From this vantage point, three years into the pandemic that appears to mark our era, some things are becoming clear: COVID-19 is not over yet, we are getting better at living with it though, and long-covid is the gift that keeps on giving. It is currently estimated that between 10 and 30% of those who suffer from COVID-19 will have long-running symptoms. These symptoms could be mild up to “severe and protracted” and weeks, if not months.  Furthermore, it’s not just the respiratory or joint pain elements of COVID-19 that have been known to carry on. Fatigue and cognitive impairment are frequent items on a laundry list of potential long-covid symptoms.
It’s clear that we have a way to go in terms of developing effective and efficient ways of dealing with this phenomenon. Thus, a big question that needs answering is this: what role, if any, does chiropractic play in care for people with long-covid?
So far, case report data has emerged, as have commentaries on what role chiropractic care might play. [2, 3] As is to be expected this close to the initial outbreak (given the speed at which research advances), the evidence has a long way to go. That’s what makes a recent paper published in the Journal of Contemporary Chiropractic so interesting. Here, a practice-based exploratory study examining procedures for caring for patients with long-COVID was put to the test in a small sample group, and their responses to care were measured over 8-12 weeks.
It is exploratory, and it is only a small group of 7 participants. However, it provided encouraging initial results. But more on that later.
First, let’s talk about the study.
While 30 people were initially interested in taking part, exclusion criteria was applied and only seven were found to be eligible. Of these, five were female, two were male and their average age was 46. The purpose of the study was to see how they would respond to a medium-length course of care (8-12 weeks of care, once-twice weekly, where the Axial Stability Method of chiropractic care was used. They were managed through an ordinary chiropractic practice.
As part of the study, each participant completed pre and post-testing including the Oswestry Disability Index for low back pain, the Headache Disability Index, or the Neck Disability index. They all had a physical exam, and they all completed self-reported surveys including the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (the FACIT), the RAND36 ( a quality of life survey), A Multidimensional Fatigue Symptom Inventory and study-specific covid-related surveys. In addition to this, a battery of physiologic recordings were taken, including pulse oximetry, finger-based blood pressure, spirometry, Fukudas and normal chiropractic tests.
This was all used to establish a baseline and to compare findings at the beginning and end of the study.
While the full case report (available for download at the open-access journal below – 1) holds all the details of the chiropractic protocol initiated, broadly speaking, it included care for stabilization of the “triad of equilibrium” using Activator methods to the Occiput, first cervical vertebra and spinal segments impacting the visual and vestibular systems as well as Sacro-iliac joint care using SOT wedges, before whole body adjusting using Activator Methods. Other elements included in the protocol took into consideration “an acupressure protocol and Viscero-Somatic Reflex Patterns protocol theorised to rebalance the autonomic nervous system.” 
While there were some practitioner-disclosed issues with spirometry, the FACIT test showed emphatic results. At the beginning, the participants averaged a 76% score on the FACIT test, meaning they were “more fatigued than 76% of the US population.” By the end of the study, this number had dropped to 25%. The other fatigue survey (MFSI) showed similar trends in fatigue. Other measures included in the study, such as heart rate variability, thermography (heat maps), balance tests and quality of life surveys all returned improvements as well. (The full case report includes all the analysis of these)
While sample size means that further research is required before we can make large claims regarding chiropractic care and long-covid, or indeed this particular protocol and long-covid. But still, it is information that trends in an encouraging direction.
Caring for the nervous systems of those who are recovering from a significant bout of this virus may just be a worthwhile cause indeed.
- Knutson. L, Sullivan. S., Langenegger. F., Massa, J., Drake, E., Hayes K., and Herbert (2023). Prototyping a long-covid study within a practice-based setting, testing procedural steps, outcome measures and patient response to care. Journal. Contemp. Chiropr. 2023; 6
- Blum, C. COVID-19 and the role of chiropractic in the healthcare aren’t with non-pharmaceutical prevention, early treatment and care for those with long COVID Syndromes: Part Three – Long COVID. Asia-Pac Chiropr.J. 2021;2.5
- Masarsky CS. Todres-Masarsky M. Long haul COVID-19 and Subluxation: a case report. Asia Pac-Chiropr.J. 2022;2.6.
- Masarsky CS. Todres-Masarsky M. Long COVID Hyposmia/Parosmia and Subluxation: a case report. Asia Pac-Chiropr.J. 2022;3.2.