Can the Perrin Technique Help ME/CFS Symptoms? Understanding the Treatment and Research

Finding an approach to managing ME/CFS symptoms can be difficult. Symptoms can vary considerably from one person to another, and what someone is able to manage one week may be very different from what they can manage the next.

The Perrin Technique is a specialised osteopathic approach developed by Dr Raymond Perrin in 1989. It combines osteopathic assessment with gentle hands-on techniques and, where appropriate, self-massage and self-management techniques.

I have been working with the Perrin Technique in London for more than 19 years. During that time, I have worked directly with Dr Raymond Perrin for over a decade, assisted with practitioner training and contributed to the second edition of his textbook. I have also worked with more than 5,000 patients and received two Excellence in Practice Awards from Dr Perrin.

Over that time, I have seen a huge variety of people with ME/CFS and, perhaps more importantly, just how differently the condition can present. That experience has shaped the way I approach treatment today. The technique itself is important, but understanding the person in front of you and knowing how to adapt the approach is equally important.

In this article, I'll explain what the Perrin Technique involves, what happens during an assessment, how I approach treatment and what someone considering the technique can realistically expect.

My Experience With the Perrin Technique

My experience with the Perrin Technique goes back more than 19 years. During that time I have had the opportunity to work closely with Dr Raymond Perrin for more than ten years, assist with practitioner training and contribute to the second edition of his textbook.

I've also treated more than 5,000 patients and received two Excellence in Practice Awards from Dr Perrin.

Those years have given me the opportunity to see many different presentations of ME/CFS. Some people I have worked with have still been able to work or maintain a relatively active lifestyle, while others have had very limited energy and struggled with everyday activities.

That variation is one of the reasons I don't think of the Perrin Technique as simply a set of techniques that are applied in exactly the same way to every patient. Knowing the techniques is important, but knowing when and how to use them is something that develops through experience.

What Exactly Is the Perrin Technique?

The Perrin Technique is a specialised osteopathic approach developed by Dr Raymond Perrin. It incorporates osteopathic assessment, assessment of posture and movement, gentle hands-on techniques and, where appropriate, self-massage and self-management.

The approach is based on Dr Perrin's theory involving the autonomic nervous system and neuro-lymphatic drainage. In practical terms, however, my work with patients involves much more than simply following a prescribed sequence.

People with ME/CFS can have very different levels of symptoms, physical tolerance and available energy. Someone may tolerate a particular technique very well, while another person may find the same approach too much.

That means treatment needs to be adapted. Pressure, the techniques used, the length of an appointment, changes of position and the amount of physical input can all be adjusted depending on the individual.

This is why I put so much emphasis on assessment and clinical judgement. The technique provides the framework, but the person determines how that framework is applied.

Why Individualised Treatment Matters

One of the biggest things I've learned from working with people with ME/CFS is that there really isn't a typical patient.

Someone may be able to work part-time but have very little energy left at the end of the day. Another person may struggle with basic activities such as preparing food, showering or having a conversation. Someone else might appear relatively well during an appointment but experience a significant increase in symptoms later that day or over the following days.

All of this matters when deciding how to approach treatment.

I don't believe that having the same diagnosis means everyone should receive exactly the same treatment. Instead, I look at what the individual is currently able to tolerate and adapt the approach accordingly.

Sometimes that means using fewer techniques, reducing pressure or allowing more time between different parts of a session. There are also occasions when doing less is the more appropriate option.

The aim is not to make every patient fit the treatment. The treatment needs to be adapted to the patient.

What I Look At Before Treatment

The first appointment isn't simply about deciding which Perrin techniques to use. Before treatment begins, I want to understand the person, their symptoms and what is happening in their everyday life.

This includes their medical history, existing diagnoses, current medical care, medications where relevant, sleep, activity levels, daily routine and, importantly, how they respond to physical and mental exertion.

I'll also assess posture, movement and the musculoskeletal system.

One of the things I pay particular attention to is what happens after activity. Someone may tell me that they can manage a particular activity, but if they then need several days to recover, that tells me something important about their current level of tolerance.

If there are symptoms that haven't been medically investigated, or something falls outside my area of practice, I may recommend speaking with a GP or another appropriate healthcare professional. Osteopathy shouldn't be seen as a replacement for appropriate medical care.

Understanding Post-Exertional Malaise

Post-exertional malaise, or PEM, is an important consideration when working with people with ME/CFS.

One of the difficulties is that the effect of activity isn't always immediate. Someone may manage an activity reasonably well at the time and then experience a noticeable increase in symptoms later that day or over the following days.

That means I don't just want to know how someone feels while they are in the treatment room. I also want to understand what happens afterwards.

This can make treatment quite different from the way people might imagine a conventional hands-on appointment. More treatment isn't necessarily better treatment, and pushing someone beyond what they can comfortably tolerate isn't the aim.

Sometimes a very gentle session followed by enough time to see how the person responds gives us much more useful information than trying to achieve too much in one appointment.

This is also why pacing and energy management are important considerations alongside treatment.

What Does Perrin Technique Treatment Look Like?

Treatment starts with assessment. I'll first look at the person's history, symptoms and physical presentation before considering whether the Perrin approach is appropriate.

If it is appropriate, treatment is generally introduced gradually. The hands-on techniques are gentle and can be adapted depending on how someone presents and what they are able to tolerate.

There isn't a fixed treatment programme that I expect every patient to follow. Some people may need more time between appointments, while others may tolerate a different frequency. The important thing is how the individual responds.

I also don't think it is helpful to promise a particular number of sessions or a particular outcome. ME/CFS can fluctuate, and people's circumstances are different.

Instead, I prefer to look at how someone is responding over time and use that information to guide the next stage of treatment.

What Can Progress Look Like?

Progress isn't always as obvious as people might expect.

For some people, the first change they notice might be improved sleep. For somebody else it could be being able to concentrate for longer, manage a conversation more easily or complete an everyday task that previously felt difficult.

Another person might notice that they recover differently after activity or that certain symptoms aren't escalating in the same way.

These changes can be quite subtle, particularly at the beginning. That's why I tend to look at the bigger picture rather than focusing on whether somebody simply says they feel "better".

What can they do now that they couldn't do previously? How are they recovering from activity? Has their sleep changed? Are everyday tasks becoming easier to manage?

Looking at those patterns over time can give a much better understanding of how somebody is progressing than concentrating on one particularly good or bad day.

I Don't Treat Every Patient in the Same Way

When I first began working with the Perrin Technique, naturally a lot of my attention was on learning the techniques themselves. With experience, my focus has increasingly moved towards the judgement behind them.

When should a particular technique be used? How much pressure is appropriate? How long should a session be? Does someone need more treatment that day, or would they be better with less?

Those decisions come from listening, observing and understanding how someone has responded previously.

For example, if someone is particularly sensitive to physical input, the treatment may need to be significantly lighter. That might mean fewer techniques, less pressure, longer pauses or fewer changes of position.

For someone with greater physical tolerance, the session may look quite different.

That doesn't mean one person is receiving "better" treatment than another. It means the approach is being adapted to the person sitting in front of me.

What Happens After the Initial Assessment?

Once the assessment is complete, I'll explain what I've found and whether I feel the Perrin approach is appropriate.

If it is, treatment can then be introduced gradually. The response between appointments is an important part of deciding what happens next.

This is particularly relevant with ME/CFS because symptoms can fluctuate. Someone can have a better period followed by a setback, and one difficult day doesn't necessarily tell us that everything has gone backwards.

Equally, I don't want to automatically assume that every change is related to treatment.

Looking at the overall pattern over time is much more useful than trying to draw conclusions from one appointment.

What If Someone Feels Worse After Treatment?

This is something patients understandably ask about.

Some people can experience a temporary increase in symptoms following treatment. If that happens, I think it is important to look at the situation rather than automatically assuming that feeling worse is a sign that treatment is working.

Was the treatment too much? Had the person already been having a difficult period? Had they done more activity than usual? Was there something else happening at the same time?

These are all questions worth considering.

I would never want a patient to feel that they need to tolerate a significant deterioration in order to make progress. If someone isn't responding well to an approach, that needs to be taken seriously and the treatment reconsidered.

Where Does Pacing Fit In?

Pacing and personalised energy management are important considerations for people with ME/CFS.

It isn't simply about continually increasing activity or pushing through symptoms. Instead, it involves understanding an individual's available energy and recognising that this can change over time.

That fits closely with the way I approach treatment. If someone's available energy is limited, repeatedly pushing beyond that limit may make managing their symptoms more difficult.

Sometimes the appropriate decision is to do less, allow more recovery time and work from someone's current level rather than where they would ideally like to be.

What Does the Research Say About the Perrin Technique?

There is research relating specifically to the Perrin approach, as well as wider research into areas that overlap with some of the theory behind it.

Research has explored areas including the autonomic nervous system, lymphatic systems and glymphatic function. These are interesting areas of research, but it is important to distinguish between research into these systems and research that has directly tested the Perrin Technique itself.

The research into its possible role remains at a preliminary stage.

Having worked with thousands of people, I've seen how different individual presentations can be. Good research should help us understand those differences rather than assuming that one approach will produce the same outcome for everyone.

What Nearly Two Decades of Experience Have Changed About My Approach

My approach today is more individualised than it was earlier in my career.

The more people you work with, the more you appreciate that experience isn't simply about accumulating years. It's about seeing different presentations, recognising patterns, listening carefully and learning when to adapt your approach.

Working directly with Dr Raymond Perrin, assisting with practitioner training and contributing to his textbook have all been important parts of my experience with the technique.

But working with thousands of individual patients has probably taught me the most.

Every person brings a different combination of symptoms, circumstances, limitations and goals. That's why I don't believe treatment should start with a predetermined plan and simply work down a checklist.

It should start with the person.

Why Experience Matters

There is a difference between knowing a technique and knowing how to apply it to different people.

People with ME/CFS can have very different levels of sensitivity, physical tolerance and available energy. The same treatment approach may therefore be appropriate for one person and completely inappropriate for another.

After more than 19 years working with the Perrin Technique, I place a great deal of importance on assessment, observation and listening.

My experience with Dr Raymond Perrin and the technique has given me the framework. Working with thousands of patients has taught me how much that framework may need to be adapted.

Who Might Consider the Perrin Technique?

The Perrin Technique is an approach that some people with ME/CFS may wish to explore as part of their wider management.

An individual assessment is important before beginning treatment, particularly where someone has complex symptoms or other medical conditions.

It's also important to have realistic expectations. There isn't a guaranteed number of sessions and there isn't a guaranteed outcome.

The approach needs to be considered alongside the person's symptoms, tolerance and wider healthcare.

For anyone considering the Perrin Technique, I think the starting point should be understanding what the approach involves, what treatment is actually like and what we currently know about it.

My Approach to the Perrin Technique Today

After more than 19 years working with the Perrin Technique, I still come back to the same basic principle: start with the individual.

The technique provides a framework, but it isn't a one-size-fits-all treatment plan. Experience helps determine how that framework is used, and the person's response helps determine what happens next.

My aim is to combine my experience of the Perrin Technique with careful assessment, individualised treatment and appropriate collaboration with other healthcare professionals.

I don't think people with ME/CFS need exaggerated promises. They need to feel listened to, understand what is being proposed and have a clear idea of what treatment involves.

For me, that's an important part of good clinical care.

Final Thoughts

There is no single experience of ME/CFS, and there isn't one approach that will be appropriate for everybody.

I've worked with the Perrin Technique for more than 19 years and have treated more than 5,000 patients. I've also had the opportunity to work directly with Dr Raymond Perrin, assist with practitioner training and contribute to his textbook.

Those experiences have taught me that knowing the techniques is only part of the picture. Understanding the person, listening to how they are responding and knowing when to adapt the approach are just as important.

The Perrin Technique provides the framework. Experience helps determine how that framework is used, and the person in front of me determines where we start.

Written and medically reviewed by Rakhee Mediratta 21st September 2026 Registered Osteopath (General Osteopathic Council reg. 6576) · BSc (Hons) Osteopathic Medicine, BCOM · Advanced Licensed Perrin Technique Practitioner, awarded twice for excellence by Dr Raymond Perrin · 19 years' experience, 5,000+ patients.