The Concise Perrin Technique E-Book

Raymond Perrin

• Herausgeber: Hammersmith Health Books
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Beschreibung

This practical handbook gives you the basics of WHY and HOW to use the Perrin Technique to underpin recovery from ME/CFS and restore healthy lymphatic drainage from the brain and follows up on the second edition of The Perrin Technique which was published on 11 March 2021. Bringing the context, the background science and Dr Perrin's clinical findings fully up-to-date, this 2nd Edition is now a comprehensive account of the structural and neuro-immunological problems that can lead to myalgic encephalomyelitis, chronic fatigue syndrome and fibromyalgia, ideal for practitioners/physical therapists and all those wishing to gain a thorough understanding of these complex conditions. But at 530 pp this will be too overwhelming for many severely fatigued patients who, at the start of their journey to recovery, just want the basics – why they are ill, why they have the symptoms they have and what they need to do to get better. The Concise Perrin Technique offers this key information together with three illuminating, detailed case histories and answers to the questions most frequently asked about the Perrin Technique – start your journey to recovery now.

Leseprobe

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To Hilda and Bernard Perrin

… parents in a million

Contents

Title PageDedicationList of figuresAcknowledgementsAbout the authorDear readerForeword:Jade Benson Chapter 1:The basics: How the Perrin Technique worksThe Perrin Technique: the factsFact 1: Fluid flowFact 2: Getting the toxins outFact 3: The pumping mechanismFact 4: The sympathetic nervous systemFact 5: BiofeedbackFact 6: What goes wrongFact 7: Build-up of toxinsConclusion Chapter 2:ME/CFS and FMS: What’s really going on?BlackoutME/CFS: ‘The black hole of medicine’The naming of the diseaseDefining ME/CFSFibromyalgiaConclusion Chapter 3:The role of toxins in ME/CFS and FMSPollutantsEffects of neurotoxinsDiet and toxicityPredisposition to toxicityConclusion Chapter 4:The stages leading to ME/CFS and FMSThe physical signs of ME/CFS and FMS1. Longstanding thoracic spinal problems2. Varicose lymphatics and 3. Perrin’s Point4. Tenderness at the coeliac or solar plexus5. Disturbance in the cranio-sacral rhythmThe two minor physical signsScoring the patientConclusion Chapter 5:Treatment using the Perrin TechniqueThe magic bullet?How osteopathy helpsLubrication for effleurageThe concertina and siphon effectsReducing inflammationPerrin Technique protocol for FMSPost-traumatic FMSThe 10 steps of the Perrin TechniqueAfter treatmentSelf-help adviceDorsal rotation and shrugging exercisesCross-crawlStrengthening exercises for hypermobile spinal jointsHypermobility of the lower lumbar regionHome-massage routineNasal releaseFacial massageHead massageSelf-massage to front of neckBreast massageBack massageBack of neck massageThe Full routineActive head restReturning to good healthDiet and nutritionSupplementsGetting worse before getting betterThe jigsaw puzzle analogyFor colds and fluFrequency of treatmentConclusionCase: Noel’s story Appendix 1:Frequently asked questionsWhat are the causes of ME/CFS and FMS?What symptoms can you get with ME/CFS and FMS?Is fibromyalgia syndrome (FMS) a different disease to ME/CFS?Who suffers from these diseases?What does the Perrin Technique treatment involve?What responses to treatment should I expect?How quickly will I recover?How often should I receive the Perrin Technique treatment?What are the dos and don’ts for patients with ME/CFS and FMS?How much exercise and activity can I do?What hobbies can I do safely?Is technology safe to use?When can I return to work/education?Are there any dos and don’ts on commuting?If I am improving, can I go on holiday?Is it safe to get pregnant with ME/CFS or FMS?If I require surgery, what precautions are needed?How important are environmental factors?Can the Perrin Technique help with other conditions?Once I have recovered, can the illness recur?viiCan ME/CFS and FMS be prevented? Appendix 2:Common pathological and radiological testsAppendix 3:The Perrin Questionnaire for chronic fatigue syndrome/ME (PQ-CFS)Appendix 4:Useful names and addresses Afterword:Aisling WhartonIndexCopyright

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List of figures

Fig. 1 Jade at home before starting the Perrin Technique, desperately ill, housebound for many years, wheelchair-bound for two years, being cared for by her devoted mother, Barbara Hodgkinson.

Fig. 2 Jade well enough after 18 months of treatment to climb with her parents Barbara and Andrew, and myself, plus a group of friends (not pictured) to the top of the highest mountain in England, Scafell Pike, to raise funds for my research.

Fig. 3 Former severe ME/CFS patients Jade Benson and Jen Turner at Jade’s wedding.

Fig. 4 The thoracic duct (the central lymphatic drainage system into the blood).

Fig. 5 Restricted drainage of toxins from the central nervous system.

Fig. 6 The downward spiral into ME/CFS.

Fig. 7 The main feature of fibromyalgia is pain in the four quadrants of the body.

Fig 8. The observed physical signs of ME/CFS.

Fig. 9 Comparative photographs showing a flattened mid-thoracic spine. Photo (a) shows the familiar flattening of the mid-thoracic spine seen in many ME/CFS and FMS patients. This differs from a normal spinal posture in the healthy subject, photo (b).

Fig.10 Examining a male patient for ‘Perrin’s Point’. Gentle pressure at a point slightly superior and lateral to the left nipple, ‘Perrin’s Point’(X). The amount of sensitivity at this point appears to correspond to the severity of lymphatic engorgement in the breast tissue and also seems to mirror the gravity of the other symptoms.

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Fig. 11 Schematic illustration showing normal flow within a healthy lymphatic vessel. The valves in this healthy vessel are intact, preventing any backflow, thus maintaining a healthy, unidirectional drainage (note the smooth muscular wall of the lymphangion regulated by sympathetic nerves).

Fig. 12. The development of varicose megalymphatics: (a) The normal lymph flow before the illness. (b) Reversal of the central lymphatic pump forces the colourless lymph fluid back, damaging the valves that separate the adjacent collecting vessels (lymphangia). (c) The lymphangia expand due to the pressure and volume of the backward flowing lymph. This leads to the large beaded vessels (varicose mega-lymphatics) palpated (felt with the fingertips) just beneath the skin in the chest of ME/CFS and FMS patients.

Fig. 13 Right subclavicular varicose megalymphatics, lacking the bluish hue of varicose veins, in patient with ME/CFS (see colour plate 4 in second edition).

Fig. 14 Upper thoracic rotation exercise.

Fig. 15 Mid-thoracic rotation exercise.

Fig. 16 Lower thoracic rotation exercise.

Fig. 17 Shoulder rolling exercise.

Fig. 18 Cervical isometrics: (a) Attempting to bend head forward, prevented by gentle backwards pressure of hands. (b) Attempting to bend head back, prevented by gentle forward pressure of hands.

Fig. 19 Cervical isometrics: (a) Attempting to bend head to the left, prevented by gentle counter-pressure of left hand. (b) Attempting to bend head to the right, prevented by gentle counter-pressure of right hand.

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Fig. 20 Cervical isometrics: (a) Attempting to tuck in chin, prevented by gentle forward counter-pressure of thumbs. (b) Attempting to push chin forward, prevented by gentle backwards counter-pressure of fingers.

Fig. 21 Nasal release.

Fig. 22 Facial self-massage.

Fig. 23 Self-massage to head.

Fig. 24 Self-massage to front of neck.

Fig. 25 Self-massage of the breast.

Fig. 26 Head rest exercise.

Fig. 27 An ME/CFS patient and her daily medication.

Fig. 28 The same patient after receiving the Perrin Technique and reducing her supplements and medication intake.

Fig. 29 Simple jigsaw puzzle of a few pieces, which is easy to solve.

Fig. 30 Complex jigsaw puzzle with lots of sea and sky, making it very difficult to solve without the guidance of the corners and edges.

Fig. 31 A random approach to solving a jigsaw puzzle, without any clues.

Fig. 32 An overwhelmingly complicated jigsaw puzzle representing a really complex case of ME/CFS or FMS.

Fig. 33 Completing the puzzle with the corners and edges in place first.

Fig. 34 Adapted back sculling technique.

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Acknowledgements

Gratitude is a vaccine, an antitoxin, and an antiseptic.

John Henry Jowett, British preacher 1864-1923

Thanks to my colleagues and all the amazing patients, plus their families and friends, who over the years have increased awareness of my work and raised most of the funds for my continued research. There have been so many kind donations and hundreds of wonderful people who have organised dinners, dances and musical evenings, jogged hundreds of miles, climbed mountains, cycled in cartoon outfits, walked in deep-sea diver suits, swum lakes and kayaked down mountain rivers, all to help pay the costs for the ongoing scientific studies that are needed to further understand how the Perrin Technique can help the millions of sufferers of ME/CFS, fibromyalgia and now long-COVID.

A special mention for the fund-raising efforts of Perrin Technique practitioner Sue Capstick and her team of physiotherapists, friends and family who annually take part and offer treatments for the runners in the Wigan 10K event, plus the past and present trustees of the Fund for Osteopathic Research into ME (FORME Trust) for all their continuous help and support.

Ray Perrin, March 2021

About the author

Raymond N Perrindophd is a Registered Osteopath and Neuroscientist specialising in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). His present academic posts include Honorary Clinical Research Fellow at the School of Health Sciences in the Faculty of Biology, Medicine and Health at the University of Manchester, Manchester, UK and Honorary Senior Lecturer in the Allied Health Professions Research Unit, University of Central Lancashire, Preston, UK. He is also Research Director of the FORME Trust and Founder and Clinical Director of the Perrin Clinic™.

Treating a patient for backpain in 1989 led him to the concept that there was a structural basis to ME/CFS. He has spent over 30 years conducting clinical trials, researching the medical facts and sifting the scientific evidence while successfully treating an increasing number of ME/CFS and fibromyalgia sufferers and teaching fellow osteopaths, chiropractors and physiotherapists the fundamentals of the Perrin Technique.

For his service to osteopathy, Dr Perrin was appointed a vice-patron of the University College of Osteopathy (formerly the BSO) and in 2015 became the very first winner of the Research and Practice Award from the Institute of Osteopathy.

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Dear reader

Dear reader,

This is a patient handbook and companion volume to the second edition of my book The Perrin Technique: How to diagnose and treat chronic fatigue syndrome/ME and fibromyalgia via the lymphatic drainage of the brain.

The first edition, The Perrin Technique: How to beat chronic fatigue syndrome/ME, was published in 2007 and was based on my doctorate, which I received after 11 years of research into myalgic encephalomyelitis at the University of Salford, UK.

Since 2007, I have continued my research and have been kept busy lecturing to the medical and scientific world on the lymphatic system of the brain and how it is disturbed in ME/CFS and fibromyalgia, plus teaching my techniques to those who wish to learn my approach. However, it wasn’t easy in the beginning, as there was no proof that a lymphatic system of the brain even existed in the first place, never mind any problems with its drainage.

Everything changed in 2012, when there was a breakthrough discovery at the University of Rochester in New York State. Scientists, using a new type of brain scan, were able visually to show that the fluid in the brain did indeed drain into the lymphatics, and in 2015 a group from the University of Virginia discovered true lymphatic vessels lining the brain in mice. Finally, after so many years, the foundation of my main theory as to what was going wrong in patients with ME/CFS was being backed up by scientific discovery…albeit in rodents. It was then that I started writing the second edition of my book and during this time, further scans of human brains have revealed a major system of lymphatic drainage of the central nervous system which may, according to scientists around the world, provide a pathway that is affected in many neurological disorders. I developed the Perrin Technique in 1989 to improve this drainage system, so it is nice to know that finally science has caught up.

My publisher, Georgina, instructed me to just start writing and let her know when I was finished. Well, after over five years, the second edition has finally been completed with over 500 pages containing all the facts a patient, practitioner and/or scientist needs to know about ME/CFS and fibromyalgia syndrome (FMS). I have added FMS to the second edition as it is very similar, and has, in my opinion, 2the same causal factors as ME/CFS, plus my treatment has helped patients with both conditions for over 30 years.

If you have ME/CFS or FMS and are unable to concentrate on long text, or wish/have to save the cost of the much larger version, this handbook is for you. It sums up my theory of diagnosis and treatment of these complex diseases, including the Perrin Technique treatment plan. This will hopefully guide you, the patient, along your own individual road to recovery. I endeavour to keep the explanations as simple as possible in this companion handbook as the comprehensive book can provide all the extra detail you might want. If, after reading this, you wish to fully understand the complexities of diagnosis and treatment of ME/CFS and FMS and related conditions, complete with hundreds of scientific references, the second edition is waiting to be read.

If you wish to start the Perrin Technique, please try to find a practitioner near to you who is a trained and a licensed Perrin Technique practitioner if possible. If there are none in your neighbourhood, seek out a practitioner trained and experienced in both cranial techniques and manual therapy but preferably an osteopath, physiotherapist/physical therapist or chiropractor. They will be able to understand the detailed second edition, which contains a comprehensive section on other clinical conditions that could cause fatigue and diseases that commonly occur in patients with ME/CFS and FMS.

Once the practitioner has read the second edition of The Perrin Technique, they should be able to follow the instructions and be equipped to help you. It is better not to rely just on the self-massage and exercises in this handbook though it is very important that you do these as they will help. It is always best to do the whole treatment programme under the direction of a qualified practitioner to confirm the diagnosis and to improve your outlook.

If your condition is more complicated, the second edition contains advice that will guide you, the patient, and your practitioner to help in even the most complex presentations that could occur together with ME/CFS and FMS.

I wish you every success with your treatment and progress to better health.

Raymond Perrin, January 2021

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Foreword

Jade Benson: recovered ME/CFS patient

I developed ME after a nasty bout of glandular fever at age 6. I was eventually diagnosed after my first ‘crash’ at 11 years old, shortly after starting secondary school. Over the next seven years my condition got progressively worse, seeing many ‘crashes’ and meaning that I couldn’t be educated in mainstream school because of the severity of my condition. By the time I reached my 18th birthday, I was extremely unwell.

I was wheelchair-bound, unable to stand for more than a few seconds, light sensitive, noise sensitive, very nauseous and in constant severe pain and fatigue. After so many years of being severely ill my body was giving up, and at 18, so was I. I had to rely on my parents as carers, couldn’t leave the house and had no quality of life, with no end in sight.

We heard about the Perrin Technique from a family friend who also had ME. Her mum had been told about the treatment by a hospital nurse whilst receiving treatment for cancer, and my friend thought the information was worth passing on. As I was too unwell, my mum did some research on the Perrin Technique and agreed it was worth a go.4

Until this point no other treatment had helped me, including seven years under a paediatric consultant, a referral to the head of paediatric ME for the country, graded exercise, pacing, allergy testing, diets and several alternative therapies. We felt that this was my last chance to get better as I was deteriorating every week (see Figure 1).

Fig. 1 Jade at home before starting the Perrin Technique, desperately ill, housebound for many years, wheelchair-bound for two years, being cared for by her devoted mother, Barbara Hodgkinson.

We met with Dr Perrin on 17th February 2010 and he, and the treatment, made immediate sense to us. He explained ME in a way nobody else ever had; all the symptoms that other doctors had brushed off, looked confused at, or had made me feel like they were ‘all in my head’ suddenly had a real medical explanation, and – thankfully – an answer. I was examined by Dr Perrin and officially and positively diagnosed with ME. I was graded at 2/10 on the Perrin scale, which is severe, but I was still able to be helped. I came away from the clinic feeling hopeful for the first time in many years. I knew I had a long way to go but was stubbornly determined that I could get there. I started a programme of treatment soon after, with my weekly treatment being done in nearby Longridge and overseen by Dr Perrin due to my severity.5

As expected, I got worse before I got better, and my condition deteriorated quickly. After one particular treatment with Dr Perrin in around April 2010, I reacted very severely and was partially paralysed for 24 hours. This reaction, although rare and frightening at the time, was the best thing that could have happened to me as once I had got through it, my recovery accelerated and I was soon seeing vast improvements in my condition. I took my first steps shortly after this reaction and dumped the wheelchair for good in June 2010, a mere four and a half months after starting my Perrin journey. By September, I was working part-time, had enrolled in college, and was practising for my driving test which I passed the next month. I was starting to finally lead a normal life for the first time in 11 years.

A year after I had ditched the wheelchair, I challenged myself and did a sponsored climb up Scafell Pike, the tallest peak in England, in aid of the charity which backs the Perrin Technique, accompanied by Dr Perrin, my parents and several friends (see Figure 2). On reaching the top and looking out over the Lake District I knew I had done it and my life would never be the same. I was never going back to being that ill shell of a person thanks to Dr Perrin and the Perrin Technique.

Fig. 2 Jade well enough after 18 months of treatment to climb with her parents Barbara and Andrew, and myself, plus a group of friends (not pictured) to the top of the highest mountain in England, Scafell Pike, to raise funds for my research.

6Nine years on and, although I still have treatment every couple of months to ensure I stay well, I am largely symptom free. I am now married (see Figure 3), have a 3-year-old son and am expecting my second child. I have a normal, happy, healthy life now. Without the treatment, there’s no way I would have the life I have today, and I am forever grateful for the second chance at life that it gave me.

Fig. 3 Former severe ME/CFS patients Jade Benson and Jen Turner at Jade’s wedding.

Jade Benson, Lancashire, UK

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Chapter 1

The basics: How the Perrin Technique works

My theory for the diagnosis and treatment of ME/CFS started with one patient: this case was the first and perhaps the most dramatic of all the ME/CFS patients I have treated. In 1989 an executive, who shall be referred to as Mr E, walked into my city-centre practice, in Manchester, where I ran a clinic specialising in treating sports injuries. He had been a top cyclist, racing for one of the premier teams in the north-west of England. He had suffered from a recurring, low back pain, which, after examination, I had diagnosed to be a strain of the pelvic joints.

While treating his pelvis, I noted that the upper part of his back was particularly restricted. I enquired whether or not he had any prior problems in his upper back, and he acknowledged that for years, during his cycling, he had experienced a dull ache across his shoulders and at the top of his back. This in itself was nothing significant, as it was very common to find cyclists with pelvic problems and a stiff and disturbed curvature in the thoracic spine (the upper part of the backbone between the waist and the neck). What was interesting was the fact that, for the past seven years, Mr E had been diagnosed with ME/CFS. He complained of tingling in both hands and a ‘muzzy’ feeling in his head. He suffered general fatigue and an ache in his knees, as well as the pain in his back and shoulders. He had been forced to stop racing since the onset of the disorder. This patient was one of many who came to me after being diagnosed by their doctor, or specialist, as suffering from ME/CFS. 8

As I have said, he originally attended for treatment to his lower back. At that time, although I had helped other patients with ME/CFS, I had done no research into the disease, and I had no specific treatment programme for the disorder. With only five treatments, Mr E’s back was better, but, most incredibly, the signs and symptoms of ME/CFS had drastically improved. He was symptom-free after a mere two months from the start of treatment. After many years he continued to remain healthy and the last news I heard of him was that he had moved to Holland, cycling with the same power and zeal that he had used to enjoy prior to his illness.

It was after helping this patient that I realised that there must be a correlation between the mechanical strain on the thoracic spine and ME/CFS. Although I had not set out to help the fatigue signs and symptoms in this patient, I had done exactly that by improving his posture and increasing movement in his spine. My thoughts turned to the other ME/CFS patients that I had treated for back pain and biomechanical strain. The restriction of the dorsal spine was a common factor that could not be ignored. Since 1989, thousands of patients with signs and symptoms of ME/CFS have visited my clinic and also practices all over the world run by practitioners trained in the Perrin Technique. None of them has presented with exactly the same symptoms but all have shared common structural and physical signs. This cannot be dismissed purely as coincidence. So, what is really going on?

The Perrin Technique: the facts

Fact 1: Fluid flow

A fluid flows around the brain and continues up and down the spinal cord: this is the cerebrospinal fluid. This fluid has many functions – for example, as a protective buffer to the central nervous system and for supplying nutrients to the brain. However, one function has been discussed in osteopathic medicine since the 1860s but has received significant scientific attention only in recent years and that is the role it plays in the drainage of large molecules. 9

In fact, not only is there visual evidence of the drainage system detailed in the first edition of my book, but actual lymphatic vessels have since been discovered in the membranes of the brain in both animal and human studies.

Fact 2: Getting the toxins out

The lymphatic system is an organisation of tubes around the body that provides a drainage system secondary to the blood flow. Why does the body need a secondary system to cope with poisons or foreign bodies in the tissues? Are the veins not good enough? The answer in one important word is ‘size’. The blood does process poisons and particles, which enter the blood circulatory system via the walls of the microscopic blood vessels known as the capillaries. Their walls resemble a fine mesh which acts as a filter, thus allowing only small molecules to enter the bloodstream itself. When the blood reaches the liver, detoxification takes place, cleansing the blood of its impurities.

Larger molecules of toxins often need breaking down before entering the blood circulation, and they begin this process of detoxification in the lymph nodes on the way to drainage points just below the collar bone into two large veins (the subclavian veins), with most of the body’s lymph draining into the left subclavian vein (see Figure 4).

The capillary beds of lymphatic vessels, known as ‘terminal’ or ‘initial lymphatics’, take in any size of molecule via a wall that resembles the gill of a fish, opening as wide as is necessary to engulf the foreign body. The lymphatics also help to dispose of some toxins and impurities through the skin (via perspiration), urine, bowel movements and our breath. Once toxins have drained into the subclavian veins, they eventually find their way into the liver and, as is the case with normal circulatory toxins, are broken down by the liver. 10

Fig. 4 The thoracic duct (the central lymphatic drainage system into the blood).