The iliolumbar syndrome (ILS) appears to be one of the most frequent causes of lumbar pain. From an anatomopathological point of view ILS is classified among the degenerative diseases of the enthesis. This degenerative pathology is caused by a number of factors since it may be the consequence of a localised pathological process (degenerative poly-enthesopathy) due to systemic degenerative diseases of the enthesis. Deep friction according to Cyriax (DF) is a massage technique based on friction in a very localised area. According to Cyriax this massage technique is extremely efficacious for muscular ligament and tendon lesions in which there is adhesion between the former and adjacent structures (muscle fasciae, subcutaneous tissue, other tendons, etc). On these grounds, it is hypothesized that DF could be useful in painful lumber syndromes caused by enthesopathy of the iliolumbar ligament. For this reason, a clinical study was carried out in order to evaluate the efficacy of DF in painful syndromes caused by iliolumbar syndrome (ILS). The study was divided into two parts: In the first part 46 patients suffering from ILS were randomly assigned to two subgroups: one was treated with DF and one with placebo in order to evaluate the efficacy of DF. The second part of the study involved a larger group of patients (76 cases) with ILS who were treated with DF in order to evaluate the possible appearance of less frequent side effects. The first of the study confirmed the marked efficacy of DF in relieving pain in ILS: a drastic reduction of pain (evaluated using Huskisson's scale and a modified version of Ritchie's index) was reported after the fourth session in the group of patients treated with DF. In addition to confirming the efficacy of DF for pain caused by ILS (a complete remission was achieved in 64 patients), the second part of the study showed the possible onset of the following side effects (scarce patient compliance in 3 cases, appearance of cutaneous eschars in 2 cases, appearance of ecchymosis in 5 cases) and even the possible (although rare) inefficacy of treatment (2 patients). In conclusion, DF showed a high degree of therapeutic efficacy for painful symptoms in ILS, only slightly less than which had been reported in other studies using local anaesthetic-steroid infiltrations, but with the advantage of not exposing the patient to frequent or severe side effects. An additional advantage of this therapeutic method was the short duration of each session (barely 5 minutes) and the rapidity of action (it is rare for all 10 planned sessions to be required). In order to avoid misunderstandings and uncertainties it is important to underline the need to warn the patient of the impossibility of knowing in advance the number of sessions necessary to relieve painful symptoms (therefore the duration of the treatment cycle must be set by examining Huskisson's scale and a modified version of Ritchie index at the start of each session) and the possibility that painful symptoms will become more acute after the first two or three sessions of DF.

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