Background

Cyriax physiotherapy, introduced in 1941, is a specific form of manual therapy based on deep transverse friction massage (TFM) often combined with targeted manipulations (e.g., Mill’s manipulation for lateral elbow tendinopathy) Although widely taught and practised, its effectiveness has been questioned, and its role within modern rehabilitation frameworks remains unclear. Recent clinical guidelines recommend manual therapy as a Level B adjunct to active treatment rather than as a primary intervention.

Aims

To narratively synthesize the available clinical evidence regarding the effectiveness of Cyriax physiotherapy in the management of common tendinopathies.

Material and methods

A narrative (semi-systematic) review was conducted using PubMed, Scopus, and Google Scholar (search completed in January 2025). Clinical trials, clinical studies, and pilot studies involving adults with lateral elbow, medial elbow, rotator cuff, patellar, or Achilles tendinopathy were included when at least one treatment arm incorporated Cyriax physiotherapy.

Results

Twenty-two studies were included: 10 on lateral elbow, 1 on medial elbow, 4 on rotator cuff, 4 on patellar, and 3 on Achilles tendinopathy. Outcomes most frequently assessed were pain, function, strength, range of motion, tendon structure, quality of life, depression, and kinesiophobia. Across conditions, evidence more consistently favoured Cyriax when integrated into multimodal rehabilitation programmes, whereas findings for Cyriax as monotherapy were inconsistent.

Conclusions

Current evidence suggests that Cyriax physiotherapy may offer short-term clinical benefits when used as an adjunct to active, exercise-based rehabilitation, particularly for lateral elbow, rotator cuff, and Achilles tendinopathy. It cannot be recommended as a standalone treatment. Evidence for patellar tendinopathy remains inconclusive. Future high-quality randomized trials with standardized Cyriax protocols and longer follow-up are required to clarify its clinical value.