CYRIAX TECHNIQUES.pptx

Basic knowledge about Cyriax Technique

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 on the 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 manually 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 : All pain arises from a lesion. All treatment must reach the affected site. 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. 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. Capsular Pattern

7. End Feel

8. 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: Deep friction Passive movements Active movements and proprioceptive training

9.  Deep Friction Massage There are two forms of treatment. 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 .

10. Amount of pressure : The amount of pressure applied depends on three elements: The depth of the lesion: increased pressure must be applied to deeper structures. 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. 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.

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

12. 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

13. 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.

14. Three main techniques can be distinguished. To-and-fro Movements Pronation-supination Pinch Grip

15. 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.

16. 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.

17. 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.

18. 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: Grade A Grade B Grade C

19. Grade A mobilization is a passive movement performed within the pain-free range. 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. 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. 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.

20. 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.  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. 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. 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. 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.

21. 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. 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. 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. 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.

22. 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.

23. 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 : Simple active movements to gain or preserve normal range in a joint Isometric contractions Isotonic contractions Coordination exercises Electrical contractions

24.  Immobilization can lead to : Capsular and ligamentous tightness or adhesion Muscle shortening and wasting 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 

25. reference https://www.orthopaedicmedicineonline.com/downloads/pdf/B9780702031458000053_web.pdf Cyriax's Illustrated Manual of Orthopedic Medicine