Abstract
The novel virus identified as severe acute respiratory syndrome coronavirus [SARS-CoV-2] has resulted in the Coronavirus disease [COVID-19] worldwide pandemic. Confirmed cases of COVID-19 has surpassed 57 million people globally and numbers are exponentially increasing weekly. Significant numbers of recovering patients are reporting long-term, on-going painful soft tissue and respiratory complications. While the total number of deaths directly associated with COVID-19 has exceeded 1million people worldwide, a more accurate figure is estimated to be significantly higher due to limited testing and issues around accurately attributing cause of death. Since its earliest emergence experts have identified the primary source of entry to the body being the nasal and oral cavities via aerosol droplets proliferating across the respiratory tract. Similar Coronaviruses have typically caused mild enteric symptoms including nausea, vomiting, diarrhoea, and respiratory diseases including the common cold. In contrast, COVID-19 has been shown to cause acute fatal pneumonia, systemic out-of-control inflammatory responses, over-production of hyaluronan, cytokines, chemokines and C-reactive protein [CRP], leaky blood vessels, clot-causing antibodies leading to coagulation of blood, and resulting blood clots. Recorded high levels of serum Interleukin 6 [IL-6], Interleukin 8 [IL-8] as well as Tumour necrosis factor alpha [TNF-α] and IL-1β have been observed in COVID-19 patients all contributing to connective tissue damage. The connective tissue fascia has been described as “the universal singularity” due to its ubiquitous nature and has been identified in virtually every organ and structure within the body. Based on available evidence this paper suggests that the Corona virus travels upon the highway that is the fascial singularity whence it permeates cells on a local and global level. A significant number of post-COVID-19 [SARS-CoV-2] patients will experience on-going fascia related pain and a wide range of functional issues. Based on current research this short report proposes that appropriate fascia focused manual and movement therapy interventions will assist patients in recovering from the COVID-19 [SARS-CoV-2]. Fascia focused therapeutic interventions are shown to reduce pain and support a re-establishment of function while providing safe, effective and appropriate non-invasive therapy. A comprehensive search was conducted to systematically review research/reports and professional opinions related to post-COVID-19 syndrome. Surveying appropriate research and reports provided unique detail concerning fascial tissue involvement and underlying disease mechanisms including long-term after-effects of the novel Coronavirus disease [COVID-19].
References
Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, et al. Attributes and predictors of Long-COVID. Nat Med. 2021 Apr;27(4):626-631. https://doi.org/10.1038/s41591-021-01292-y
Goërtz YMJ, Van Herck M, Delbressine JM, Vaes AW, Meys R, Machado FVC, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020 Oct 26;6(4):00542-2020. https://doi.org/10.1183/23120541.00542-2020
Krueger JM. The role of cytokines in sleep regulation. Curr Pharm Des. 2008;14(32):3408-16.. https://doi.org/10.2174/138161208786549281
Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004 Jun;203(2):631-7. https://doi.org/10.1002/path.1570
Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003 Nov 27;426(6965):450-4. https://doi.org/10.1038/nature02145
Bosso M, Thanaraj TA, Abu-Farha M, Alanbaei M, Abubaker J, Al-Mulla F. The Two Faces of ACE2: The Role of ACE2 Receptor and Its Polymorphisms in Hypertension and COVID-19. Mol Ther Methods Clin Dev. 2020 Jun 25;18:321-327. https://doi.org/10.1016/j.omtm.2020.06.017
Zhang H, Li HB, Lyu JR, Lei XM, Li W, Wu G, et al. Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection. Int J Infect Dis. 2020 Jul;96:19-24. https://doi.org/10.1016/j.ijid.2020.04.027
Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020 Jun;92(6):577-583. https://doi.org/10.1002/jmv.25757
Stecco C, Stern R, Porzionato A, Macchi V, Masiero S, Stecco A, et al. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat. 2011 Dec;33(10):891-6.https://doi.org/10.1007/s00276-011-0876-9
Chaitow L, Bradley D, Gilbert C. Multidisciplinary Approaches to Breathing Pattern Disorders. London, UK: Churchill Livingstone; 2002.
Sheehy LM. Considerations for Postacute Rehabilitation for Survivors of COVID-19. JMIR Public Health Surveill. 2020 May 8;6(2):e19462.. https://doi.org/10.2196/19462
Barker-Davies RM, O'Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020 Aug;54[16]:949-959. https://doi.org/10.1136/bjsports-2020-102596
Stecco C, Stern R, Porzionato A, Macchi V, Masiero S, Stecco A, et al. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat. 2011 Dec;33(10):891-6.https://doi.org/10.1007/s00276-011-0876-9
Lew HL, Oh-Park M, Cifu DX. The War on COVID-19 Pandemic: Role of Rehabilitation Professionals and Hospitals. Am J Phys Med Rehabil. 2020 Jul;99(7):571-572. https://doi.org/10.1097/phm.0000000000001460
Guimberteau JC, Delage JP, Wong J. The role and mechanical behaviour of the connective tissue in tendon sliding. Chir Main. 2010 Jun;29(3):155-66. https://doi.org/10.1016/j.main.2010.04.002
Kaber G, Kratochvil MJ, Burgener EB, Peltan EL, Barlow G, Yang S, et al. Hyaluronan is abundant in COVID-19 respiratory secretions. medRxiv [Preprint]. 2020 Sep 11:2020.09. https://doi.org/10.1101/2020.09.11.20191692
Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. J Bodyw Mov Ther. 2014 Apr; 18(2):273-81. https://doi.org/10.1016/j.jbmt.2013.05.007
Stecco C, Porzionato A, Macchi V, Stecco A, Vigato E, Parenti A, et al. The expansions of the pectoral girdle muscles onto the brachial fascia: morphological aspects and spatial disposition. Cells Tissues Organs. 2008; 188(3):320-9. https://doi.org/10.1159/000121433
Stecco A, Gilliar W, Hill R, Fullerton B, Stecco C. The anatomical and functional relation between gluteus maximus and fascia lata. J Bodyw Mov Ther. 2013 Oct;17(4):512-7. https://doi.org/10.1016/j.jbmt.2013.04.004
Stecco C. Functional Atlas of the Human Fascial System. Edinburgh: Churchill Livingstone; 2015.
Sharkey J. Should bone be considered fascia: Proposal for a change in taxonomy of bone-a clinical anatomist’s view. Internat J Biol Pharmac Sci Arch. 2020. http://dx.doi.org/10.30574/ijbpsa.2021.1.1.0001
Tozzi P. Selected fascial aspects of osteopathic practice. J Bodyw Mov Ther. 2012 Oct;16(4):503-19. https://doi.org/10.1016/j.jbmt.2012.02.003
Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with non-specific cervical or lumbar pain. J Bodyw Mov Ther. 2011 Oct;15(4):405-16. https://doi.org/10.1016/j.jbmt.2010.11.003
Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, et al. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med. 2018 Dec;52(23):1497. https://doi.org/10.1136/bjsports-2018-099308
Parravicini G, Bergna A. Biological effects of direct and indirect manipulation of the fascial system. Narrative review. J Bodyw Mov Ther. 2017 Apr;21(2):435-445. https://doi.org/10.1016/j.jbmt.2017.01.005
Chaitow L. New evidence of a dynamic fascial maintenance and self-repair process. J Bodyw Mov Ther. 2016 Oct;20(4):701-703. https://doi.org/10.1016/j.jbmt.2016.08.013
Stecco A, Stern R, Fantoni I, De Caro R, Stecco C. Fascial Disorders: Implications for Treatment. PM R. 2016 Feb;8(2):161-8. https://doi.org/10.1016/j.pmrj.2015.06.006
Iwasaki M, Saito J, Zhao H, Sakamoto A, Hirota K, Ma D. et al. Inflammation Triggered by SARS-CoV-2 and ACE2 Augment Drives Multiple Organ Failure of Severe
Fascia in SARS,COVID-19COVID-19: 2020. Molecular Mechanisms and Implications. Inflammation. 2021 Feb;44(1):13-34. https://doi.org/10.1007/s10753-020-01337-3
Mense S. Innervation of the thoracolumbar fascia. Eur J Transl Myol. 2019 Sep 6;29(3):8297. https://doi.org/10.4081/ejtm.2019.8297
Yahia L, Rhalmi S, Newman N, Isler M. Sensory innervation of human thoracolumbar fascia: An immunohistochemical study. Acta Orthop Scand. 1992 Apr;63(2):195-7. https://doi.org/10.3109/17453679209154822
Fraissé M, Logre E, Mentec H, Cally R, Plantefève G, Contou D. Eosinophilia in critically ill COVID-19 patients: a French monocenter retrospective study. Crit Care. 2020 Nov 3;24(1):635. https://doi.org/10.1186/s13054-020-03361-z
Talaee N, Varahram M, Jamaati H, Salimi A, Attarchi M, Kazempour Dizaji M, et al. Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire. Z Gesundh Wiss. 2022;30(3):531-536. https://doi.org/10.1007/s10389-020-01313-z
Roman M, Chaudhry H, Bukiet B, Stecco A, Findley TW. Mathematical analysis of the flow of hyaluronic acid around fascia during manual therapy motions. J Am Osteopath Assoc. 2013 Aug;113(8):600-10. https://doi.org/10.7556/jaoa.2013.021
Chaudhry H, Bukiet B, Roman M, Stecco A, Findley T. Squeeze film lubrication for non-Newtonian fluids withapplication to manual medicine. Biorheology. 2013;50(3-4):191-202. https://doi.org/10.3233/bir-130631
Gupta RC, Lall R, Srivastava A, Sinha A. Hyaluronic Acid: Molecular Mechanisms and Therapeutic Trajectory. Front Vet Sci. 2019 Jun 25;6:192. https://doi.org/10.3389/fvets.2019.00192
O'Laughlin TJ, Klima RR, Kenney DE. Rehabilitation of eosinophilic fasciitis. A case report. Am J Phys Med Rehabil. 1994 Jul-Aug;73(4):286-92. https://doi.org/10.1097/00002060-199407000-00012
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