Friction massage : references ? |
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Where can I find reference material on deep friction massage ? |
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Does a private course exist ? |
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Can I attend a custom made private training program in OM Cyriax ? |
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Difference between ETGOM and other associations ? |
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There are several organizations that offer Cyriax courses ; why choose for ETGOM ? |
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What's new about Cyriax ? |
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Dr. Cyriax passed away 20 years ago : how can this method still be innovating ? |
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Link to other methods |
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Is OMCyriax compatible with sports medicine ? |
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I already attended a McKenzie, Kaltenborn, Maitland and Mulligan training program : what do I need Cyriax for ? |
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Lumbar manipulation |
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Lumbar manipulations seem to be very aspecific : how can they be functional ? |
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Why attend an ETGOM Cyriax course ? |
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What is the final learning outcome ? |
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Practical aspects of the techniques |
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Some techniques seem to be difficult to perform, because sometimes one needs one or more assistants ? |
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Course schedule |
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Do I have to attend the complete course ? |
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Diploma |
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Is it obligatory to do the examination course ? |
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Dangers of manipulation |
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Cyriax cervical manipulation : very aspecific and it looks terribly dangerous ? |
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Friction massage |
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Is friction massage not a bit oldfashioned ? |
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Danger of infiltrations |
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Corticosteroid infiltrations for tendinitis : isn't it dangerous ? |
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Friction massage : references ? |
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Where can I find reference material on deep friction massage ? |
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When you are looking for specific scientific references on the efficiency or mechanism of deep friction massage, not many recent references are available. It doesn't seem to be a hot topic in the scientific world. However, you can find some references in our overview list.
Please take into account some less quality publications too : sometimes friction massage techniques are performed in an incorrect way, not on the right spot, or in the presence of other contra-indications.
Good reference material on the effect of movement on soft tissue during the inflammation, repair and remodeling phase can be found e.g. in "The human exxtremities, mechanical diagnosis and therapy, McKenzie and May, Spinal publications New Zealand, 2000, p 22-36"
ETGOM also did a ministudy on the anaesthetic effect of friction massage and its diagnostic use.
More specific and general references on friction massage can also be found in following excellent publications :
A system of Orthopaedic Medicine, first edition, Ombregt et al., Saunders 1995, p 71-77
Orthopaedic medicine, a practical approach, 2nd edition, Kesson-Atkins, Elsevier 2005, p 65-82
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Does a private course exist ? |
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Can I attend a custom made private training program in OM Cyriax ? |
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Yes, on demand of several colleagues, we created a special private training program, offering a range of advantages.
This program is unique in the world. |
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Difference between ETGOM and other associations ? |
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There are several organizations that offer Cyriax courses ; why choose for ETGOM ? |
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ETGOM strategy and innovations
ETGOM is one of the only organizations world wide that offers a detailed, to the point, updated orthopaedic medicine Cyriax course : our courses are, purely for didactical and safety reasons, confined to the study of the updated OM Cyriax, without forgetting important interlinks.
We don't agree with "cocktail courses" where participants receive an overview of different approaches in a very hypercomplicated way, without receiving the necessary details of each method separately. Studying highlights of Cyriax, McKenzie, Maitland, Kaltenborn, Mulligan... in a period of 3 weeks is somehow unrealistic and even unsafe.
We clearly do make links to other methods and illustrate the compatibility, but for more detailed information we refer to the specific institutes who offer specialized training programs such as e.g. McKenzie.
We don't offer "artificial hypercomplication" ! In a balanced time frame one receives the best possible training program.
The ETGOM course is the only Cyriax course world wide where clinical reasoning is based on the use of the Cyriax Assessment Forms.
Our basic and advanced training program, incl. examination course, is spread over 25 days.
Many other organisations do it in 35 days, 40 or even 50 days, spending time on some non-relevant contents and making it thus less efficient and more expensive for the participants. Sometimes there seems to be a high "artificial hypercomplication factor".
Which are the relevant Cyriax organisations ?
There are only three organisations who offer reliable, good Cyriax based training programs :
Orthopaedic Medicine International (BWVOG /OMI - Global)
Society of Orthopaedic Medicine, UK (and affiliations)
European Teaching Group of Orthopaedic Medicine Cyriax (ETGOM Cyriax).
History of and differences between those organisations ?
Under Impuls of Dr Cyriax, Mr. Bob De Coninck was the leading founder of the BWVOG (Belgian Scientific Association of Orthopaedic Medicine) of which Dr Cyriax was the honorary president.
Mr. Bob De Coninck is the only Cyriax teacher world wide with such a long experience ; he became a teacher in 1969 ! and was the leader of Dr Cyriax's International Teaching Team until Dr Cyriax passed away in 1985.
Co-founders of the BWVOG (--> from which in a later stage OMI Global grew) were Mr. Pierre Bisschop, Mr. Tony van de Velde, Mr. Ludwig Ombregt.
Mr. Pierre Bisschop was mainly trained by Bob De Coninck, since he assisted Bob De Coninck in his practice for several years. Via Bob De Coninck he came in contact with dr Cyriax and eventually he also became a Cyriax teacher.
Unfortunately, after Dr Cyriax passed away, internal problems arised among some people, which was a very unfortunate situation. Bob De Coninck left BWVOG-OMI.
This event triggered the later birth of ETGOM in 1989.
Attempts to join several organisations in one big new association failed until now.
After all, in his original publications, Dr Cyriax refers directly to Bob De Coninck as a teaching facility in OMCyriax.
All information on course contents can be found on this page.
Have a look at the ETGOM-references ! Until now, we presented courses in more than 20 countries !
ETGOM wishes to set the standards, does so, and only aims for best quality !
ETGOM and the SOM have an official affiliation, which has several advantages for what is concerned the exchange of ideas and experiences. We clearly share the same goals.
The question has also come from the ACPOM (Assoc. of Chartered Physiotherapists in Orthopaedic Medicine) to affiliate with ETGOM, which of course is another positive step towards the future.
For more information on those matters described above please don't hesitate to contact us.
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What's new about Cyriax ? |
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Dr. Cyriax passed away 20 years ago : how can this method still be innovating ? |
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Indeed, time didn't stand still. We feel it is our responsability (ETGOM) to update the hughe value of the method created by dr. Cyriax.
Out of respect for his imput, our courses still carry the label of the "Einstein of OM", dr J.H. Cyriax.
We adapted and changed many techniques so that they became more practical, efficient, patient and therapist-friendly.
We abandoned some techniques, based on recent science, in favour of others ; the creation of symbiotic links to other methods is also new, but, we don`t agree with "artificial hypercomplication" of some examination and treatment procedures advocated in some other methods.
We offer a course in UPDATED orthopaedic medicine, anno 2009, based on reliable and new research. Based on research the content of the training program evoluates.
On the didactical field we incorporated important improvements : new standardized assessment forms, DVD's, books, etc.
The clinical reasoning part in OM has been especially optimized by means of the creation of the standardized Cyriax Assessment Forms.
New books and DVD's illustrate those changes.
Perhaps, nowadays, updated OMCyriax could be even more actual as it already was. It offers an absolute basis in clinical reasoning and treatment and makes your investment in other methods evens more efficient.
Our affiliation with the Society of Orthopaedic Medicine is also a useful way of transferring interesting information.
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Link to other methods |
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Is OMCyriax compatible with sports medicine ? |
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Yes, the two go hand in hand. Diagnosis and treatment of soft tissue injuries is the core business of updated OMCyriax.
Every therapist who is confronted with sports lesions of soft tissue structures can benefit from a detailed Cyriax knowledge.
Treatment consists of mobilisation, manipulation, traction, friction, infiltration and injection techniques |
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I already attended a McKenzie, Kaltenborn, Maitland and Mulligan training program : what do I need Cyriax for ? |
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A thourough knowledge of updated OMCyriax offers you much more than the necessary basis ; it increases ones efficiency and gives you a better comprehension of linked methods and approaches.
The beauty of the updated OM Cyriax is in fact the compatibility with those methods, not necessarily in total, but certainly partial.
At first sight there might be big differences, but after detailed study of different approaches one rather sees the symbiotic elements.
Updated OM Cyriax offers an absolute basis in clinical reasoning in the field of soft tissue lesions. It helps you to understand more and analyze, in an objective way, the features of those other methods. Cyriax clinical reasoning is up to a certain point even more important than some treatment modalities.
A good e.g. McKenzie therapist benefits from a solid Cyriax basis AND vice versa. |
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Lumbar manipulation |
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Lumbar manipulations seem to be very aspecific : how can they be functional ? |
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Indeed, most of them are "aspecific" and this makes them in many cases even more efficient and safer.
Before deciding to manipulate we need a valid/useful diagnosis and exactly this is a major problem. Nowadays there seems to be tendency toward "artificial hypercomplication" of many examination and treatment procedures. We have a dream to reach diagnoses as specific as possible (e.g. "a dysfunction between L4 and L5 in left rotation and a secondary locking of the facet joint").
Scientific and clinical reality shows that many of those diagnoses are merely "wishful thinking", because they are entirely based upon unreliable examination techniques und unrelevant other data.
Having an aspecific, but valid and useful, diagnosis such as "internal derangement in the lumbar spine", one doesn´t need specific treatment techniques.
If you want to reduce a disc protrusion it can be done more easily and safely by using techniques with a traction component. We create space in order to let the reduction take place more easily and we avoid dangerous compression on the spinal cord (specifically in the cervical spine this is very important).
Specific indications and contraindications are described and are imperative.
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Why attend an ETGOM Cyriax course ? |
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What is the final learning outcome ? |
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After attending the basic and advanced training program the therapist must be able to examine a patient in an independant and safe way and to reach a diagnosis as specific and as valid as possible. He manages the clinical reasoning process in a good way.
This only within the field of soft tissue lesions of the locomotor system. Once a diagnosis is achieved the therapist can start a relevant conservative treatment (friction massage, manipulation, mobilization, traction, infiltration and injections (for MD's)), taking into account the nature, the severity and the localization of the lesion, together with the personality of the patient.
The therapist will promote a thourough team work between MD and physical therapist in order to optimize the efficiency of the examination and treatment techniques.
Besides achieving a diagnosis one must also know how to achieve a differential diagnosis including the recognition of certain alarm patterns.
Firstly the therapist must try to achieve a relevant diagnosis and a safe treatment, secondly he should try to relieve the patient from his problems in a period as short as possible, taking into account changing the treatment strategy, also with emphasis on self treatment and prophylactic elements.
These final terms should be reached after attending a Cyriax continuing education program which respects the Global Cyriax Institute standards. |
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Practical aspects of the techniques |
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Some techniques seem to be difficult to perform, because sometimes one needs one or more assistants ? |
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In updated OM Cyriax some techniques from the past have been abandonned or have been partly modified in order to make them more patient and therapist friendly.
For the absolute majority of techniques where an assistant could be helpful (e.g. cervical manipulation or loose body manipulation knee) we developed an "assistant-free" version. |
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Course schedule |
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Do I have to attend the complete course ? |
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No, of course you are recommended doing so.
We advocate a very flexible modular training program, so that you can attend the training program in your own rythm. We even offer a special personalized private training program.
If you want to do the examination course, then you must have completed both the basic and the advanced training program. |
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Diploma |
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Is it obligatory to do the examination course ? |
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No, but strongly recommended.
In a period of 25 days, you received a lot of detailed information and practical exercise. You did a lot of recapitulation work inbetween.
You made a financial and time-consuming investment ; then it would be a pitty not to go to the end.
By deciding to study the material more profoundly, you automatically increase your fun and efficiency in clinical practice and doing so you receive more return on investment. |
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Dangers of manipulation |
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Cyriax cervical manipulation : very aspecific and it looks terribly dangerous ? |
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Every kind of manipulation has its dangers. The danger lies in not respecting the specific indications and contraindications and not respecting the practical execution details.
Once again, first the diagnosis will determine if some kind of manipulation is necessary or not.
If we perform a manipulation we must always be certain that we can control what we do : so, don't give a cocktail of several techniques after eachother, but stick to one single maneuver and then immediately check its effect on the patient's symptoms by interpeting the positive tests from the functional examination.
For those who are not familiar with the specific Cyriax details, indeed, cervical manipulation might look somewhat "brutal". The reality however shows that, in case of disc problems, manipulation under strong traction is one of most safe procedures we can perform. Not using traction is far more dangerous (accidents have been described in literature !). If performed when indicated and in a correct way, it is not uncomfortable for our patients.
Since it is our aim to build in traction for safety reasons, specificty is not very important : does it play a role if we try to reduce a C5 or C6 disc protrusion ? Not at all.
In many cases, diagnostic specificty is merely "wishful thinking". |
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Friction massage |
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Is friction massage not a bit oldfashioned ? |
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On the contrary !
First we have to establish where exactly we have to perform the friction massage ; the interpretation of our clinical examination will be decisive.
Our main purpose is to influance in a positive way the scar formation/healing during the inflammatory phase, repair phase or remodelling phase. This specific to the point mobilization is very helpful.
It can and should be combined with a home-exercise program ; again a nice McKenzie-link.
This friction massage can even be used as a diagnostic tool: e.g. there is doubt between a chronic subdeltoid bursitis in the shoulder and a superficial, tenoperiostal lesion of the supraspinatus --> perform 5 minutes of "test-friction" on the supraspinatus and immediately after that, repeat the positive tests from the examination. If there is a clear difference compared to the beginning, then you can exclude the bursa as the culprit.
--> Conclusion : if used properly, it can be very actual instead of "oldfashioned". |
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Danger of infiltrations |
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Corticosteroid infiltrations for tendinitis : isn't it dangerous ? |
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Yes, this could be contraindicated.
We have to consider different variables : which product, which concentration, which quantity, which needle and which technique is used ?
Even more important : was it indicated ? It is imperative that we can rely on the outcome of our examination and that we constantly have to re-assess, after applying whatever technique.
Before infiltrating with triamcinolonacetonide, it would be a good idea to perform a diagnostic infiltration first, by using a procaine solution. Only if the positive test(s) of our examination become much better or even negative after a diagnostic infiltration, we think of that specific structure being the culprit.
Mostly corticosteroid infiltration is only an option when the lesion doesn't react well on other conservative therapy (e.g. friction massage and mobilization) or if the lesion is not reachable for our palpating finger, making friction massage not possible. |
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