Functional massage according to Cyriax

The deep transverse friction or functional massage according to Cyriax is the type of manipulation that serves the treatment of soft tissue.

In the 30s and 50s, Dr. Cyriax proved that with regard to soft tissue diseases, diagnoses varied from doctor to doctor.

Injuries affecting bony structures require a different type of diagnostic treatment.

Cyriax left orthopedic surgery and the bone-only studies and focused on the study of muscles and soft tissues. He developed a new method of diagnostics, in which an accurate medical history is collected, a functional examination and finally palpation of the body structures is performed. His method includes: deep tissue massage, infiltrations and manipulations of peripheral joints.

What is a functional massage according to Cyriax?

Cyriax deep transverse friction or functional massage is a type of massage based on: deep massage, infiltration and manipulation that focuses on the location of pain and injury, sparing the surrounding healthy tissues. It deals with mild muscle lesions or tendon injuries, with the aim of restoring or maintaining the elasticity and mobility of the tissues. This massage allows the treatment of a well-defined and localized zone by acting on adhesions or the anatomical structure affected by post-traumatic inflammation. Usually, such a therapy session lasts 15 minutes and is repeated two or three times a week.

Of course, treatment must be preceded by a thorough examination to obtain an overall assessment of the patient’s clinical situation.
In preparation for treatment, an examination is carried out with the determination of the region to be treated.
The aim of the treatment is to make the movements painless, but not to restore the complete sequence of movements, especially since osteophytes often make this impossible.
Many vortex manipulations are performed by maintaining a traction component.What does the deep transverse massage do?

The aim of treatment is to maintain or restore normal mobility and elasticity of tissues; it also allows only certain zones to be treated without affecting parts of the adjacent healthy tissue.
The main indication is the treatment of tendonitis: epicondylitis, pubalgia, tendinitis of the shoulder, etc.

Other treatment goals:

  1. Blocking the formation of fibrous scar tissue, thereby avoiding the formation of adhesions between fibrils.
  2. Temporary reduction of pain and stabilization of the influx of metabolites and substrates by stimulating local hyperemia.
  3. Align the collagen fibers to their initial position (before injury) by bringing the fascia back into their correct position in order to respond appropriately to mechanical stimuli.
  4. Sending stimuli to the mechanoreceptors to influence nociceptive afferents that run to the brain.
  5. Prevention of the formation of inflammation in fibrous damaged tissues, which maintain themselves.
  6. Formation of a strong and functional wound egg.
  7. Movement inside the affected anatomical structures prevents or releases adhesions that form as a result of tissue injury.

The only contraindications are:

  • Large soft tissue calcifications.
  • Tendon injuries of rheumatoid origin.

How to use?

A precisely defined and localized anatomical structure, which is affected by a post-traumatic form of inflammation or adhesions, is applied with a special manual technique.


  1. The physiotherapist places his finger, elbow or ankle on the affected area and performs movements (pressure and friction) perpendicular to the fiber direction of the affected structure. As a result, it interrupts or inhibits the formation of scar adhesions (cross-links).
  2. This massage causes local hyperemia (excessive blood supply), as a result of which the rate of degradation of inflammatory substances increases.
  3. The strong stimulus to the mechanoreceptors inhibits pain transmission (gate control).

There are different types of massage: the classic the vertical friction is fundamental. In addition, there is manipulation with circular friction. In the latter, the affected tendon is taken between the thumb and forefinger and pressure is applied to it in circular motion.
With this circular technique you can find a “bump” or the points where the tendon is particularly sensitive.
With the circular friction, one can prevent inflammation from forming in the fibrous damaged tissue, which is self-sustaining. So the goal is to promote the formation of functional wound healing.
Once the painful point has been determined, the massage is performed with a “back and forth movement” with the tip of the index finger and supported by the middle finger, always at right angles to align the injured fibers.

It is important not to exert friction on the skin during treatment.
It is necessary to detect the area of skin where the keloids are located and mobilize the subcutaneous tissue with opposite movements of the hands.
This technique is used first because it prepares the affected area for massage by creating the best conditions. It is necessary to achieve good suppleness and discreet hyperemia of the tissue to carry out the second part of the treatment.

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