An examination of Cyriax's passive motion tests as a diagnostic tool in patients having osteoarthritis of the knee joint

The selective tissue tension scheme of James Cyriax is an evaluation method commonly used by physical therapists. Cyriax's scheme consists of active range of motion (AROM), passive range of motion (PROM), and resistive tests followed by palpation of anatomical structures. Based on the conflicting results of the past research and the importance of Cyriax selective tissue tension scheme for soft tissue diagnosis, further research in this area appears warranted. The purpose of this study was to examine the capsular pattern and the pain resistance sequence in patients suffering from knee osteoarthritis.

Both males and females subjects referred to physical therapy centers for treatment of unilateral knee OA and fulfilling the ACR criteria for Osteoarthritis of knee (n=30) were included in the study after they gave their informed consent. All the subjects were tested only once for VAS, chronicity, capsular pattern and pain resistance sequence.

13.3% patients demonstrated capsular pattern in knee whereas 86.70% patients showed non capsular pattern. The frequencies of capsular pattern and non capsular pattern were significantly different. (χ2 = 16.13, p <.001). Therefore the hypothesis that significant proportion of subjects would have capsular pattern was not supported as the results were in opposite direction. 27% patients felt pain before resistance on PRS testing, 33% patients felt pain during resistance whereas 40% patients felt pain after resistance on PRS testing. It was found that PRS was significantly correlated with pain intensity and is not correlated with chronicity.

The results of this study provide evidence of the need to question and further examine the existence of capsular pattern and pain resistance sequence as a diagnostic tool.