Massage After COVID - Addressing the Symptoms That Didn’t Go Away

Sometimes the symptoms of COVID-19 linger

So you've finally recovered from COVID-19 and you want to get a massage. Is it a good idea? The answer is yes. But you will probably get the most benefit out of the session if you know what you're looking for and have realistic expectations about how massage can help you. Even two people living in the same household can have vastly different experiences after becoming sick with coronavirus. Some people experience very mild symptoms and feel pretty much themselves soon after recovery. Other people find themselves dealing with unexpected and unexplained symptoms long after their bout with the virus. Depending on where you are in your recovery process, you may want to select a massage therapist who understands the complex challenges that are faced by some people long after their time of quarantine is over.

What to Look For

Unless you are in good health and are simply looking for relaxation, it is important to find a massage therapist that will listen closely to your concerns and who is trained to address your specific needs. This can be a little bit tricky as there is still much that we do not know about the long-term effects of COVID-19. Over the past two years we have seen a vast array of responses to the virus ranging from no noticeable symptoms at all to severe inflammation and even death. The recovery process can also be completely different from one person to the next. The massage treatment that you receive should be as unique as you are. There is enough preliminary information out there to know that massage can help with quality of life after COVID. It just depends on what you need.

The Intake Process: Your massage therapist should be interested in whether you have experienced any excessive bleeding or blood clotting. Tell your therapist if you have any rashes, clusters of dark dots on the skin or if there has been any swelling or discoloration in your toes. They should ask whether you experienced any organ damage resulting from the sickness, such as any scarring in the lungs, any heart or kidney damage. They should take note of any fatigue, weakness, brain fog, depression, numbness/tingling or any other symptoms that may have arisen while you were sick or afterwards. They will also need to know any medications that you are currently taking because these can also affect your response to massage. For example, if you are on a blood thinner or have renal failure, deep pressure should be avoided.

A Treatment Plan: All of your symptoms should be taken into account when creating a massage session for you. Your therapist should ask about your activity level, whether you have any discomfort with exertion and your goals. Ideally, they will design a series of sessions to help you manage your symptoms and support you as you recover and return to the daily activities that you have been missing. It might be a good idea to start with one or two shorter sessions to see how you feel after massage and adjust accordingly.

The Environment: While your body is recovering from its fight against the covid virus, a treatment room with low stimulation is an ideal environment to help your overworked nervous system to rest and calm down. It can be a supportive place to both heal and mark your progress.

Safe Practices: At the start of the pandemic, the virus was thought to spread via respiratory droplets and lots of effort was put into reducing contact between people and disinfecting surfaces and everything that we touched. While cleaning is still important and, fortunately, the virus dies very easily, we have now learned that it is an airborne particle. It is much, much smaller than a respiratory droplet and can float for hours. However, at 40% humidity, it is more likely to drop to a surface where it can be easily eliminated. Based on this new understanding, a properly ventilated room with good airflow and humidity is very important for reducing viral transmission.

The Long Haul

It is difficult to say how many people have been affected by long-term conditions after covid or for how long. There is much that we still do not know. However, covid is not the only virus to have caused long-term problems in survivors. Both the flu and Ebola have been known to do the same. Post-sepsis syndrome and chronic fatigue syndrome (CFS) both share symptoms that are common among survivors of covid. There is also an extensive list of symptoms that seem to have no direct connection to the disease. Experts remain uncertain whether the

se issues will eventually go away. If you are experiencing new symptoms that you did not have before you got sick, you could be one of the people affected by a phenomenon that is now called long covid or post-acute sequelae of COVID (CPASC) by the medical community. People who identify with this group refer to themselves as “long haulers”. Long haulers must learn to adapt to a variety of challenges that may change from day to day. Self-care is vital and massage can be an important part of the regimen.

What Does the Virus Do?

SARS-CoV-2 attacks cells with specific membrane markers called ACE-2 receptors. Because cells rich in ACE-2 receptors are found all over the body, there is the potential for damage to all kinds of systems in the body. We still do not know what determines who gets long covid and when or why. There are many theories but very few answers so far. Researchers have begun to gather data and there are several studies being done but it is difficult to make comparisons or draw conclusions across the board. However, certain parts of the body tend to be more vulnerable to direct damage from the virus:

The Lungs

SARS-CoV-2 can attack a variety of sites within the body but its most common avenue into the body tends to

be the nose, the mouth and even the eyes. Thus the attack begins in the lungs and this is where most people encounter the most problems. Scarring in the lungs can lead to pulmonary fibrosis. Lung damage can increase susceptibility to infection, cause shortness of breath and low oxygen levels.

The Blood

One of the alarming discoveries about COVID-19 was its ability to create blood clots including tiny microvascular thromboses that can prevent healthy organ function and cause blisters, rashes and other skin problems. It can cause thickened blood. Many people are prescribed anticoagulants after covid. It is important to let your massage therapist know if you are taking any medications so that they can adjust their treatment accordingly.

The Heart

COVID-19 can cause heart problems in a variety of direct and indirect ways. It can affect young people who had no heart conditions prior to contracting the disease. Heart damage can lead to weakness, fatigue, poor stamina, palpitations, irregular heartbeat and chest pain.

The Kidney

The kidney is another organ that is very vulnerable to the virus. It can attack it in a variety of different ways. Micro thrombi (micro clots) can cause further damage.

The Central Nervous System

Loss of smell or taste was previously considered one of the main neurological indicators of covid and the one most commonly reported. New research from Harvard Medical School suggests that support cells, not neurons, are damaged when the sense of smell is lost. Long haulers often report neurological issues such as headaches, migraines, brain fog, memory loss, dizziness, nausea, vomiting, seizures, and poor concentration. We now know that the virus can get into spinal fluid and affect the brain and nervous system, possibly through the nose and the olfactory nerve. Headaches can be caused by neurological damage or deterioration; they can also be caused by muscle tension. Inflammation of the brain can cause problems in the respiratory center in the brain stem, making it difficult to breathe when oxygen levels in the blood are already low.

Other Organs

Digestive issues can persist long after infection due to damage to the lining of the gastrointestinal tract. Damage to the pancreas can lead to diabetes. Thyroid problems can lead to Hashimoto’s or Graves’ diseases. Patients have reported problems with lymphatic drainage leading to swelling. Some experts speculate that long haulers may develop osteopenia, osteoporosis or other bone-related issues.

Chronic Problems

The CDC lists 10 symptoms of COVID. The WHO website divides 13 symptoms into 3 categories. A study conducted by Dr. Natalie Lambert of the Indiana University School of Medicine and Survivor Corps, a support group for survivors of COVID, found more than 100 symptoms. The most common complaint was fatigue which was reported by 1156 people. Number 50 on the list was irritability with 197 responses. There seems to be a sobering similarity between COVID long-haul symptoms and those suffered by people with chronic conditions such as chronic fatigue syndrome (CFS), fibromyalgia post-sepsis syndrome, and chronic Lyme disease. David Weintraub, a NYC massage therapist and instructor who is experienced in the treatment of post-COVID symptoms, has observed that PTSD also seems to play a significant role in long haulers’ symptoms.

Common complaints include:

● fatigue that does not seem to be helped by sleep

● brain fog that can be mild or debilitating

● post-exertional malaise – a pain and fatigue that hits after any kind of physical or mental effort

● a deep muscle pain that may or may not be related to exercise

● anxiety

● depression

The Benefits of Massage Therapy

Weintraub points out that it is important to distinguish between structural and functional issues. Structural issues are caused by the virus’ direct attack on the cells of the body and cannot be alleviated by massage. For example, massage cannot dissolve scar tissue in your lungs and internal organs, repair damage done by the virus, or restore taste and smell. Inflamed joints need time to recover. However, massage can help to manage the symptoms while the body heals. Regular massage sessions can help to reduce chronic stress so that your body can devote more resources to repair and regeneration.

People with CFS, fibromyalgia, depression, anxiety, etc often have an overactive stress response that won't turn off. The bo

dy creates a response to stress that does not go away even after healing has occurred. In the absence of disease, these stress responses tend to be bigger than necessary to confront whatever triggered them and the cortisol that is released into the system remains circulating for longer than is needed. The body becomes stuck in fight or flight mode. There is a strong possibility that the stress response can be interrupted or hopefully even eliminated through the help of massage. Massage reduces muscle tension and quiets the sympathetic nervous system which may in turn relieve a variety of symptoms.

Symptoms related to the stress response that may be helped through massage include:

● joint and muscle pain as a result of protective compression

● headaches from neck and shoulder tension or teeth grinding or jaw clenching

● dry cough from tight sternocleidomastoid muscles

● breathing difficulties arising from an overtired diaphragm and rib muscles

● insomnia

● fatigue

● anxiety

● depression

Compressed joints and shortened muscles may find relief through rehabilitative massage.

Headaches that are caused by stress and muscle tension are often lessened or eliminated after massage. Although the underlying neurological causes cannot be treated by massage, the threshold of triggers for migraine headaches could be reduced. However, people who previously did not have migraine headaches prior to contracting covid, or who have even mild recurring headaches afterwards should consult with a medical specialist for treatment.

If prolonged coughing is caused by tight neck muscles as opposed to damaged lung tissue, then careful and thorough work on the neck may be beneficial. An experienced massage therapist may be able to help overtired breathing muscles so that the body can return to a more relaxed breathing pattern. Working the ribcage and diaphragm, and reducing overall muscle tension not only promotes more normal breathing, it can also help with reducing the flight/flight response.

Long before the pandemic, studies had already documented the role of massage therapy in reducing fatigue, improving breathing, alleviating pain, increasing quality of sleep, and easing anxiety. Over time, massage can retrain the nervous system to reduce stress.

It has been long believed that massage improves circulation; however, this claim is in fact difficult to study and the results over the years have been conflicting and inconclusive. Massage most likely does not increase blood circulation and does not directly rid the body of toxins.

What About Blood Clots?

Ruth Werner, an award winning instructor and author of several textbooks on pathology has explored this question multiple times throughout the pandemic. In a consultation between Werner and Dr. Yaser Diab, a hematologist at Children's National Hospital who has treated many cases of COVID-related MIS-C (multisystem inflammatory syndrome in children), they came to the conclusion that if a proper screening takes place prior to the session and the patient has no symptoms of DVT, then massage will not create an increased risk of pulmonary embolism.

Find a Licensed Massage Therapist Who Will Be There For the Long Haul

The bottom line: massage cannot cure COVID or reverse the structural damage done by the illness; however, long COVID encompasses a cluster of symptoms that can potentially be alleviated or reversed by massage therapy. Reducing the symptoms can help the body to work more efficiently to heal and recover. If your doctor has already cleared you and you have completed your quarantine, yet you find yourself tired and stressed after recovering from COVID; if you have lingering or new symptoms that just won’t go away; if you are tired of being isolated and you are constantly tense, it could be worth your while to schedule a massage or a series of massages. A competent practitioner will work with you to address your concerns and support you as you work towards returning to your normal level of daily activities. Long COVID symptoms continue to baffle scientists, but there is a strong case for adding massage to the list of interventions.

Sources

Al Refaei, Assem. “The Case for Therapeutic Massage as an Adjuvant in Hospitalized COVID-19 Patients.” International journal of therapeutic massage & bodywork vol. 14,1 49-50. 1 Mar. 2021

July 25 Covid-19 “Long-Hauler” Symptoms Survey Report, Indiana University School of Medicine and Survivor Corps

“Coronavirus disease (COVID-19).” WHO | World Health Organization,

https://www.who.int/health-topics/coronavirus#tab=tab_3. Accessed 18 January 2022.

Gandhi, Sonu et al. “Is the Collapse of the Respiratory Center in the Brain Responsible for Respiratory Breakdown in COVID-19 Patients?” ACS Chemical Neuroscience, vol. 11, no. 10, 2020, pp. 1379-1381.

JIANG, KEVIN. “How COVID-19 Causes Loss of Smell | Harvard Medical School.” Harvard Medical School, 24 July 2020,

https://hms.harvard.edu/news/how-covid-19-causes-loss-smell. Accessed 18 January 2022.

“Massage Therapy During the Pandemic: Is It Safe?” Pacific College of Oriental Medicine, 23 July 2021, https://www.pacificcollege.edu/news/blog/2021/07/23/massage-therapy-during-the-pandemic-is-it safe. Accessed 18 January 2022.

Muscolino, Joseph. “Can Massage Increase Blo

od Circulation?” Learn Muscles, 25 May 2018, https://learnmuscles.com/blog/2018/05/25/can-massage-increase-blood-circulation/. Accessed 18 January 2022.

“Symptoms of COVID-19.” CDC,

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed 18 January 2022.

Weintraub, David. “for Covid-19 Long Haulers - Bodyworks DW.” Bodyworks DW Advanced Massage Therapy, 7 February 2021,

https://bodyworksdw.com/advanced-massage-for-covid-19-long-haulers/. Accessed 18 January 2022.

Weintraub, David. “A New Type of Massage Client: COVID-19 “Long-Haul” Survivors.” Massage Magazine, 4 October 2021,

https://www.massagemag.com/a-new-type-of-massage-client-covid-19-long-haul-survivors-13122 1/. Accessed 18 January 2022.

Werner, Ruth. “COVID-Related Coagulopathy, Take 3: A Conversation with a Hematologist.” ABMP, 16 July 2020,

https://www.abmp.com/updates/blog-posts/covid-related-coagulopathy-take-3-conversation-hema tologist. Accessed 18 January 2022.

Werner, Ruth. “Is Your Massage Client a COVID-19 Survivor?” Massage Magazine, 14 April 2021, https://www.massagemag.com/is-your-massage-client-a-covid-19-survivor-128234/. Accessed 18 January 2022.

Werner, Ruth. “Massage Therapy for Clients with Breakthrough COVID-19 Infections.” ABMP, 6 January 2022,

https://www.abmp.com/updates/blog-posts/massage-therapy-clients-breakthrough-covid-19-infect ions. Accessed 18 January 2022.

“Unpacking the Long Haul.” Massage and Bodywork Digital, Massage and Bodywork Magazine, January - February 2022,

http://www.massageandbodywo

rkdigital.com/i/1439667-january-february-2022/36?token=N2MyNj g0MGJhZDhiODg4ZTU2Mzg3MTQyZGQyYTMxNzYyZGQ0Mjk5Nw%3D%3D. Accessed 18 Jan 2022.

Wu, Liu et al. “The effect of massage on the quality of life in patients recovering from COVID-19: A systematic review protocol.” Medicine vol. 99,23 (2020): e20529. doi:10.1097/MD.0000000000020529