CFS/ME and The Perrin Technique: A Personalised Approach to Chronic Fatigue Relief in London

Living with CFS/ME (Chronic Fatigue Syndrome / Myalgic Encephalomyelitis) can affect almost every part of daily life. Fatigue, unrefreshing sleep, brain fog and post-exertional malaise can make ordinary activities feel disproportionately difficult.

For some people, even a shower, journey to an appointment or conversation can use a significant amount of their available energy. For others, they may continue working while having very little capacity left for anything else.

This is one of the reasons that Chronic Fatigue Relief in London needs to be approached on an individual basis. Two people with the same diagnosis can have very different symptoms, severity and physical capacity.

At Rakhee Osteopathy, Rakhee Mediratta uses the Perrin Technique London, a specialist osteopathic approach developed by Dr Raymond Perrin, as part of an individualised approach for people with CFS/ME and related persistent post-viral symptoms.

“Careful listening is just as important as physical examination.”— Rakhee Mediratta

After more than 19 years of clinical practice and treating more than 5,000 patients, Rakhee considers the patient's complete history, symptoms, physical findings, capacity and response to treatment when developing a treatment plan.

Importantly, The Perrin Technique is a complementary osteopathic approach. It does not replace medical diagnosis, investigation or treatment, and not everyone will respond in the same way.

What is CFS/ME?

CFS/ME is a complex, chronic medical condition that can affect multiple body systems. NICE notes that it affects everyone differently, with symptoms and their severity capable of changing over a day, week or longer.

The main symptoms include debilitating fatigue, post-exertional malaise, unrefreshing sleep or sleep disturbance, and cognitive difficulties such as brain fog. NICE recommends that people with suspected ME/CFS receive appropriate medical assessment and investigations to exclude other possible conditions.

Other symptoms can include:

• Muscle and joint pain

• Headaches

• Difficulty concentrating

• Flu-like symptoms

• Dizziness or nausea

• Sensitivity to light, sound, touch or smell

• Problems with sleep

• Difficulty recovering after physical or cognitive activity

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The severity of CFS/ME can vary considerably. Someone may be able to work but spend most of their remaining energy recovering, while another person may be housebound or bedbound.

As Rakhee explains:

“A person's visible level of activity does not always show the true severity of their condition.”

This distinction is important when assessing someone with CFS/ME. It is not simply about what a person can do; it is also about how much effort an activity requires, what symptoms it produces afterwards and how long recovery takes.

Why post-exertional malaise matters

One of the defining challenges of CFS/ME is post-exertional malaise (PEM), where symptoms worsen following physical, cognitive, emotional or social activity.

According to NICE, PEM can be delayed by hours or days, may be disproportionate to the activity that triggered it, and can involve a prolonged recovery period.

This means that a person may appear to tolerate an activity at the time but experience a significant increase in symptoms afterwards.

For this reason, treatment and self-care need to take the patient's available energy and recovery time into account. NICE advises people with suspected ME/CFS not to use more energy than they perceive they have and not to simply “push through” their symptoms.

“Progress is not achieved by pushing through symptoms or relying on only one piece of the jigsaw.”— Rakhee Mediratta

What is The Perrin Technique?

The Perrin Technique is a specialised osteopathic approach developed by Dr Raymond Perrin.

The approach is based on Dr Perrin's model involving the relationship between the musculoskeletal system, the autonomic nervous system and neuro-lymphatic drainage. His published work has proposed a theoretical model involving cerebrospinal fluid and lymphatic drainage and describes a manual treatment protocol for people with chronic fatigue syndrome.

One of the key publications relating specifically to this model is Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome, published in 2007. The research supplied for this article also includes earlier work evaluating osteopathic treatment for symptoms associated with myalgic encephalomyelitis.

Further research has explored the proposed neuro-lymphatic pathways. The 2013 publication Neurolymphatic Pathways: New Scientific Evidence Corroborating the Perrin Technique examined evidence relating to the neuro-lymphatic model.

These publications provide background to the Perrin model, but they should not be interpreted as establishing The Perrin Technique as a proven cure for ME/CFS.

How is the Perrin Technique thought to work?

Within the Perrin model, treatment focuses on areas including:

• The thoracic spine and ribcage

• The upper and lower back

• The diaphragm

• The chest and upper-chest lymphatic tissues

• The neck and head

• Relevant lymphatic pathways

• Cranial and soft-tissue structures

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The techniques are intended to support spinal and rib mechanics and encourage fluid movement and lymphatic drainage, according to the Perrin model.

Treatment is not simply a standard massage or a single lymphatic-drainage procedure. Rakhee describes The Perrin Technique as a structured approach incorporating a detailed history, physical examination, clinical scoring, hands-on treatment, home care and regular reassessment.

The wider research into ME/CFS, autonomic function and lymphatic systems

The Perrin Technique sits within a wider and still developing area of research into ME/CFS.

For example, research has investigated autonomic nervous system function in people with ME/CFS. The research supplied for this article includes the 2019 publication Evidence of Altered Cardiac Autonomic Regulation in ME/CFS.

The scientific understanding of the brain's lymphatic and glymphatic systems has also developed considerably. The research provided for this article includes studies on meningeal lymphatic vessels, glymphatic function and their possible relationship with ME/CFS. More recent publications include Glymphatic-System Dysregulation as a Possible Contributor to ME/CFS (2025) and Disrupted Glymphatic Function in ME/CFS Assessed Using DTI-ALPS MRI (2026).

This research is relevant to understanding the biological mechanisms being investigated in ME/CFS, but it is important to distinguish research into these mechanisms from clinical evidence showing that The Perrin Technique itself treats or reverses them.

How Rakhee assesses CFS/ME severity

A key part of Rakhee's approach is understanding the individual rather than applying exactly the same treatment to everyone.

Following the history and physical examination, Rakhee calculates a Perrin-Juhl score. This considers symptoms, the impact on quality of life and daily function, how long the person has been unwell, relevant comorbidities and physical examination findings.

The score runs from 1 to 10, with 10 representing the best level of health. It is used as an aid to treatment planning and monitoring, but does not replace an appropriate medical diagnosis.

The Perrin approach has also been investigated in relation to physical assessment. The 2017 paper Can Physical Assessment Techniques Aid Diagnosis in People With CFS/ME? explored whether physical assessment findings could help distinguish people with CFS/ME.

This is particularly relevant to Rakhee's clinical approach because assessment is an important part of determining how much treatment an individual may tolerate.

How treatment is adapted to the individual

One of the central principles of Rakhee's approach is that The Perrin Technique should not be delivered as a rigid, one-size-fits-all protocol.

“The Perrin Technique has a defined clinical framework, but it should never be applied as an identical, one-size-fits-all treatment.”— Rakhee Mediratta

For someone who is severely affected or highly sensitive, treatment may begin with:

• Much lighter pressure

• Fewer techniques

• Shorter hands-on treatment

• Longer pauses

• Fewer changes of position

• A reduced home programme

• More recovery time

• Wider intervals between appointments where necessary

For someone with greater physical capacity, a broader selection of techniques may be appropriate, while still controlling the intensity, duration, sequence and amount of home care.

Even someone who continues to work full-time should not automatically receive more intensive treatment. Their available energy may already be largely consumed by work, commuting, childcare or other responsibilities.

What happens during your first Perrin appointment?

The initial consultation at Rakhee Osteopathy lasts up to 90 minutes and focuses on understanding the patient's history and completing a thorough assessment. Perrin treatment normally begins at the second appointment.

Before attending, patients may find it helpful to bring:

• A current list of medication and supplements

• Relevant medical reports or consultant letters

• A timeline of when symptoms began

• Information about what happens following physical or mental activity

• Details of the everyday activities they would most like to regain

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The physical assessment may consider posture, the spine, ribcage, neck, head, abdomen and relevant upper-chest tissues.

Every part of the examination is explained beforehand, with consent obtained throughout. Patients can pause or decline any part of the examination.

How often will you need treatment?

There is no single treatment schedule that is suitable for every patient.

Many patients initially begin with weekly appointments during the first 12 weeks. This provides continuity for monitoring the response, adapting treatment and establishing an appropriate home programme.

At the 12-week review, treatment frequency may be adjusted according to the patient's progress. Someone who is becoming more stable may gradually move from weekly to fortnightly appointments and then longer intervals, while someone with more severe or longstanding symptoms may need weekly treatment for longer.

The 12-week period should therefore be viewed as an assessment and review period, not a guarantee of improvement.

Can symptoms temporarily feel worse after treatment?

Some patients report a temporary increase in familiar symptoms during the early stages of treatment. This can include tiredness, aching, headache, nausea or an increase in existing symptoms.

Within Rakhee's clinical framework, the response to treatment is monitored carefully. A strong reaction is not the aim, and worsening is not considered necessary for improvement.

If a reaction is stronger than expected, treatment can be adapted by reducing pressure, using fewer techniques, shortening the session, changing the treatment position or allowing more recovery time.

New, prolonged or concerning symptoms should not automatically be attributed to treatment and should be medically assessed where appropriate.

What changes might patients notice?

Every person's experience is different, and no particular outcome can be guaranteed.

Rather than looking for one dramatic change, Rakhee monitors patterns over time. Early changes may include:

• Improved recovery after everyday activity

• Less intense or shorter periods of post-exertional malaise

• Clearer thinking and concentration

• More stable energy

• Reduced aches and discomfort

• More restorative sleep

• Fewer or less intense headaches

• Everyday tasks feeling slightly easier

• Improved tolerance of sensory input

• Greater participation in family, social or everyday activities

Rakhee emphasises that progress is rarely completely linear. A patient's overall pattern across several weeks is more informative than a single particularly good or difficult day.

“The aim is to provide the most appropriate amount of treatment for that individual and support progress that is manageable and sustainable.”— Rakhee Mediratta

Pacing and energy management

For people living with CFS/ME, understanding personal energy limits is an important part of managing symptoms.

NICE recommends personalised energy management and advises people with ME/CFS not to simply push through symptoms. It also advises against generalised exercise programmes and fixed incremental increases in physical activity because these can worsen symptoms.

At Rakhee Osteopathy, treatment planning may therefore incorporate pacing, rest, relaxation, breathing exercises and an individually prescribed home programme alongside hands-on treatment.

The important point is that activity recommendations should be individualised rather than based on a generic exercise programme.

Can The Perrin Technique be used alongside medical care?

Yes. The Perrin Technique is intended as a complementary osteopathic approach and does not replace appropriate medical care.

Patients should continue with their GP, consultant, prescribed medication and recommended investigations unless their healthcare professional advises otherwise.

This is particularly important because CFS/ME symptoms can overlap with other medical conditions. NICE recommends appropriate medical assessment and investigations to exclude other possible diagnoses before ME/CFS is confirmed.

The NICE Guideline NG206: ME/CFS Diagnosis and Management provides detailed guidance on diagnosis, personalised care, symptom management and energy management.

Patients can also find independent information about ME/CFS through the NHS ME/CFS information.

Is The Perrin Technique suitable for everyone?

No. Suitability needs to be assessed individually.

The initial consultation provides an opportunity to identify symptoms or medical circumstances that may require further investigation or medical clearance before treatment begins. According to Rakhee's clinical guidance, treatment would normally be postponed during an acute fever or active infection, while active cancer requires specific medical or oncology clearance.

The pressure, number of techniques, treatment position and duration can also be adapted for people who are particularly sensitive or experiencing a flare.

A personalised approach to Chronic Fatigue Relief in London

There is no single CFS/ME experience and, consequently, there should not be a single treatment plan applied to everyone.

Rakhee's approach is based on understanding the whole picture: the person's symptoms, history, physical findings, daily demands, post-exertional malaise, available capacity and response to previous treatment.

With more than 19 years of clinical experience and over 5,000 patients treated, Rakhee's focus is on careful assessment and adapting treatment according to the individual rather than simply increasing treatment intensity.

The Perrin Technique is not presented as a guaranteed cure for CFS/ME. NICE states that there is currently no cure for ME/CFS and recommends personalised management based on the individual's symptoms, needs and energy limits.

For patients who are exploring complementary osteopathic support, The Perrin Technique may be something to discuss with their healthcare team alongside appropriate medical care

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Research and Further Reading

The Perrin Technique has been the subject of publications exploring osteopathic treatment, physical assessment and proposed neuro-lymphatic mechanisms. The wider scientific literature is also investigating autonomic regulation, lymphatic and glymphatic systems and the biological features of ME/CFS.

Some of the research and further reading relevant to The Perrin Technique and ME/CFS includes:

• An Evaluation of the Effectiveness of Osteopathic Treatment on Symptoms Associated With Myalgic Encephalomyelitis (1998)

• Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome (2007)

• Neurolymphatic Pathways: New Scientific Evidence Corroborating the Perrin Technique (2013)

• Can Physical Assessment Techniques Aid Diagnosis in People With CFS/ME? (2017)

• Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: Diagnosis From an Osteopathic Perspective (2018)

• Evidence of Altered Cardiac Autonomic Regulation in ME/CFS (2019)

• Deep Phenotyping of Post-Infectious ME/CFS (2024)

• Glymphatic-System Dysregulation as a Possible Contributor to ME/CFS (2025)

• Disrupted Glymphatic Function in ME/CFS Assessed Using DTI-ALPS MRI (2026)

• NICE Guideline NG206: ME/CFS Diagnosis and Management

• NHS: ME/CFS

  
  

The research supplied for this article also includes the official Perrin Technique website, official Perrin self-help information, the practitioner directory and Dr Raymond Perrin's book, The Perrin Technique.

Written and medically reviewed by Rakhee Mediratta 1st 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.