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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Cite the three primary intervention strategies used within the Cyriax approach to orthopaedic manual physical therapy.

  • Identify when each intervention is most appropriate and provide rationale for the use of each.

  • Understand the nature of referred pain and how symptoms can change based on which structure is compressed.

  • Define the pressure phenomenon and the release phenomenon.

  • List the questions believed to be pertinent during the subjective examination.

  • List the major components of the objective examination.

  • Define selective tissue tension (STT) testing and the three major components that comprise this testing.

  • Describe the four possible responses to STT testing and the structure that each implicates.

  • Define end-feel and identify the major end-feels as described by Cyriax.

  • Define capsular (full articular) and noncapsular (partial articular) patterns and describe how each may be used in diagnosis.

  • Describe the purpose and value of palpation during the examination.

  • List the five questions that may be used to determine the specific soft tissue lesion at fault for the patient's symptoms.


James Cyriax (1904-1985) was born in London, England, the son of Edgar and Annyuta Kellgren, who were both physicians. Cyriax qualified to practice medicine in 1928 after attending University College School in Gonville, Caius College in Cambridge, and St. Thomas Medical College in London. He commenced his practice at St. Thomas Hospital in 1929. Early in his career, Cyriax observed that orthopaedic surgical diagnosis was based almost entirely upon palpation and radiographic findings that often proved to be fairly accurate. Conversely, the diagnosis of soft tissue lesions appeared to present a greater challenge to the physician. Cyriax concluded that the discipline of orthopaedic medicine lacked a well-developed system for diagnosis of such disorders as tendinosis, ligamentous sprains, and capsulitis. Over the subsequent 12 years, Cyriax developed a system of examination and intervention that was designed to address nonsurgical, soft tissue lesions.

In his private practice on Wimpole Street in London, Cyriax collaborated with physical therapists in the development of this new approach. From its inception, a major component of this approach was the concept of selective tissue tension (STT), which is designed to aid in the identification of specific soft tissue lesions. Cyriax's intervention approach focused primarily on the use of three types of nonsurgical procedures. These intervention procedures are manipulation (high-velocity thrust), and deep friction massage (DFM), traction, and injection. Cyriax believed that most, if not all, musculoskeletal impairments could be effectively managed through the use of one, or a combination, of these three procedures.


"To be effective, treatment must be an appropriate countermeasure for the condition diagnosed, and this is as much a concern of the doctor as the physiotherapist… the relationship between physician and physiotherapist becomes complimentary. Between the two of them, nearly all patients can ...

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