Osteopathy Boosts Immunity – Helping Protect Against COVID-19 - A more technical overview

In 1919, following the Spanish Influenza pandemic a review of over 110,000 patients with confirmed cases was conducted. Patients who received treatment including Osteopathic Manual Medicine “OMM” had a survival rate forty times greater than those receiving standard medical care.[i] Like our current situation in 2020 with COVID-19, back in 1918 there was no cure, no antiviral medications or vaccines to prevent the disease.[ii] So what is the next “best-move” in staying healthy? How can osteopathy help prevent infection? This question is all the more important as the best means of stopping the disease to date, shelter-in-place and stay at home orders[iii] are lifted or curtailed and the economy begins to reopen.

Osteopathy is a medical science which acknowledges the patient’s own body has the necessary means and ability to help prevent and fight off infectious diseases such as COVID-19. Osteopathic Manual Medicine, OMM, involves a trained physician placing their hands on the body utilizing precise techniques that change the organization and anatomy to improve function of the patient’s immune, lymphatic, vascular and nervous systems. Research, detailed below, shows specifically how the immune system can be boosted, providing a possible explanation for the dramatic results achieved by osteopaths in 1918-1919 and the relevance osteopathy can play today in boosting immunity in the current pandemic.

Understanding how this particular coronavirus (there are tens of thousands of coronaviruses in our environment) attacks the body will help to understand how boosting immune, vascular, lymphatic and physical function can prevent onset and expedite recovery. Like all coronaviruses, COVID-19 is a string of RNA, short for ribonucleic acid, placed in a glycoprotein – a fancy term for a sugar envelope.

Like all viruses, it is not active until it enters a host cell in the body. To enter the host, the virus travels via respiratory droplets exhaled by an infected person and inhaled by a healthy individual (the new potential host). Facial masks worn over both the nose and mouth have been shown to be effective at reducing this mode of transmission.

A second common means of transmission involves a respiratory droplet of an infected person depositing virus on a surface. The virus is transmitted to a new host when they contact the surface with the virus and then touch their nose, mouth or eyes. Hand washing is highly effective in reducing this means of transmission. The immune system is under continuous assault, not only from COVID-19 but thousands of viruses and bacteria inhabiting our world. The immune system is busy keeping us safe from over 300,000 potential bacterial, viral and fungal pathogens out there.

Once inside a host, the RNA makes copies of itself, a process called replication. Any cells having ACE-2 receptors, the virus’ gateway into individual host cells are susceptible. Cells which have ACE-2 receptors include the lungs, the most common site of infection, but also the GI tract, liver, kidney and brain[iv], where infection has also been observed.

The body’s first defense against any virus, including COVID-19 are Natural Killer “NK” cells and antiviral T Cells. These are produced in two organs in the body, the spleen and the thymus. Antiviral T cells and antibodies are crucial for clearing the virus and preventing recurrence.[v] The effectiveness of the body’s own immune response determines how much the virus replicates and the viral load the host must overcome to clear the infection. Blood samples taken before and after OMM of the spleen have shown increased output of white blood cells such as leukocytes, NK cells, cells programmed to destroy foreign invaders and increased antibody output all after osteopathic manipulation.[vi] [vii] [viii]

To activate Natural Killer and other T and B cells the body produces a series of chemicals called cytokines. The specific cytokine that activates the NK cells is called interferon. COVID-19 deactivates interferon thereby making it harder for the body to know it is under attack. If the NK cells don’t knock the virus out the body mounts a second immune response of B and T cells and these in turn produce more cytokines. The release of these cytokine chemicals signals the need for a further larger immune response. Ironically, an undesirable consequence of this cytokine release (it can be a “cytokine storm”) are the common side effects associated with infection onset, fever, chills, headache, fatigue, cough, new onset of loss of taste and smell.

The lymphatic system and vasculature are key in first alerting the body it has been infected by an antigen, a foreign invader, such as COVID-19 and that an immune response is required. Optimizing lymphatic and vascular function expedites the early warning and subsequently helps the body better clear the cytokines causing symptoms.

The lymphatic system has no intrinsic pumping mechanism, unlike the vasculature which has the heart. Lymphatic pumping is almost solely dependent on the contraction of muscles. Of these, the respiratory diaphragm, a large domed muscle in the center of our bodies is the central piston in the middle of the torso. Diaphragmatic motion occurs with every inhalation and exhalation pumping the extensive lymph system. The size of this domed muscle is huge with attachments to the lower six ribs all around, the base of the sternum in front and the lumbar spine in back. With every breath in, the muscle of the diaphragm contracts moving downward causing lung space to expand -- exhalation results in opposite motion. OMM gets the diaphragm and associated structures moving helping all immune systems, but especially the lymphatics, to function better. The MOPSE study of over 500 patients infected with pneumonia, utilized OMM to improve diaphragmatic motion resulting in reducing hospital stays by 20% as compared to standard antibiotic therapy alone.

Study of lymphatic pumping done as part of OMM shows a 30% increase in lymph flow as measured in test subjects in real time. Almost the entire lymphatic system drains through the connective tissue around the shoulders and upper torso. Mobilizing these structures is one likely reason osteopaths had such success in decreasing death rates in patients treated with OMM during the 1918-19 pandemic.

Stress has a major impact on the biochemical immune system of the body.[ix] Reducing stress can boost immunity.[x] When we experience stress whether it be physical or emotional, the body goes into sympathetic innervation. This is commonly referred to as “fight or flight.” The result is a release of cortisol by our adrenal glands. Increased cortisol levels shut down the immune system. As an aside, steroids drugs that mimic cortisol are given to patients to tamp down immune responses like inflammation. People in fight or flight suffer worse from viral infections, take longer to heal, respond more poorly to vaccinations[xi] [xii] and have decreased immune responses. Conversely increased parasympathetic response in the body helps lower cortisol levels improving immune system activation and function. OMM commonly rebalances the two halves of this “autonomic” nervous system[xiii] [xiv]which along with boosting immune function helps with a host of other health issues such as chronic inflammation, GI complaints and chronic pain issues.

Modern research shows osteopathy can improve immune function and helps prevent COVID-19 by improving:

· Lymphatic system function – The lymph:

o sounds the first alarm of infection

o helps deliver critical immune response

o removes metabolic waste

· Circulation – increased blood flow through arteries and veins to and from sites of infection:

o reduces chemical cytokines that produce symptoms

o reduces the severity of infection

o reduces the amount of virus the body must clear if infected

· Function of major structures such as:

o The respiratory diaphragm – the central piston of the body affecting

multiple systems

o The thoracic inlet where all lymphatics drain

o The neck where improved lymph and blood flow better fight

infections such as COVID-19 where they first enter and start, in the

nose mouth and eyes

· Immune system organs such as the spleen which produce critical white

blood cells in fighting infections such as Natural Killer, T and B cells

· Balancing the nervous system reduces stress decreasing cortisol levels

which suppresses immune response - Decreasing cortisol through OMM

boosts immune response

Andrew Taylor Still, MD the founder of osteopathy stated “we strike at the source of life and death when we go to the lymphatics.” “No space is so small that it is out of connection with the lymphatics.” “The goal of an osteopathic treatment is to effect a more efficient interchange between all the fluids of the body and across all their tissue interfaces.[xv]” This is how osteopathy optimizes the body’s inherent immune responses in preventing and fighting infection whether from Covid-19 or endless other sources. Osteopathy works well with naturopathic medicine and integrative medicine to help support all systems of the body in boosting immune response and function.

Dr. Walter Cohen is an osteopathic physician specializing in osteopathic manual medicine in San Diego, CA. To learn more visit his website at www.findinghealth.info. He can be reached at his office at 858-58

References and Footnotes:

[i]Smith RK. One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment. 1919. J. Am Ost­eopath Assoc. 2000 May; 100(5):320-3.

[ii] Wang, H.; Wang, S.; Yu, K. COVID-19 infection epidemic: The medical management strategies in Heilongjiang Province, China. Crit. Care 2020, 24, 107.

[iii]Perlman S, Netland J. Coronaviruses post-SARS: update on replication and pathogenesis. Nat. Rev. Microbiol. 2009 Jun;7(6):439-50

[iv] Perlman S, Netland J. Coronaviruses post-SARS: update on replication and pathogenesis. Nat. Rev. Microbiol. 2009 Jun;7(6):439-50­­­­

[v] Bergmann CC, Lane TE, Stohlman SA. Coronavirus infection of the central nervous system: host–virus stand-off. Nature Rev. Microbiol. 2006;4:121–132. doi: 10.1038/nrmicro1343

[vi] Whiting CA. 1916 Yearbook of the Academy of Applied Osteopathy. Carmel, CA: Academy of Applied Osteopathy; 1955. Investigations of the phagocytic index [rep­rint] pp. 107–109.

[vii] Castilio Y, Ferris-Swift L. 1932 Yearbook of the Academy of Applied Osteopathy. Carmel, CA: Academy of Applied Osteopathy; 1955. Effects of splenic stimulation in normal individuals on the actual and differential blood cell count, and the opsonic index [reprint] pp. 111–120.

[viii] Ferris-Swift L. The effects of indirect splenic treatment in normal individuals. JAOA. 1936;35:225–229.

[ix] Selye, H., A syndrome produced by diversive nocuous agents, Nature 138 1936

[x] Davis, Daniel, The Beautiful Cure The revolution in Immunology and What It Means for your Health. University of Chicago Press. 2018 p.115

[xi] Ironson, G. et al. Posttraumatic stress symptoms, intrusive thoughts, loss and Immune function after hurricane Andrew, Psychosomatic Medicine59, 128-41. 1997

[xii] Davis, Daniel, The Beautiful Cure The revolution in Immunology and What It Means for your Health. University of Chicago Press. 2018 p.122

[xiii] Fornari M, Carnevali L, Sgoifo A. Single Osteopathic Manipulative Therapy Session Dampens Acute Autonomic and Neuroendocrine Responses to Mental Stress in Healthy Male Participants. J Am Osteopath Assoc. 2017 Sep 1;117(9):559-567. doi: 10.7556/jaoa.2017.110.

[xiv] Rechberger V, Biberschick M, Porthun J. Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature. Eur J Med Res. 2019;24(1):36. Published 2019 Oct 25. doi:10.1186/s40001-019-0394-5

[15] Still, AT. Philosophy and Mechanical Principles of Osteopathy. Kansas City, MO The Journal Printing Company 1910