Neuroinflammation, Cranial Fluid Dynamics, and Myofascial Dysfunction: A Translational Model Across PTSD, Chronic Stress Disorders, Long COVID, and Traumatic Brain Injury

Over the years, I have developed a substantial level of understanding in addressing PTSD, chronic stress disorders, Long COVID, and traumatic brain injury. More importantly, I have repeatedly reproduced positive clinical outcomes while working with these highly complex conditions.

For the last five years, the primary focus of my practice has been the treatment of chronic stress disorders and Long COVID. It has been both fascinating and deeply rewarding work. There is nothing more meaningful than seeing patients who arrive exhausted and overwhelmed by multiple symptoms — including sleep disorders, cognitive decline, headaches, disorientation, dizziness, chronic fatigue, / autonomic dysfunction — gradually regain their functionality and quality of life through consistent treatment.

About seven months ago, I had an extensive conversation with a double board-certified neurologist. During our discussion, I explained what I believe to be a clinically observable translational model connecting PTSD, chronic stress disorders, Long COVID, and mild traumatic brain injury.

The conversation quickly evolved into a long and highly detailed clinical discussion. He continuously asked clinically oriented questions, and I was able to explain my observations and reasoning in depth.

By the end of the discussion, he became very enthusiastic and encouraged me to write an overview article on the subject. He stated that the concepts I was describing made complete clinical sense and deserved deeper investigation and publication.

I composed the article, and he edited it according to professional publication standards. After reviewing the final version, he told me:
“I guarantee they will publish this.”

I then asked whether he would consider being listed as a co-author, since I felt that an article submitted solely by a massage therapist might not be taken seriously. He replied that he could participate as an editor, but not as a co-author.

Eventually, the article was rejected by a reviewer who stated that she could not identify the translational model connecting PTSD, chronic stress disorders, Long COVID, and mild traumatic brain injury. The reviewer held a PhD in biochemistry.

Initially, I assumed there would be no further communication. However, since I already knew the reviewer’s identity, I responded and expressed my surprise that a clinically oriented article involving complex physical treatment concepts had been reviewed by someone without direct clinical experience in physical medicine or hands-on therapeutic treatment.

I explained that the article was based on extensive successful clinical observations and years of hands-on therapeutic experience. I also expressed concern regarding the broader issue of non-clinicians reviewing clinically oriented physical treatment methodologies.

To my surprise, she called me personally. We spoke for approximately 20 minutes. During that conversation, I explained the same clinical concepts presented in the article, and afterward she advised me to resubmit it.

At that point, however, I decided not to pursue publication further and instead published the article on my own website as an educational discussion.

My dear colleagues, when reading peer-reviewed material, it is important not only to examine the conclusions, but also to consider who the reviewers are — and whether they possess actual clinical experience relevant to the treatment methods they are evaluating.

To my further surprise, shortly afterward I was contacted by another publication with an established reputation offering to publish the article for $2,300.

When I asked how this process worked, I was told that once one publication rejects an article, other publications may approach authors and offer publication for a fee.

Frankly, this did not sit well with me. It did not feel scientifically rigorous, nor ethically reassuring.

Regardless of all this, I remain what I have always been — a practicing massage therapist dedicated to clinical work, education, and patient outcomes.

As always, you are welcome to post questions.

Best wishes,
Boris Prilutsky

Abstract

PTSD, chronic stress-related disorders, post-acute sequelae of SARS-CoV-2 infection (Long COVID), and mild traumatic brain injury (mTBI) are increasingly recognized as conditions with overlapping clinical features, including cognitive dysfunction, fatigue, headache, and autonomic instability. Emerging evidence suggests shared underlying mechanisms involving neuroinflammation, endothelial dysfunction, and altered central nervous system fluid dynamics.

This paper proposes a translational model linking neuroinflammation with impaired cerebrospinal fluid (CSF) and venous drainage, integrating the role of myofascial dysfunction in the cervical, thoracic, and diaphragmatic regions. These biomechanical factors may contribute to impaired cranial fluid regulation and symptom persistence.

The model highlights potential mechanisms through which medical massage, may influence fluid dynamics, autonomic balance, and inflammatory processes. This framework provides a clinically relevant perspective for integrating bodywork approaches into multidisciplinary care.

Introduction

PTSD, chronic stress disorders, Long COVID, and mTBI represent a growing clinical challenge due to their persistent and often overlapping symptom profiles.¹–⁴ Patients frequently report cognitive impairment, fatigue, headache, sleep disturbance, and dysautonomia, with limited response to conventional interventions.

Although these conditions differ in etiology—psychological trauma, chronic stress exposure, viral infection, or mechanical injury—there is increasing recognition of shared biological pathways. These include neuroinflammation, vascular dysfunction, and autonomic imbalance.⁵–⁸

In parallel, clinicians working in physical methods of treatments and rehabilitation settings consistently observe patterns of myofascial tension, particularly in the cervical region, upper thorax, and diaphragm. The potential relationship between these biomechanical findings and central nervous system physiology remains underexplored.

This paper proposes an integrative model linking neuroinflammation, cranial fluid dynamics, and myofascial dysfunction, with implications for clinical practice in massage, physical and movement therapies.

Neuroinflammation Across Conditions

Neuroinflammation is a central feature across PTSD, chronic stress disorders, mTBI, and Long COVID.

PTSD and chronic stress are associated with sustained activation of inflammatory pathways, including elevated cytokines and altered hypothalamic–pituitary–adrenal (HPA) axis regulation.⁵,⁶ These changes contribute to both central and systemic dysfunction.

In mTBI, mechanical injury triggers a cascade of inflammatory responses, including microglial activation, blood–brain barrier disruption, and cerebral edema.⁷ These processes may persist beyond the acute phase and contribute to chronic symptoms.

Long COVID is characterized by persistent immune activation and endothelial dysfunction, with increasing evidence of neurological involvement.⁸

Importantly, neuroinflammation interacts with vascular, autonomic, and mechanical systems, creating a self-perpetuating cycle of dysfunction.

Cerebrospinal Fluid and Glymphatic Function

The glymphatic system facilitates clearance of metabolic waste and inflammatory mediators through CSF–interstitial fluid exchange.⁹ Efficient function of this system depends on:

• arterial pulsatility
• sleep quality
• intact tissue compliance
• pressure gradients

Disruption of glymphatic flow has been demonstrated in traumatic brain injury and is associated with impaired clearance of neurotoxic substances.¹⁰

Sleep disturbance and autonomic dysregulation—common across all four conditions—further impair glymphatic activity.¹¹ This may contribute to the persistence of neuroinflammation and neurological symptoms.

Venous Outflow and Intracranial Dynamics

Cranial fluid regulation depends on the dynamic balance between arterial inflow, venous outflow, and CSF circulation.

Neuroinflammatory processes may contribute to:

• increased vascular permeability
• interstitial edema
• altered venous tone

Impaired venous drainage may lead to changes in intracranial pressure dynamics and cerebral perfusion.¹² While severe intracranial hypertension is not typical in these conditions, subclinical or fluctuating impairments in fluid dynamics may contribute to symptom persistence.

Myofascial Dysfunction and Mechanical Influences

A consistent clinical finding across these patient populations is increased myofascial tension in:

• suboccipital musculature
• sternocleidomastoid and scalene muscles
• upper thoracic region
• diaphragm

Cervical Region

The internal jugular veins pass through deep cervical fascial compartments. Increased muscle tone or fascial restriction may influence venous outflow from the cranial vault.

Suboccipital Structures

The suboccipital region has anatomical continuity with dural membranes, suggesting a potential role in modulating cranial compliance and CSF movement.

Thoracic Outlet

Restrictions in the thoracic outlet region may impair venous and lymphatic return to the central circulation.

Diaphragm

The diaphragm plays a critical role in generating pressure gradients necessary for venous and lymphatic flow. Reduced diaphragmatic excursion, commonly observed in chronic stress states, may compromise these mechanisms.¹³

These findings suggest that myofascial dysfunction may contribute to impaired cranial fluid dynamics, providing a potential link between peripheral biomechanics and central neurological symptoms.

Autonomic Nervous System Integration

All four conditions demonstrate autonomic imbalance, characterized by increased sympathetic activity and reduced parasympathetic tone.⁶

This imbalance contributes to:

• increased muscle tone
• vasoconstriction
• impaired inflammatory regulation

The autonomic nervous system therefore serves as a functional bridge linking neuroinflammation, vascular regulation, and myofascial tension.

Implications for Massage Therapy

The proposed model supports the integration of massage therapy within multidisciplinary care.

Potential Mechanisms

Therapies by means of massage may:

• reduce myofascial tension
• improve venous and lymphatic flow
• enhance diaphragmatic mobility
• modulate autonomic activity

Evidence Base

Massage therapy has been associated with reduced inflammatory signaling and increased parasympathetic activity.¹⁴,¹⁵ These effects may indirectly support improved fluid dynamics and symptom reduction.

While direct effects on glymphatic function and intracranial pressure remain to be established, the proposed mechanisms are consistent with current physiological understanding.

A Translational Clinical Model

A proposed integrative pathway:

Trigger (trauma, stress, infection)
Neuroinflammation
Microvascular dysfunction
Impaired CSF and venous drainage
Myofascial restriction (cervical, thoracic, diaphragm)

Further impairment of fluid dynamics
Persistent symptoms

This model highlights multiple intervention points relevant to rehabilitation and bodywork practice.

Limitations

This paper presents a conceptual and translational model rather than a systematic review. Some proposed mechanisms—particularly those linking myofascial dysfunction to glymphatic flow—remain hypothetical and require empirical validation.

Future Directions

Future research should:

• investigate relationships between cervical fascial tension and venous outflow
• evaluate medical massage effects on autonomic and fluid regulation
• incorporate imaging and physiological measures of CSF dynamics
• explore integrative rehabilitation protocols

Conclusion

PTSD, chronic stress disorders, Long COVID, and mTBI share overlapping mechanisms involving neuroinflammation, autonomic dysregulation, and impaired cranial fluid dynamics.

Myofascial dysfunction in the cervical, thoracic, and diaphragmatic regions may represent an important and underrecognized contributor to these processes.

A systems-based, integrative approach—including massage therapy—may offer clinically meaningful benefits and warrants further investigation.

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