Application Protocol of the Cyriax Method in Patients with Lateral Elbow Tendinopathy: A Scoping Review

Abstract

Background: The Cyriax method (CM), which combines deep friction massage with Mill’s manipulation, is applied in the treatment of lateral elbow tendinopathy (LET). However, the available scientific data present significant heterogeneity regarding application. The aim of this scoping review was to record the different application approaches of CM for LET, to compare existing protocols in terms of session number, treatment duration, induction of anesthesia, and to identify potential research gaps. Method: A literature search was conducted in PubMed, Embase, Cochrane, BMI, and Google Scholar databases, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Review) checklist. Out of 2752 articles screened, 14 met the eligibility criteria, involving a total of 891 patients. Results: Among the included studies, 50% were randomized controlled trials (RCTs), 14% non-RCTs, 14% systematic reviews, 14% literature reviews, and 7% review articles. CM was investigated as a monotherapy in 26.6% of studies and in combination with other interventions in 33.3%. Additionally, 45% of the trials followed J. Cyriax’s original protocol, while 55% presented variations. Conclusions: The heterogeneity of interventions and study designs complicates the establishment of an ideal application protocol for the CM. The most frequently reported approach includes 12 sessions over 4 weeks, with at least 10 min of deep friction massage (DFM), followed by Mill’s manipulation. Further studies are required to determine whether considering the anesthetic effect influences treatment efficacy.