Title: Effects of deep transverse friction or cyriax therapy in lateral epicondylitis (tennis elbow): An Evidence-based Case Report.
Title: Effects of deep transverse friction or cyriax therapy in lateral epicondylitis (tennis elbow): An Evidence-based Case Report.
Introduction:
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ADDIN EN.CITE.DATA (Young et al., 2019). This diversity of terminology reflects different components, theoretical frameworks, and contextual factors that influence clinical reasoning, but it can also lead to confusion regarding teaching and assessment targets ADDIN EN.CITE <EndNote><Cite><Author>Higgs</Author><Year>2008</Year><RecNum>79</RecNum><DisplayText>(Higgs and Jones, 2008)</DisplayText><record><rec-number>79</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705430850">79</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Higgs, Joy</author><author>Jones, Mark A</author></authors></contributors><titles><title>Clinical decision making and multiple problem spaces</title><secondary-title>Clinical reasoning in the health professions</secondary-title></titles><periodical><full-title>Clinical reasoning in the health professions</full-title></periodical><pages>3-17</pages><volume>3</volume><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>(Higgs and Jones, 2008). As such, health professions education literature would benefit from clearly defining clinical reasoning terms and providing conceptual practices PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hb3Jkb248L0F1dGhvcj48WWVhcj4yMDIyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (Gordon et al., 2022). Overall, better standardization and shared understanding of clinical reasoning concepts have important implications for improving healthcare delivery and patient outcomes.
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ADDIN EN.CITE.DATA (Sanders et al., 2015). It is estimated that 50% of people who play tennis will experience some degree of lateral elbow pain at some point in their lives, even though less than 10% of patients with lateral epicondylitis (tennis elbow) are tennis players ADDIN EN.CITE <EndNote><Cite><Author>Boyer</Author><Year>1999</Year><RecNum>90</RecNum><DisplayText>(Boyer and Hastings 2nd, 1999)</DisplayText><record><rec-number>90</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705517779">90</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Boyer, Martin I</author><author>Hastings 2nd, H</author></authors></contributors><titles><title>Lateral tennis elbow:" Is there any science out there?"</title><secondary-title>Journal of Shoulder and Elbow Surgery</secondary-title></titles><periodical><full-title>Journal of Shoulder and Elbow Surgery</full-title></periodical><pages>481-491</pages><volume>8</volume><number>5</number><dates><year>1999</year></dates><isbn>1058-2746</isbn><urls></urls></record></Cite></EndNote>(Boyer and Hastings 2nd, 1999). Novice tennis players and those who use one-handed backhand strokes are at greater risk of developing this condition due to poor technique ADDIN EN.CITE <EndNote><Cite><Author>De Smedt</Author><Year>2007</Year><RecNum>91</RecNum><DisplayText>(De Smedt<style face="italic"> et al.</style>, 2007; Giangarra<style face="italic"> et al.</style>, 1993)</DisplayText><record><rec-number>91</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705517798">91</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>De Smedt, Thomas</author><author>de Jong, Andy</author><author>Dossche, Lieven</author><author>van Leemput, Wim</author><author>Van Glabbeek, Francis</author></authors></contributors><titles><title>Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment</title><secondary-title>British journal of sports medicine</secondary-title></titles><periodical><full-title>British journal of sports medicine</full-title></periodical><dates><year>2007</year></dates><isbn>0306-3674</isbn><urls></urls></record></Cite><Cite><Author>Giangarra</Author><Year>1993</Year><RecNum>92</RecNum><record><rec-number>92</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705517807">92</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Giangarra, Charles E</author><author>Conroy, Betty</author><author>Jobe, Frank W</author><author>Pink, Marilyn</author><author>Perry, Jacquelin</author></authors></contributors><titles><title>Electromyographic and cinematographic analysis of elbow function in tennis players using single-and double-handed backhand strokes</title><secondary-title>The American Journal of Sports Medicine</secondary-title></titles><periodical><full-title>The American Journal of Sports Medicine</full-title></periodical><pages>394-399</pages><volume>21</volume><number>3</number><dates><year>1993</year></dates><isbn>0363-5465</isbn><urls></urls></record></Cite></EndNote>(De Smedt et al., 2007; Giangarra et al., 1993). Recognized risk factors encompass tobacco use, high occupational loads involving repetitive arm movements or vibration, and obesity ADDIN EN.CITE <EndNote><Cite><Author>Shiri</Author><Year>2006</Year><RecNum>85</RecNum><DisplayText>(Shiri<style face="italic"> et al.</style>, 2006; Bretschneider<style face="italic"> et al.</style>, 2022)</DisplayText><record><rec-number>85</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705443265">85</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shiri, Rahman</author><author>Viikari-Juntura, Eira</author><author>Varonen, Helena</author><author>Helivaara, Markku</author></authors></contributors><titles><title>Prevalence and determinants of lateral and medial epicondylitis: a population study</title><secondary-title>American journal of epidemiology</secondary-title></titles><periodical><full-title>American journal of epidemiology</full-title></periodical><pages>1065-1074</pages><volume>164</volume><number>11</number><dates><year>2006</year></dates><isbn>1476-6256</isbn><urls></urls></record></Cite><Cite><Author>Bretschneider</Author><Year>2022</Year><RecNum>87</RecNum><record><rec-number>87</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705443316">87</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bretschneider, S Fransje</author><author>Los, Felicia S</author><author>Eygendaal, Denise</author><author>Kuijer, P Paul FM</author><author>van der Molen, Henk F</author></authors></contributors><titles><title>Workrelatedness of lateral epicondylitis: Systematic review including metaanalysis and GRADE workrelatedness of lateral epicondylitis</title><secondary-title>American Journal of Industrial Medicine</secondary-title></titles><periodical><full-title>American Journal of Industrial Medicine</full-title></periodical><pages>41-50</pages><volume>65</volume><number>1</number><dates><year>2022</year></dates><isbn>0271-3586</isbn><urls></urls></record></Cite></EndNote>(Shiri et al., 2006; Bretschneider et al., 2022). 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ADDIN EN.CITE.DATA (Curti et al., 2021). Lateral epicondylitis can cause significant pain and functional impairment, yet evidence suggests that symptoms tend to resolve within 1-2 years for most patients, irrespective of treatment ADDIN EN.CITE <EndNote><Cite><Author>Mens</Author><Year>1999</Year><RecNum>89</RecNum><DisplayText>(Mens<style face="italic"> et al.</style>, 1999; Wolf, 2023)</DisplayText><record><rec-number>89</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705444201">89</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mens, JMA</author><author>Stoeckart, Rob</author><author>Snijders, CJ</author><author>Verhaar, JAN</author><author>Stam, HJ</author></authors></contributors><titles><title>Tennis elbow, natural course and relationship with physical activities: an inquiry among physicians</title><secondary-title>Journal of sports medicine and physical fitness</secondary-title></titles><periodical><full-title>Journal of sports medicine and physical fitness</full-title></periodical><pages>244</pages><volume>39</volume><number>3</number><dates><year>1999</year></dates><isbn>0022-4707</isbn><urls></urls></record></Cite><Cite><Author>Wolf</Author><Year>2023</Year><RecNum>82</RecNum><record><rec-number>82</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705441129">82</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wolf, Jennifer Moriatis</author></authors></contributors><titles><title>Lateral Epicondylitis</title><secondary-title>New England Journal of Medicine</secondary-title></titles><periodical><full-title>New England Journal of Medicine</full-title></periodical><pages>2371-2377</pages><volume>388</volume><number>25</number><dates><year>2023</year></dates><isbn>0028-4793</isbn><urls></urls></record></Cite></EndNote>(Mens et al., 1999; Wolf, 2023). Despite the substantial impact of the condition, there is no consensus on optimal management strategies. Various conservative and surgical options exist, reflecting the uncertainty surrounding the most effective approach due to the favorable natural history of the condition.
In addition to lateral epicondylitis or tennis elbow, the deep transverse friction also known as cyriax therapy has been advocated as an effective conservative treatment approach. This technique was empirically developed by Cyriax and involves applying deep friction massage transversely across the involved tissue to break down scar tissue and adhesions, align connective tissue, and prepare the area for manipulation ADDIN EN.CITE <EndNote><Cite><Author>Stasinopoulos</Author><Year>2004</Year><RecNum>93</RecNum><DisplayText>(Stasinopoulos and Johnson, 2004)</DisplayText><record><rec-number>93</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705520033">93</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stasinopoulos, D.</author><author>Johnson, M. I.</author></authors></contributors><auth-address>Centre of Rheumatology and Rehabilitation, Leeds Metropolitan University, Leeds, UK. d_Stasinopoulos@yahoo.gr <d_Stasinopoulos@yahoo.gr></auth-address><titles><title>Cyriax physiotherapy for tennis elbow/lateral epicondylitis</title><secondary-title>Br J Sports Med</secondary-title></titles><periodical><full-title>Br J Sports Med</full-title></periodical><pages>675-7</pages><volume>38</volume><number>6</number><keywords><keyword>Humans</keyword><keyword>Manipulation, Orthopedic/methods</keyword><keyword>Massage/methods</keyword><keyword>*Physical Therapy Modalities</keyword><keyword>Tennis Elbow/*rehabilitation</keyword></keywords><dates><year>2004</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1473-0480 (Electronic)
0306-3674 (Print)
0306-3674 (Linking)</isbn><accession-num>15562158</accession-num><urls><related-urls><url>https://www.ncbi.nlm.nih.gov/pubmed/15562158</url></related-urls></urls><custom2>PMC1724968</custom2><electronic-resource-num>10.1136/bjsm.2004.013573</electronic-resource-num><remote-database-name>Medline</remote-database-name><remote-database-provider>NLM</remote-database-provider></record></Cite></EndNote>(Stasinopoulos and Johnson, 2004). Though the mechanism is not proven, DFT massage is believed to modulate pain signals and stimulate local circulation and tissue healing ADDIN EN.CITE <EndNote><Cite><Author>De Bruijn</Author><Year>1984</Year><RecNum>96</RecNum><DisplayText>(De Bruijn, 1984)</DisplayText><record><rec-number>96</rec-number><foreign-keys><key app="EN" db-id="0r90vfvaiswsfte29rox55tcv2dee259rfxw" timestamp="1705520702">96</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>De Bruijn, R</author></authors></contributors><titles><title>Deep transverse friction; its analgesic effect</title><secondary-title>International Journal of Sports Medicine</secondary-title></titles><periodical><full-title>International Journal of Sports Medicine</full-title></periodical><pages>S35-S36</pages><volume>5</volume><number>S 1</number><dates><year>1984</year></dates><isbn>0172-4622</isbn><urls></urls></record></Cite></EndNote>(De Bruijn, 1984). Despite longstanding use of Cyriax physiotherapy foe LE, evidence confirming its efficacy is very limited. Early findings suggest some analgesic benefits with DFT and short term reductions in pain and disability with the Cyriax approach, but high quality studies validating these effects and optimal application are still needed PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGFzaW5vcG91bG9zPC9BdXRob3I+PFllYXI+MjAwNDwv
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ADDIN EN.CITE.DATA (Stasinopoulos and Johnson, 2004; Verhaar et al., 1996).
Lateral epicondylitis can severely affect an individual`s ability to use their arm. The purpose of this paper is to conduct a comprehensive analysis of the data supporting the efficacy of the deep transverse friction or Cyriax therapy approach for treating lateral epicondylitis.
Overview of the case study:
The study considers a 45 year old female right-hand dominant who presented with a 6-week history of lateral elbow pain that began following her annual spring cleaning routine. She reported spending several days scrubbing floors and walls on her hands and knees which required repetitive and forceful gripping of brushes as well as carrying heavy buckets of water. She initially noted soreness in her right elbow but continued her cleaning activities assuming it would resolve. Over the next month she experienced persistent lateral elbow pain which was more with activities requiring forceful wrist movement or sustained gripping. For example, she had increased difficulty opening jars or lifting pots without elbow pain. She also noted subjective weakness in her hand, dropping items held in her right hand on occasion. The pain was localized to the area over her right lateral epicondyle. She denied any prior history of elbow pain or injuries. Her past medical history was significant only for well-controlled hypertension and seasonal allergies. She was otherwise healthy and physically active. Her goal was to relieve her elbow pain so she can regain strength and function of her dominant hand. Previous treatments had been limited to over-counter NASAIDs and rest with little relief.
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