Cyriax: ainda é importante? Entrevista com Steven de Coninck

1. Steven, can you please tell us, in a few words, what is Cyriax and in what is it based?
Modern Orthopaedic Medicine (Cyriax) deals with diagnosis and treatment of soft tissue lesions of the locomotor system. In fact, the therapist becomes kind of a "three dimensional anatomical private detective”: first we have to find out which structure is responsible for the complaints, then we would like to know, if possible, where exactly in this structure the lesion lies. After having established an objective diagnosis, we will focus on the determination of a conservative treatment strategy which can consist of deep transverse massage techniques in combination with stretching exercise, manipulation, mobilization, traction, and for MD's infiltration and injection techniques.

2. Cyriax in a not a new methodology. Is it still useful?
I would say "Cyriax", well, the modern updated version, has never been as actual and useful as now! There is a tendency in our profession to focus all the time on a number of treatment techniques/procedures, but, unfortunately we think less of relevant diagnostic clinical reasoning and exactly that part is the biggest value of modern orthopaedic medicine. In fact it offers the absolute basic knowledge for every therapist who is involved in soft tissue lesions. It also provides a basis to better understand advantages and disadvantages of some other methods. The moral of the story is: the more relevant and objective the diagnosis, the more efficient certain treatment procedures become. It is imperative that we focus on reliable and relevant testing: in some other methods a number of examination techniques are used which, unfortunately, don't have any intertester nor intratester reliability (e.g. since many years we know, on the basis of solid qualitative scientific research, that the SI-joint mobility tests don't have any reliability at all; well, let's face the consequences and act accordingly!). We stimulate our colleagues to think in an objective way and to develop a critical mind, with open vision. The question we should ask ourselves all the times is: "What exactly am I doing and what is my purpose; what do I hope to achieve ?".

3. ETGOM is the institution "behind" this course. What can you tell us about ETGOM and its role in Cyriax's continued education?
Well, ETGOM has been setting the standards ever since and still does so: we transferred the "old" Cyriax into a modern, even more reliable, version of orthopaedic medicine : • ETGOM has been founded by Bob De Coninck, who was the first official Cyriax teacher in Europe and was the leader of Cyriax's International Teaching Team until he passed away in 1985. • we created a practical modular education system • we were the first ones to release video productions on examination and treatment techniques in 7 different languages; as well we released the first DVD's, in a later stage included injection techniques ; autumn 2010 our newest productions will be released • we created the standardized Cyriax Assessment Forms i.e. orthopaedic assessment forms • we taught courses in about 29 countries until now and also published different books • we published the first DVD on prevention and self-treatment of lumbar problems • we will publish beginning September the first dvd on "RSWT applications in orthopaedic medicine" • it is our mission to inspire colleagues to examine patients in an objective way, and once they reached a valid diagnosis, to give them a possible treatment pathway, which is, on many occasions, very compatible with some elements from some other methods. We strongly believe in an open vision mentality, without losing the capacity to be objective analytic and asking profound questions

4. In Portugal, lots of PTs have had some Cyriax during their graduation courses. Is this course also suitable for them? What are the benefits for the students?
Unfortunately, following to our vast international experience, I must say that the so-called "Cyriax" education people received during their graduation courses, on many occasions is extremely poor and still not adapted to the year 2010: e.g. I was already confronted many times with course hand outs in which e.g. the friction massage technique of the tenoperiostal aspect of the supraspinatus was illustrated in a completely wrong way: wrong position of the patient, of the therapist,... it is amazing; it says something about the non-quality of some "teachers". In many cases people just got some information about "friction massage", but we should realize that modern orthopaedic medicine is so much more than just friction massage. It is mainly about detailed objective clinical reasoning! Many colleagues give the feedback: "waw, that's totally different as I learned at school”! Frankly, it doesn't wonder me. I don't want to sound arrogant, but continuing education in orthopaedic medicine is my passion and profession since many years and this reflects in our courses. After all, I teach about 90-100 full course days per year. So, yes, students who just graduated will have a huge benefit of the ETGOM course, as well as experienced colleagues.

5. This is a short course (3 days). Is there enough time to understand and practice the techniques?
We created this course especially for those colleagues who don't have too much time for continuing education and who would like to study some important features in a short time frame. It is also an advantage for colleagues who still have doubt about this method and want to discover it without having to register for a very long course; in three days, with a small financial investment, they can discover an interesting world. The planned topics will be discussed clinically in detail: we don't loose time on our courses with extensive biomechanical and physiological explanations, but instead we focus on that what really matters for us, clinicians: history of the patient, inspection, relevant functional examination, palpation, diagnosis, differential diagnosis and treatment strategy. Of course, for colleagues who want to continue we provide the diploma course program.

6. Has Cyriax evolved in the last few years? How is the investigation that supports Cyriax as a method?
I gladly refer to the answers on the previous questions: indeed, there has been a huge evolution. Many techniques not only became more "patient friendly", but also "therapist friendly”; some techniques/procedures have been optimized and others have been abandoned (on the basis of scientific honesty!). We created the standardized assessment forms, which make evaluation quite easier. Therefore I also refer to the books I have written. We made, again as standard setters, a link with radial shock wave therapy, which is very compatible with orthopaedic medicine. In fact, we will release in September a first instruction film on RSWT application in modern orthopaedic medicine. The teaching approach has evolved too, giving the individual therapist a bigger responsability and a higher satisfaction.

7. What can Portuguese PT and MDs expect from these 3 days with you?
They can expect real value for their money: on a short time frame they will learn a lot, which they can really use in daily practice as from Monday. We don't teach what I call "artificial hypercomplication”; they also will receive excellent course materials (hand outs and DVD's); they receive a complete high quality package which is the result of the high standard of the ETGOM course. On top of that they will experience a good atmosphere, with some Portuguese input this surprise is going to be discovered by the people who attend our course!

8. A last question. Dr. James Cyriax is someone who left a great legacy. What would you highlight from his work?
That's easy: First use your brains instead of your hands! First think, analyze in an objective anatomical way, don't be afraid of auto-evaluation, come to a conclusion and act whenever you have to act. We always emphasize the important communication triangle between patient-doctor-physical therapist. When we work together, each one taking his responsibility, we reach the best results, resulting in happier patients and therapists.

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