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FRI0256 Local pulsed ultrasound therapy versus cyriax?s method of deep friction-manipulation in the treatment of lateral epicondylitis: preliminary report
  1. R Guzel,
  2. F Uysal,
  3. M Buyukkose,
  4. A Guney
  1. Physical Medicine and Rehabilitation, Cukurova University Medical Faculty, Adana, Turkey


Background Although physical therapy measures are commonly used for the conservative management of lateral epicondylitis, limited randomised prospective studies exist comparing the effects of different approaches.

Objectives The aim of the study was to compare the efficacy of local pulsed ultrasound (US) therapy with deep friction-manipulation as advocated by Cyriax in the treatment of lateral epicondylitis.

Methods 36 lateral epicondylitis patients with a mean age of 50,42 ± 8,71 years and a mean disease duration of 3,14 ± 2,38 months were enrolled into the study. Patients were randomly allocated into two treatment groups: 1) Ultrasound application of 1.5 watt/cm2 for 5 min 2) Cyriax technique of deep friction massage and Mills? manipulation. Use of analgesics or epicondylitis bracing were not allowed and the treatment intervention lasted for a maximum period of 2 weeks. The same physiotherapist carried out the treatments and the observer was blinded to the treatment modality. Activity modification and gentle range of motion, stretching exercises were recommended to both groups. Outcome measures were pain intensity measured by VAS, pain produced by pressure on lateral epicondyle and on resisted wrist extension, grip strength and Verhaar?s scoring system for treatment results of lateral epicondylitis.

Results At baseline, the groups were similar in terms of age, pain scores, and the duration of symptoms. After treatment, pain produced by pressure on the lateral epicondyle and on resisted wrist extension were found to be significantly decreased in both groups (p < 0.01). Reduction in pain intensity measured on VAS was significant in the Cyriax group but not in the US group (p < 0.05 and p > 0.05 respectively). The improvement in grip strength was significant in both groups, being 38,4% in the Cyriax group, and 19,3% in the US group (p < 0.001 and p < 0.05). Percentage of patients that reached excellent or good results according to Verhaar?s criteria was 55% in the Cyriax and 33% in the US group. When the two treatment groups were compared, the decrease in pain, improvement in grip strength and Verhaar?s criteria seemed to be in favour of the Cyriax group but the differences were not statistically significant.

Conclusion Our preliminary results support the efficacy of two different conservative approaches in the treatment of lateral epicondylitis. Although Cyriax type physiotherapy consisting of deep friction massage and Mills? manipulation seemed to be a better treatment approach than US, the difference did not reach statistical significance. The study is still running for investigating the long term effects of both treatments with increasing number of cases at 12 months.


  1. Verhaar JAN, Walenkamp GHIM, Mameren H, et al. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg (Br) 1995;77-B:128–32

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