The Concise Perrin Technique

A Handbook for Patients - a practical companion to The Perrin Technique 2nd Edition

Raymond Perrin

• Publisher: Hammersmith Health Books
• Year: 2021
• ISBN:
  9781781612071
• Topic: Medicine
• Subtopic: Diseases & Allergies

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.

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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).

Fact 3: The pumping mechanism

For over 300 years, from 1622 when Italian physician and anatomist Gasparo (Gaspere) Aselli (1581 – 1626) discovered the lymphatic system, it was thought not to have a pump of its own. Its flow was believed to depend on the massaging effect of the surrounding muscles and the blood vessels lying next to the lymphatics, akin to squeezing toothpaste up the tube. However, we now know that the collecting vessels and ducts of the lymphatic system have smooth muscle walls, and Professor John Kinmonth, a London chest surgeon, discovered in the 1960s that the main drainage of the lymphatics, the thoracic duct, has a major pumping mechanism in its walls and that this is controlled by the sympathetic nervous system. If there is a disturbance of the sympathetic nervous system, the thoracic duct pumping mechanism may push the lymph fluid in the wrong direction and lead to a further build-up of toxins in the body.11

Fact 4: The sympathetic nervous system

The sympathetic nervous system is part of the autonomic nervous system, which deals with all the automatic functions of the body. Although it is known for being the system which helps us in times of danger and stress, often referred to as the ‘fight or flight’ system, the sympathetic nervous system is also important in controlling blood flow and the normal functioning of all the organs of the body, such as the heart, the kidneys and the bowel. We know it is vital for healthy lymphatic drainage. In ME/CFS and FMS sufferers, the sympathetic nervous system will have been placed under stress for many years before the onset of the signs and symptoms. This stress may be of a physical nature due to postural strain or an old injury, or it may be emotional stress, or environmental, such as pollution, or due to stress on the immune system due to infection or allergy.

The sympathetic nerves spread out from the thoracic spine to all parts of the body. The hypothalamus, just above the brain stem, acts as an integrator for autonomic functions, receiving regulatory input from other regions of the brain, especially the limbic system which involves emotion, motivation, learning and memory. Significantly, the hypothalamus also controls all the hormones of the body.

Fact 5: Biofeedback

The hypothalamus controls hormones by a process called biofeedback. This mechanism can be explained with the following example. If the sugar levels in the body are too low, it may be due to a rise in the hormone insulin, which is produced in the pancreas, which lies in the upper right side of the abdomen beneath the liver. Insulin, like other hormones, is a large protein molecule that travels through the blood and stimulates the breakdown of sugar. It passes from the blood into the hypothalamus, which will calculate if more or less insulin production is required and, accordingly, send a message to the pancreas to make the necessary adjustments.

The region of the hypothalamus is one of a few sections of the brain that allow the transfer of large molecules into the brain from the blood. In all other parts of the 12brain there is a filter known as the blood–brain barrier (BBB) allowing only small molecules to pass into the brain.

Unfortunately in many disease states, a damaged or disturbed BBB means that further large toxic molecules can invade the brain and wreak havoc on the normal functioning of the central nervous system, and in ME/CFS it has now been proven that many immune cells that promote inflammation do just that.

Fact 6: What goes wrong

The central nervous system, composed of the brain and the spinal cord, is the only region in the body that for hundreds of years was believed to have no true lymphatic system. Since we now know the lymphatics exist to drain large molecules, what can the central nervous system do if attacked by large toxins? It has now been demonstrated that the cerebrospinal fluid (see Fact 1) drains toxins along minute gaps next to blood vessels and then into the lymphatic system outside the head through perforations in the skull. The lymphatic vessels found in the head and around the spine take the toxins away via the thoracic duct and right lymphatic duct (see Figure 4) into the blood and the liver where they are broken down.

This drainage mechanism has now been filmed, with the largest amount draining through a bony plate (the cribriform plate) situated above the nose. The toxins then drain into lymphatic vessels in the tissue around the nasal sinuses. There is further drainage down similar channels next to blood vessels supplying other cranial nerves, especially the ones in the eye, ear and cheek respectively, and also down the spinal cord outwards to pockets of lymphatic vessels running alongside the spine.

The neuro-lymphatic drainage has been shown to occur during deep restorative sleep known as delta-wave sleep. Most patients with ME/CFS and FMS complain that they don’t get enough sleep and that, when they do, they still feel exhausted. The problem for them is that though they may often have plenty of sleep, it isn’t the restorative kind as it is consists of a high proportion of shallow, non-restorative alpha-waves. 13

Researchers at Stanford University in the USA have shown that ME/CFS patients have fewer delta-waves during the night, but too many during the day. The drainage of the brain and spinal cord occurs more during waking hours in ME/CFS and FMS, making those patients feel ill and shattered during the daytime. However, during the night in ME/CFS and FMS, the brain switches on, leading to the ‘wired and fired’ state, affecting ...