Treatment of Post-COVID and Chronic Fatigue Syndrome with a Proprioception Based Treatment, 2025, Betker

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Treatment of Post-COVID and Chronic Fatigue Syndrome with a Proprioception Based Treatment

Betker JA1,2 *, Peters K3, Hinterberger T1 and Loew T1,3

1Department for Psychosomatic Medicine, University Hospital Regensburg, Germany

2Department for Trauma Surgery, University Hospital Regensburg, Germany

3Department of Psychosomatic Medicine and Psychotherapy, Caritas-Krankenhaus Donaustauf, Germany

*Corresponding author: Betker JA, Department for Psychosomatic Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Germany Email: Johann.Betker@klinik.uni-regensburg.de

Received: November 19, 2025 Accepted: December 10, 2025 Published: December 15, 2025

Abstract

Introduction:

Post-COVID (PCS) syndrome manifests with profound fatigue, cognitive impairment, pain, myalgias, dizziness, shortness of breath and depression. Therapeutic options remain limited and the condition is often considered refractory.

Case Series:

We describe nine patients with severe PCS and chronic fatigue syndrome (CFS) treated with a structured, multimodal inpatient program emphasizing sophisticated pacing for a median treatment duration of 116 days. The program is based on psychosomatic treatment principles, particularly those applied in conditions affecting body image, and has been specifically adapted by incorporating pacing to address profound fatigue. Daily activity was titrated to individual tolerance, beginning with brief exertion followed by rest and gradually increasing. Medical management was individualized and included supplementation, antidepressants, antipsychotics, and in selected cases nicotine patches or low-dose naloxone. Clinically meaningful improvements were observed across nearly all domains of Health-49 and ICD-10-based symptom rating (ISR). The largest gains occurred in somatoform complaints, with median scores decreasing from 2.50 to 1.43 in Health-49 and from 1.06 to 0.55 in ISR. Additional improvements were noted in activity, self-efficacy, and anxiety. Four patients remained wheelchair-dependent at discharge.

Discussion:

The constellation of symptoms including chronic pain, myalgias, dizziness, and sensory hypersensitivity suggests that proprioceptive dysfunction may contribute to PCS and CFS. The selective improvement in somatoform domains following a psychosomatic, body-oriented intervention provides preliminary support for this hypothesis. Although limited by sample size, these findings indicate that post-COVID chronic fatigue syndrome may not be inherently untreatable and highlight somatosensory processing as a potential target for novel therapeutic strategies.

Keywords Post-COVID; Chronic fatigue syndrome; Proprioception; Body image; Quality of Life
 
The program is based on psychosomatic treatment principles, particularly those applied in conditions affecting body image, and has been specifically adapted by incorporating pacing to address profound fatigue. Daily activity was titrated to individual tolerance, beginning with brief exertion followed by rest and gradually increasing.
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Where by "pacing" they mean "graded exercise therapy" or at least "pacing up".

The therapeutic philosophy emphasized systematic reduction of physiological and psychological strain through radical pacing. The structure of care was individualized and precisely aligned with each patient’s functional limitations, which were carefully assessed at admission.

This approach parallels the multimodal treatment programs previously developed in our institution for patients with psychosomatic disorders and disturbances of body image. The regimen integrates psychotherapeutic interventions, cognitive training, and physician-supervised biofeedback therapy.
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Given that the cardinal clinical features comprised a profound reduction in physical capacity, manifesting as debilitating fatigue, and diminished cognitive performance, often termed “brain fog,” in conjunction with pronounced post-exertional malaise, initial activity intervals were deliberately reduced to the lactate inflection point: three minutes of exertion followed by twenty minutes of rest. Over a typical fourteen-hour therapeutic day, this regimen yielded approximately thirty-seven short training sessions encompassing activities of daily living, such as personal hygiene, as well as light physical or cognitive exercises. The intensity of exertion was increased incrementally in 10% steps, contingent upon individual tolerance and clinical stability.
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