Perrin Technique London: Frequently Asked Questions Answered by Rakhee Mediratta

If you are searching for the Perrin Technique in London, you may have questions about how the treatment works, whether it is suitable for you, how severe CFS/ME affects treatment and what you can realistically expect from your first appointment.

The Perrin Technique is a specialist osteopathic approach developed by Dr Raymond Perrin for people living with ME/CFS and related conditions. Rakhee Mediratta is an Advanced Licensed Perrin Technique Practitioner with more than 19 years of clinical experience using the technique and has treated more than 5,000 patients. She has also worked closely with Dr Perrin and has assisted with Perrin Technique training for other healthcare professionals.

Her approach is based on a simple principle: the treatment should be adapted to the person, rather than expecting the person to adapt to a fixed treatment protocol.

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

Rakhee has developed the following answers to some of the questions she hears most frequently from people considering The Perrin Technique.

What is The Perrin Technique?

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

It is based on Dr Perrin's theory concerning the relationship between the musculoskeletal system, the autonomic nervous system and neuro-lymphatic drainage.

The treatment combines adapted osteopathic and manual techniques involving areas such as the spine, ribcage, diaphragm, chest, neck, head and relevant lymphatic pathways.

The approach is more than a general massage or a single lymphatic-drainage treatment. It involves a detailed history, physical examination, clinical assessment, hands-on treatment, an individualised home programme and regular reassessment.

The research supplied for this article includes Perrin-related publications dating back to 1998, including research into osteopathic treatment and the proposed lymphatic drainage of the neuraxis in CFS/ME.

It is important to understand that The Perrin Technique is a complementary osteopathic approach. It does not replace appropriate medical diagnosis, investigations or treatment.

Why does Rakhee specialise in the Perrin Technique?

Rakhee: Experience matters when working with people who have ME/CFS because there is such a wide spectrum of severity.

Over more than 19 years of clinical practice, and after treating more than 5,000 patients, I have learned that one of the most important clinical skills is knowing how much treatment is appropriate for each individual at that particular stage of their illness.

I have also worked directly with Dr Raymond Perrin and assisted him in teaching the technique to other osteopaths and healthcare professionals. I am one of the practitioners recognised as an Advanced Perrin Technique Practitioner following the advanced training programme.

My experience has taught me that simply knowing the techniques is not enough. You need to understand how a particular patient is likely to respond to them.

Can two people with CFS/ME require completely different treatment?

Rakhee: Absolutely.

Two people can have the same diagnosis but completely different symptoms, physical capacities and levels of disability.

I may see someone who is completely bedbound or predominantly housebound. Another person may find washing, dressing or eating exhausting. Someone else may be able to work part-time but experience significant post-exertional malaise afterwards.

I also see people who continue to work full-time but use almost all of their available energy simply to maintain employment.

This is why I assess not just what someone can do, but:

• How much effort the activity requires

• What symptoms it produces afterwards

• How long recovery takes

• Whether the person has to sacrifice other activities to manage it

• How stable or changeable their symptoms are

• Their sensitivity to touch, movement, light, sound and positioning

• Their sleep, pain, headaches, brain fog and post-exertional malaise

• The physical and mental demands of work, family life and travelling to appointments

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

How do you assess someone before starting The Perrin Technique?

Rakhee: The first appointment is primarily about understanding the whole person.

The initial consultation lasts up to 90 minutes and involves a detailed history and physical assessment. Perrin treatment normally begins from the second appointment.

I want to understand:

• When your symptoms began

• How they developed

• What makes them better or worse

• What happens following physical or mental activity

• How your symptoms affect everyday life

• Your current physical capacity

• Your sleep

• Pain and sensory sensitivity

• Your medical history and relevant conditions

• Current medication and other clinical support

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

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

What is the Perrin-Juhl score?

Rakhee: Following the history and physical examination, I calculate a Perrin-Juhl score.

The score considers:

• Your symptoms

• How your quality of life and daily function have been affected

• How long you have been unwell

• Relevant comorbidities

• Findings from the physical examination

• 
  

The scale runs from 1 to 10, with 10 representing the best level of health. A lower score represents a more severe presentation.

I use the score to help explain the current level of severity, discuss a realistic prognosis, plan the initial frequency of treatment and monitor changes over time.

It is important to stress that the Perrin-Juhl score supports treatment planning but does not replace an appropriate medical diagnosis.

Research into physical assessment associated with the Perrin approach has also been published, including the 2017 study Can Physical Assessment Techniques Aid Diagnosis in People With CFS/ME?.

How does the Perrin Technique work?

Rakhee: Within Dr Perrin's model, physical, emotional, chemical or immune stresses may contribute to an overload of the sympathetic nervous system.

The model proposes that this may affect neuro-lymphatic drainage and contribute to symptoms associated with ME/CFS.

Treatment therefore combines adapted osteopathic and manual techniques involving the:

• Thoracic spine and ribcage

• Upper and lower back

• Diaphragm

• Chest and upper-chest lymphatic tissues

• Neck and head

• Relevant lymphatic pathways

• Cranial and soft-tissue structures

One of the Perrin-specific publications exploring this model is Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome.

There has also been subsequent research into proposed neuro-lymphatic pathways, including Neurolymphatic Pathways: New Scientific Evidence Corroborating the Perrin Technique.

However, I always explain that these publications represent research and theoretical models rather than proof that The Perrin Technique is a guaranteed cure for ME/CFS.

Is The Perrin Technique a form of massage?

Rakhee: No.

Although some of the techniques involve manual work and gentle lymphatic stimulation, The Perrin Technique is not simply a massage treatment.

It is a structured osteopathic approach involving:

1. Detailed history taking

2. Physical examination

3. Clinical assessment and scoring

4. Individualised hands-on treatment

5. Home care

6. Pacing and recovery strategies where appropriate

7. Regular reassessment

The treatment is adapted according to how the patient responds.

Is the Perrin Technique gentle?

Rakhee: Yes, but “gentle” does not mean that every patient receives exactly the same light treatment.

The pressure, number of techniques, treatment position and length of the appointment can all be adapted.

Someone who is severely affected, highly sensitive to touch or experiencing a flare may need significantly lighter and shorter treatment.

For a severely affected patient, I may use:

• 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

The objective is not to complete as many techniques as possible.

The objective is to provide an amount of treatment that the individual is able to tolerate.

“Stronger treatment is not automatically better treatment.”

What if I have severe or very severe ME/CFS?

Rakhee: Severe ME/CFS requires a particularly careful approach.

Someone who is bedbound or housebound may have such a limited tolerance that travelling to an appointment, changing position or being touched can itself represent a significant physical demand.

This means that I may need to significantly reduce the amount of hands-on treatment and allow longer recovery periods.

I may also divide self-massage into shorter sections or reduce the home programme.

The priority is to introduce an appropriate amount of treatment, observe the response and build the programme gradually where possible.

NICE similarly recognises that severe and very severe ME/CFS can involve profound effects on everyday functioning, including significant sensitivities to light, noise, touch and movement.

What if I can still work but have CFS/ME?

Rakhee: Continuing to work does not necessarily mean that someone has a high level of available energy. Some people maintain full-time employment by using almost all of their available capacity for work. They may spend their evenings and weekends recovering, leaving little energy for family life, exercise or social activity.

Therefore, someone who is working full-time should not automatically receive stronger or more extensive treatment.

Treatment may need to be planned around demanding workdays, commuting, childcare and the recovery time available afterwards.

How often will I need Perrin Technique treatment?

Rakhee: There is no fixed timetable that applies to everyone.

Many patients begin with weekly appointments during the first 12 weeks. This provides enough continuity to monitor the response, adapt treatment and establish the home programme.

At the 12-week review, I look at the overall response. If someone is progressing and becoming more stable, appointments may gradually move from weekly to fortnightly and then wider intervals. Someone with a more severe or longstanding presentation may need weekly treatment for longer.

The first 12 weeks are therefore an assessment period, not a guarantee that everyone will improve within that time.

Can I feel worse after my first Perrin Technique treatment?

Rakhee: Some patients report a temporary increase in familiar symptoms when treatment begins.

This may include:

• Increased tiredness

• Aching

• Headache

• Nausea

• A temporary increase in existing symptoms

A strong reaction is not the aim, and worsening is not required for improvement.

If a response is greater than expected, I can reduce the pressure, use fewer techniques, shorten the treatment, change the patient's position or allow more recovery time.

Patients should not simply push through a severe reaction.

If symptoms are new, prolonged or concerning, they should be medically assessed rather than automatically attributed to treatment.

What changes might I notice first?

Rakhee: The first positive changes can sometimes be very subtle.

A patient may initially notice:

• More restorative sleep

• Clearer thinking

• Less intense or shorter post-exertional malaise

• Everyday activities becoming slightly easier

• Less fatigue

• Brief periods of greater clarity or energy during the day

I don't expect progress to happen in a perfectly straight line. Instead, I look at the overall pattern across several weeks. The changes I monitor can include improved recovery after everyday activity, clearer thinking, greater stability in energy, less discomfort, more refreshing sleep and greater ability to participate in everyday activities.

How do you know whether treatment is helping?

Rakhee: Every follow-up appointment begins with a review of what happened after the previous treatment.

I consider:

• Whether familiar symptoms temporarily increased

• How strong the response was

• How long it lasted

• Whether it was manageable

• How quickly the patient returned to their previous baseline

• Whether sleep, clarity, energy or pain changed

• Whether post-exertional malaise changed

• Whether everyday activities became easier

• Whether any new or concerning symptoms developed

This helps me decide whether the treatment should be maintained, reduced, adapted or gradually progressed.

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

Does everyone improve at the same rate?

Rakhee: No.

The pace of progress can be influenced by:

• How long someone has been unwell

• Current symptom severity

• Physical capacity

• Relevant comorbidities

• Intensity of post-exertional malaise

• Sleep quality

• Pain and sensory sensitivity

• Stress and everyday responsibilities

• The demands of travelling to appointments

• Ability to pace activity

• Consistency with prescribed self-massage and home care

• Response to previous treatment

• Other medication or clinical support

A slower pace does not mean that someone is doing anything wrong.

It means their history, body, capacity and circumstances are individual.

What is pacing and why is it important?

Rakhee: Pacing is about understanding and respecting your available energy rather than repeatedly exceeding your limits.

This is particularly important for people who experience post-exertional malaise.

NICE describes energy management as a personalised strategy that takes into account physical, cognitive, emotional and social activity and aims to reduce the risk of exceeding an individual's energy limits and triggering PEM.

Pacing may therefore form part of an individual's wider management plan alongside treatment, rest, sleep routines, relaxation and appropriate home care.

I do not encourage patients to simply push through symptoms.

Can I do exercise while having The Perrin Technique?

Rakhee: This needs to be considered on an individual basis.

Someone with ME/CFS should not automatically be given a generic exercise programme.

The important consideration is how activity affects that particular person and whether it results in post-exertional malaise.

NICE specifically distinguishes energy management from a fixed exercise programme and recommends that energy management takes account of a person's fluctuating energy limits.

If movement, breathing exercises or gentle activity are appropriate for an individual patient, these can be discussed and adapted according to their presentation and response.

Can I continue seeing my GP or consultant?

Rakhee: Yes.

The Perrin Technique is a complementary osteopathic approach and can be provided alongside appropriate medical care. Patients should continue prescribed medication, investigations and medical reviews unless their prescribing clinician advises otherwise.

ME/CFS can involve a complex range of symptoms, and appropriate medical assessment remains important.

The NICE guideline for ME/CFS provides current clinical guidance around diagnosis, personalised care and energy management.

Is The Perrin Technique suitable for everyone?

Rakhee: No.

Suitability must be assessed individually.

The consultation is also an opportunity to identify symptoms or medical findings that may require further investigation or clearance before treatment begins.

Treatment would normally be postponed during an acute fever or active infection. Active cancer requires specific medical or oncology clearance and may mean that treatment is

unsuitable.

This is why I don't recommend that someone assumes The Perrin Technique is appropriate for them simply because they have received an ME/CFS diagnosis.

The first step is always proper assessment.

Can The Perrin Technique cure CFS/ME?

Rakhee: I would not describe The Perrin Technique as a guaranteed cure.

CFS/ME is a complex condition and every person's experience is different. Some patients report meaningful improvements in symptoms and everyday function, while others may experience more limited change.

My role is to assess the individual, monitor their response and adapt the treatment accordingly.

It is also important that patients have realistic expectations. The aim is not to promise a particular outcome, but to provide appropriate, individualised care and monitor whether meaningful changes are occurring.

NICE describes energy management as not curative and emphasises personalised management according to each person's individual and fluctuating energy limits.

Why choose Rakhee Mediratta for The Perrin Technique in London?

Rakhee: My experience with The Perrin Technique has developed over many years.

I have practised the technique for more than 19 years and have treated more than 5,000 patients. I trained directly with Dr Raymond Perrin and have worked alongside him in practitioner education. I have also been recognised as an Advanced Perrin Technique Practitioner.

My experience has taught me that treating CFS/ME is not about applying the maximum amount of treatment.

It is about understanding what that particular person can tolerate at that particular point in their illness.

Someone who is bedbound may need an entirely different approach from someone who is working full-time. Someone who has recently experienced a flare may need a different treatment from the same person several weeks later when they are more stable.

That is why I continually reassess the patient and adapt the treatment.

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

What should I expect from my first appointment?

The first appointment is about understanding you, rather than simply treating you.

It lasts up to 90 minutes and includes a detailed history and physical assessment. Perrin treatment normally begins at the second appointment once the assessment has been completed and suitability has been considered.

It can be helpful to bring:

• A current medication and supplement list

• Relevant medical reports

• Consultant letters

• Details of previous investigations

• A timeline of your symptoms

• Information about what happens after physical or mental activity

• Questions you would like answered

• A relative, friend or chaperone if this would make you more comfortable

The purpose is to understand the whole person and develop an individual treatment plan.

Research and Further Reading

The research supplied for this article includes publications relating specifically to The Perrin Technique, as well as wider research into ME/CFS, autonomic regulation and neuro-lymphatic and glymphatic systems.

Selected further reading 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)

• 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

About Rakhee Mediratta

Rakhee Mediratta is a Registered Osteopath and Advanced Licensed Perrin Technique Practitioner based in London and the South East.

She has more than 19 years of experience practising The Perrin Technique and has treated more than 5,000 patients. She has worked closely with Dr Raymond Perrin and has assisted with Perrin Technique practitioner training. She was also invited to contribute to the second edition of Dr Perrin's book, reflecting her experience and involvement with the technique.

Her approach combines specialist Perrin Technique experience with a broader osteopathic perspective, with treatment adapted to the individual's symptoms, physical capacity and response.

For Rakhee, expertise is not simply about knowing the technique.

It is about knowing when to use it, how much to use, when to adapt it and when to allow the patient more time to recover.

“My role is to recognise those differences, monitor the response carefully and provide the appropriate amount of treatment at the appropriate time.”— Rakhee Mediratta

Considering The Perrin Technique in London?

If you are living with ME/CFS, chronic fatigue, fibromyalgia or persistent post-viral symptoms and would like to understand whether The Perrin Technique may be appropriate for you, the first step is an individual assessment.

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.