Serological assessment of the effect of osteopathic manipulative treatments in conjunction with COVID-19 Booster shots

This randomized controlled trial investigated whether osteopathic manipulative treatment (OMT) incorporating lymphatic pump techniques augments the immune response to COVID-19 mRNA vaccination. The trial enrolled subjects receiving their first Pfizer-BioNTech (BNT162b2) COVID-19 vaccination in 2021 and randomized them to receive OMT at each vaccination or not. The study measured anti-spike protein, anti-nucleocapsid, and neutralizing antibody responses, with primary endpoints focused on time-resolved and cumulative anti-SARS-CoV-2 spike protein antibody titers. Secondary endpoints included frequency, severity, and duration of breakthrough infection symptoms. Of 104 subjects randomized, 91 completed the primary vaccination series.

Baseline antibody titers separated participants into COVID-19-naïve (51) and COVID-19-pre-exposed (40) groups; analyses emphasizing homogenous data focused on the COVID-19-naïve cohort. In COVID-19-naïve participants, the OMT group demonstrated a statistically significant increase in anti-SARS-CoV-2 spike protein antibody titers at three weeks post-vaccination compared with controls (p = 0.038). Cumulative antibody titers were also significantly higher in the OMT group at five weeks (p = 0.046) and at thirteen weeks (p = 0.009). An intention-to-treat analysis across all subjects similarly found significant differences favoring OMT at three weeks (p < 0.001) and in area-under-the-curve (AUC) titers at thirteen weeks (p = 0.035). The pre-exposed cohort did not show significant differences between OMT and control groups. Both study arms experienced ten breakthrough infections; however, OMT-treated subjects reported fewer and less severe symptoms.

Notably, symptom duration was reduced from a mean of eight days in controls to 4.5 days in the OMT group (p = 0.013), and medication use duration was shorter in the OMT group (1.5 days) versus controls (5 days) (p = 0.014). The trial situates its rationale in preclinical and pilot human data suggesting that OMT, particularly lymphatic pump techniques targeting regions such as the thoracic inlet, axilla, thoracic diaphragm, spleen, and thoracic regions, may enhance lymphatic flow and thereby improve immune trafficking and response. By mobilizing lymphatic fluid and addressing myofascial restrictions thought to impede lymphatic function, OMT is hypothesized to act as a complementary therapy that potentiates vaccine-induced antibody production.

The findings reported by Fuchs and colleagues indicate that OMT can accelerate and increase early antibody responses to COVID-19 mRNA vaccination in COVID-19-naïve individuals and may mitigate symptom burden and medication reliance in breakthrough infections. While the pre-exposed group did not show similar benefits, the overall results support further study of OMT as an adjunct to vaccination protocols. The authors recommend additional research to confirm these effects across diverse vaccines and populations and to explore mechanisms by which OMT-related lymphatic modulation influences adaptive immune responses.