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How to work safely with people

who have ME

We often hear from people with ME seeking our support because they have to see a physiotherapist for a problem other than ME. This could be something like a shoulder injury, or following knee surgery, or neck pain etc.


While the physio does not work in ME services, their standard treatments might not be suitable for someone with ME, so they still need a basic level of awareness about ME to be able to adapt their treatment.

We’ve therefore created a new downloadable one-sheet:

“How to work safely with people who have ME/CFS”.

A text-only accessible version for your information is below. To download the handout, click this link.

Information for physiotherapists: How to work safely with people who have ME/CFS

Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS)

Multi-system disease causing substantial impairment to function Systems impacted can be neurological, musculoskeletal, cardiovascular, endocrine, gastrointestinal and immune

Key characteristic of ME/CFS: Post Exertional Malaise (PEM)

Additional symptoms and/or exacerbation of current symptoms in response to exertional triggers (physical, cognitive, sensory and/or emotional).


A physio may see someone with ME/CFS in any setting. Any physiotherapy intervention may cause PEM

Ask your patient about their PEM (known triggers / symptoms / current abilities)

Adapt your session/treatment to avoid causing PEM

Monitor the impact of your input for PEM (onset often delayed, average 1-2 days)

Consider these adaptations to your practice

Environment:  In clinic, ask if need adjustments to lighting, sound or scent

Offer home visit if possible

Patient position: Elevate feet / lying (in waiting room & during session)

Time: Shorter assessment, offer rest breaks before/during/after

Communication: Reduce cognitive load (e.g. shorter subjective assessment, provide written information)

Assessment: Physical tests only if necessary. Use objective markers, e.g. heart rate

Manual therapy: Monitor for sensory triggers (e.g. Reduce pressure, avoid scented oils)

Exercise*: Is it necessary? Will it be tolerated? (e.g. Reduce intensity, position, load, reps)

*Exercise is not a treatment for ME/CFS and a high-risk trigger for PEM, but may be indicated for unrelated injury/condition

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