Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.

1. CYRIAX TECHNIQUES
Submitted By: Sakshi Upadhyay
MPT Sports

2. Introduction
• Cyriax is one of the form of diagnostic and treatment based
approach of manual therapy.
• It is both invasive and non-invasive technique which depends
type, extent and position of the disorder present.
• Cyriax method of diagnosis is mainly by “Selective Tissue
Tension’’ which is basically application of specific amount of
applied pressure on selective tissue which is to be assessed and
treated.

3. History
• Dr James H Cyriax (1904-1985), an orthopedic surgeon in London, was
the first to approach the study of soft tissue injuries in a systemic way.

4. Principles
• The Principles of Cyriax concept are :
1. All pain arises from a lesion.
2. All treatment must reach the affected site.
3. All treatment must exert a beneficial effect on the affected site.

5. Examination by Selective Tissue Tension Test
• Three principles for examination by Selective Tissue Tension Test.
1. Passive movements test the function of the inert structures.
2. Capsular patterns differentiate between joint conditions and other
inert structure lesions.
3. Isometric contractions test the function of the contractile tissues.

6. • It includes muscles and its
attachment.
• Pain may be elicited by active
contraction as well as passive
stretching in opposite
directions.
Contractile
Structure
• These tissues posses no inherent
capacity to contract and relax.
• Extreme range of active
movements will stretch the
structures causing pain.
• Testing a muscle in its neutral
position eliminates the pain of
impingement and instability.
Non-
contractile

7. Capsular Pattern

8. End Feel

9. treatment
• Treatment depends largely on the existing type of disorder and can be
categorized as: Traumatic, inflammatory, degenerative, internal
derangement, functional disorders, psychogenic pain.
• The types of treatment options are:
1. Deep friction
2. Passive movements
3. Active movements and proprioceptive training

10. 1. Deep Friction Massage
• There are two forms of treatment.
1. The longitudinal in which the application of force runs parallel to fibers of the
soft tissue structures.
2. The transverse friction massage in which the force is applied perpendicular to
the fibers, separate each fiber, assisting in alignment of newly-formed collagen
during healing.
Friction
• Should be applied with sufficient sweep to reach all the affected tissue and
• Should produce movement between the individual connective tissue fibers of the
affected structure.
• The main goal of friction is to move fibers in relation to each other and adjacent
structures, called Sweep.

11. Amount of pressure: The amount of pressure applied depends on
three elements:
1. The depth of the lesion: increased pressure must be applied to
deeper structures.
2. The ‘age’ of the lesion: recent sprains and injuries require only
preventive friction because crosslinks or adhesions have not had
time to form. In long-standing cases more pressure is needed to get
rid of these.
3. The tenderness of the lesion: Pain can be avoided by starting with a
minimal amount of pressure – just enough to reach the lesion – and
progressively increasing the force as treatment proceeds.

12. Duration and frequency:
1. Usually given for about 10–20 minutes and on every second day.
2. Massage immediately after an injury should be of very low intensity and short
duration.
3. Treatment is stopped once the patient is pain-free during daily activities and
functional tests are totally negative.
Effects
1. Increased blood supply relieves pain.
2. By moving the painful structure to and fro, helps to free it from adhesion.
3. The structures moved in the limitation of normal behavior but not stretched.
4. It increases tissue perfusion at damaged area and stimulates mechanoreceptor
cells.
5. Friction itself is a painful technique.

13. Position of the Patient
• The patient's position must be comfortable, and the lesion must be
within finger's reach,
• Full relaxation is necessary for a muscle belly to access a deeply
seated lesion.
• Tendons with a sheath must be
kept taut.
Friction to the infraspinatus tendon:
counterpressure is by the fingers

14. Position of the Therapist and the Hands
• The therapist should avoid flexed positions.
• Movement is generated in the shoulder and conducted via elbow and
forearm to the digits.
Friction to the supraspinatus tendon:
counterpressure is by the thumb.

15. Three main techniques can be distinguished.
1. To-and-fro Movements
2. Pronation-supination
3. Pinch Grip

16. 1) To-and-fro movements
• These are used in the treatment
of dense, round or flat collagenous
bundles (tendons or ligaments)
and in the treatment of tenosynovitis.
• Movement is with the arm; friction
is given by use of the pulpy part of the finger
• Counterpressure is usually provided
to enable a good sweep.

17. 2) Pronation-supination
• Used where the lesion is difficult to reach
• For Example: the anterior aspect of the Achilles tendon
• Is performed with the pulpy part of the third finger reinforced by the
index finger.
• No counterpressure is given.

18. 3) Pinch grip
• Normal technique for a muscle belly
which is fully relaxed.
• The pinch is between the thumb and
the other fingers
• By drawing the fingers upwards over
the affected area, the therapist feels
the muscle fibers escape from the grip
until only skin and subcutaneous tissue
remain.

19. 2. Passive movements
• Treatment by passive movement is otherwise known as mobilization.
• Depending on its velocity and the range of movement, it can be
graded as:
1. Grade A
2. Grade B
3. Grade C

20. Grade A mobilization is a passive movement performed within the
pain-free range.
I. To promote healing of injured connective tissue: Grade A mobilizations
are applied early in the treatment of sprained ligaments to promote
orientation of the regenerating fibers.
II. Distractions at the shoulder: Gentle and rhythmical grade A movements
stretch the arthritic joint capsule fibers longitudinally, stimulate the
mechanosensor mechanisms in the joint and so inhibiting
somatosympathetic reflexes that are co-responsible for the
vasoconstriction, muscle spasm, pain and increased inflammation of the
joint.
III. Reduction of an intra-articular displacement in a peripheral joint:
elements of traction combined with joint rotations/movements in the
less painful direction and repeated several times with progressively
increasing force.

21. Grade B mobilizations are passive movements performed to the end of the possible
range indicated by an end-feel. All stretching and traction techniques are grade B
mobilizations.
I. To maintain a normal range at the joint: Passive Movements with gentle
stretching of the capsule, starting as soon as possible after the onset of
paralysis, injury or surgery to prevent loss of capsular elasticity.
II. To stretch the capsule of a joint: Useful in all ‘non-irritable’ capsulitis where
the condition is characterized by capsular pattern with hard-elastic end-feel.
Stretching aims at restoring mobility and function by breaking micro-adhesions
and stretching of shortened capsule.
III. To stretch a muscle: Children with short calf muscles can be helped by
sustained stretching followed by full relaxation and active contraction of the
muscle.
IV. Traction: Traction is used to separate articular surfaces from each other. Can be
used for reducing a displaced fragment by increasing joint space, pain
reduction, relax of the muscle.

22. Grade C mobilization is a minimal thrust with a high velocity and over a small
amplitude performed at the end of the possible range OR end-feel. Another word
for grade C mobilization is manipulation.
I. Rupture of ligamentous adhesions: Small ligamentous adhesions from
immobilizations can be ruptured by a high-velocity, small-amplitude thrust
manipulation, along with intensive deep transverse friction. The joint is
stretched as far as possible in the limited direction and manipulated with a
single firm thrust, during which a typical ‘snap’ is often heard.
II. Rupture of tenoperiosteal adhesions: Adherent and disorganized scar tissue
which causes a self-perpetuating inflammation in conditions like Tendinitis
(e.g. Tennis Elbow) can be ruptured to produce a permanent elongation of the
tendon.
III. To reduce a bony subluxation: A subluxation of one of the carpal bones or of
the cuboid bone can easily be reduced by digital pressure combined with
translatory movement during traction.

23. Contraindications to forced movements
• Capsular inflammation
• Muscle spasm: Grade C mobilizations is absolute Contraindication.
Grade B mobilizations may be used.
• Severe osteoporosis: Grade B and C mobilizations should always be
carried out with caution for fear of avulsion fracturing.
• Joints and ligaments not under voluntary tension control: This is the
case for the acromioclavicular, the sternoclavicular and the sacroiliac
joints and the sacrococcygeal ligament.

24. 3. Active movements
• Physical activity is also the primary stimulus for the repair of
musculoskeletal tissues especially during immobilization on skeletal
muscle, tendon, ligament, joint capsule and articular cartilage.
• These are in the form of :
a. Simple active movements to gain or preserve normal range in a joint
b. Isometric contractions
c. Isotonic contractions
d. Coordination exercises
e. Electrical contractions

25. • Immobilization can lead to :
a. Capsular and ligamentous tightness or adhesion
b. Muscle shortening and wasting
c. Development of arthritis
• Moving the joint early in injured as well as non injured direction helps
to maintain tissue integrity.
• Simple active movements to gain or preserve normal range in a joint

26. reference
• https://www.orthopaedicmedicineonline.com/downloads/pdf/B9780
702031458000053_web.pdf
• Cyriax's Illustrated Manual of Orthopedic Medicine