Why These Ligaments Matter in Treating Long COVID

As a holistic occupational therapist who uses modalities of craniosacral and visceral therapy—and someone who personally has been navigating long COVID for 4 years with breathing difficulties, I deeply appreciate the complexities of long covid symptoms and systemic inflammation. A critical piece in treatment I have discovered in both my healing journey and in treating others is the role of treating the often overlooked thoracic ligaments related to the pericardium.

Long COVID often brings with it systemic inflammation and deep restrictions throughout the thorax. This can manifest as impaired breathing, reduced rib cage mobility, limited chest expansion, diaphragm dysfunction, autonomic nervous system dysregulation, and persistent chest, neck, and back pain. From my own personal experience and from working on others using gentle manual therapy to release the pericardial ligaments, I’ve seen results in better breathing, improved nervous system regulation, more normalized heart rate, and decreased chest pain.

Through gentle manual therapy, I’ve focused on releasing the pericardial ligaments—structures that are rarely discussed in this context—and have seen meaningful changes. Clients (and myself) have reported improvements in breathing capacity, reduced chest pain, more balanced nervous system function, and a steadier heart rate.

Let’s break it down:

• Superior and inferior sterno-pericardial ligaments: Releasing these can free both the sternum and the pericardium, the latter of which is often inflamed in Long COVID cases. This helps restore thoracic mobility, decreases chest pain, and reduces tension around the heart.

• Vertebro-pericardial attachments (to the thoracic vertebrae and C7): Easing these may help reduce mechanical pull on the heart and spine, easing discomfort and improving posture and nerve communication.

• Phreno-pericardial ligament: This critical structure links the diaphragm to the heart. Releasing it helps improve diaphragm function, supports fuller breath, and gives the heart space to move freely.

  
  

Why is this important? 

I presume that the benefits from releasing these structures is not only more availability to expand the chest and breathe, but also the heart is able to regain its motility—it’s inherent twisting and contracting and releasing movements so it can pump blood more efficiently. Additionally, with less restriction in the pericardium, the major blood vessels (aorta, pulmonary artery and veins, vena cavae) and even the critical phrenic and vagus nerves may experience more freedom.

Of course, I don’t just focus on ligaments. Treatment includes the pleura, surrounding muscles, ribs, and nerves. But working with these often-neglected pericardial attachments has added a powerful dimension to my practice—and to my personal healing.

This work reminds me that even the most subtle structures can have a profound impact on recovery. And in conditions as complex as Long COVID, those subtle structures are often where the key to healing lies.

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Picture Source: Gray, Henry, Gray’s Anatomy: Descriptive and Applied (Philadelphia: Lea and Febiger, 1913, pg. 549