For this blog post, we wanted to follow up on a paper shared last month at the IPIC Society 2026 Annual Conference (Long COVID), taking a deeper dive into the content. As always, we also consider the practical implications for recovery that the learning suggests.

When people are dealing with ongoing fatigue, reduced capacity, or a sense that their body just isn’t responding the way it used to, they often look to commonly discussed drivers like inflammation or stress.

These are important, to be sure. But even when steps are taken to address them, something still doesn’t fully resolve. Progress can feel partial or inconsistent. The system doesn’t quite “come back online.”

A recent preprint study led by Lisa Quadt offers a different lens: Likely neurodivergence and variant connective tissue in patients with chronic pain/chronic fatigue: a case-control study. The paper has been submitted for peer review but is not yet published in a journal. That said, it provides useful insight into how complex systems in the body may interact and influence each other more than is often recognized.

The study does not offer a single explanation. But it does add to our understanding of underlying factors contributing to symptoms like chronic pain and fatigue. Importantly, insight into potential drivers helps point toward solutions.

The paper explores the relationship between chronic pain and fatigue, neurodivergent traits (variations in cognitive, sensory, and behavioral patterns - like ADHD, dyslexia, and autism spectrum disorder), and differences in connective tissue. What stands out is not any one factor in isolation, but the way these elements appear to cluster. In the study, individuals with chronic pain or fatigue were significantly more likely to meet screening criteria for traits associated with ADHD or autism. Alongside this, there was a higher prevalence of joint hypermobility, often used as a proxy for differences in connective tissue. It is useful to note that these characteristics can exist along a spectrum, or some people may experience just one without being impacted by others. 

Importantly, the study builds on earlier work suggesting that connective tissue characteristics may help explain part of the relationships shown in the paper. When hypermobility is present, symptoms like pain, fatigue, and dysautonomia appear more likely and, in some cases, more pronounced. This does not mean one causes the other, or that you have to have one condition to experience the other. But it does suggest that how well connective tissue works may be part of the mechanism shaping how these symptoms are experienced.

This is where it becomes useful to look more closely at fascia. Fascia is often described as a structural tissue, but in practice, it plays a much more dynamic role. It forms a continuous network throughout the body, helping to distribute force, support movement, and carry sensory information. It is closely linked to how we coordinate movement and how the brain interprets signals from the body.

When this system is functioning well, movement tends to feel efficient and coordinated. Effort translates more directly into output. There is a sense of clarity in how the body responds. When it is not functioning as well, the experience can shift. Movement can feel less efficient. Effort increases relative to output. Signals between the body and brain may feel less clear or less reliable. Note, it is not that tight is bad and flexible is good, or vice versa, rather it is about effective balance and functioning of this system. 

This offers a different way of understanding a pattern many people recognize. Resting does not offer the repair people need to feel better, and pushing through symptoms often leads to a setback. Progress can feel difficult to achieve, even when doing the “right” things. If connective tissue is part of the picture, this lack of progress with traditional “rehabilitation” methods becomes easier to understand. Fascia is rich in sensory receptors and plays a role in both proprioception and interoception (how external and internal signals are perceived and sent to your brain). If those signals are less precise, the brain has more work to do to interpret and regulate what is happening. Over time, that increased demand can contribute to fatigue, overload, and reduced clarity.

The study also touches on links with neurodivergent traits, like those with ADHD and on the autism spectrum. This is helpful to frame not as a label, but as an indication that some systems may be more sensitive or more reactive. Connective tissue may be one of the underlying structures influencing that sensitivity. Again, not a single explanation, but part of a broader pattern that helps make sense of why experiences can differ between individuals.

The natural question that follows is: what do we do with this information?

If part of the issue driving symptoms sits within connective tissue and how the system coordinates, then improving the function of that system becomes a logical place to include when considering rehab options. This is not a new idea. Practices such as yoga and tai chi have, for a long time, included slow, controlled movements that gently load and lengthen connective tissue while also supporting coordination and regulation. What is beginning to emerge now is a clearer scientific understanding of why those approaches can be so effective.

One way this shows up in the work we do is through “activated stretching”. Rather than passively holding a stretch, activated stretching involves gentle engagement of the muscles to elongate. The intention is to support the tissue in a way that improves its responsiveness and its ability to transmit both force and information. Over time, this can help improve what is often referred to as fascial tone, not in the sense of tightness, but in the sense of balanced, functional tension that allows the system to work more efficiently.

When this begins to shift, the changes tend not to happen in isolation. As the body becomes more coordinated and signals become clearer, people often notice that energy, clarity, and tolerance to activity begin to improve together. The system becomes easier to work with, rather than something that needs to be constantly managed or pushed through.

At ThriveNinety, this is an area we have deliberately included as an element in our programs and PEDAL™ approach [https://www.thriveninety.com/blog/a-deep-dive-into-the-p-e-d-a-l-approach-for-long-covid-symptom-management] - “L” stands for Loosen and is a broad term capturing improving the function and tone of soft and connective tissue, including fascia. The actions are simple, targeted, and can take under a minute to do, but are designed to support connective tissue and system coordination in a way that is practical and repeatable. That approach was based on earlier research and observed outcomes. It is encouraging to now see emerging evidence that helps explain why it works with even greater detail and a focus on how it may link with the body’s systems.

There is still more to learn in this space. This research is early, and it does not provide all the answers. But it does offer a useful piece of the puzzle. It suggests that for many people, symptoms may not be about a single issue to fix, but about how well the system is functioning as a whole. And if connective tissue plays a role in that system, then working to improve its function may offer a meaningful and accessible way to support more consistent progress.

Warmly,
Katie & Andrea

Source: Likely neurodivergence and variant connective tissue in patients with chronic pain/chronic fatigue: a case-control study

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