It noted that a focus on exercise programs had discouraged patient participation in other types of physical activity due to concerns of  increased symptoms. An addendum stated, if studies based on the Oxford criteria were excluded, there would be insufficient evidence of the effectiveness of GET.A 2019 updated Cochrane review stated that, exercise therapy probably has a positive effect on fatigue in adults, and slightly improves sleep, but the long-term effects are unknown and has limited relevance to current definitions of ME/CFS. Cochrane started re-evaluating the effects of exercise therapies in chronic fatigue syndrome in 2020.Patient organisations have long criticised the use of exercise therapy, most notably GET, as a treatment for CFS. Based on an opinion survey of patients who had received GET, in 2015 the ME Association concluded, GET in its current delivered form should not be recommended as a primary intervention for persons with CFS. Adaptive pacing therapy
APT, not to be confused with pacing, is a therapy rather than a management strategy. APT is based on the idea that CFS involves a person only having a limited amount of available energy, and using this energy wisely will mean the "limited energy will increase gradually". : 5  A large clinical trial known as the PACE trial found APT was no more effective than usual care or specialized medical care.
Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP flexion with PIP hyperextension). It is commonly caused by injury, hypermobility or inflammatory conditions like rheumatoid arthritis or sometimes familial (congenital, like Ehlers–Danlos syndrome). Pathophysiology
Swan neck deformity has many of possible causes arising from the DIP, PIP, or even the MCP joints. In all cases, there is a stretching of the volar plate at the PIP joint to allow hyperextension, plus some damage to the attachment of the extensor tendon to the base of the distal phalanx that produces a hyperflexed mallet finger. Duck bill deformity is a similar condition affecting the thumb (which cannot have true swan neck deformity because it does not have enough joints). Diagnosis
Diagnosis of swan neck deformity is mainly clinical. MRI of the hand may suggest volar plate attenuation of PIP and extensor tendon damage for DIP  Genetic screening tests such as for CMT disease may also be indicated. Treatment
Splinting for fingers. Passive stretching and clearing the deformity. References
External links
Swan neck deformity at Wheeless Textbook of Orthopedics, a technical review of the condition
Rheumatoid arthritis: Image showing deformities