Synopsis: 13

CYRIAX MANIPULATION FOR LUMBAR SPINE

Dr. Mohammed Jamsheer K V

Consultant Manual Therapist,

Gimcare Hospital, Kerala

According to an estimate 70 to 80% of the adult population will experience a clinically relevant episode of LBP at some time in their lives. The most common source is intervertebral degeneration leading to degenerative disc disease and lumbar disc herniation.

Before getting into Cyriax manipulation, we know in the field of manual therapy there exist many concepts like Mckenzie approach, Maitland, Mulligan, Neural mobilisation, Myofascial release concepts, etc.

Cyriax approach gives us the clinical reasoning to clearly differentially diagnose the specific pathology and which technique has to be applied and the dosage of the technique.

Here I will be discussing on how to differentially diagnose conditions in the lumbar spine and the treatment techniques.

Cyriax concept is based on selective tension. The rule is to find out whether the patient complaints of a local lesion or a referred lesion.

If its a local lesion then the question will arise to know whether its an inert structure or a contractile structure . In inert structure lesion, further we have to know whether it's a capsular or a non capsular pattern. Further assessment will be done through palpation.

In lumbar spine 80% of the mechanical low back pain is in relation to Disc pathology. It can be annular bulge/hard protrusion, nuclear bulge/soft protrusion or mixed protrusion.

Lumbar Manipulation is performed for Hard protrusion after ruling out with our assessment.

Key clinical assessment points are sudden of onset low back pain, partial articular pattern and hard endfeel