TREATMENT OF LONG-COVID GASTROINTESTINAL SYMPTOMS UTILIZING MANUAL THERAPY TECHNIQUES THAT TARGET BREATHING: A CASE STUDY

J. Lucas¹, G. Johnson¹

¹Institute of Physical Art, Physical Therapy, Steamboat Springs, United States

Background: The COVID-19 pandemic has resulted in over 572 million cases worldwide and 60% will experience Long COVID symptoms. Consequently, clinicians should be ready to treat increasing numbers of Long COVID patients, 50% of whom have gastrointestinal (GI) symptoms. The diaphragm, the primary muscle of respiration, mechanically facilitates digestion. Diaphragmatic dysfunction is an established cause of reflux. However, a correlation between disordered breathing during the COVID-19 illness and subsequent GI symptoms has not been established.

Purpose: The purpose of this study was to describe the evaluation and treatment of a patient with Long COVID GI symptoms and a possible relationship with her respiratory dysfunctions.

Methods: This case involved a 29-year-old female with 23 days of Long COVID GI symptoms that included daily reflux, loss of appetite, sensation of fullness, indigestion, bloating, and burping with positional changes (rolling, sit to stand, walking). Symptom severity prevented her from working as a yoga instructor and dog walker (hiking miles every day). Respiratory objective measures focused on evaluating the following: circumferential measurement of inhalation/exhalation, sniff test, core strength, and breathing with an occluded nostril and tracheal deviation. The patient had five appointments: two for assessing objective measures and three treatments. Manual therapy treatments targeted postural education via the Saliba Postural Classification System, Proprioceptive Neuromuscular Facilitation (PNF) to the diaphragm and left intercostals, and mobilization of the ribs and intranasal structures.

Results: After three treatments, the patient reported full recovery from all GI symptoms. There was an audible increase in airflow during the sniff test, occluded nostril inhalation, and tracheal deviation. Core strength evaluated with the Unilateral Hip Bridge Endurance Test (UHBET), Lumbar Protective Mechanism (LPM) and Cervoprotective Mechanism (CPM) all improved. Her UHBET increased from about 30 seconds to 69 seconds with the right leg and 102 seconds with the left. The LPM and CPM (Anterior to Posterior on the left) both increased from 1+/5 to 4+/5. Outcomes questionnaires indicated decreased fatigue and the GAD-7 decreased by 50%, changing her category from “moderate anxiety” to “mild anxiety”.

Conclusions: The patient reported resolution of all GI symptoms including burping, reflux, indigestion, and fullness. She was able to return to work and resumed hiking regularly. Her breathing, range of motion, strength, digestion, and anxiety all improved. In addition, her right-sided neck pain resolved without direct treatment to the cervical spine. Although a single case study cannot demonstrate causation, the outcomes of the study presented here may indicate a relationship between respiratory dysfunctions in patients with contemporaneous Long COVID GI symptoms.

Implications: As more patients with Long COVID come for physical therapy (PT), there will be a greater need to understand whether digestive symptoms could be related to respiratory changes caused by the virus. Even if patients’ symptoms are not respiratory in nature, changes in breathing mechanics could be a driver for their chief complaint. In light of the case study findings reported here, it is our opinion that respiratory manual PT should be explored as a potential treatment to help patients manage a range of Long COVID symptoms.

Funding acknowledgements: This work was unfunded.

Keywords:
COVID-19
Gastrointestinal
Proprioceptive Neuromuscular Facilitation

Topics:
Orthopaedics
COVID-19
Musculoskeletal

Did this work require ethics approval? No

Reason: This work did not require ethics approval because it was a case study. According to Johns Hopkins, “A case report for IRB purposes is a retrospective analysis of one, two, or three clinical cases.If more than three cases are involved in the analytical activity, the activity will constitute ‘research.’” While research requires IRB approval, a retrospective analysis of one clinical case does not constitute research. Therefore, IRB approval was not necessary for a solitary case study.