There’s an increasing amount of anecdotal evidence from people suffering from Long Covid.  This is where symptoms remain for much longer than the suggested two week period and are often accompanied by issues outside the officially recognised cough, fever and loss of taste or smell.  These most commonly include debilitating fatigue, breathlessness, muscle aches and joint pain.  Also, ‘brain fog,’ memory loss, lack of concentration, and depression. Very similar to the symptoms of Chronic Fatigue Syndrome (CFS).

What is Chronic Fatigue Syndrome?

The main symptom of Chronic Fatigue Syndrome (CFS) is feeling extremely tired and generally unwell.  But this tricky condition can also deliver a range of additional nasties.  The severity of which can vary from day to day, or even within a day.  These include:

  • muscle and/or joint pain
  • headaches
  • sleep issues
  • brain fog – problems thinking, remembering or concentrating
  • a sore throat or sore glands that are not swollen.
  • flu-like symptoms.
  • feeling dizzy or sick.
  • fast or irregular heartbeats (heart palpitations)

Over the past few weeks, Osteopath Robin Kiashek has seen an increase in the number of patients presenting with these types of symptom.

Robin said: “Several of the patients I’ve seen with CFS symptoms know they have had COVID.  But, of course, we will never know how many people have already had it but were asymptomatic.”

What can be done to ease the symptoms of CFS?

Robin has been a licensed practitioner in The Perrin Technique™ for CFS/ME and Fibromyalgia for over 10 years.

This is a manual method that aids the diagnosis and possible treatment of Chronic Fatigue Syndrome/ME.  It was developed by Osteopath and neuroscientist Dr Raymond Perrin DO PhD in 1989.

What is the Perrin Technique™?

The Perrin Technique™ is based on Dr Perrin’s theory that different stress factors whether physical, allergies, emotional or infections lead to an overstrain of the sympathetic nervous system.

Further investigation has led to a probable cause of this nervous system overload being a build-up of toxins in the fluid around the brain and the spinal cord.

Some of the poisons caused by infection or inflammation in the head or spine flow through channels from the brain into the lymph ducts of the head face and neck.

The toxins are also meant to drain down the spinal cord and out into the lymph ducts lying along the spine. In a CFS/ME sufferer there is a back flow of these normal drainage points which leads to further toxicity and dysfunction of the central nervous system. This leads to the many symptoms we see in CFS/ME.

Research over past 30 years has validated Dr Perrin’s theories read more about them here.

The Perrin Technique and Long COVID

Dr Perrin and his colleagues from the University of Manchester have written to a number of medical publications to highlight the potential for a post-viral syndrome to manifest following COVID-19 infection.  A similar situation was previously reported following Severe Acute Respiratory Syndrome (SARS) infection, also a coronavirus.

Back in the clinic

Whilst this may sound like yet another blow from the hammer that is proving to be 2020, there is light at the end of the tunnel.

Robin said: “Working with the symptoms of CFS is never straightforward and patients often end up at my door after suffering for months (if not years).

“They have frequently been subjected to a barrage of medical tests and received lots of negative results.  So, they are also feeling understandably anxious about what’s could be ailing them.

“The good news for people struggling with Long COVID symptoms is that they are fairly recent and are therefore likely to respond more quickly to treatment.  But it can still be a long haul.”

Patient X has been seeing Robin intermittently since the end of April, shortly after they started to feel unwell.

Patient X explains: “In April, I was feeling the post-viral effects of likely Covid-19 and felt I had nowhere to turn to for support from a health and well-being perspective. My GP practice still remains phone consultations-only and I was frustrated that my health wasn’t improving. I had crippling fatigue, strange neurological symptoms, insomnia, dizziness and many other symptoms following the acute viral phase.

“Luckily, I did some research and learned that the Perrin Technique might be beneficial.

“I started regular sessions with Robin and was grateful for the holistic advice. He confirmed that I had post viral fatigue which mirrors chronic fatigue syndrome and I started my Perrin Techniquesessions weekly.

“I am not 100% yet back to normal, but I feel it’s been a beneficial journey so far. I also feel empowered that I have a way of helping my recovery beyond resting and healthy eating.”

There are two Robin Kiashek Osteopath Clinics  – in Central London (on Regent Street) and in East Finchley.

If you’re suffering with any of the symptoms listed above, then why not request an appointment or call on 020 8815 0979?

I recently spent a fascinating day at the Royal Society of Medicine for the 9th Annual Spinal Symposium which looked at the spine from a range of perspectives.

The spine is often the part of the body that people most readily associate with Osteopathy (although we can assist with many other issues and help you to reach your goals in mind and body).

I think it’s vital to remain up to date with current thinking and I regularly refresh my learning with CPD events such as this, where I am always interested to hear about new developments, opinions and practices.

Annual Spinal Symposium

We heard from six excellent orthodox medical consultants who covered topics including dizziness and facial pain, degenerative spinal diseases and sport and the spine. But, for me, the most interesting speaker was Rheumatologist, Dr Roger Wolman who talked about the different types and levels of pain that people experience, and then focussed on chronic pain.

This is an issue that fascinates me and Dr Wolman’s assertion that there is often a poor correlation between chronic pain and structural abnormality certainly resonated with my experiences in clinic. Pain is often a measure of distress , both physical and sometimes emotional and not necessarily injury.

Managing chronic pain

He spoke at length about managing chronic pain and the important role that we can play in educating people about it. According to Dr Wolman, even just understanding chronic pain can help to change pain levels. He also stressed the need for patients to understand the relationship between stress, anxiety, depression and pain; to know their pain triggers; and the limited role of medication in these situations.

I have written before about the approach I take at my Clinics and how I believe in treating the person and not just the symptom they present with. This ‘body-mind detective’ role – systematically locating and treating the root cause of often very complex problems – is one I greatly enjoy and I have been able to help a number of patients who have been suffering with chronic pain over long periods of time.


I’ll leave you with the kind words from a patient: “Robin’s treatments have helped reduce my back and neck pain which had plagued me for years. He has taught me how to reduce re-occurrences through exercise and lifestyle change – I was very despondent before I came to see him and he continues to help me hugely; I’m very grateful.”

So, if you’ve been nursing a niggle or putting up with pain for a while then why not book an appointment?

I know my story is your story too.

Five years ago, I turned 50. It felt as though everything changed overnight. 
In my 20s, 30s and 40s, I charged ahead with life, first throwing myself into my career — I worked as a magazine publisher — and then, in my late 30s, meeting my husband, getting married and having children. 
Those busy years almost seemed like one long decade, during which I didn’t feel any different about how I looked or acted. 
I never stopped to think about what impact the way I was living might have down the road.

Then, one day, I woke up and… I was 50. Suddenly, I would catch myself in the mirror and notice my drying skin, crow’s feet, the way my hair looked. I felt aches and pains for the first time. I also began to gain weight. 
It wasn’t a huge amount, but it was steady and showing no signs of slowing down. Weight gain can often be a part of the aging process, especially after women go through menopause. However, I remember reading somewhere that five pounds was an acceptable amount to gain, but anything more was another term for “letting yourself go.”

I knew that if changes weren’t made — and fast — I’d be heading into my 50s at a terrible disadvantage. Wanting to stay healthy, fit, energetic and productive for the rest of my life, I was ready to change — and possibly save — my life.
 I didn’t simply want to think, “I’m 50 now, that’s it, my life is over.” I wanted to be fearless after 50. There’s been a lot written about how women cease to exist once they hit this age. 
Despite our great consumer power, post 50 women are often dismissed as invisible, and seen as neither young nor interesting enough. This is so wrong, and I was depressed thinking that this was my future.

But, there was more…

When I turned 50, I found myself asking the ‘what if’ questions: What if I get sick or have a heart attack? What if I get Alzheimer’s? What if I get cancer? Do I already have cancer without knowing it? 
I looked around and people my age were having strokes, struggling with depression, developing diabetes. 
It’s not that younger people didn’t have some of these health concerns, but that after 50 they seemed all too common. And the closer I looked, the more I realized that many of these health issues were in my control. The more I thought about it, the more questions I had. I began to wonder if there were tests I should be getting and asking what I could do to make sure that I lived a healthy life.

Like many women, I had gone a long time without doing simple things that could positively affect my health. 
Many of us are part of the so-called sandwich generation — caught between looking after our children and caring for elderly parents — and I realized life had kept me busy taking care of others, yet failing to do the right things for myself.

Sleeping enough and exercising daily had come to seem like an indulgence, even as I made sure that my family was well-fed and well-rested. 
So I embarked on a quest to discover how ordinary women could look and feel their best in their 50s and beyond. 
I soon realized that what I wanted was the best information I could find. I began to contact beauty experts and financial experts. 
I talked to the renowned hairdresser Frederic Fekkai, and to fashion designer Diane von Furstenberg. 
I tracked down women’s health specialists and exercise gurus, nutritionists and make-up experts. And, after hearing their advice, I took it.

I started going for slow runs with breaks for walking every day and learned how to do push-ups and other exercises to prevent osteoporosis. 
I went for annual health checks. I changed the way I ate and dropped the bad habits I’d slipped into. 
Where I had once spent my time dieting instead of eating, I began to pay attention to what I ate and to eat something healthy and small every couple of hours. 
I even accepted the fact that my hair, which I had spent decades straightening, was naturally wavy and looked its best that way. And I didn’t just lose the 15 lbs. I gained, I dropped an entire pants size.

Five years later, I feel fitter then I have at any time since I turned 30. 
More importantly, I found that I don’t only look and feel better, my health has improved. 
My cholesterol levels dropped and I even ran the New York City Marathon this year to celebrate my 55th birthday and raise money for a very deserving charitable organization. 
And, while turning 50 gave me a shock, now that I am 55 I am happier than ever before.

I loved the earlier decades of my life but I rushed through them. I was more insecure then and less happy about how I looked and felt. 
Like many women, I sought approval from everyone except myself. Now, when I look in the mirror, I see a woman who is brimming with confidence, enthusiasm, and energy. I am happy with who I am and with how I look — including my crow’s feet, which are a part of the story of my life.

So many of us fear aging when we should embrace it. But the greatest lesson I learned on my quest for reinvention is we need to feel comfortable in our own skin, whatever age we are. 
Whether you are 49, or 62, or 75, you need to decide that you are going to be the fittest, healthiest and best-looking 49, 62, or 75-year-old there is. 
For too long, women have been tricked into seeing 50 as the end of the road when, instead, we should be viewing it as the start of a new life, one in which we are truly comfortable with who we are. Instead of retreating from the world, we can embrace our place within it.

Turning 50 did more than save my life. It put me on the path to a new one.

From a recent Times newspaper article on Chronic Pain (see Page 7)

Article supplied with kind permission of the BOA publication ‘Osteopathy Today’, June 2010, Vol.16.5., Author Theresa Devereux

“I have seen this treatment approach work again and again and again – ME is a
terrible illness but it’s just waiting for osteopathy to show what we can do.”
In the spotlight with Dr Raymond Perrin
Dr Raymond Perrin is a Manchester-based osteopath who has come to prominence for his
work with Myalgic Encephalomyelitis (ME) otherwise known as Chronic Fatigue Syndrome
(CFS). He qualified from the BSO in 1984 and for the last 21 years has dedicated himself to
the research of ME and the development of a system of manual diagnosis and treatment
which he claims has helped hundreds of patients and cured many.
He has established a Fund for The Osteopathic Research into ME (F.O.R.M.E) which has raised
over £250,000 and in 2005 was awarded a Doctorate by The University of Salford for his thesis
on CFS/ME.
In 2007 Raymond published a book – The Perrin Technique – How to Beat Chronic Fatigue
Syndrome/ME (1) and his work is being taken seriously by the medical profession. Last year he
made presentations to The International Association of CFS/ME in Reno, Nevada, the World
Congress of Psychosomatic Medicine in Turin and the First World Congress of Neurobiology and
Psycho-pharmacology in Greece.
Raymond, how did your journey with ME start?
At the end of the eighties I was heavily involved in sports medicine and was treating a top cyclist
who had been out of the saddle for 7 years because he had ME. He came in with a back problem
which I treated and explained to him that I couldn’t do very much for his ME – at that time it
was known as yuppie flu and considered very much a psychological problem. His back problems
settled down and rather unexpectedly so did his ME to the extent that within a few months he
had no symptoms at all. He was convinced it was down to my treatment so I thought: well if I
have helped him, how have I? And that’s what started me on this quest.
Considerable controversy surrounds the cause of ME and there is no generally accepted theory
– what do you believe is happening?
There are many theories about ME – some with good evidence – and I think what I’ve done is
bring many of those theories together. I believe the key lies in a problem of the drainage system
of the brain and CNS – a system which most of the medical world have no idea exists. Drainage
of the waters of the brain into the lymphatic system is something Still and Sutherland talked
about and recent work at Southampton University has proved the system does exist – in fact
they are currently looking at it as a possible root cause of Alzheimer’s.
So how does drainage of cerebro spinal fluid into the lymphatic system occur?
There is no true lymphatic system in the CNS but CSF drains through peri-vascular spaces in the
cranium around the optic, trigeminal, auditory and particularly the olfactory nerve through the
cribiform plate in the ethmoid bone and into the lymph. It also drains into the paraspinal
lymphatics via the peri-vascular spaces that lie along the spine.
I believe what is happening in ME is that the drainage system stops working and therefore you
get a build up of toxins in the brain that can’t drain out through any other method. It can be
caused by a structural problem in the spine – trauma, developmental or even a congenital
weakness. But mostly the cause is a disturbance of the afferent sympathetic supply and you find
all ME suffers have a long history of sympathetic overload either emotional, physical, postural,
environmental or immunological for many years preceding the onset of symptoms. With all ME
patients there is a definite weakness in the cranial rhythmic impulse and all have problems in
the thoracic spine greater than the norm.
What is the mechanism by which the flow malfunctions?
The sympathetic nervous system, the thoracic duct, the diaphragm, the lymphatic system and
the hypothalamus all have a role. It would take too long to explain here but in summary
overstimulation of the sympathetics can cause the thoracic duct to pump lymph the wrong way,
away from the main drainage point at the subclavian vein, and back into the lymph system. This
can damage the lymph vessels and valves to the extent that it can cause a flow of lymph back
into the CNS. There’s a build up then of poisons in the brain to which the hypothalamus is
particularly vulnerable (because it is not protected by the blood:brain barrier) so it becomes
irritated – dysfunctional and as controller of the sympathetic nervous system causes further
over-stimulation of the sympathetics.
Where do those toxins in the brain come from?
Those toxins can often be post-infection or inflammatory and notably involve large protein
molecules called cytokines which are produced in response to a virus, other infection or
inflammation and have been linked to ME for years. Some toxins can enter the body in the form
of pollutants such as organophosphates used in pesticides. Also neurochemical changes due to
too much stress can become toxic to the central nervous system.
Is there any evidence in patients of this backflow?
That backflow is seen physically and felt physically by the presence of varicose lymphatics which
we have been trying to prove exist. You feel this in every single patient who has ME and in a few
cases you can see them – in fact I’ve produced the very first picture of a varicose lymphatic which
you can see in my book. We’ve tried to scan them but that’s been unsuccessful because
lymphatics are very difficult to scan.
What do they feel like?
Very specific, not just a lump or bump but a series of lumps and bumps going in one direction
like a chain going along a vessel. The skin overlying is a normal colour.
You have observed a 5-sign diagnostic criteria for ME … can you explain?
I’ve come up with five signs that are all always present in all ME patients. They are:
– Varicose lymphatics
– Perrins point – which is sensitivity to gentle pressure at a point slightly superior and lateral to
the left nipple due to sensory crossover from sympathetic nerve irritation in both the lymphatic
vessels plus the cardiac plexus.
– Coeliac plexus tenderness
– Longstanding thoracic spinal problems with tenderness at T4/T5/T6 segments
– Disturbance of the regular sacro/cranial rhythm.
This diagnostic criteria is about to be researched formally and you’ve just received a
commendation from the local NHS research ethics committee?
Yes, it’s a combined project with North Manchester General Hospital and the University of
Central Lancashire and we have some very good people on board including the Consultant
Rheumatologist in charge of the Fatigue Clinic, a Professor of Physiotherapy, the Head of
Statistics at the University and a Professor of Bio-engineering. It will be a blinded comparative
study comparing my diagnostic criteria with the current conventional approach to diagnosing
Currently ME is diagnosed by exclusion which involves an exhaustive and expensive process of
tests and examinations to rule out other causative diseases – anaemia, hormonal problems,
myasthenia gravis, glandular fever etc.
If we can prove that my criteria is as reliable as the conventional approach in the diagnosis of
ME we will have a good case to present to NICE for integration into the NHS based on
effectiveness and cost savings. If we are successful it could really open the door for more
funding for more extensive research into my treatment approach
What research have you already done to back up your hypothesis?
My first paper was published in the British Osteopathic Journal in 1993 (2) which led to my first
clinical trial with Professor Jack Edwards, a world-renowned bio-engineer and Dr Pat Hartley, a
leading health psychologist published in The Journal of Medical Engineering and Technology(3) in
1998. The aim was to evaluate the effectiveness of osteopathic treatment on symptoms
associated with ME and the results were positive. It received world-wide interest although the
scientific community were critical of the fact that we didn’t use double-blind randomly
controlled trials. There were faults in the research – the sample numbers were not as big as we
wanted because funding is always a problem and it was not randomised as much as it should
have been but the main thing is it showed a very high success rate.
The second clinical trial looked at the possible mechanisms for improvement – what are we
actually doing physiologically and anatomically in the treatment? It hasn’t been fully published
but last year I presented the paper to The International Association of CFS/ME in Reno, Nevada
and a paper on the MR imaging from this second study has just been published in the British
journal of Radiology.(7)
How seriously is your work being taken?
A lot of the research into ME has been directed at looking at a viral cause – the thinking is more
on the infectious or psychological side and the structural/mechanical side is largely ignored.
The general trend in the ME associations is that they don’t like supporting one particular
treatment approach and GOsC has a rule that they don’t support one particular osteopath.
However I do receive referrals from GPs and some specialists who over the years have seen
many of their patients improve with my technique. Also the PCTs’ online magazine Primary Care
Today ran an article on my work a few years ago with some PCTs funding patients’ treatment.
And I’ve had some interesting recognition from government. The Gibson enquiry, an all-party
review into ME in 2007, was interested in my work and the final report mentioned my diagnostic
criteria as something worthy of future research because of its potential as a very simple and
cost-effective way of diagnosing ME.
Can you tell me something of your treatment approach?
The theory and treatment has been an evolution over the years of noticing common patterns in
ME patients and finding things that worked and stopping and asking why? I started looking at
ME very much as a spinal problem then became aware of the lymphatic involvement but found
that a lot of the traditional lymphatic drainage techniques made patients worse.
The treatment involves simple effluage techniques directed toward the subclavian veins. I work
on the paraspinal muscles relaxing off the soft tissue to reduce the general tone and
sympathetic tone. Some work on the diaphragm and cranial work to open up the drainage
pathways for CSF and to get the rhythm going in a functional passive way.
We offer supplements – vitamins and minerals, Evening Primrose Oil and an Omega-3 fatty acid
– EPA (eicosapentaenoic acid) which have both been shown to speed up healing of the cell
membranes in the brain that are damaged by the toxic chemistry.
On diet, after years of experience, I recommend a rotation diet – eat lots of different types of
food, reduce the dairy and wheat but don’t cut it out altogether – eat a little bit of everything
with small regular meals preferred.
There is a mind element so you find NLP (Neuro Linguistic Programming) or EMDR (Eye
Movement Desensitisation and Reprocessing) can help but ME is much more than just a
psychological problem.
Lifestyle changes are important and I prescribe regular specific exercises and self-massage to
back up the osteopathic treatment.
What success rate do you have with patients?
We help about 90% of patients that come to us and I would say we can discharge about 30% as
fully cured. 70% need other things as well – the problem lies in patients who continually produce
further toxins or are in an environment where there’s a lot of toxicity or a lot of stress-producing
chemical changes which are toxic or they have a chronic infection or inflammation that can go
on and on.
There are some who just don’t follow instructions and there are a few whose symptoms are so
severe they might need a lot of other treatment before they start with us. Sometimes they are
not still suffering from ME but the effects of having ME for so long and major disease is setting
But I have seen this treatment approach work again and again and again – ME is a terrible
illness but it’s just waiting for osteopathy to show what we can do.
….but will osteopathy be able to? How are the current advertising restrictions affecting you?
Last year I attended a meeting at the GOsC where a group of us discussed scope of practice
within the profession. I told the meeting that osteopathy has to expand beyond the joint and
muscular ailments to allow future research into other conditions that may benefit from our
techniques. As long as ethically approved research has taken place and that the treatment is
evidence-based I think we as a profession should shout loud and clear from the rooftops
about the range of conditions we can help without claiming miracle cures! Let the scientific
argument do the talking.
With sincere thanks to Dr Raymond Perrin DO.
(1) The Perrin Technique – how to beat chronic fatigue syndrome/ME by Dr Raymond
(2) Perrin R,N. 1993 Chronic Fatigue Syndrome, a review from the biomechanical
perspective, British Osteopathic Journal; vol xi.
(3) Perrin RN, Edwards J and Hartley P (January/February 1998) an evaluation of the
effectiveness of osteopathic treatment on symptoms associated with myalgic
encephalomyelitis. A preliminary report. Journal of Medical Engineering and
Technology, 22(1), 1-13
(4) Perrin RN. Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome: A
Hypothetical Model for the Cranial Rhythmic Impulse. Journal of the American
Osteopathic Association, 107(06), 218-224. 2007
(5) Perrin R, Tsaluchidu S. Integrating biological, psychological and sociocultural variables in
myalgic encephalomyelitis: onset, maintenance and treatment. Panminerva Medica
51(03) Suppl. 1, 88, Sept 2009
(6) Perrin R. EPA and The Perrin Technique: A combined approach to treating myalgic
encephalomyelitis. Annals of General Psychiatry. 9 (Supplement 1):S25, 2010
(7) Perrin R, Embleton K, Pentreath VW, Jackson A. Longitudinal MRI shows no cerebral
abnormality in chronic fatigue syndrome. Br J Radiol. 2010 May;83(989):419-23

My long term childhood friend and colleague, who practices from Ithaca in upstate New York as an endocronologist ( ), was recently thanked by The Tompkins Mental Health Services:

“Physician Adam Law was thanked for his conscientious and caring treatment of those with serious mental and physical challenges, but downplayed the achievement, saying it was simply a matter of listening to his patients.

“We all need to listen, not just with our intellects but our hearts as well,” Law said. “As long as we see the people in front of us as people and hear their stories, I think there is a lot of hope.” “


The ME association has published the results of the largest independent survey for ME patients ever conducted in the UK.
The result of which treatments were most successful. Of a list of 25, 1st was Pacing and 2nd was Relaxation/meditation, both which obviously  help ME sufferers who are doing too much.
The 3rd most popular treatment (and dare I say the top actual treatment programe rather than just advice) is The Perrin technique

Researchers have shown that stress and anxiety can make it more difficult for wounds to heal.  Professor John Weinman, from the Institute of Psychiatry at King’s College London, presented the findings at the Cheltenham Science Festival.  Healthy volunteers, whose levels of stress were determined using a standard questionnaire, were subjected to small ‘punch’ wounds.

The wounds of the the most stressed candidates were found to heal twice as slowly as the least stressed candidates.  It was found that levels of the stress hormone cortisol determined the differences in healing rates.