The Perrin Technique in London: What 19 Years of Clinical Experience Have Taught Me

Written and medically reviewed by Rakhee Mediratta 8th 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.

About ME/CFS

When I first started working with people with ME/CFS, I quickly realised that no two patients were really the same. That might sound obvious, but it becomes much clearer when you sit across from someone who has been living with the condition for years. One person may still be working full-time but have almost no energy left by the end of the day, while another may be largely housebound. Someone else might have a relatively good day where they appear quite well, followed by several days of a significant setback after doing something that, to somebody else, would seem completely ordinary.

That is one of the reasons I have always felt that treating ME/CFS requires much more than simply knowing a technique. I have been working with the Perrin Technique in London for more than 19 years and have treated more than 5,000 patients. During that time, I also had the opportunity to work directly alongside Dr Raymond Perrin for more than a decade, assist with Perrin Technique training in London and contribute to the second edition of his textbook. Those experiences have shaped how I approach treatment today.

I still use the principles of the Perrin Technique, but I don't see my role as simply applying a set sequence of techniques to every person who walks through the door. The technique is important, but understanding the individual sitting in front of me is what determines how I use it.

What exactly is the Perrin Technique?

The Perrin Technique is a specialised osteopathic approach developed by Dr Raymond Perrin in 1989. The theory behind it involves the relationship between the autonomic nervous system and what Dr Perrin describes as neuro-lymphatic drainage. The approach includes osteopathic assessment, postural and movement assessment, gentle hands-on techniques and, where appropriate, an individual programme of self-massage and self-management.

That last part is particularly important. I don't expect someone who is severely affected by ME/CFS to tolerate the same treatment as somebody who is still working, exercising occasionally and managing most of their daily activities. The amount of pressure I use, the areas treated, the number of techniques, the length of the appointment and even how much movement I ask of somebody may all need to change according to their presentation.

Over the years, I've become increasingly aware that knowing when not to do something can be just as important as knowing what to do.

The theory behind the Perrin Technique

Dr Perrin's model proposes that dysfunction of the autonomic nervous system may be associated with changes in neuro-lymphatic drainage and that this may be relevant to some of the symptoms experienced by people with ME/CFS. The hands-on techniques used within the Perrin approach are intended to support these pathways.

There is also some interesting science around the movement of fluid around the brain and spinal cord, and our understanding of these systems has developed considerably since the Perrin Technique was first developed. However, I think it is important to be very clear about where the evidence ends.

Research into glymphatic and meningeal lymphatic systems does not prove that the Perrin Technique works, nor does it prove that impaired drainage causes ME/CFS. A study looking at the brain's fluid-clearance systems is not automatically a study of the Perrin Technique. There is a difference between an interesting scientific finding and evidence that a particular treatment is effective, and I think patients deserve that distinction. The Perrin Technique is still an area where more high-quality research is needed.

Why the lymphatic and glymphatic research is interesting

One of the things I have found particularly interesting over the years is how much scientific understanding of the brain's fluid and waste-clearance systems has developed. In 2012, researchers described what became known as the glymphatic system in the brains of mice. Further research identified lymphatic vessels associated with the meninges, and in 2024 researchers reported evidence of glymphatic waste-clearance pathways in living human brains.

These are fascinating developments, particularly because they give us a better understanding of systems that were not fully understood when the Perrin Technique was first developed. But I wouldn't tell a patient that this research has “proven the Perrin Technique”. It hasn't.

The studies were not investigating the Perrin Technique and they do not establish that abnormalities in these systems cause ME/CFS. What they do is add to our understanding of how fluid movement and waste clearance around the brain may work. For me, that makes the area worth continuing to investigate rather than something that should be presented as settled science.

What I've learned from treating people with ME/CFS

Perhaps the biggest thing I have learned over the years is that appearance can be very misleading. Someone can walk into my clinic looking well. They may be dressed normally, still be working and may even have driven themselves to the appointment, but none of those things tells me how much energy that journey has cost them or what they may need to do afterwards to recover.

I've treated people who are working full-time but have very little capacity outside work. They might spend their evenings and weekends recovering because work uses almost all of the energy available to them. I've also treated people who are much more severely affected and may struggle with relatively simple activities such as getting dressed, preparing food or having a conversation for any length of time.

Both people are living with ME/CFS, but their treatment cannot be identical. This is why I spend a lot of time listening before I begin treatment. Understanding what somebody experiences in their everyday life, particularly what happens after activity, can tell me a great deal about how much they may be able to tolerate during a session.

Post-exertional malaise changes the way I think about treatment

If somebody has ME/CFS, I always want to understand what happens after activity, not simply what they can manage during the activity itself. Post-exertional malaise (PEM) can be one of the most difficult aspects of the condition because someone might manage an activity on Monday, feel ok afterwards and then experience a significant increase in symptoms later that day or over the following days.

That matters enormously when deciding how much treatment someone can tolerate. It is one of the reasons I don't believe that more treatment automatically means better treatment. Sometimes a very gentle session followed by enough time for someone to see how their body responds is more appropriate than trying to achieve too much in one appointment.

For me, this is also where pacing and energy management become particularly relevant. The aim isn't to keep adding more and more activity. It is about understanding what the person can currently tolerate and finding ways of managing their available energy without repeatedly exceeding their limits.

How I assess someone before treatment

My first appointment is not simply about deciding which techniques to use. I want to understand the person sitting in front of me, including their medical history, symptoms, existing diagnoses, current medical care, medications where relevant, activity levels, sleep, daily routine and how they respond to physical and mental exertion.

I also look at posture and movement and assess the musculoskeletal system, but one of the most important things I want to understand is the person's tolerance. If somebody tells me they can manage an activity but then spends two days recovering from it, that is clinically relevant information.

The assessment needs to take the whole picture into account. If somebody has symptoms that have not been medically assessed, or there are symptoms that require further investigation, I may recommend that they speak to their GP or another appropriate healthcare professional. I don't see osteopathy as replacing medical care. I collaborate with an excellent network of other medical professionals who specialise in chronic illness including ME/CFS that I recommend where appropriate for my patients, alongside the Perrin treatment. For someone living with a complex condition like ME/CFS, it is often about bringing the right pieces of care together.

The Perrin-Juhl score

One of the tools I use as part of my assessment is the Perrin-Juhl score. It provides a way of recording a person's overall level of health and function and can help us monitor changes over time. I don't use it as a diagnosis, and a questionnaire or physical assessment cannot replace appropriate medical assessment for ME/CFS. Instead, I find the score useful as one part of a much bigger picture. Progress isn't always dramatic, and sometimes the changes that matter most are quite subtle. A patient might tell me that their sleep is slightly better, that they can have a conversation without becoming as exhausted, or that they have been able to do something at home that they haven't managed for months.

Those changes can be much more meaningful than simply asking whether someone feels “better”. And it is often these small but subtle changes that are the first steps and signs of progress that indicate that something is shifting in the patient’s recovery. Of course every patient is different and for some their recovery may happen more quickly than others. Many factors apply from how much they are applying the treatment aftercare advice (if applicable), if they are implementing their pacing routine and also not putting too much pressure on themselves to get better quickly as this can often drive more stress and affect the sympathetic nervous system, slowing down progress.

I don't treat every patient in the same way

This is probably one of the biggest differences between how I work now and how I approached treatment earlier in my career. Experience changes your clinical judgement, and with ME/CFS that judgement is particularly important because people can have very different levels of sensitivity and tolerance.

If someone is very severely affected, I may use much lighter pressure, fewer techniques and longer pauses. I may minimise changes of position and keep the session simpler, and their home programme may also need to be much smaller. For somebody who is more functional, the approach may look quite different.

That doesn't mean one person is receiving “more treatment” than another. It means the treatment is being adapted to what that person can currently tolerate. The Perrin Technique has a defined clinical framework, but in my view it should never become a one-size-fits-all treatment.

What happens after the initial assessment?

Usually, I will explain what I have found and whether I feel the Perrin approach is appropriate. Treatment itself is generally introduced gradually. For some patients, weekly appointments may be appropriate initially, followed by a review and adjustment depending on how they are responding. I don't want somebody to think that a particular number of sessions guarantees a particular result, because it doesn't. A programme needs to be reviewed according to the individual, and this is especially important with ME/CFS because symptoms can fluctuate.

A person may be improving and then have a setback. That doesn't necessarily mean treatment has failed, just as a good week doesn't necessarily mean the condition has resolved. We have to look at the pattern over time rather than trying to draw conclusions from one appointment or one particularly good or bad day.

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, but I don't believe that a strong reaction should be deliberately created or interpreted as proof that a treatment is working.

If somebody has a significant reaction, I want to understand it. Was the treatment too much? Was the person already having a difficult period? Had they overexerted themselves? Was there something else going on? Those questions are much more useful than simply saying, “You feel worse because the treatment is working.”

I would never want a patient to feel that they have to tolerate a significant deterioration in order to get better. If something isn't being tolerated well, that needs to be taken seriously and the approach reconsidered.

What does progress actually look like?

Progress isn't always obvious, particularly when someone has a condition that can fluctuate so much. For some people, the first meaningful change might be sleep. For somebody else it might be brain fog, the ability to concentrate, or having slightly more capacity to manage everyday tasks.

Sometimes the change is simply that a person's symptoms don't escalate as dramatically after a particular activity. I encourage patients to look at their overall pattern rather than judging everything by one day, because a single good day or bad day doesn't necessarily tell us very much.

What matters more is what happens over a number of weeks and whether there is a gradual change in the person's overall level of function and quality of life.

Where does pacing fit in?

Pacing and energy management are extremely important for people with ME/CFS. I don't tell patients to simply “push through”, particularly when they are experiencing post-exertional malaise. Current NICE guidance recommends personalised energy management that takes account of an individual's available energy and recognises that this can fluctuate.

That fits naturally alongside the way I approach treatment. If someone's available energy is limited, repeatedly pushing beyond that limit is unlikely to be helpful. Sometimes the appropriate decision is to do less, allow more recovery time and work from the person's current level rather than where they would ideally like to be.

Can the Perrin Technique cure ME/CFS?

No, and I want to be very clear about this because people living with ME/CFS are understandably looking for answers.

Research into its possible role remains at preliminary stages.

What does the research actually tell us?

There is a small body of research relating specifically to the Perrin approach, as well as wider research into areas that overlap with aspects of the theory. For example, a 2007 paper by Dr Raymond Perrin explored the proposed relationship between lymphatic drainage of the neuraxis and ME/CFS. There has also been research examining physical assessment techniques in people with ME/CFS and research looking at autonomic regulation, while more recent work has explored lymphatic and glymphatic systems and their relationship with the brain.

These areas are interesting, but they are not all the same thing. A study of the glymphatic system is not a clinical trial of the Perrin Technique, and a study involving manual lymphatic drainage is not necessarily a study of the complete Perrin approach. Equally, a preliminary study involving a small number of participants cannot tell us how a treatment will work for everyone.

That distinction is something I feel very strongly about. Patients should be able to understand what research has actually shown rather than having different pieces of science presented together as though they all prove the same thing.

Where I think the research needs to go next

I'd like to see much more rigorous research into the Perrin Technique, particularly larger clinical studies with appropriate control groups, clearer outcome measures and longer follow-up. I'd also like to see research that helps us understand which patients may respond and which may not.

When you've treated thousands of people, you see just how different individual presentations can be. It would be much more useful to understand who is most likely to benefit from a particular approach than simply asking whether a treatment “works” or “doesn't work” for everyone. That is rarely how healthcare works in real life.

What 19 years of working with the Perrin Technique has taught me

I think my approach has become more individualised as my experience has grown. Earlier in my career, I was naturally focused on learning the technique itself. Now, I'm equally focused on judgement: when to use a particular technique, how much pressure is appropriate, how long to treat for, whether someone needs more treatment that day or less, and how they are recovering between appointments.

I'm also conscious of recognising when something may need medical attention outside my own area of practice. That is part of treating the whole person rather than becoming too focused on one particular approach.

I have had the privilege of working directly with Dr Raymond Perrin for many years, assisting with practitioner training and contributing to his textbook. I have also received two Excellence in Practice Awards from Dr Perrin. Those experiences are important to me, but ultimately I think the most valuable experience is the thousands of individual patient consultations that come in between.

Every patient teaches you something. Sometimes it is about the technique, sometimes it is about the condition, and sometimes it is simply about listening more carefully.

Why experience matters

There are now more practitioners learning about the Perrin Technique, which I think is positive. But this is a complex patient group, and having a technique is one thing; knowing how to adapt it to somebody who is extremely sensitive to physical input is another.

After nearly two decades of working in this area, I have learned that clinical experience isn't just about accumulating years. It is about seeing enough different presentations to understand that the same approach won't necessarily be appropriate for everyone.

That is why I place so much importance on assessment, observation and listening. The technique provides a framework, but the person in front of me determines how that framework is applied.

My approach today

After 19 years, I don't think of the Perrin Technique as a magic answer to ME/CFS. I think of it as a specialised approach that may have a role for some people, alongside appropriate medical care and sensible energy management.

I also think we should remain curious about the science without overstating it. There is fascinating research taking place around the autonomic nervous system, lymphatic pathways, glymphatic function and the relationship between these systems and health, but there are still many unanswered questions. I don't think we should be afraid to say that.

Patients deserve hope, but they also deserve honesty. My role is to give someone the benefit of my experience while being honest about what we know, what we don't know and what we are still learning. For me, that is an important part of good clinical care.

Research and further reading

For anyone who wants to explore the science behind the Perrin Technique and the wider areas discussed above, I recommend starting with the original research, reading this article and established medical guidance rather than relying solely on online summaries.

• Perrin RN (2007) – Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome: A Hypothetical Model for the Cranial Rhythmic Impulse. PubMed reference

• Perrin, Edwards & Hartley (1998) – An evaluation of the effectiveness of osteopathic treatment on symptoms associated with myalgic encephalomyelitis: A preliminary report. PubMed reference

• NICE Guideline NG206 – Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE guideline

• NHS – Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). NHS overview