Physiotherapy resources


People with ME have historically seen no role for physiotherapy in their healthcare. This is largely due to reports that people’s health has deteriorated following treatment.

The group Physios for ME have sought to change this through their website and articles.

They advise:

  • Understand the hallmark characteristic of ME – post exertional malaise (PEM
  • Teach Symptom Contingent pacing: pacing within energy limits
  • Do not recommend Quota Contingent pacing (gradual increases in activity)
    Teach the use of a Heart Rate Monitor to keep within threshold and avoid triggering Post Exertional Malaise
  • We do not recommend Graded Exercise Therapy
  • Symptom easing can be achieved for some through positional advice, massage, soft tissue mobilisation, stretching and isometric muscle strengthening but some of these interventions may also trigger symptoms.
  • Physiotherapy intervention should be individual, cautious and constantly evaluated.



Find out more about the physiological response to exertion in people with ME and management through physiotherapy on their website


With reports of post-viral symptoms affecting Covid-19 survivors and the possibility this could develop into ME in some patients, Physios For ME also offer advice on how physiotherapy can support such patients:

Covid-19: Post Viral Fatigue Syndrome and Myalgic Encephalomyelitis

 “Swift identification of PVFS is important because the management techniques differ to the typical reconditioning approach that a physiotherapist may adopt.”

Article in Frontline: Post viral fatigue in Covid-19

If I suspect someone recovering from Covid-19 is developing PVFS, what should I do?

“Adapt to provide pacing strategies to work within energy levels, rather than push beyond limits. And make sure you are clearly communicating your concerns with the multidisciplinary team for ongoing monitoring and support.”

The best approach is to ensure adequate:      Rest     Nutrition     Sleep

University of Leicester: Patients at higher risk of developing ME after COVID-19 diagnosis

“The challenge for physiotherapists who are working to rehabilitate COVID-19 survivors is to identify those who start to display symptoms of ME so that they can adapt their approach to avoid triggering PEM and worsening the condition.”

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