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Physiotherapy Management of ME

We believe that physiotherapists have the right skillset to help people with ME, as long as physios understand that our input will not "treat" the disease, but may help with symptom management, the ability to carry out activities of daily living, and ultimately improve quality of life.

This is not a new concept for physiotherapists. Many of our specialities lie in chronic conditions for which our techniques will not "cure" but can still have a beneficial effect.

It is vital to understand that every person is unique and their response to a treatment is unpredictable. The evidence base for any intervention is very limited. Therefore, there is no approach that is suitable for all

Any physiotherapy intervention should be individual, cautious and regularly evaluated for signs of post exertional malaise (PEM), which is the exacerbation of current symptoms or addition of new symptoms in response to physical, cognitive, sensory or emotional exertion. PEM can be a delayed response, averaging 24 to 48 hours, so monitoring over time is key.

More information about ME in general can be found here.



Specific symptom management 

Reduced activity / exertion tolerance


Energy management: A key management strategy, discussed in detail here.



Massagemay help with pain in some people, but may also cause an increase in pain in others. Evidence is of poor quality. Consider touch and smell sensitivities - reduce pressure and avoid scented oils.

Acupuncture: may help with pain relief in some people, but high drop-out rates in some studies suggest there can be adverse effects and all evidence quality is poor. 


Autonomic Dysfunction

Vagus nerve stimulation: no evidence-based protocols currently exist but some people with ME are using this with mixed results reported

Non-invasive stimulation of parasympathetic system: There are many ways of stimulating the autonomic nervous system, but none have been researched in relation to ME. These include cold water, breathing exercises, music therapy, massage, mindfulness and even OM chanting. Exploration of these methods must be highly individualised and monitored for adverse effects.


Orthostatic Intolerance: Postural Orthostatic Tachycardia Syndrome (POTS)

Compression garments: Venous return may be helped with compression garments. However there is little research in relation to their effects specifically on people with ME, and the energy and sensory overload required to put on garments may make this counter-productive.


Exercise: Caution is advised when seeking typical treatments for POTS as recumbent aerobic exercise is often recommended. Aerobic exercise is likely to cause post exertional malaise and subsequent deterioration, so these protocols are not suitable for people with ME. However, there is potential for supine isometric calf strengthening to help with venous return. Consider the key questions detailed here before introducing any type of exercise.

There are also pharmacological and dietary interventions for POTS.



Maintenance and prevention

For those with severe or very severe ME who may spend the majority of time confined to bed, positional advice and maintenance of joint, muscle and skin integrity is key. More details on severe ME and management options can be found here.

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