Rapid Reduction in Posttraumatic Stress Disorder Symptom Severity after Three Fascial Counterstrain Manual...

Posttraumatic stress disorder (PTSD) is associated with hyperactivity of the sympathetic nervous system (SNS) and elevated levels of central and peripheral pro-inflammatory biomarkers. Fascial Counterstrain (FCS) is a manual therapy technique purported to reduce inflammation and neuroexcitation by decreasing the concentration of pro-inflammatory mediators in the interstitial tissues. We hypothesized that a short course of FCS treatment that specifically targets the interstitium surrounding the SNS will result in a decrease in the severity of PTSD symptoms.

Twenty-four consenting volunteers with a baseline Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score ≥ 11 were randomized to either an FCS treatment group (n = 13) or waitlist control group (n = 11) after obtaining informed consent as approved by Solutions IRB. Changes in PTSD symptom severity were assessed after three 1.5-hour FCS treatments in 11 subjects in the treatment group and compared to 11 waitlist controls using a piecewise linear mixed-effects regression model. Changes in self-reported depression, anxiety, somatic symptoms, life satisfaction, and subjective measure of overall improvement were also assessed.

Three 1.5-hour FCS treatments administered over an average duration of 19.5 days [95% CI (15.2-23.8)] resulted in a significantly greater reduction in PTSD symptom severity in the FCS treatment group compared to the waitlist control group [CAPS-5 scores: 18.7-point decrease, 95% CI (8.7-28.7) vs. 1.3-point decrease, 95% CI (0.7-1.9); main effect for FCS treatment: P < .001; FCS group vs. control group comparison: P = .0017]. Compared to waitlist controls, the FCS treatment group also had statistically significant decreases in self-reported depression, anxiety, and somatic symptoms in addition to increases in self-reported overall improvement and life satisfaction.

This proof-of-concept study is the first to demonstrate that a short course of FCS manual therapy targeting the SNS resulted in a rapid and statistically significant reduction in clinician-rated PTSD symptom severity, as well as patient-reported depression, anxiety, and somatic symptoms. Large, randomized studies in PTSD should compare the effectiveness of FCS manual therapy to evidence-based psychotherapies or pharmacotherapies to evaluate its potential as a rapid, cost-effective, and scalable public health intervention.

IRB Registration # IORG0007116.