How Lymphatic Drainage May Help Long Covid Sufferers

by Abby Stewart, LMT, MLD/C

Long covid syndrome shares many striking similarities with chronic fatigue syndrome (myalgic encephalitis), including fatigue, unrestful sleep, post-exertional malaise, brain fog, headache, and nonspecific pain. In fact, up to 75% of chronic fatigue syndrome (CFS) cases can be traced back to a viral infection. More research is focusing on the link between these 2 conditions in hopes to find treatments and possibly cures. In the last few years, it has been shown that CFS is a biological illness and not a psychological condition.

A study published in 2015 entitled “Distinct plasma immune signatures in ME/CFS are present early in the course of illness” showed that among those with short-duration illness (<3 years) of chronic fatigue syndrome,  there was a distinct immune signature: prominent activation of pro-inflammatory and anti-inflammatory cytokines. Cytokines are small proteins released that aid cell communication in immune responses and stimulate movement of cells toward areas of inflammation, injury, and infection. You may be familiar with the term “cytokine storm” which refers to a severe immune reaction when the body releases too many cytokines into the blood very quickly, essentially an overly-strong immune response. Though cytokines are a necessary component of the immune response, they cause many of the symptoms such as fever, runny nose, achiness, etc in response to a pathogen. In this 2015 study mentioned above, there was a stronger correlation between cytokine numbers and illness duration rather than illness intensity.

The biological implications of CFS and presumably, long covid syndrome, should be more strongly considered in treatments, in lieu of or in addition to common suggestions from medical practitioners such as antidepressants, pain medications, counseling, etc.  

Another prominent similarity between CFS and long covid is hypothesized by Peter Wostyn, MD, Psychiatrist from Belgium, in his paper “COVID-19 and chronic fatigue syndrome: Is the worst yet to come?” He states that the mechanisms involved in post-viral syndrome occurring after covid-19 infections are similar to those in CFS and fibromyalgia. Furthermore, severe cases of long covid mimic idiopathic cranial hypertension (IIH) symptomatology. IIH occurs when there’s increased pressure inside the skull due to a build-up of too much cerebrospinal fluid around the brain from an unknown cause, leading to symptoms such as: headache, vision problems, tinnitus, fatigue, nausea, dizziness, neck pain, depression, and brain fog. There’s quite an overlap of symptoms between IIH, CFS, fibromyalgia, and long covid. Dr. Wostyn hypothesizes there is a common mechanism in these syndromes: congestion of the glymphatic system and toxic build-up around the central nervous system. Thus the treatment would be to restore proper glymphatic transport and waste removal from the brain. 

The glymphatic system was discovered in 2013 by Danish neuroscientist Dr. Maiken Nedergaard, and is a network of vessels that clear waste, including potentially neurotoxic proteins, from the central nervous system (CNS), mostly taking place during sleep. This network functions similarly to the peripheral lymphatic system, with its main role being to clear excess fluid and metabolic waste and having no central pump. The peripheral lymphatic system it is named after brings waste products from bodily tissues and organs, in addition to bacteria, viruses, and excess fluid, back to the bloodstream to be filtered by the kidneys and eliminated from the body. The lymph system also is a highway for white blood cells and is a major part of our immune system. The glymphatic system got its name due to its similarity with the lymphatic system’s function and its reliance on glial cells, which are in the CNS and do not produce electrical impulses. These glial cells maintain homeostasis, form myelin in the peripheral nervous system, and support/protect neurons.

The CNS is highly metabolically active and lacks typical lymphatic vessels, but does connect to the lymphatic system to eventually remove waste. A 2017 study entitled “Outflow of cerebrospinal fluid is predominantly through lymphatic vessels and is reduced in aged mice” researchers demonstrated that lymphatic vessels are major exit pathways for cerebrospinal fluid in the brains of mice (previously it was thought that the venous system was). This has major implications in utilizing lymphatic therapies in central nervous system pathologies. 

Furthermore, the study “Human and nonhuman primate meninges harbor lymphatic vessels that can be visualized noninvasively by MRI” (2017) by researchers from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, National Cancer Institute, National Institutes of Health, & University of Virginia, demonstrated the existence of lymphatic vessels within the dura mater of primates. The dura mater is the outer layer of dense connective tissue that surrounds the brain and spinal cord. The glymphatic system drains large molecules and toxins via cerebrospinal fluid into these lymphatic vessels lining the brain. This emphasizes another puzzle piece as to how the waste exits the brain via the lymphatic system.

Going back to Dr. Peter Wostyn’s hypothesis that increased intracranial pressure and subsequent toxic waste build-up in the brain contributes to or causes various syndromes including long covid and CFS, he explains that drainage of cerebrospinal fluid (CSF) to the cervical lymph nodes occurs through the cribriform plate at the bottom of the skull. This happens to be where the olfactory nerves pass, and it supports the olfactory bulb in the brain, all responsible for our sense of smell. This fluid then enters the nasal cavity which is very vascular and has a lymphatic network that drains this fluid into the deep cervical lymph nodes. In those covid-19 sufferers with a loss of smell, there may be an increased rate of olfactory nerve death and waste build-up in the area of the cribriform plate, further leading to decreased drainage of fluid from the brain. Conversely, if there is increased pressure on the olfactory nerves in this area due to fluid build-up, it may impair their function. 

Based on current research, we are led to believe that therapies such as lymphatic drainage and craniosacral therapy may be helpful in easing symptoms from long covid syndrome, chronic fatigue syndrome, and fibromyalgia, though further research is needed to substantiate this claim. 

comment by "lucybolton"
on Jan 2023