Orthopaedic Medicine Cyriax, Part I
Orthopaedic Medicine Cyriax : updated value in daily practice, part I
A detailed practical description of the Cyriax clinical examination procedures (basic and accessory examination) and treatment options for the extremities and the spine. Clinical reasoning by using the Cyriax Assessment Forms.
"Orthopaedic Medicine Cyriax" through the years became a vast philosophy in medical practice. Today, "Cyriax" sounds very familiar to many of our colleagues around the world, but can we conclude that the content behind the name are fully understood as well?
When we are confronted with soft tissue lesions of the locomotor system, we would like to safely reach a usefull diagnosis and start an efficient treatment plan. For this purpose, a detailed knowledge of updated orthopaedic medicine Cyriax is necessary. Some views from the past have been abandoned and many others have been confirmed by research. Some practical procedures have been optimized or have become more patient and therapist friendly. The new standardized Cyriax Assessment Forms make functional examination and assessment easier and more reliable.
It is the purpose of the author to give you a very practical and insightfull view in the diagnostic and therapeutic procedures, emphasizing many valuable practical details.
Which questions do you ask during the history and why? What are the diagnostic consequences of these questions? How to assess and detect possible alarm signs? How to perform a functional examination and make a differential diagnosis? How to create a treatment strategy and to interpret the expected prognosis pattern? How and when to use the treatment procedures?
Answering the above questions is the major purpose of these publications.
Published by OPTP, USA, 2003, Steven De Coninck, ISBN 0966285840, 283 pages
Book review by the APTA :Orthopaedic Physical Therapy Practice, The magazine of the Orthopaedic Section, APTA, volume 16 no 3, 2004, page 27-28
"Steven DeConinck's 2-part series is designed to provide the physical therapist with a comprehensive and systematic approach to the diagnosis and treatment of soft tissue lesions of the musculoskeletal system. Based on the diagnostic scheme and anatomical logic of Dr. James Cyriax, this series aims to enable the clinician to: (1) decide which questions to ask during a patient history, (2) identify the diagnostic consequences of the questions, (3) identify potential red flags, (4) perform a functional examination, (5) formulate a differential diagnosis, (6) create a treatment strategy and carry out appropriate interventions, and (7) interpret the expected prognosis pattern.
DeConinck's series is intended to represent an updated version of the Cyriax model based on the premise that "some views from the past have been abandoned and many others have been confirmed by research." In addition, some procedures described in this text have been optimized in order to become more user-friendly.
References toward the McKenzie,Maitland, and Kaltenborn methods are interspersed throughout both texts.
Part I is dedicated to clinical examination and diagnosis, and begins with an indepth review of Cyriax's principles of diagnosis. The chapters that follow are based on specific anatomical location and include titles such as Shoulder, Elbow, Wrist and Hand, Buttock, Hip, Knee, Leg and Foot, Lumbar Spine, Thorax and Abdomen, and Cervical Spine.
Each chapter is presented in an outline format and contains detailed information on the history,examination, interpretation of findings, differential diagnoses, and standardized assessment forms relevant to the specific body part. The author concludes each chapter with a case study and a 'recapitulation scheme'-a table that relates the physical examination findings to various differential diagnoses.
Part II is designed to provide the reader with a description of Cyriax-based treatment techniques, their indications, and contraindications. The book begins with an introduction to treatment principles.
Chapter one describes the principles of treatment for muscular, tendinous, and ligamentous soft tissue lesions,and chapter 2 is dedicated to the principles of deep friction massage. Chapters 4 through 8 pertain to specific body parts such as the shoulder, elbow,wrist and hand, hip, knee, and leg and foot. The remaining chapters cover topics such as lumbar manipulation, lumbar traction, thoracic manipulation and deep friction, and cervical manipulation and deep friction.
I found these volumes to be valuable contributions to the literature. The author skillfully presents the material in a clear, concise, and easy-to-read format.Throughout the text he consistently provides examples in which to reinforce an understanding of the material. Of particular value was Part I's chapter on Cyriax's Principles of Examination.The information presented in this chapter forms the foundation for orthopaedic examination and diagnosis and should be appreciated by all physical therapy clinicians and students, regardless of whether or not they adopt Cyriax's treatment techniques. Other valuable contributions throughout the series included the abundance of illustrations, the standardized assessment forms, the recapitulation schemes, the case studies, and the clear manner in which treatment interventions, their indications, and contraindications were presented.
While this series should be recognized for its strengths, it did have a few minor shortcomings.Part I could have been more comprehensive to include examination of the joints above and below the symptomatic body part.For example,there was no mention of examination of hip strength for the patellofemoral patient, in spite of the recent research findings in this area. It should be noted though, that the emphasis of this book is on the Cyriax philosophy, which should provide the basis for the examination of musculoskeletal impairments. More comprehensive examination techniques for specific body parts can be found in other texts. I felt that another shortcoming of the book involved the illustrations in Part II. While they were plentiful, they could have been described in better detail in order to provide the reader with a clearer understanding of how to perform the techniques. Finally, in the shoulder case that was presented, the patient presented with pain on resisted shoulder medial rotation, yet the diagnosis was infraspinatus tendonitis. This is an apparent error, since according to Cyriax, pain on resisted medial rotation of the shoulder would lead to the diagnosis of subscapularis tendinitis.
The shortcomings that were described in this review should not diminish the value of this series. It is a valuable addition to the library of the physical therapy student, new graduate, or seasoned clinician.
Steven DeConinck deserves praise for his ability to present such a well-written and useful guide to the Cyriax-based examination, diagnosis, and treatment of musculoskeletal impairments.
Phyllis Clapis, PT, DHSc, OCS"
How do colleagues appreciate those publications ?
"...I've purchased your part 1 and part 2 Cyriax books. I have been extremely impressed by this rational approach to examination and treatment. Thank you for this work."
Stephen Harkins, D.C., CA, USA, july 2004
"...I have just recently purchased your Cyriax book updated value in
daily practice. I just wanted to say thank you for producing
a book so clear and comprehensible. As a new graduate and practicing
PT I have truly appreciated your book, and it has proved time and time again a
valuable tool in helping establish my clinical pattern recognition
and thought process. I look forward to buying part II soon..."
Michael Leal, PT ; USA, april 2004