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76 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 2 Dysautonomia and Long COVID More Unpacking of the Long Haul By Ruth Werner Dysautonomia: its name is a little confusing. It sounds like someone is having trouble (dys) with naming (nomia) their car (auto). Of course, that's not it: Dysautonomia is an umbrella term for a variety of things that can go wrong with the autonomic nervous system (ANS). Dysautonomia turns out to be a common factor in long COVID, which is the focus of the feature article in this issue of Massage & Bodywork ("Unpacking the Long Haul," page 35). It is a complicated and frustrating situation that can be a freestanding disorder or part of a bigger pathological picture. It has some specific ramifications for clinical decisions with massage therapy. And because long COVID is common, the chances are excellent that clients with this kind of ANS dysregulation will be asking us for help. In a previous issue of Massage & Bodywork magazine, I published a Pathology Perspectives column ("The Lowdown on Lightheadedness," January/February 2020, page 36) on postural orthopedic tachycardia syndrome (POTS), which is a common type of dysautonomia. To do that, I compiled some background information on autonomic nervous system function and dysfunction that will be useful in this context as well. Following is a small excerpt from that article. AUTONOMIC NERVOUS SYSTEM REVIEW Because dysautonomia involves problems with autonomic function, it will be useful to review a few things about the autonomic nervous system. Readers will remember that the ANS helps us maintain physiological homeostasis: a stable internal state, even amid changing external environments. It does this through neurons, but ANS processes are also carried out and prolonged by some hormone secretions. to any specific problem or pathology. Instead, it describes results of various disruptions in normal autonomic function. WHO GETS DYSAUTONOMIA? Dysautonomia is surprisingly common. Before COVID-19, some form of chronic dysautonomia affected between 1 and 3 million people in this country. Those numbers are likely to climb, as many of those with long COVID are likely to develop dysautonomia symptoms. DYSAUTONOMIA PATHOPHYSIOLOGY: WHAT HAPPENS? As mentioned at the outset, the autonomic nervous system is the network of nerves that helps us maintain a stable internal environment, especially in setting our blood pressure, heart rate, temperature, respiratory rate, digestive function, and many other processes. Dysautonomia Structurally, the ANS operates under the control of the hypothalamus and uses motor neurons to do its work. Some of these neurons emerge from the brain and pass into the body, packaged within cranial nerves. And some of them emerge from the spinal cord, encased in the bundles that make up spinal nerves. Functionally, the ANS provides motor signals to muscles and glands that allow us to respond to our environment, and this happens below levels of conscious thought or voluntary action. Autonomic neurons help regulate heart rate, respiratory rate, blood pressure, peristalsis and digestive secretions, and a myriad of other processes that keep us alive. These motor signals are discussed as sympathetic ("fight or flight") and parasympathetic ("rest and digest") responses. WHAT IS DYSAUTONOMIA? Dysautonomia occurs when a problem in ANS neurons affects the ways we respond to the environment. This can manifest as suppressed or exaggerated reactions in sympathetic or parasympathetic responses, such as a racing heartbeat, a slowdown in digestive motility, an inability to sweat, sweating too much, or a number of other symptoms. In this way, the term dysautonomia doesn't apply essential skills | PATHOLOGY PERSPECTIVES

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