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

From the author

I typically write clinically oriented articles based on my direct clinical experience and observation. I do not develop educational material unless I have treated at least 20 cases, reproduced outcomes consistently, and followed patients after discharge to observe durability of results.

Approximately four months ago, a neurologist—after completing a full neurological workup, including brain imaging—referred a patient to my practice. Over the past four years, I have received a large volume of referrals from this medical group involving patients with chronic stress–related disorders. These patients consistently present with a similar constellation of symptoms, including anxiety, clinical depression, TMJ dysfunction, cognitive fog, headaches, impaired concentration, head pressure, short-term memory complaints, and sleep disturbances.

Identical MS symptoms.

This patient demonstrated the same symptom profile. Neither the referring physician nor the patient initially emphasized Long COVID as a original diagnosis; however, the patient 8 treatments later reported that she had been diagnosed with Long COVID. After approximately eight treatment sessions, she began reporting meaningful improvement, including reduced head pressure, fewer headaches, improved cognitive clarity, and better sleep quality. At that point, she stated, “I have been suffering from Long COVID for three years and believed nothing could help me.”

This prompted me to investigate further: who had made the diagnosis, when the infection occurred, and what criteria were used. At that time, my understanding of the systemic effects of COVID-19 infection was limited. Notably, the protocol I had developed for chronic stress–related disorders appeared to be working effectively.

I immediately contacted all 24 neurologists within the medical group, presented this case, and requested referrals of patients diagnosed with Long COVID. I subsequently applied the same protocol to 20 Long COVID patients. Each patient received approximately 15 treatment sessions, followed by a two-week observation period, after which they were invited to return for reassessment and additional care. Clinical improvements were consistently observed.

My assessment protocol always begins with a dermographism test. All patients demonstrated autonomic irregularity at baseline. I use this test not only for initial assessment but also as a marker of clinical improvement, as I strongly believe that autonomic nervous system dysregulation is a biomarker of central nervous system dysfunction, including altered brain regulation. Dermographism responses were also monitored throughout treatment to assess physiological change.

Naturally, these clinical outcomes sparked a deeper interest in the pathophysiology of Long COVID. At the time, the available literature was limited, with much of the evidence coming from autopsy studies demonstrating damage to small blood vessels. The question is, would damage to vessels trigger cognitive decline, TMJ dysfunction, ets. Was there involvement of chronic stress side effects?

Chronic stress produces sustained hypothalamic–pituitary–adrenal , prolonged cortisol exposure, which disrupts microvascular regulation through combined endocrine, autonomic, and cellular mechanisms. Elevated cortisol suppresses endothelial nitric oxide synthase (eNOS) activity and promotes oxidative stress, reducing nitric oxide–mediated vasodilation at the level of capillaries . Concurrently, chronic sympathetic dominance inhibits parasympathetic acetylcholine (ACh) signaling, limiting cholinergic-mediated vasodilation and anti-inflammatory endothelial protection. Reduced ACh availability further impairs endothelial–mitochondrial communication, diminishing mitochondrial ATP production required for vascular tone regulation and cellular repair. Excess cortisol and catecholamine exposure increase mitochondrial reactive oxygen species, leading to functional mitochondrial downregulation within endothelial and smooth muscle cells. The combined effect is functional microvascular constriction, reduced capillary recruitment, and impaired oxygen delivery. This stress-mediated pathway produces reversible microvascular inefficiency , inflammatory endothelial injury.

Today’s writing should be viewed as Part Two of my article,
Pandemic-Related Chronic Stress as a Contributor to Neurocognitive and Somatic Dysfunction: Clinical Implications for Medical Massage Therapy.

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

Approximately 19 million Americans are currently living with Long COVID, many of whom are at elevated risk for neurocognitive decline, including dementia. At the same time, research shows that psychological distress during the pandemic extended far beyond anxiety alone.

Separate surveys that combined anxiety and depressive symptoms found a 33–36% prevalence of psychological distress during late April–May 2020, reflecting a profound and widespread mental health burden.

Pre-pandemic: anxiety ~8%
Peak lockdown: anxiety ~21%
Psychological distress (anxiety + depression): ~36%

These data demonstrate a rapid rise in anxiety and distress during the onset of lockdowns . The pandemic and its early public health responses—including stay-at-home orders, school closures, social isolation, and economic uncertainty—were associated with a dramatic increase in stress-related disorders well beyond pre-pandemic levels.

These percentages represent tens of millions of Americans. The clinical demand for effective treatment approaches is real—and growing.

Coming Soon: my Webinar

Medical Massage in Cases of Long COVID and Chronic Stress-Related Disorders

• 20% of the webinar will be dedicated to a clear, clinically grounded theoretical framework, including a detailed presentation of the pathophysiological cascade of chronic stress and its effects on the nervous, vascular, and metabolic systems.
• 80% of the time will be devoted to hands-on demonstration, including:
  • Dermographism testing
  • Introductory medical massage protocols
  • Myofascial release and mobilization
  • Techniques aimed at supporting mitochondrial biogenesis and acetylcholine release
  • Methods to enhance venous and cerebrospinal fluid drainage, reduce intracranial pressure, and improve cerebral blood supply
  • Approaches influencing glymphatic system movement
  • TMJ dysfunction techniques
  • Abdominal massage applications

All techniques are designed to address the underlying mechanisms of complex, multi-system symptoms, rather than isolated complaints.

This will be the first presentation of this webinar. I am planning to answer questions throughout the session. As this is an educational experiment, enrollment will be limited, allow me to answer adequately..

Please subscribe here:
https://www.medicalmassage-edu.com/products/post-covid-chronic-stress-related-disorders.htm

You will be notified on the day of the webinar. Registration will be first come, first served.

I look forward to seeing you at the workshop.

Best wishes,
Boris

PS.

For a better understanding of what to expect from upcoming webinar I decided to offer you written summary and conclusion from script

Summary and Conclusions

Boris appears on screen to summarize and conclude the webinar.

I hope you have enjoyed today’s educational event. I certainly feel that I gave my very best.

Generally speaking, I favor a simple, practical approach to biomedical science—especially to the science of massage and other physical treatment methods. By “simple,” I mean a clinically practical approach that leads to sustainable results, and, most importantly, to our ability to consistently reproduce those results.

Practically speaking, I would like to briefly summarize the mechanism of pathological developments triggered by chronic stress.

The first reaction to stress is elevated myofascial tension and sympathetic nervous system dominance, driven by prolonged stress-hormone influence. This triggers neuroinflammation, autonomic dysregulation, and subsequently widespread dysfunction across multiple organs and systems. This is a very dangerous condition—not only functionally disabling for patients, but one that can progress to life-threatening autoimmune diseases, including, but not limited to, multiple sclerosis.

Prolonged neuroinflammation initiates degenerative changes. By improving cerebral blood supply, we can gradually reduce and, over time, help eliminate brain inflammation. We also understand the importance of stimulating mitochondrial biogenesis and promoting the release of acetylcholine.

Today, I explained and demonstrated a specific sequence of techniques. As you have seen, following the correct sequence is essential.

One critical question we must clarify for ourselves—and be able to explain to our patients and fellow healthcare professionals—is this:
Why, three years after the pandemic, are millions of people still suffering from chronic stress-related disorders, even though one might say the crisis is “over”?

This brings us back to the difference between acute and chronic stress. Chronic stress is not adaptive. During prolonged periods of constant stress, muscles and fascia continue to adapt until a vicious cycle is established. Fascial connective tissue builds excessive tension, creating persistent irritation that cannot resolve naturally without therapeutic intervention.

As you now understand, this leads to impaired cerebrospinal fluid and venous drainage, insufficient glymphatic flow, and reduced perfusion—particularly decreased delivery of glucose and oxygen. Autonomic dysregulation becomes sustained, and the body continues to deteriorate, potentially leading to degenerative brain diseases, autoimmune disorders, and other serious conditions.

I encourage you to submit your questions, and I also recommend reading my articles on this subject—the links are provided below.

Thank you very much for choosing my master class. I look forward to seeing you in many more of my courses in the future.