ElbowCyriax Deep Transverse FrictionTechnique-specific guide
PNA Clinical Application Guide
Transverse Friction for Common Extensor Tendon Region
What changes when Cyriax Deep Transverse Friction meets the elbow? Start with the patient's movement, assess safely, and see what the re-test reveals.
2 specific variationsClinical re-test built in
Specific variations
How this technique is applied in the elbow
Each variation below is written so you can follow patient setup, contact, direction, dose and the re-test that decides whether the technique earned a place in the plan.
01
ElbowCommon wrist-extensor tendon
Common Extensor Tendon — Deep Transverse Friction
One question matters more than the name of this variation: will the patient notice a useful change in Pain-free grip, resisted wrist extension and local tendon tenderness.? The careful re-test gets the final word.
The change we are looking for
Adjunct for selected chronic lateral-elbow tendon pain when the common extensor origin is the familiar symptomatic structure.
Primary target
Common wrist-extensor tendon
The movement that tells us
Pain-free grip, resisted wrist extension and local tendon tenderness.
Patient focus
Adjunct for selected chronic lateral-elbow tendon pain when the common extensor origin is the familiar symptomatic structure.
Therapist verifies
Pain-free grip, resisted wrist extension and local tendon tenderness.
Success signal
Keep the technique only if the re-test shows a meaningful improvement in pain-free grip, resisted wrist extension and local tendon tenderness. without symptom worsening.
Full clinical application
1
Position the patient
Sitting with the forearm supported and elbow flexed comfortably.
2
Set the contact
Stabilize the skin over the lateral epicondylar tendon region and place a fingertip/reinforced finger across the tendon fibers.
3
Apply the technique
Use a small transverse movement across the tendon; avoid sliding over the skin or pressing directly on bone.
4
Dose & re-test
Short tolerable bouts only, then progress to wrist-extensor loading. Re-test: Pain-free grip, resisted wrist extension and local tendon tenderness.
Clinical pearl
The key outcome is improved loading tolerance, not how sore the tendon becomes during friction.
Safety / avoid
Avoid acute tear or highly irritable inflammatory presentation.
02
ElbowCommon wrist-flexor tendon
Common Flexor Tendon — Deep Transverse Friction
One question matters more than the name of this variation: will the patient notice a useful change in Resisted wrist flexion/pronation, grip and local tenderness.? The careful re-test gets the final word.
The change we are looking for
Adjunct for selected chronic medial-elbow tendon pain.
Primary target
Common wrist-flexor tendon
The movement that tells us
Resisted wrist flexion/pronation, grip and local tenderness.
Patient focus
Adjunct for selected chronic medial-elbow tendon pain.
Therapist verifies
Resisted wrist flexion/pronation, grip and local tenderness.
Success signal
Keep the technique only if the re-test shows a meaningful improvement in resisted wrist flexion/pronation, grip and local tenderness. without symptom worsening.
Full clinical application
1
Position the patient
Sitting with forearm supported and the medial elbow relaxed.
2
Set the contact
Precise transverse contact over the flexor-pronator tendon region while protecting the ulnar nerve posterior to the medial epicondyle.
3
Apply the technique
Small transverse movement across the tendon fibers.
4
Dose & re-test
Short symptom-guided bouts followed by graded flexor/pronator loading. Re-test: Resisted wrist flexion/pronation, grip and local tenderness.
Clinical pearl
Know where the ulnar nerve is before applying pressure around the medial elbow.
Safety / avoid
Stop with tingling/electric symptoms.
Safety / do not apply when…
Avoid acute tear, hematoma, skin lesion or uncontrolled bleeding risk.
Clinical rule
A technically correct technique is not automatically a useful technique. Keep it only when the patient's pain, range or function improves in a clinically meaningful way, then transfer that gain into active movement, loading or self-management.
