Pandemic-Related Chronic Stress as a Contributor to Neurocognitive and Somatic Dysfunction: Clinical Implications for Medical Massage Therapy

From the author.

For the last almost 4 years ,I have observed a very substantial rise in patients presenting with brain fog, short-term memory impairment, headaches, fatigue, dizziness, and autonomic imbalance. While such symptoms do not constitute a diagnosis of neurodegenerative disease, chronic stress is a recognized risk factor for increased neurocognitive vulnerability

During the COVID-19 pandemic, the US population was exposed to prolonged psychosocial stressors. Large-scale epidemiological data demonstrate a marked and persistent increase in stress-related symptoms worldwide, consistent with chronic stress physiology rather than transient acute stress. Most of medical publications published conclusion about :” Chronic activation of the hypothalamic–pituitary–adrenal (HPA) axis and autonomic nervous system is known to contribute to neuroinflammation, immune dysregulation, sleep disturbance, cognitive dysfunction, and widespread somatic complaints.

My article reviews relevant stress physiology literature and proposes a clinically grounded framework through which medical massage therapy interventions may support autonomic regulation, circulation, connective tissue health, and symptom resolution in stress-related conditions. The intent is not to assert causation for neurodegenerative disease, but to emphasize early intervention strategies for stress-induced dysfunction using evidence-informed massage therapy approaches.

Introduction

The COVID-19 pandemic represented an unprecedented global stressor. Unlike time-limited traumatic events, the pandemic imposed sustained exposure to psychological threat, social isolation, disruption of routine, and reduced access to social buffering mechanisms. Population-level studies demonstrate significant increases in anxiety, depression, sleep disorders, and cognitive complaints during and after the pandemic period .

Media exposure played a critical amplifying role. Repeated exposure to threat-based messaging has been shown to prolong stress responses and exacerbate physiological dysregulation, even in individuals without direct exposure to illness Simultaneously, quarantine measures and school closures reduced protective social interactions, further increasing allostatic load .

Chronic Stress Physiology and Neurocognitive Vulnerability

Chronic stress differs fundamentally from acute stress in its biological consequences. Sustained activation of the HPA axis and sympathetic nervous system leads to dysregulated cortisol signaling, impaired sleep architecture, altered immune responses, and neuroinflammatory processes These mechanisms are associated with impaired attention, memory consolidation deficits, executive dysfunction, and persistent fatigue.

Importantly, chronic stress does not directly cause dementia or Alzheimer’s disease; however, it is recognized as a significant modifier of neurocognitive resilience. Individuals experiencing prolonged stress may therefore exhibit heightened vulnerability to cognitive decline, particularly in the presence of additional risk factors. The widespread increase in cognitive complaints observed during the post-pandemic period warrants clinical attention and early supportive intervention.

Clinical Observations and Relevance to Massage Therapy

Massage therapy practitioners have reported a notable rise in patients presenting with combined cognitive and somatic symptoms, including brain fog, headaches, myofascial pain, dizziness, and autonomic imbalance. These presentations are consistent with stress-mediated dysfunction rather than isolated structural pathology.

Massage therapy approaches that emphasize circulatory support may play a meaningful adjunctive role in addressing these conditions, secondary contributing to autonomic regulation, Historical and contemporary literature supports the influence of massage therapeutic interventions on peripheral and central circulation, autonomic tone, and somatovisceral reflex pathways.

Pandemic-Related Chronic Stress Pathways

Proposed mechanisms by which COVID-19–related psychosocial stressors contribute to chronic stress physiology. Prolonged exposure to threat-based media, social isolation, school closures, and uncertainty activate the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system, leading to cortisol dysregulation, autonomic imbalance, neuroinflammatory signaling, sleep disruption, and cognitive dysfunction. Sustained exposure may contribute to long-term somatic and neurocognitive symptoms.

Implications for Practice

Early recognition of stress-related dysfunction is critical. Massage therapy practitioners should understand the physiological mechanisms linking chronic stress to neurocognitive and somatic symptoms and apply structured, outcome-oriented protocols accordingly. Existing evidence and clinical experiences,supports the inclusion of massage therapy within a multidisciplinary framework for managing chronic stress–related conditions.

Cognitive Decline and Dementia Risk

Chronic stress and persistent neuropsychiatric symptoms are increasingly recognized as risk factors for long-term cognitive decline. If not to restore adequate cerebral blood supply. it is significantly increased risk of new-onset cognitive impairment and dementia, including Alzheimer’s disease. While not all individuals with cognitive symptoms will progress to dementia, the convergence of chronic stress, neuroinflammation, sleep disruption, and mood disorders creates a high-risk profile for neurodegenerative disease.

Summary

Collectively, data from the past three years indicate that tens of millions of individuals in the United States and hundreds of millions globally are experiencing chronic stress–related illnesses. Long COVID represents a major driver of this trend, compounded by widespread increases in anxiety, depression, sleep disorders, and cognitive dysfunction. These findings support the conclusion that chronic stress–related illness constitutes a significant and ongoing public-health burden with potential long-term consequences, including increased dementia risk.

Conclusion and clarifications.

The purpose of this article extends beyond providing general education on chronic stress–related disorders. As a massage educator and clinician, my primary objective is to highlight the role of massage procedures in the assessment and treatment of chronic stress-related conditions.

From my clinical perspective, the pathological process begins at the level of the fascia and skeletal musculature. Persistent stress leads to sustained increases in muscular tone and fascial restriction, which then initiate a cascade of secondary dysfunctions. These secondary developments—previously described in detail—include impaired drainage, altered circulation, and subsequent disturbances in neurological and autonomic regulation.

Chronic stress shows up first in the body as sustained tension, especially in the neck and upper back. That tension can mechanically affect circulation and fluid drainage from the brain. When drainage and blood flow are compromised, brain function can suffer, which then feeds back into autonomic imbalance.
By reducing excessive muscular tension, we may help restore these physiological processes and support nervous system regulation

Increased Muscular & Fascial Tone (Neck / Upper Back)

Mechanism

• Chronic activation of the sympathetic nervous system increases baseline motor neuron excitability , secondary triggering sustained HPA-axis activation that supporting and fueling increased resting muscle tone
• Stress preferentially increases tone in cervical and upper thoracic musculature.
• Stress increases tonic muscle activity and reduces relaxation capacity, therefore today we are observing continuation of increase of chronic stress-related diseases.

References

1. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998.
2. Lundberg U. Stress responses in neck and shoulder muscles. J Electromyogr Kinesiol. 2002.
3. Thayer JF, Lane RD. Neurovisceral integration model. J Affect Disord. 2000.

Sustained Cervical / Fascial Tension , Impaired Venous, Lymphatic & CSF Drainage

Mechanism

• Cervical muscles, fascia, thoracic outlet, and diaphragm mechanically influence:
• Internal jugular veins
• Vertebral venous plexus
• Cervical lymphatic vessels
• Elevated tone reduce compliance of these pathways
• CSF and glymphatic flow depend on pressure gradients and venous outflow

Key Evidence

• Venous outflow obstruction alters intracranial pressure and CSF dynamics
• Neck posture and muscle tension affect jugular venous flow
• Lymphatic drainage of the brain exits via cervical pathways

References
4. Bateman GA. The role of venous drainage in intracranial disorders. J Clin Neurosci. 2002.
5. Valdueza JM et al. Influence of posture on jugular venous flow. J Neurol Neurosurg Psychiatry. 2000.
6. Louveau A et al. Structural and functional features of central nervous system lymphatic vessels. Nature. 2015.

Impaired Drainage ,Reduced Cerebral Perfusion & Metabolic Waste Accumulation

Mechanism

• Cerebral blood flow depends on venous outflow and pressure balance
• Impaired venous/CSF clearance:
• Reduces perfusion efficiency
• Increases interstitial and inflammatory metabolite accumulation
• Glymphatic clearance is sensitive to autonomic tone and sleep quality

Key Evidence

• Reduced clearance increases neuroinflammatory signaling
• Impaired glymphatic function associated with cognitive symptoms

References
7. Iliff JJ et al. A paravascular pathway facilitates CSF flow through the brain. Sci Transl Med. 2012.
8. Nedergaard M, Goldman SA. Glymphatic failure as a final common pathway to dementia. Science. 2020.
9. Kisler K et al. Cerebral blood flow regulation and neurodegeneration. Nat Rev Neurosci. 2017.

Brain Dysfunction ,Secondary Autonomic Dysregulation

Mechanism

• Brainstem, limbic, and cortical regions regulate autonomic balance
• Neuroinflammation and hypoperfusion alter autonomic output
• Results in:
• Sympathetic dominance
• Reduced vagal tone
• Poor stress recovery

Key Evidence

• Brain inflammation disrupts autonomic signaling
• HRV reduction linked to cognitive and inflammatory states

References
10. Pavlov VA, Tracey KJ. Neural regulation of immunity. Nat Rev Immunol. 2017.
11. Shaffer F, Ginsberg JP. Overview of heart rate variability. Front Public Health. 2017.

Reducing Muscular/Fascial Tension ,Improved Drainage, Perfusion & Autonomic Balance

Mechanism

• Massage reduction of tone:
• Improves venous compliance
• Enhances lymphatic and CSF movement
• Supports cerebral perfusion
• Parasympathetic activation follows sensory and mechanical input

Key Evidence

• Massage increases parasympathetic activity
• Massage therapy improves regional circulation and autonomic markers

References
12. Field T. Massage therapy research review. Complement Ther Clin Pract. 2016.
13. Diego MA et al. Massage therapy affects autonomic regulation. Int J Neurosci. 2004.
14. Moyer CA et al. Massage therapy effects: meta-analysis. Psychol Bull. 2004.