How structure and function play an important role in Osteopathy in relation to long Covid/Chronic Fatigue

Body Systems And Their FunctionsBody Systems And Their Functions (

In our day-to-day existence, countless essential processes such as cell divisions, information transfers, waste removal, hormone production, and more unfold imperceptibly.

We often overlook the remarkable autonomic capacity that allows these crucial functions to seamlessly take place.

Nevertheless, these processes play a pivotal role in preserving our inherent balance (homeostasis), enabling us to effortlessly engage in our daily activities without pondering the intricate mechanisms sustaining our optimal well-being.

It is not until the “wheels fall off” and our health becomes sub-optimal that we begin to question and search for answers as to why.

As osteopaths, we are taught that structure (body framework) governs function. What does this really mean and how deeply does this hold true?

Over the past two years, a significant number of individuals have observed or personally undergone a decline in health because of succumbing to a Covid infection. Symptoms like those endured during an acute infection and also unrelated to virus infection, remained long after the infection subsided, resulting in the diagnosis of Long Covid.

Initially this baffled medical science, however a great deal of research has and is still being undertaken to unravel some of the mystery. Many of the symptoms are not dissimilar to the symptoms that present in chronic fatigue syndrome.

As an osteopath, this made me begin to think and search for answers to why this occurred. Initially it was simply out of curiosity and then I was treating patients with prolonged symptoms and realized there was perhaps a small component of the issues being of mechanical origin. This thought of structure governing function was always close to my thoughts in this search.

Many researchers have uncovered numerous causes. Mermaid central medical clinic’s, Dr Grahm Exelby, is a specialist GP who has undertaken a great deal of research to unravel the causations involved with these conditions. Please read his research on his website for more comprehensive papers written on these topics. Home | MCMC Research (

Through navigating these papers and others, one of the numerous possible hypotheses is the glymphatic system involvement. This has been thought to be implicated in some of the symptoms related to conditions like long covid and potentially chronic fatigue. The main symptoms related to this can be brain fog, pain sensitivity and fatigue.

The glymphatic system functions as the brain’s waste disposal centre, akin to the body’s lymphatic system.

It has only recently been discovered(2013), however, the osteopathic forefathers often spoke of such a system.

The glymphatic pathway in neurological disorders - The Lancet NeurologyThe glymphatic pathway in neurological disorders – The Lancet Neurology

Sometimes I tell patients I am working on the “plumbing “of their body. To elaborate on this, like a hose, for the water to get from one end to the other to water the plants, it cannot have any kinks. If it does, you won’t get flow and eventually you will also get back up of pressure.

Endocrine and Lymphatic System ( and Lymphatic System ( and Lymphatic System ( and Lymphatic System (

As it leaves the cranium, the glymphatics join to the deep cervical lymphatic chain and this passes though the base of the skull where it joins the neck and then passes, near the spine under the musculature of the anterior and lateral neck.

Anterior and lateral neckSo lymph and for that matter, venous drainage have a couple of obstructions regions as these drain into the vital structures around your collar bone, this area is called the thoracic outlet.


Lymphatics – crfw872 (

The venous blood and lymphatic fluid must pass then into the thoracic duct and the subclavian vein at the thoracic outlet.

So you can see from these illustrations how the structure governs function can come into play here.

If there are certain findings within the upper neck spine, restrictions withing the fascia and musculature and mobility of the clavicles and ribs at the thoracic outlet, the flow of these vital structures can be implicated and potentially cause back flow issues that can result in symptoms such as brain fog and headaches.

The osteopathic management approach is only a component of medical management of these conditions, however more evidence is being discussed in relation to these structures impacting functions that occur day to day autonomously.

As osteopaths, we conduct patient screenings to exclude worrisome pathologies, and frequently collaborate with GPs in the comprehensive management of individuals with chronic pain. If referral for investigations are required to evaluate the extent of the presentation, this would be undertaken first before osteopathic treatment commences.

Osteopathy has a spectrum of treatment approaches. For these types of presentations our experienced practitioners utilise specific, delicate treatment approaches to alleviate structural issues within these regions to optimise function.

The search will continue to understand the how and why of these debilitating, chronic conditions.

It is always a collaborative approach that works best as it can target the various components that contribute to what is often a “perfect storm” scenario that presents as these chronic complaints.

Other factors like poor posture, poor ergonomics and incorrect breathing patterns may also contribute to the structure impacting function. Wherever there is ongoing mild compression on vessels and nerves , symptoms will prevail. We believe it is imperative that these habits/ patterns are also addressed to provide the best outcomes. As such exercise, postural/breathing  guidelines are an integral part of the management.

Article by Dr Deborah Calleja

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