DTFM to infra-patellar tendon (Cyriax technique)

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This following technique is very effective in infra-patellar tendinitis. So may times it is associated with jumping injuries.

The lesion: 1. Cause: It occurs nearly always as a result of overuse but occasionally over load is also responsible.
2. Site: Lies at the insertion of the tendon into the inferior pole of patella. The area is 1.5 cm long.

How to identify it? 1. PROM- A full and painless ROM of knee.
2. No warmth or fluid is detected.
3. Resisted test- Resisted knee extension cause pain at the exact site.
4. Palpation- Tenderness is found at the insertion of the tendon into the patella.

Patient cues: Supine lying with the knee fully extended and the quadriceps muscle relaxed.

Therapist cues: Therapist arrange himself suitably facing the affected knee at the mid-thigh level.
Stabilization of the upper pole of the patella (UE towards the head end of the patient): He presses downwards on the upper pole of the patella with the web of his thumb, his fingers to one and his thumb to the other side of the knee.

The grip of hand at the superior pole of the patella not only steadies the patella and at the same time tilts the lower pole forwards, thus bringing the teno-periosteal junction into a more accessible position.

UE towards the foot end of the patient: He places the ulnar border of the ring finger of his other hand, reinforced by the middle finger, or the middle finger reinforced by the index finger, against the lower pole of the patella.

DTFM act: Pressure is applied & maintained by the adductors of the arm while applying the seesaw movement at the TPJ (teno-periosteal junction).

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