COVID-19 Treatment:  An Osteopathic Manipulative Treatment Approach

Mary Goldman, DO
April, 2020

Osteopathic Manipulative Treatment (OMT) was the only effective treatment known to physicians during the most virulent influenza, H1N1 Spanish flu pandemic of 1918.  Like this pandemic, COVID-19 causes Cytokine storm.  Research regarding the effectiveness of OMT in treatment of COVID-19 is underway.  REMEMBER YOUR Protective Equipment!  Until further information is available, the below approaches may be of value:

  1.  START BY CALMING THE PATIENT, HAVING THEM LET GO OF THEIR EXHALATION SO THAT IT INCREASES PARASYMPATHETIC FUNCTION.  A longer exhalation than inhalation phase will result.  If they are overwhelmed by emotion, a babbling brook music may help them reconnect with nature, or use other gentle rhythmic music.  Avoid pursing lips and blowing out the air.
    Why:  Osteopaths focus on cause: “a growing body of experimental data suggest that the host response to infection rather than direct viral injury of respiratory cells primarily accounts for the clinical and pathologic changes observed during respiratory viral infections.”(1)  Cytokine storm, has an abnormally fast heart rate, fever, and a drop in blood pressure, all symptoms of Autonomic Nervous System response.  OMT is effective in treating ANS dysregulation.  An OA release while relaxing your own breathing is a good invitation to the patient to relax.
  2. CONTINUE TO MONITOR AND SUPPORT THE PATIENT WHO HAS “RECOVERED FROM” SEVERE COVID-19.  Coronavirus SARS-CoV and MERS-CoV more frequently reach the terminal airways, so more likely to lose lung elasticity due to organization of inflammatory processes during the resolution phase, putting host at risk for superinfection. (2) 
  3. EARLY TREATMENT.  Remember that COVID-19 generally starts as a URI.  Periauricular drainage and lymphatic drainage of anterior cervical lymphatic nodes/vessels may be helpful.  Open the thorax and ribs.  Rest & fluids. (3)
  4. TREAT THE ABDOMINAL DIAPHRAGM AND OMENTUM LYMPHATICS(4).  Rib raising, treatment of the sympathetic ganglia in the epigastric region (celiac & mesenteric), and diaphragm release(3)  Remember that pelvic diaphragm restriction can affect the abdominal diaphragm tension, the tension on the shoulders (transmits to thoracic duct dysfunction) and the ANS regulation through its affect on the sacral motion.  Also, pelvic dysfunction can link to shoulder immobility (see next tip).
  5. MAKE SURE THE TRACTIONED ABDUCTED ARMS PULL ON THE SAME THORACIC VERTEBRAL LEVEL.  If not, the cervical plexus and the thoracic ducts have impaired function!
  6. DO NOT FATIGUE YOUR PATIENT.  The assessment of the patient vitality is essential to treating, because the patient who exerts energy guarding against your treatment may actually be harmed.  Sick hospital patients need limited but more frequent treatments.  Particularly in rib raising and thoracic spine treatments, the amount of force should be very minimal, backing off whenever you sense that the patient is tightening their tissues.  Patience!  Remember that aggressive pedal pumps and other lymphatic drainage techniques may overwhelm the very sick patient.  Also remember internal organs may be damaged by the immune system reaction to COVID-19 and be gentle with them.
  7. DEATH IS NOT FAILURE, BUT A NORMAL PART OF THE LIFE CYCLE.  The osteopathic focus is on life, not death, and when your patient is dying, your gift to them is respect and support.  Impending death does not signal your failure, but rather an opportunity to help your patient find peace.  In order to properly care for your patients, you need your rest and your connection to nature.

References:

  1.  Newton, AH, Cardani, A, Braciale,TJ.  2016.  The host immune response in respiratory virus infection:  balancing virus clearance and immunopathology.  Semin Immunopathol. 38(4):  471-482.  Published online 2016 Mar 10.doi:  10.1007/s00281-016-0558-0.    p.1
  2. Ibid, last page immediately before conclusion section.
  3. Still, AT.  1902.  The Philosophy and Mechanical Principles of Osteopathy.  Hudson-Kimberly Publishing Co., Kansas City, MO.  p. 118.
  4. King Channell, M., Mason, DC.  The 5-Minute Osteopathic Manipulative Medicine Consult, 2nd Ed. (multiple techniques—see index).