A silhouetted image of the human body with organ systems highlighted is used to illustrate the concept of long COVID, an illness that often affects various body systems.

Learn how noninvasive vagal nerve stimulation may be combined with CranioSacral Therapy and Manual Lymph Drainage to effect relief for long-haul COVID-19 clients.

COVID-19 is a contagious disease resulting in widespread lung inflammation, inflammatory cytokine storms, and severe imbalances within the autonomic nervous system. In reading the literature, it becomes clear that COVID-19’s high related mortality rate is primarily due to the cytokine inflammatory responses, called a sympathetic storm, that can quickly spread through the bloodstream to cause multi-organ failure.

At the time of this article, worldwide COVID-19 infections have reached over 770 million, with over 100 million in the U.S. While most infected individuals recover, a significant proportion experience symptoms and complications long after their acute illness. It is reported that up to 41% of COVID-19 patients experience symptoms and complications after their acute illness, a condition referred to as post-acute COVID-19 or, more colloquially, as long COVID.

Long-COVID patients report prolonged systemic neurological and cognitive comorbidity symptomology and significant disabilities long after the infection. By seven months, many of those with long-COVID have not yet recovered and continue to experience a wide range of physical and mental or psychological symptoms that can diminish quality of life.

Long-haul symptoms can include:

  • Fatigue
  • Brain fog
  • Depression or anxiety
  • Shortness of breath
  • Chest pain
  • Insomnia
  • Higher blood pressure
  • Gastrointestinal problems and IBS

The Role of the Vagus Nerve

The vagus nerve may contribute to some of the symptoms of long-haul COVID, according to new research. The vagus nerve is the primary nerve of the parasympathetic nervous system, and it mediates and modulates the immune response to inflammatory processes in the body.

The vagus nerve has two branches, the dorsal right and the ventral left. They are the brakes of our body, countering stress activation to bring homeostasis back into our lives. Statistically, 90% of humans will expire due to a stress-related disease, so the health of the left and right vagus nerves is vital to both our health and longevity.

New research reports that the COVID-19 virus attacks the vagus nerve, contributing to long-haul COVID, according to infectious disease specialist Gemma Lladós, MD, lead researcher at University Hospital Germans Trias I Pujol in Barcelona, Spain.

This study and other papers report how most people experiencing long COVID had a range of significant structural and functional alterations in their vagus nerve, suggesting vagus nerve dysfunction as a central cause of long-haul COVID.

This hypothesis helps to explain the long list of post-COVID symptoms, including fatigue, anxiety, joint pain, cough, digestive problems, dizziness, tachycardia (abnormally high heart rate) and chest pain, all of which are linked to stress activation and lowered vagal tone.

Therefore, one approach to successful long-haul COVID patient recovery appears to be enhancing the vagus nerve through sympathetic stress reduction.

Noninvasive Vagal Stimulation

One modality that targets the vagus nerve is noninvasive vagal stimulation, which is the application of tiny electro-currents to the ear lobe or tragus targeting the auricular branch of the vagus nerve, known as the endogenous systemic brakes of the body. Vagus nerve activation reduces pro-inflammatory cytokines, stimulates immunity and improves respiratory dysfunction. Noninvasive vagal stimulation is reported to alleviate many conditions, including epilepsy, depression, pain and stroke rehabilitation

Noninvasive vagal stimulation is widely reported to increase vagal tone and improve respiratory-pulmonary functioning. Early evidence suggests that noninvasive vagal stimulation could help alleviate symptoms related to the long-haul COVID. In a report written by the independent Canadian Journal of Health Technologies titled “Vagus Nerve Stimulation for the Treatment of Post-COVID-19 Condition,” noninvasive auricular vagus nerve stimulation was recognized as a potential treatment for long-haul COVID.

The Dolphin Neurostim vagal nerve stimulator is the first medical device authorized by Health Canada, a federal institution that engages in health policy, testing, and drug and product approvals, to provide an effective treatment for long-haul COVID. [Editor’s note: The author of this article is co-owner and head of research and development for MPS therapy and Dolphin Neurostim.]

According to its “List of Medical Devices for Expanded Use in Relation to COVID-19,” Health Canada states:

“Dolphin Neurostim (NS) applied as a vagal nerve stimulator (VNS) is authorized for emergency use in the acute treatment of adult patients with known or suspected COVID-19. Intended for those: who are experiencing exacerbation of longhaul symptoms and/or asthma-related dyspnea and reduced airflow and for whom approved drug therapies are not tolerated or provide insufficient symptom relief as assessed by their health care provider. Using noninvasive VNS applied to the auricular branch of the vagus nerve (ABVN) during the COVID-19 pandemic can help with symptom relief.”

People who have long COVID say that noninvasive vagal stimulation helps alleviate many symptoms related to long-term effects of COVID-19, and report that manual techniques integrated with vagal stim is an effective approach for successful alleviation of long-haul symptoms. Further, bodywork practitioners are utilizing the Dolphin Neurostim vagal nerve stimulator in routine (not emergency) sessions with clients who present with long-haul COVID.

Bodywork Complements Vagal Stimulation

Not all types of massage therapy techniques activate vagal tone, as manual pressure applied during treatment influences the stress response.

One of our primal defense mechanisms is sensory touch, which is part of our sympathetic nervous system (SNS). All skin pressure activates sympathetic stress. SNS stress triggers the hypothalamus-pituitary-adrenal axis, causing in the fight-flight-freeze stress response the production of such local pro-inflammatory factors as cortisol and critical hormones, called catecholamines, which can direct immune cells from the bloodstream into the skin or stimulate pro-inflammatory skin cells.9

Massage therapy is a tension-based therapy applying finger pressure to the skin, so it is no surprise that it is not supported by research to activate vagal tone or help clients recover from long-haul COVID. However, two specialized manual techniques are synergistic when applied with noninvasive vagal nerve stimulation. These subtle therapies—CranioSacral Therapy and manual lymph drainage—are highly sensitive to stress activation (vasoconstriction) and stress de-activation (vasodilation).

Integration of CST and Vagal Stimulation

CranioSacral Therapy (CST) was developed by John E. Upledger, DO (1932-2012). He described the craniosacral system as “a membrane system that surrounds the brain and spinal cord, the central nervous system and the dura mater membrane that houses the cerebrospinal fluid.” CST achieves health benefits with tiny manipulations of the cranium and sacral regions, which affect the pressure and circulation of cerebrospinal fluid. Upledger recognized that all bodily systems rely on the brain and spinal cord, as life needs to keep this environment healthy and free from interference.

“By integrating vagal stimulation with CST, practitioners aim to activate the parasympathetic nervous system to enhance the flow of cerebralspinal fluid before performing CST,” said Lisa Upledger, DC, the ex-wife and a student of John E. Upledger, and founder of the Upledger Center for Integrative Therapy (which is not affiliated with John E. Upledger’s Upledger Institute International).

When a body has held restrictions or contracture for a long time, she added, it can take many sessions for the layers of fascial release to eventually re-program into the nervous system and for it to download into a more parasympathetic mode and remain there, and, she said, the Dolphin Neurostim vagal nerve stimulator is unique in its ability to free up tissues and allow for increased fluid flow.

“Using vagal stimulation during CST gives the body the needed input and retraining in real time, speeds the treatment, healing and recovery, and locks in the effects more rapidly, making it a tremendous asset during CST treatment,” Lisa Upledger said. “Vagal stim aids in resetting the body’s nervous systems and allows for a more powerful CST session. This innovative new approach enhances the flow of cerebrospinal fluid (CSF) while performing C.” The two together are mutually beneficial and deliver enhanced positive outcomes, especially for individuals who suffer from chronic pain, anxiety, neurological disorders and other health conditions,” Lisa Upledger added.

Integration of MLD and Vagal Stimulation

The integration of vagal stim work with manual lymph drainage (MLD) is another highly synergistic combination that holds great promise in the field of long-haul COVID recovery.

Noninvasive vagal stimulation de-activates stress and anxiety, reducing muscle tone and enhancing lymphatic movement. When paired with MLD, which utilizes gentle massage techniques to promote lymphatic drainage and circulation, clients can experience significant improvements in lymph flow and overall lymphatic health. Improved lymphatic health is theorized to be an essential step in recovery from long-haul COVID.

“When I learned about Dolphin Neurostim vagal nerve stimulaton MPS, I was impressed with how it significantly improves the healing potential and the overall outcomes when integrated with MLD, said Elisa DiFalco, founder of MLD Institute International.

“Manual therapy improves the mobility of lymphatic fluid, and when that fluid becomes solidified or is blocked by stress, the effectiveness of MLD techniques is compromised,” she added. “I find that [Dolphin Neurostim vagal nerve stimulaton] is an essential tool for promoting the movement of lymph, and I highly recommend it to my students, so much so, that Dolphin Neurostim training is part of our master certification at the MLD Institute International.”

Practitioner Laine Miller, PTA, LMT, also uses noninvasive vagal nerve stimulation in sessions. “I typically start a lymphatic therapy session with vagal nerve therapy to help my clients decrease the sympathetic activation in the body and increase the activation of the parasympathetic nervous system,” she said. “I find that the two modalities produce a powerhouse combo that has been life-changing for many of my clients.”

As people continue to suffer from the effects of long-haul COVID, researchers are exploring causes of the syndrome and treatment options. One promising avenue is the integration of noninvasive vagal nerve stimulation with subtle bodywork therapies.

Studies have shown that stimulating the vagal nerve can help to de-activate stress and enhance lymph and cerebral spinal fluid flow, leading to improved overall health outcomes when combined with MLD and CST. This approach could be particularly beneficial for people experiencing long COVID who require a multi-pronged approach to overcome the vast range of physical and psychological symptoms they continue to experience.

It is evident that vagal nerve stimulation holds great promise in the field of manual health care and recovery from long-haul COVID.

About the Author

Bruce Fashong, D.Ac, MDMA, Prof. IntMed., is the co-developer of Microcurrent Point Stimulation (MPS) Therapy, an innovative, autonomic nervous system-based approach to chronic stress and pain management. He has co-authored several Neuro-Acupuncture books, including “Acupuncture for Healing” (2012), and “Functional Acupuncture for Pain Management” (2013) and has published several peer-reviewed studies. He  resides in the city of Toronto, Ontario, Canada.