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What Is Chronic Fatigue Syndrome?

It is estimated that over one million Americans suffer with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME). CFS/ME is a serious, debilitating, typically lifelong illness.

A person living with chronic fatigue suffers with:

woman with chronic fatigue syndrome

These symptoms make it hard to function day and night.

Physical exercise, or exertion of any kind, such as brushing the teeth, cooking a meal, or carrying a child, make symptoms worse. Even when a person with CFS/ME is resting, they often have ongoing pain and discomfort. The disease affects multiple body systems and finding relief from the symptoms is nearly impossible.

The Cause of CFS/ME Is Unknown

There are no approved drug therapies or treatments for ME and, at best, doctors offer drug treatment to manage certain symptoms. According to the Phoenix Rising website, about 25% of the people living with CFS are home or bedridden.

Often, patients suffer in silence and slowly become depressed, as they await the proper diagnosis, treatment and care. Doctors and researchers are just beginning to discover approaches to definitively diagnose and treat this mysterious disease.

Being Diagnosed With ME

According to the Centers for Disease Control, in order to be diagnosed with ME, a person must be living with significant fatigue that makes it hard to do daily activities for at least 6 months. The CDC diagnosis also requires that four or more of the following symptoms “must persist or reoccur within a 6 month time frame: impaired memory or concentration, post-exertion malaise, sore throat, tender lymph nodes, aching or stiff muscles, joint pain, headaches and un-refreshing sleep (Hives et al, 2017).”

In addition, most healthcare providers feel that a two-year time span and differential diagnosis is important before giving a CFS diagnosis due to the overlap of symptoms with other chronic diseases such as:

symptoms of chronic fatigue syndrome can overlap with symptoms from other chronic diseases

This often puts off diagnosis and treatment for many months or even years.

Each person’s experience of this disease is different. Some people have stages of remission when they feel well and at ease, whereas some people constantly feel intense sickness and/or pain.

How do we find answers for this complicated disease?

In recent years, research is beginning to move closer to uncovering the mystery of CFS. In a study done in 2017, there was formal agreement on the presence of specific visual, physical signs to be utilized as screening for chronic fatigue syndrome. Tender lymph nodes and the visual lymphatic system dysfunction have come to researcher’s attention as a means of CFS diagnosis. Across all systems of diagnosing CFS, there is commonality of lymph node involvement. More specifically, the researchers found that varicose lymph vessels can be observed and felt on examination in consistent locations on the chest of people with CFS/ME.

During the course of the research from Hives et al., these four assessments were analyzed as potential screening techniques for CFS/ME:

  1. “Participant standing: observation and palpation of thoracic spine for any postural defects; regions of redness, temperature change or skin rashes or eruptions, for example, acne/boils.
  2. Participant lying supine: observation and palpation of breast tissue for varicosities in the surface lymphatics and abnormal breast tenderness at ‘Perrin’s point’, which is a superficial tender area found at around 2–3 cm lateral and superior to the left nipple.
  3. With the participant remaining supine, palpation of the region of the coeliac plexus just below the xiphoid in the upper central area of the abdomen for any abnormal tenderness with possible temperature change in the region.
  4. With the participant remaining in a supine position, cradle the head and examine the quality of the cranial rhythmic impulse.”
    The inflamed lymph system of a person with CFS suggests a “toxic buildup within the central nervous system (Hives et al, 2017).” This is a tremendous breakthrough in both the diagnosis and development of treatment for CFS.

Massage for Chronic Fatigue Syndrome

Massage can be successfully used as a complementary treatment for chronic fatigue syndrome. Gentle Swedish massage is beneficial for relaxing the body and mind of people with chronic illness.

massage for chronic fatigue syndrome


Bodywork for chronic fatigue syndrome can bring comfort by:

  • relaxing the body systems
  • supporting digestion
  • encouraging the parasympathetic nervous system response

Relaxation massages using slow, soothing techniques can slowly increase the circulation of blood and lymph to the muscles and allow for faster muscle repair. As muscles recover, they become more flexible, have more range of motion, and less pain. The decrease in pain can lead to improved sleep patterns, and overall less stress and reduced tendency toward depression.

The Perrin Technique

The manual assessment system tool mentioned above was developed by Dr. Raymond Perrin. Perrin’s technique of assessment is the beginning of a new way of looking at CFS/ME.

Now, healthcare providers have straightforward, hands-on clinical screening tools for CFS literally at their fingertips. This screening approach shortens the waiting time for a patient diagnosis, and treatment can literally begin right away.

In addition, the manual treatment techniques developed by Dr. Perrin can be used to effectively relieve this buildup of lymph through specific, gentle lymphatic drainage and cranial sacral release techniques. Over the course of several weeks and months, patients regain strength and feel significant relief of their CFS symptoms.

Dr. Perrin recommends a course of treatment for ME that includes:

  1. osteopathic work
  2. chiropractic care
  3. massage/manual therapy

Perrin’s technique includes a series of targeted bodywork approaches, at the sites of lymph engorgement, to stimulate the drainage of toxins directly into the body systems. Of importance to the massage therapist, is the ability to help aid drainage in the cervical and thoracic lymphatic vessels with superficial, stroking motions to move lymph into the blood stream (Perrin, 2007, 93).

Massage therapists can also perform soft tissue massage along the spine and with the muscles of respiration to help reduce restrictions of movement and improve breathing patterns. Lastly, cranial sacral holds of the suboccipital region and sacrum, followed by stimulation of the cranial rhythmic impulse are beneficial to the client.

All of these gentle, supportive hands-on techniques improve ease of cerebral spinal fluid, soften muscle tissue and help with movement of fluids through the lymphatic system for removal. In general, massage therapists can play an important role in helping people reduce their symptoms of chronic fatigue syndrome.

Massage Contraindications

Deep tissue massage of any kind is contraindicated for CFS/ME. Strong pressure on the muscles and tissues, whether it be neuromuscular therapy, deeper Swedish massage, or myofascial work can leave a person struggling with this disease very uncomfortable.

Bodywork approaches that move fluids briskly, abruptly, or without directing toward the lymphatic system for absorption, may cause more neuromuscular pain. It is important to be trained in the specific, gentle techniques mentioned above.

Finding a Cure for Chronic Fatigue Syndrome

Further research is needed to uncover the mystery surrounding CFS/ME diagnosis and treatment. In the late 90s, the CDC admits to diverting money away from doing research on chronic fatigue syndrome because of the belief (at the time) that CFS is a psychosomatic disease. Even in 2015, less money went into health research related to CFS/ME than headaches, infertility or tobacco.

The bottom line is that CFS/ME affects a vast number of Americans and deserves an investment of research funding, time and attention.

Dr. Perrin is beginning to break down some of the barriers to finding a cure for CFS with his research and development of a hands-on approach that makes a difference for people suffering with this disease. However, more research needs to be done to further explore Dr. Perrin’s findings and bring this screening tool to more healthcare providers.

In the future, it will be beneficial for clinicians to utilize this non-invasive clinical observation technique to help diagnosis CFS and make recommendations to the appropriate manual therapists for care.

Massage therapists with training and experience in lymphatic drainage and cranial sacral therapy can play a role in CFS care and make a difference in the life of someone living with this debilitating illness.


In addition to the variety of effective techniques available to massage therapists to help with CFS/ME, Dr. Perrin also provides a variety of self care practices that people living with chronic fatigue syndrome can utilize to help their bodies heal. In his book, The Perrin Technique: How to beat chronic fatigue syndrome/ME, he describes these techniques in detail.