress without adequate blood supply —potentially explaining cognitive fatigue and brain fog.

Interestingly, in post-concussion cases we observe a similar metabolic mismatch between energy demand and supply during hypermetabolic and hypometabolic stages. The parallels are difficult to ignore.

Brain Fog as Biomarker vs. Autonomic Dysregulation as Clinical Marker

In research settings, brain fog is increasingly treated as a biomarker linked to receptor density and neuroinflammatory findings.

In clinical practice, however, autonomic dysregulation often serves as a more dynamic and functional biomarker. We assess:

• Breathing patterns
• Heart rate variability trends
• Tolerance to physical load
• Emotional regulation during treatment sessions
• Cervical mobility and fascial tone

Improvement in autonomic regulation frequently precedes subjective cognitive improvement.

Clinical reality sometimes differs from laboratory modeling. Much of the current research understandably aims to develop pharmacological interventions targeting receptor activity. However, the pathophysiology of chronic stress–related disorders and Long COVID is complex from the outset, involving cascades of vascular, inflammatory, autonomic, and metabolic dysfunction.

Why a Multimodal Massage Therapy Approach Is Applied

As described in my previous articles, insufficient cerebral blood supply, inflammatory activation, and autonomic imbalance form a self-perpetuating cycle.

For this reason, we apply multiple medical massage techniques aimed at:

• Stimulating parasympathetic activity through acetylcholine-mediated mechanisms
• Reducing sympathetic overdrive
• Improving microvascular circulation
• Supporting mitochondrial activity and tissue metabolism
• Facilitating vascular repair
• Modulating inflammatory responses

Restoring vascular health and managing inflammation through improved perfusion may play a central role in addressing receptor overactivation indirectly. Was this not also the case in post-concussion rehabilitation?

Closing Remarks

Chronic stress–related disorders and Long COVID are complex, multifactorial conditions involving layered physiological and psychological components. Addressing only one mechanism is unlikely to produce lasting recovery.

In the coming weeks, my webinar will be released. It represents the most comprehensive master class I have presented to date, integrating:

• Neurophysiology
• Vascular dynamics
• Autonomic regulation
• Clinical case analysis
• Practical application of medical massage protocols
  • Twenty percent of the webinar will be dedicated to theoretical explanations.
  • Eighty percent will consist of continuous hands-on demonstrations with detailed explanations, including:
    • Introductory massage techniques designed to increase pain threshold
    • Fascial release and mobilization techniques
    • Muscular mobilization techniques
    • Anterior and posterior neck massage techniques addressing all muscle groups, including upper back massage.
    • TMJ dysfunction massage protocols
    • Specialized techniques to facilitate cerebrospinal fluid and venous blood drainage
    • Acupressure techniques for tension headaches
    • Abdominal massage techniques

This structure ensures a strong balance between scientific understanding and practical clinical application.

Selected References

• Douaud, G. et al. (2022). SARS-CoV-2 is associated with changes in brain structure. Nature.
• Field, T. (2014). Massage therapy research review. Complementary Therapies in Clinical Practice.
• Gianaros, P.J., & Wager, T.D. (2015). Brain–body pathways linking stress and health.
• Kawamura, T. et al. (2023). PET imaging findings in Long COVID.
• Kreher, J.B., & Schwartz, J.B. (2012). Overtraining syndrome. Sports Health.
• Leddy, J.J. et al. (2016). Rehabilitation of concussion. Sports Health.
• McEwen, B.S., & Akil, H. (2020). The stress response. Neuron.
• Raj, S.R. et al. (2021). Autonomic dysfunction in Long COVID. Clinical Autonomic Research.
• Rapaport, M.H. et al. (2012). Massage therapy and immune function.
• Slavich, G.M. (2020). Stress and inflammation. Psychological Bulletin.

I sincerely invite questions, agreements, and disagreements. Professional dialogue advances understanding.

Best wishes,
Boris