Rapid Reduction in Posttraumatic Stress Disorder Symptom Severity after Three Fascial Counterstrain Manual Treatments: A Proof-of-Concept Study

Introduction 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. Materials and Methods 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. Results 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. Conclusion 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. Clinical Trial Registration IRB Registration # IORG0007116.