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Effect of Cupping Therapy on Range of Motion, Pain Threshold, and Muscle Activity of the Hamstring Muscle Compared to Passive Stretching

Authors:
J Korean Soc Phys Med, 2017; 12(3): 23-32
http://dx.doi.org/10.13066/kspm.2017.12.3.23
Online ISSN:
Print ISSN:
2287-7215
1975-311X
Research Article Open Access
Effect of Cupping Therapy on Range of Motion, Pain Threshold, and Muscle
Activity of the Hamstring Muscle Compared to Passive Stretching
Jae-Eun Kim
Ji-Eun Cho
Kwang-Sun Do
Seung-Yeop Lim
Hee-Joong Kim
Jong-Eun Yim
Dept. of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
Received: May 31, 2017 / Revised: June 19, 2017 /
A
ccepted: July 28, 2017
2017 J Korean Soc Phys Med
| Abstract |1)
PURPOS E:
Flexibility and range of motion are very
important factors in sports performance, rehabilitation, and
musculoskeletal pain. The purpose of this study was to
measure the effects of cupping therapy on flexibility, muscle
activity, and pain threshold of hamstring muscle compared to
passive stretching in healthy subjects.
METHODS:
Thirty healthy subjects were randomly
assigned in a crossover design to cupping therapy and passive
stretching. Subjects were tested to compare their effects
according to the intervention such as Passive range of motion
(PROM) (straight leg raising) and active range of motion
(AROM). And algometer (pain) testing and MVC assessment
using EMG were performed as dependent variables.
RESU LTS:
The cupping therapy group and passive
stretching group showed significant differences in all
variables including PROM (
p
=.00,
p
=.00), AROM (
p
=.00,
p
=.03), Pain Threshold (
p
=.03,
p
=.08), Semitendinosus
MVC (
p
=.01,
p
=.00), and Biceps femoris MVC (
p
=.01,
p
=.16). There were no significant differences between the
Corresponding Author : jeyim@syu.ac.kr
This is an Open Access article distributed under the terms of
the Creative Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/3.0) which permits
unrestricted non-commercial use, distribution, and reproduction
in any medium, provided the original work is properly cited.
two groups in all variables.
CONCLUSION:
These findings of this study suggested
that cupping therapy has as much positive effect on flexibility,
pain threshold, and muscle contraction as passive stretching.
Also, it is more convenient and easier to work on patients than
passive stretching. Therefore, cupping therapy should be
considered as another option to treat range of motion, pain,
and muscle activity in the clinical field.
Key Words:
Cupping therapy, Hamstring muscle, Pain,
Passive stretching, Range of motion
. Introduction
Flexibility and range of motion are very important fac-
tors in sports performance, rehabilitation, and muscu-
loskeletal pain (Decoster et al., 2004; Decoster et al., 2005;
Law et al., 2009; Kim et al., 2011). Flexibility can be
defined as the capacity for muscle extension to enable
movement of a joint within its range of motion, and is
a crucial component of normal biomechanic function
(Zachazewski, 1989; Hopper et al., 2005).
The hamstring muscle is one of the principle elements
in rehabilitation programs and sports activities that enable
recovery of optimal muscle length (Fasen et al., 2009; Kim
et al., 2014). The hamstring is most widely used in
24 | J Korean Soc Phys Med Vol. 12, No. 3
stretching studies because it is a biarticular muscle that
can be extended without impedance by an articular capsule
or ligament (Ylinen et al., 2010). Moreover, decreased
flexibility in the hamstring muscle disturb the biomechanics
of the waist and pelvis, leading to low back pain or
musculoskeletal disorders (Witvrouw et al., 2003; Meroni
et al., 2010; Muyor et al., 2011; Kim and Hwang, 2012;
Rogan et al., 2013). Therefore, it is clinically very important
to maintain adequate length.
Passive stretching is the most widely used method to
extend the length of muscles, and is the most used
intervention to enhance the flexibility of muscles and
increase the range of motion; however, there have been
reports that question the beneficial effect of stretching on
exercise performance because extension of muscle length
may lead to decreased strength (Marek et al., 2005; You
and Lee, 2010).
Cupping therapy is a type of alternative medicine for
pain relief, and for treatment in addition to acupuncture
therapy (Tham et al., 2006). Cupping therapy has been used
for various illnesses to headache, low back pain, neck pain
and carpal tunnel syndrome (Ahmadi et al., 2008; Farhadi
et al., 2009; Michalsen et al., 2009; Lauche et al., 2011).
Cupping therapy has been recommended for treatment of
musculoskeletal disorders following publication of various
studies (Ahmadi et al., 2008; Farhadi et al., 2009; Michalsen
et al., 2009; Lauche et al., 2011), and is expected to become
a new trend in sports medicine when applied in combination
with use of movement patterns or functional exercises
(Lacross, 2014; Musumeci, 2016; Ries, 2016).
Based on prior studies, the effects of cupping therapy
can be divided into mechanical and chemical components.
The mechanical effects induce free movement of deep
fascia and muscles by activating lubrication of superficial
fascia between skin and deep fascia (Guimberteau et al.,
2010). This eases the restriction caused by adhesion of
the deep fascia and enables independent movement of
muscle by intensive application of cupping therapy (Tham
et al., 2006). In addition, cupping therapy reportedly
maintains normal physical function through an immediate
reaction by skin and fascia (Benjamin, 2009). Lastly, it
removes the tension in soft tissues caused by pain and
relieves mechanical deficits by efficiently restoring the
tissues (Malliaropoulos et al., 2004).
Studies on the chemical effects reported that efficient
physical recovery was possible with application of cupping
therapy, as it increased blood flow and removed toxins
from the deep fascia (Yoo and Tausk, 2004; Tham et al.,
2006; El Sayed et al., 2013). Cupping therapy also
stimulated small nerves in muscle and induced secretion
of endorphins in the brain in response to application of
cupping therapy to the skin (Tham et al., 2006).
Although many studies scientifically demonstrated the
effects of cupping therapy (Yoo and Tausk, 2004; Tham
et al., 2006; Ahmadi et al., 2008; Farhadi et al., 2009;
Michalsen et al., 2009; Lauche et al., 2011; El Sayed et
al., 2013; Hanan and Eman, 2013), there is a lack of studies
on changes in muscle length, muscle activity, and pain
thresholds. Therefore, the purpose of this study is to
measure and compare the change in flexibility, muscle
activity, and pain threshold in hamstring muscle with
application of cupping therapy and static stretching.
. Methods
1. Participants
The subjects of this study were 30 healthy males and
females in their 20s and 30's who were students attending
S University in Seoul. The subjects voluntarily agreed to
participate in the experiment, and those without lower limb
muscle pain, restriction in range of motion (ROM),
backache, disc disease, or an open wound at surface
electromyogram (SEMG) attachment sites were selected.
The characteristics of subjects are shown in Table 1. All
experimental protocols and procedures were explained to
|
25
Effect of Cupping Therapy on Range of Motion, Pain Threshold, and
Muscle Activity of the Hamstring Muscle Compared to Passive Stretching
Subjects (N=15)
Sex Male 12 (80%)
Female 3 (20%)
Age (years) 30.10 ± 5.52
Height (cm) 167.38 ± 8.82
Weight (kg) 59.98 ± 12.14
Mean ± SD
Table 1. General characteristics
Fig. 1. Study design
each subject and approved by the institutional review board
of Sahmyook University in Korea. All subjects provided
written informed consent prior to study enrollment.
2. Procedure
After pre-test, subjects were randomly divided into
cupping therapy group and passive stretching group by
coin-tossing method. Three physical therapists with greater
than 3 years' experience conducted stretching and cupping
therapy intervention and each of the four testing sessions
under the same environmental conditions. Participants
were not blinded to the intervention. Only the testers were
blinded.
Cupping therapy was applied to the hamstring muscle
for 5 minutes in the cupping therapy group. The passive
stretching group was treated with a passive stretching for
10 seconds and repeated 9 times. Then, a post test was
conducted after ether cupping therapy or passive stretching,
in a manner similar to that of the pretest. Passive range
of motion (PROM) (straight leg raising), active range of
motion (AROM), and algometer (pain) testing, and MVC
assessment using EMG were performed as dependent
variables. After 1 week of washout period, following a
pretest, subjects were switched to the other group. Then,
a posttest was conducted, in a manner similar to that of
the pretest (Fig. 1).
3. Interventions
1) Cupping Therapy
Cupping therapy can be applied either with the use of
a suction pump or by briefly heating the inside of a glass
cup with a flame. Cupping therapy is usually applied with
a suction pump but there is a gradual increase in the use
of heat for cupping therapy due to outstanding treatment
effects and convenience in sterilization. The application
time varies based on the reason for treatment and intensity
of negative pressure, but the application time is usually
1-10 minutes (Tham et al., 2006). Accordingly, the
assessment was conducted in this study after a 5-minute
application of cupping therapy with the use of a flame.
In flame-heated cupping therapy, the inside of the glass
cup momentarily develops a vacuum. When the glass cup
is applied to the skin, the negative pressure within the
cup causes myofascial decompression. To apply cupping
therapy to the hamstring muscle in the experiment leg
group, the muscle was divided into 3 areas and 3 cupping
therapy cups were applied to each area (Fig. 2).
26 | J Korean Soc Phys Med Vol. 12, No. 3
Fig. 2. Attachment point of cupping therapy
2) Passive stretching
Subjects lay supine keeping their backs flat throughout
the stretch. The leg was passively raised until to the point
of “slight discomfort” in the hamstring and held for 10
seconds, followed by a and slow return; this was repeated
9 times (Johnson et al., 2014).
4. Measurement
In order to verify treatment efficacy of cupping therapy
and passive stretching, a pre and posttest were conducted.
ROM, algometer, and MVC tests were conducted before
and after the intervention.
1) ROM Test
PROM and AROM testing were conducted. PROM was
conducted with the subject in supine position on a medical
bed. The distance between the greater trochanter and the
knee joint was indicated with a straight line for the PROM
test, and an electronic goniometer (Dualer IQ, J-tech
Medical, USA) was attached to the femoral region on the
indicated line. Measurement was conducted after setting
the value in the supine position at zero. Examiner performed
the passive SLR by keeping the knee in full extension
and the ankle in neutral position. Full ankle dorsiflexion
was avoided to prevent calf muscle stiffness or pain
(gastrocnemius and soleus) from confounding the sensation
of hamstring stiffness and pain which would signal the
limit of the SLR test. The examiner would hold the talus
and avoid any hip rotation during flexion of the hip as
they lifted the subject's lower limb until he or she first
complained of stiffness or pain in the region of the thigh,
bent his/her knee, or began to swing into a posterior pelvic
tilt (noted as movement of the ASIS).
For AROM, the hip joint angle was measured after
voluntary straight leg raising. For this measurement, the
ankle was held in ankle neutral position and the leg was
lifted slowly to avoid generating elasticity from a quick
leg lift. This measurement was within a range that would
not cause bending of the knee on the measured side or
an increase in lumbar lordosis angle.
2) Pain Threshold Test
The pain threshold value based on pressure applied to
the hamstring muscle was measured with the use of an
electronic algometer (Algometer, J-tech Medical, USA)
with the subject in prone position on a medical bed. Three
areas 2cm apart from the cupping place on the hamstring
muscle were selected as pain points and the average value
for the 6 pain points was calculated to obtain the pain
index.
3) EMG test
Wireless EMG electrodes were attached to the
semitendinosus (ST) and biceps femoris (BF) with the
subject in prone position on a medical bed. Before
attachment of electrodes, hair at the attachment area was
removed, and the keratin layer was removed to reduce
impedance to the myoelectric signal by rubbing; electrodes
were then attached after cleansing the skin 3-4 times with
a sterilized alcohol swab. EMG electrodes were attached
along the contracting direction of the muscle fibers. The
ST electrode was attached at the midpoint between the
ischial tuberosity (IT) and the halfway point to the medial
condyle in the femoral region. The BF electrode was
attached at the midpoint from the IT to the halfway point
|
27
Effect of Cupping Therapy on Range of Motion, Pain Threshold, and
Muscle Activity of the Hamstring Muscle Compared to Passive Stretching
of the lateral condyle in the femoral region (Konrad,
2005; Shenoy et al., 2010). The distance between wireless
electrodes was 2-3 cm. Muscle activity during sustained
isometric MVC for 5seconds with the knee held in 90°
knee flexion was measured.
5. Data Analysis
Data collected in this study were analyzed with SPSS
18.0 for Windows and a statistically significant level
α
was set as .05. In order to compare the differences between
the 2 groups before experiment for homogeneity ver-
ification, an independent t-test was conducted. Normality
was verified by conducting a Kolmogorov-Smirnov test
for the 2 groups. The differences between the groups were
compared with an independent parametric t-test, and a
paired t-test was used to compare results for ROM, pain,
and EMG before and after intervention in the experiment
and control groups.
. Results
There was a statistically significant increase in ROM
after intervention in the cupping therapy and passive
stretching group for both the PROM and AROM tests.
However, there was no significant difference between the
2 groups for both tests (Table 2, 3).
The pain threshold increased from 56.1 to 63.8 before
and after the intervention in the cupping therapy group
(p<.05). However, there was no statistically significant
difference in the Passive stretching group from 53.3 to
58.2 (p<.05). In a comparison of the 2 interventions, there
was no difference between the groups (Table 4).
The muscle activity value of the ST increased from 175.4
to 214.9
before and after the intervention in the
cupping therapy group (p<.05). The muscle activity value
of the ST increased from 176.0
to 210.8
before and
after the intervention in the passive stretching group
Cupping therapy
(n=15)
Passive stretching
(n=15) tp
Before (angle, °) 64.6 ± 9.085 64.8 ± 10.23 -.75 .940
After (angle, °) 76.0 ± 10.65 75.1 ± 11.09 .218 .829
Difference 11.4 ± 8.46 10.2 ± 7.67 .384 .704
t-5.215 -5.180
P.000* .000*
mean ± standard deviation
Table 2. Comparison of Cupping Therapy and Passive stretching on PROM
Cupping therapy
(n=15)
Passive stretching
(n=15) tp
Before (angle, °) 55.5 ± 9.26 56.5 ± 9.65 -.280 .728
After (angle, °) 66.8 ± 7.68 66.6 ± 14.34 .35 .972
Difference 12.3 ± 7.04 10.6 ± 12.59 .405 .689
t-5.160 -2.587
P.000* .025*
mean ± standard deviation
Table 3. Comparison of Cupping Therapy and Passive stretching on AROM
28 | J Korean Soc Phys Med Vol. 12, No. 3
Cupping therapy
(n=15)
Passive stretching
(n=15) tP
Before Pain 56.1 ± 11.16 53.3 ± 10.06 .738 .467
After Pain 63.8 ± 12.71 58.2 ± 12.04 1.235 .227
Difference 7.6 ± 12.47 4.8 ± 9.88 .663 .513
t-2.365 -1.918
P.033* .076
mean ± standard deviation
Table 4. Comparison of Cupping Therapy and Passive stretching on Pain Threshold
Cupping therapy
(n=15)
Passive stretching
(n=15) tp
Before- MVC ()175.4 ± 98.94 176.0 ± 58.08 -.202 .984
After- MVC () 214.9 ± 115.07 210.8 ± 71.75 .118 .072
Difference 39.5 ± 50.50 34.8 ± 39.86 .285 .778
t-3.035 -3.384
P.009* .004*
mean ± standard deviation
Table 5. Comparison of Cupping Therapy and Passive stretching on Semitendinosus-EMG
Cupping therapy
(n=15)
Passive stretching
(n=15) tP
Before- MVC ()115.2 ± 57.40 80.0 ± 44.47 1.877 .907
After- MVC () 132.5 ± 64.18 128.1 ± 130.6 .116 .908
Difference 17.3 ± 22.87 48.1 ± 126.0 -.932 .359
T-2.938 -1.481
P.011* .161
mean ± standard deviation
Table 6. Comparison of Cupping Therapy and Passive stretching on Biceps femoris -SEMG
(p<.05). In a comparison of the 2 interventions, there was
no difference between the two groups (Table 5).
The m uscle activity value of the BF increased from
115.2
to 132.5
before and after the intervention
in the cupping therapy group (p<.05). In Passive
stretching group, muscle activity value of BF increased
from 80.0
to 128.1
, but there was no statistically
significant difference (p<.05). In a comparison of the
2 interventions, there was no difference between the two
groups (Table 6).
. Discussion
In order to evaluate the effect of MFD (Myofascial
Decompression, cupping) and passive stretching on ROM,
pain threshold, and muscle activity of hamstring muscles,
this study was conducted with 15 normal adults without
musculoskeletal disorders. There was a significant increase
in ROM after the intervention with both cupping therapy
and passive stretching. In prior studies, there was a statisti-
cally significant increase in ROM in a comparison of a
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29
Effect of Cupping Therapy on Range of Motion, Pain Threshold, and
Muscle Activity of the Hamstring Muscle Compared to Passive Stretching
cupping therapy intervention group and a foam roll & heat
pack intervention group in 17 collegiate athletes. This study
also found the same result as the preceding study, which
implies that cupping therapy has a positive impact on an
increase in flexibility of muscle (Lacross, 2014). The reason
why cupping therapy may induce as much change in flexi-
bility as passive stretching can be explained by research
findings that suggest a mechanical basis for its effects;
cupping therapy generates effective manipulation of phys-
ical structures including fascia, skin, and musculocutaneous
tissues, increases the neurophysiological activity at the level
of nociceptors, the spinal cord, and other nerves, and ulti-
mately leads to significant relaxation (Musial et al., 2013).
In addition, negative pressure generated by application of
an cupping therapy cup is about 4 inches removed from
soft tissues and exerts various mechanical effects including
the relief of muscular pain, restoration of muscle, recovery
from adhesions, and release of tissues bound up within
muscle (Hanan and Eman, 2013).
The precise physiological mechanism of pain alleviation
by cupping therapy remains unclear, but there are several
theories. First, chemical transmitters, such as serotonin,
endorphin, and cortisol, which can block pain are secreted
during cupping therapy, as occurs with acupressure or
acupuncture, and play a role in ultimately reducing pain
(Schulte, 1996). Second, nociceptor activation induces pain
(Schaible et al., 2002), and it is suggested that cupping
therapy alleviates pain by its anti-nociceptive effect and
counter irritation (Michalsen et al., 2009). Third, all
noninvasive and non-drug treatments have a placebo effect;
a recent research finding suggested that a placebo-device
is more effective in pain alleviation compared to
placebo-pill (Kaptchuk et al., 2006).
Muscle activity analysis showed a significant increase
in in the ST and semimembranosus muscles for both
interventions in the cupping therapy and passive stretching
groups. In regards to BF, there was a significant increase
in muscle activity after the intervention in the cupping
therapy group alone. Moreover, there was an increase in
muscle activity followed by an increase in flexibility of
the muscle after cupping therapy treatment, which can be
explained by the interaction between muscle length and
tension. Many studies have suggested that there is a
correlation between muscle flexibility and muscle strength.
At optimal muscle length, it has been suggested that there
are corresponding serial sarcomere numbers (Cox et al.,
2000; Coutinho et al., 2004), and that these serial sarcomere
numbers can be increased with flexibility exercises
(Ferreira et al., 2007; Chen et al., 2011). It has also been
suggested that muscle strength may have an influence on
adaptation of serial sarcomere numbers, and that an increase
in serial sarcomere numbers has an influence on muscle
strength (Koh, 1995). It can be surmised that the flexibility
generated by cupping therapy and passive stretching in this
study had an effect on sarcomeres and that an increase
in muscle activity was followed by an improved sarcomere
environment with an increased serial sarcomere number.
Additionally Report of Coutinho suggests that muscle fiber
performance may be enhanced by an increase in the number
of muscle fibers and the cross-sectional area of the muscle
fibers after muscle stretching (Coutinho et al., 2006). Thus,
as in this study, the significant increase in muscle activity
after application of a Cupping therapy can be explained
by this therapeutic mechanism.
A limitation of this study is that it examined the
therapeutic effect for only a single application, and no
assessment was performed regarding the duration of the
application. Moreover, the correlation between sufficient
rest and pre-intervention may be ambiguous since this was
examined on the same day through the crossover design.
Although cupping therapy was performed by experienced
therapists, the negative pressure may not have been
controlled either qualitatively or quantitatively. Lastly, the
results will be more reliable when applied to more subjects
since the number was small in this study.
Future study is needed using various cupping therapy
30 | J Korean Soc Phys Med Vol. 12, No. 3
techniques and ROM evaluation that combines cupping
therapy and exercise. Moreover, a study of whether long-
term application of cupping therapy has an effect on not
only physical and physiological parameters but also on
psychological aspects and quality of life should also be
conducted.
. Conclusion
The aim of this study is to measure the effects of cupping
therapy on flexibility, muscle activity, and pain threshold
of hamstring muscle compared to passive stretching. It was
evident from findings of this study that cupping therapy
has as much positive effect on flexibility, pain threshold,
and muscle contraction as passive stretching. The cupping
therapy could be a new clinical method to improve range
of motion and it also could be an alternative tool for patients
who cannot conduct the stretching exercise. Also, it is more
convenient and easier to work on patients than passive
stretching. Therefore, cupping therapy could be considered
as another option to treat pain, ROM, and muscle activity
in the clinical field.
Acknowledgements
This study is supported by the Graduate School of
Sahmyook University.
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... At the same time, wet cupping is used as a means to reduce muscle pain, muscle tenderness, improving a range of motions and fatigue among athletes Hanan and Eman, 2013;Ma et al., 2013;Kim et al., 2017). Wet cupping is thought to act mainly by increasing local blood circulation and relieving the painful muscle tension (Lauche et al., 2011;Mehta and Dhapte, 2015). ...
... The mechanical effects induce free movement of deep fascia and muscles by activating lubrication of superficial fascia between skin and deep fascia (Guimberteau et al., 2010;Lauche et al., 2013). This eases the restriction caused by adhesion of the deep fascia and enables independent movement of muscle by intensive application of wet cupping therapy Kim et al., 2017). ...
... Kargar-Shoragi et al. (2016) have revealed the positive effect of wet cupping on muscular damages inflicted by trainings of handball players. Kim et al. (2017) have concluded that wet cupping increases the flexibility of athletes and has a positive effect on pain. In consideration of these studies, it is thought that short recovery time, cease in muscular pains and increased muscular flexibility would positively contribute to the performance of athletes. ...
Research
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Özet Bu çalışmanın amacı, sporcularda hacamat uygulamasının sporcuların bazı performans ve kan parametreleri üzerine etkisinin araştırılmasıdır. Çalışmaya katılan sporcular (n=23), rastgele örneklem yöntemi ile yaş ortalaması 20,36±1,286 yıl, antrenman yaşı ortalaması 7,45±4,132 yıl, boy uzunlukları ortalaması 177,82±6,585 cm, vücut ağırlıkları ortalaması 74,09±11,476 kg olan kontrol grubu (KG) (n=11) ve yaş ortalaması 21,17±2,290 yıl, antrenman yaşı ortalaması 9,08±3,825 yıl, boy uzunlukları ortalaması 179,67±8,553 cm, vücut ağırlıkları ortalaması 71,25±10,314 kg olan deney grubu (DG) (n=12) olmak üzere iki farklı gruba ayrıldı. Katılımcıların bacak kuvveti, ivmelenme, sürat, dikey sıçrama ve durarak uzun atlama değerleri, kan parametrelerinde ise WBC, RBC, HGB, PLT ve HCT düzeyleri ölçüldü. Çalışmanın istatistiksel analizlerinde tanımlayıcı olarak aritmetik ortalama ve standart sapma değerleri kullanıldı ve dağılımların normalliği için Shapiro-Wilks testi uygulandı. Gruplar arası farkın belirlenmesinde Independent-Sample T testi, grup içi farkın belirlenmesinde ise, Paried-Sample T testi yapıldı. Anlamlılık düzeyi p<0.05 olarak alındı. Sonuç olarak hacamat uygulamasının sporcuların bacak kuvveti, ivmelenme, dikey sıçrama ve Yoyo-1 değerleri üzerinde olumlu etkisinin olduğu ifade edilebilir. Abstract The aim of this study was to investigate how wet cupping effects performance and certain blood parameters of athletes. The athletes participating in the study (n=23) were divided into control group (CG, n=11) and experimental group (EG, n=12) by using random sample method. The athletes in sample group were selected in accordance with following criteria; age average: 20,36±1,286 year, average training age: 7,45±4,132 year, average stature: 177,82±6,585 cm, average body weight: 74,09±11,476 kg. The same criteria for the athletes in experimental group (EG) (n=11) were as follows; age average: 21,17±2,290 year, average training age: 9,08±3,825 year, average stature: 179,67±8,553 cm, average body weight: 71,25±10,314 kg. Leg force, acceleration, speed, vertical jump and standing long jump values of the participants were measured along with their blood parameters such as WBC, RBC, HGB, PLT and HCT levels. In statistical analyses of the study, arithmetic mean and standard deviation values were used as descriptive statistics, and Shapiro-Wilks was made in order to analyze the normality of distributions. Independent-Sample t-Test was made to determine the difference between the groups and Paired Sample t-Test to determine the difference within each group. Significance level was taken as p<0.05. Consequently, it can be said that wet cupping has a positive effect on leg force, acceleration, vertical jump and Yoyo-1 values of athletes.
... In cupping therapy, a vacuum is applied to a targeted skin area [1]. Several researchers have investigated changes in flexibility due to cupping therapy; furthermore, some found significant increases in the joint range of motion (ROM) after cupping therapy [2][3][4][5][6], while others discovered that cupping therapy did not significantly change the joint ROM [7,8]. ...
Article
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This study aimed to investigate the acute and prolonged effects of dermal suction on joint range of motion (ROM) and passive muscle stiffness. Eight-minute dermal suction was prescribed for the quadriceps femoris in 15 participants. Hip extension ROM, knee flexion ROM, and passive muscle stiffness of the rectus femoris (RF) and vastus lateralis (VL) were measured before and immediately, 30 min, 60 min, 120 min, 24 h, and 48 h after dermal suction. Passive muscle stiffness was measured using shear wave elastography. Hip extension ROM significantly increased immediately (p = 0.032), 60 min (p = 0.029), and 120 min (p = 0.031) after dermal suction compared with before dermal suction; however, it was not significantly different at 30 min, 24 h, and 48 h after dermal suction (p > 0.05). Passive muscle stiffness of the RF and VL and knee flexion ROM did not significantly change at any measurement time compared with before dermal suction (p > 0.05). Our preliminary results suggest that dermal suction improves hip extension ROM immediately after dermal suction of the quadriceps femoris, followed by a return to the pre-prescription level 30 min after. However, the effect was prolonged for 120 min and disappeared before 24 h.
... Notably, the number of clinical trials of CT has increased as an official practice. CT is an easily handled, natural, safe, cost effective and holistic relaxation resource in treatment of chronic or sub-acute painful conditions such as back pain, headache or migraine, muscle soreness, knee, neck, shoulder pain, and fibromyalgia by resolving inflammation and increasing in endogenous opioid production similar to analgesic effect [25][26][27][28][29][30][31][32][33]. Despite the possibilities of the favorable multidimensional effects of CT, few randomized controlled trials the benefits of CT on PPP are available and also we did not encounter any previous trials testing the effectiveness of dry CT with lavender oil massage in the treatment of PPP. ...
Article
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Background: Perineal pain is an important complaint in the postpartum period for several weeks. This study aimed to examine the effect of dry cupping therapy with lavender oil massage on the intensity of postpartum perineal pain. Methods: A 33 years old female had suffered with postpartum perineal pain. She experienced bilateral episiotomy on the third birth. Dry cupping therapy was administrated on selected areas two times. Before giving cupping therapy , at the 4th and 24th hours of birth was investigated effectiveness of dry cupping therapy on postpartum perineal pain based on the short-form of McGill pain scale. Results: According to the McGill pain scale, the mean of postpartum perineal pain intensity decreased from 37.9 ± 10.5 before the dry cupping therapy with lavender oil massage to 12.1 ± 5.3 in 4th hour, and 6.3 ± 1.3.2 in 24th hour after delivery. The patient on cupping therapy with lavender oil message showed better results terms of pain intensity (P < 0.001). Conclusion: The study confirmed that dry cupping therapy with lavender oil massage reduced postpartum perineal pain. In this regard, this intervention may be considered as affective method for reducing postpartum perineal pain. However, further trials are required to identify the effectiveness of this therapy regiment.
... Passive stretching dilakukan tanpa adanya kontraksi otot sehingga otot yang memendek mencapai relaksasi secara sempurna sehngga otot yang diregangkan mengalami pemanjangan (Kim, Do, and Kim 2017). Stretching adalah suatu bentuk terapi yang ditujukan untuk memanjangkan otot yang mengalami pemendekan atau menurunnya elastisitas dan fleksibilitas otot yang menghambat lingkup gerak sendi normal (Han et al. 2021). ...
Article
Osteoarthritis (OA) merupakan penyakit degeneratif yang berkembang lambat dan tersebar luas prevalensinya meningkat seiring bertambahnya usia pasien. Tujuan dari studi ini untuk mengendalikan nyeri yang dirasakan pasien serta meningkatkan kemampuan fungsional pada kegiatan sehari-hari yang dilakukan pasien. Penelitian ini termasuk case study yang dilakukan di salah satu rumah sakit yang ada di kota Surakarta pada seorang pasien Ny. S, Berusia 63 tahun, berprofesi sebagai ibu rumah tangga. Pasien mengeluhkan nyeri pada saat gerakan dari jongkok ke berdiri terutama saat gerakan sujud ke berdiri saat beribadah yaitu salat Nyeri yang di rasakan pasien terkadang hilang saat kondisi istirahat dan tidak terlalu banyak aktifitas berat yang dilakukan. Pasien terapi selama 2 x/ minggu dalam 3 minggu, satu kali terapi mengikuti selama 30 menit. Pasien diberikan terapi berupa terapi latihan, ultrasound dan tens. nyeri diukur menggunakan Visual Descriptive Scale (VDS), dan Western Ontario dan McMaster Universities Arthritis Index (WOMAC) untuk mengukur aktivitas fungsional pasien. Modalitas fisioterapi seperti Pemberian Latihan Quadriceps Setting, Passive Stretching, Ultrasound (US), serta Transcutaneous Electrical Nerve Stimulation (TENS) yang diberikan sebanyak 4 kali pertemuan belum mampu meningkatkan aktivitas fungsional sehari-hari serta terdapat sedikit penurunan nyeri
... The muscle's connections-bridge harness is among the noncontractile components of the muscular tendon, cross-bridge attachments, proteins within the myofibril, and the muscle's connective tissue harness [11,12] . Improvement in muscle flexibility and range of motion and passive stretching is the most common method for muscle length extension [13] . A recreational marathoner's performance and everyday activities might be hampered by injury. ...
Article
Medial tibial stress syndrome (MTSS) is Exertional leg discomfort. There are two forms of shin splints: anterior leg compartment dysfunction and posterior leg compartment dysfunction. MTSS patients are routinely offered graded jogging, strengthening, and stretching activities for the calf muscles. Instrument-assisted soft tissue mobilization (IASTM) includes stroking the skin with a bar or spurtle to apply repetitive mechanical stimulations to (tendons, muscle, and overlaying deep fascia) soft tissue. Cupping is a therapeutic technique that involves applying negative pressure to the skin over a sore location to relieve muscular spasms and discomfort. The rationale of the study is to find how effective the therapy for shin pain in recreational runners. The effectiveness of cupping therapy in MTSS and compares the efficacy of IASTM and cupping with strengthening and stretching exercises to see which can enhance function and reduce discomfort in a short duration of time in runners. These is randomized control trials. The study’s sample will be 46. The group B experimental group in which cupping therapy will be given, the control group, i.e., group A in which IASTM will be given for four weeks with the following baseline examinations- VAS, Treadmill test, step up and down test with MMT and ROM. The efficacy of the technique for both groups will be examined every week utilizing treadmill testing, VAS, step up and step down as end measures the pain assessment, the improvement in termination time of treadmill test as well as step up and down test.
... The negative pressure within the silicon cup produces myofascial decompression when placed on the skin [8]. The leg muscle was separated into three parts like anterior, posterior, and lateral and three cupping therapy cups were applied to each area to apply cupping therapy to the affected area of the leg [9]. ...
Article
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Runners are most commonly attributed to the shin splint, which is showing commonly the symptom of leg pain. It may be misdiagnosed as compartment syndrome as well. This case report depicts the standard condition of medial tibial stress syndrome in a long-distance runner, which is an acute condition with worsening symptoms in many authors' opinion. Patients with accurate symptoms of the conditions may be diagnosed with shin splints for medical usage. Only pain along the posterior medial border of the tibia at the origin of the posterior tibialis muscle should be referred to as shin splints. The chronic form of anterior compartment syndrome may attribute to the runner if they ignore the symptoms of leg pain that occurs in shin splints. Anterior tibial pain during activity is frequent in athletes. It has been linked to various disorders, including periostitis from improper stretching and muscular conditioning, as well as exertional compartment syndromes.
... The more blood clots, the better the results (Lu et al., 2019). The wet cupping therapy mechanism can remove toxins mixed with blood or oxidants from the body through the skin surface (Kim et al., 2017). The release of toxins can increase blood flow and prevent atherosclerosis. ...
Article
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Wet cupping therapy can remove toxins and prevent atherosclerosis. This process will stimulate the sensitivity of the arterial baroreflex which will stimulate a decrease in blood pressure. This is to determine the impact of cupping therapy on the sensitivity of arterial baroreflex with blood pressure indicators in the elderly suffering from hypertension. Quasi-experimental research using pre and post-test and group control design approaches. The sampling technique was simple random sampling, consisting of 21 respondents which was carried out from January to April 2020. The statistics used the General Linear Model Repeated Measures (GLM-RM) test. There was a significant difference between the sensitivity of arterial baroreflex on blood pressure measurement indicators before and after 2 weeks of follow-up period at systolic BP p-value = 0.000 (24.29 ± 8.11 mmHg) and diastolic BP p-value = 0.001 (5.24 ± 6.02); between 2 weeks and 4 weeks at systolic BP p-value = 0.000 (10.95 ± 6.25 mmHg) and diastolic BP p-value = 0.000 (9.05 ± 6.25 mmHg); Between 4 weeks and 6 weeks there was no significant difference in the sensitivity of arterial baroreflex on the measurement indicator systolic BP p-value = 0.267 (-1.43 ± 5.73) and BP diastole p-value = 0.771 (-0.48 ± 7.40). Wet cupping therapy effectively increases the sensitivity of arterial baroreflex with an indicator of decreasing blood pressure in the elderly suffering from hypertension to a limit of 4 weeks after therapy and measurement after 6 weeks of having increased blood pressure.
... Findings of the present study revealed that addition of dry cupping therapy to conventional treatment led to significantly greater improvements in functional performance assessed as compared to the conventional treatment alone (p-< 0.001). A study by Kim et al. [15] showed significant effects of dry cupping therapy on flexibility, range of motion and muscle activity of hamstring muscle group which is closely related to functional performance. Proposed mechanism behind these findings could be that when dry cupping therapy is applied to PF patients, it leads to an increase in blood flow in the painful area by increasing negative pressure in the microvasculature of the tissues. ...
Background There is limited evidence available on the effects of dry cupping therapy on outcomes of pain, dynamic balance and functional performance in young female recreational runners chronic plantar fasciitis. Purpose To investigate the effectiveness of dry cupping therapy on pain, dynamic balance and functional performance parameters in young female recreational runners with chronic plantar fasciitis. Method Thirty female recreational runners with plantar fasciitis were recruited from outpatient department of SGT hospital. They were randomly divided into two equal groups: Dry cupping therapy (Experimental group n = 15) and Conventional therapy (Control group n = 15). The experimental group received dry cupping therapy along with the conventional treatment whereas the control group received conventional treatment alone for 4 weeks (3 days/week). Outcome variables such as pain (Numeric pain rating scale), dynamic balance (Star excursion balance test) and functional performance (Figure of eight hop test) were evaluated at baseline and after 4 weeks of study period. Appropriate statistical tests were performed to test hypothesis the study hypothesis. Results Findings suggested a significant improvement in parameters of pain, dynamic balance and functional performance (p < 0.05). However, these improvements were found to be significantly greater (p< 0.05) with the addition of dry cupping therapy to the conventional treatment. Conclusion Findings of the present study suggests that dry cupping therapy may be considered as an adjunct treatment method in addition to the conventional treatment in young female runners with chronic plantar fasciitis.
Article
Clinical scenario: There are a variety of therapeutic modalities used to treat flexibility issues in athletes, which can be the main cause of hamstring injuries. Myofascial decompression is one modality used to treat these patients. Focused clinical question: Is myofascial decompression effective at increasing hamstring flexibility in the athletic population? Summary of Search, "Best Evidence" Appraised, and Key Findings: The literature was searched for studies of level 2 evidence or higher that investigated the use of myofascial decompression to increase hamstring flexibility, that were published in the last 5 years. Two high-quality randomized controlled trials were included and one cohort study. Clinical bottom line: There is not enough consistent, clinically significant, high-level evidence to support the use of myofascial decompression to increase hamstring flexibility. Strength of recommendation: There is level B evidence to support that myofascial decompression is effective at increasing hamstring flexibility.
Article
Background: Cupping therapy has been used to treat musculoskeletal impairments for about 4000 years. Recently, world athletes have provoked an interest in it, however, the evidence to support its use in managing musculoskeletal and sports conditions remains unknown. Objective: To evaluate the evidence level of the effect of cupping therapy in managing common musculoskeletal and sports conditions. Methods: 2214 studies were identified through a computerized search, of which 22 met the inclusion criteria. The search involved randomized and case series studies published between 1990 and 2019. The search involved five databases (Scopus, MEDLINE (PubMed), Web of Science, Academic Search Complete PLUS (EBSCO), and CrossRef) and contained studies written in the English language. Three analyses were included: the quality assessment using the PEDro scale, physical characteristic analysis, and evidence-based analysis. Results: The results showed that most studies used dry cupping, except five which used wet cupping. Most studies compared cupping therapy to non-intervention, the remaining studies compared cupping to standard medical care, heat, routine physiotherapy, electrical stimulation, active range of motion and stretching, passive stretching, or acetaminophen. Treatment duration ranged from 1 day to 12 weeks. The evidence of cupping on increasing soft tissue flexibility is moderate, decreasing low back pain or cervical pain is low to moderate, and treating other musculoskeletal conditions is very low to low. The incidence of adverse events is very low. Conclusion: This study provides the first attempt to analyze the evidence level of cupping therapy in musculoskeletal and sports rehabilitation. However, cupping therapy has low to moderate evidence in musculoskeletal and sports rehabilitation and might be used as a useful intervention because it decreases the pain level and improves blood flow to the affected area with low adverse effects.
Article
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Introduction: Quantification of muscle strength is an essential component of assessment and treatment in rehabilitation. Considering the measurement of the muscle strength, mostly two methods are used. They are qualitative and quantitative measures. Maximum voluntary isometric contraction (MVIC), measured using dynamometer and manual muscle testing (MMT) are the most common measurement techniques used in the clinical and research setting. Objectives: This study's aim was to observe, if greater activity is produced using mechanical instruments for torque measurements (since the resistance is adjusted to subject's maximum capacity) or if tests, position of MMT, and resistance offered by trained physiotherapist are effective. We compared the IEMG (Integrated electromyography) output between manual and mechanical testing during maximal voluntary isometric contraction. Subjects and Methods: Forty normal healthy subjects including 20 males and 20 females were selected for the study. The measuring system comprises an EMG (Noraxon USA, INC, Scottsdale, Arizona) and ®HUR 5340 (Kokkola, Finland) leg extension/curl computer controlled machine for isometric evaluating peak torque. MVIC of the Vastus medialis oblique (VMO), Vastus lateralis (VL), Rectus femoris (RF), Semitendinosis (ST) and Biceps Femoris (BF) were measured from dominant leg using SEMG and then subjects were seated on HUR with hip flexed and chest, pelvis, thigh stabilized. The axis of rotation of HUR aligned with the joint axis and moment arm is fixed for every subject. Each subject performed maximal contraction of 10sec at 60°of test angle to get the peak torque and myoelectrical activity are also recorded while performing the same. Result: Paired t-test analysis were used to see the difference between MMT and HUR IEMG amplitude and the results show significance difference(p< .05) for each muscle when comparing between the EMG amplitude between MMT and HUR. Conclusion: HUR system has very good reliability in measuring muscle strength of the knee extensors and flexors as compared to the MMT, suggesting that it will be useful in clinical applications, especially for professional athletes or physically powerful populations.
Article
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PURPOSE: The purpose of this study was to compare the effects of Graston and self-myofascial release (SMR) techniques on knee joint flexibility, hamstring, and quadriceps strength. METHODS: Twenty subjects with hamstring shortness participated in this study. The subjects were assigned randomly to one of two groups: The Graston technique (GT) group received intervention using a Graston instrument for one minute, and the SMR group performed self-exercises using a foam roll for one minute. The range of motion (ROM) of the knee joint was measured by active knee extension test, and a handheld dynamometer was utilized to collect the hamstring and quadriceps muscle strength. This experiment was performed by two physical therapists. The significant level was set at {\alpha}
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Wet cupping therapy (WCT) is a simple and economic treatment that still needs scientific interpretation. It treated effectively diseases with different etiologies and pathogeneses e.g. rheumatoid arthritis (RA), hypertension, migraine, carpal tunnel syndrome (CTS), fibromyalgia, cellulitis and others. Here, we review medical and scientific bases underlying cupping therapy and introduce Taibah theory as a novel evidence-based scientific mechanism to explain it. Briefly, in Taibah theory, WCT is a minor surgical excretory procedure related scientifically to the principles of renal glomerular filtration and abscess evacuation, where a pressure-dependent excretion of causative pathological substances (CPS) occurs. CPS include disease-causing substances and disease-related substances (that result during disease pathogenesis). Negative pressure applied to skin surface causes local collection of filtered and interstitial fluids containing CPS at skin upliftings inside cups. Scarifying skin upliftings followed by cupping causes a pressure gradient and a traction force across the skin and capillaries to excrete collected fluids with CPS and cause bleeding at puncture sites. This increases filtration at both capillary ends and causes clearance of blood and interstitial spaces from CPS. WCT benefits from the suction pressure, phenomenon of reactive hyperemia, nitric oxide production and skin scarifications (openings in skin barrier) in enhancing natural excretory skin functions, improving lymphatic and capillary circulations and restoring homeostasis. Reported CPS of RA include autoantibodies, immune complexes, soluble interleukin-2 receptors, inflammatory mediators, certain cytokines, prostaglandins, toxic cellular products and rheumatoid factor, while CPS of CTS include malondialdehyde, interleukin 6, prostaglandin PGE- 2 and progressive edema (causing pain). WCT-induced filtration pressure may excrete those CPS in cupped blood. Prophetic medicine (related to Prophet Mohammad peace be upon him) recommends WCT: “The best among what you use in therapy is Al-hijamah (prophetic method of WCT)”. In conclusion, WCT has scientific bases in treating different diseases being the only treatment that clears blood and interstitial fluid from CPS.Therapeutic benefits of WCT is related to the amount of excreted CPS not the amount of letted blood.
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Purpose : The purpose of this study was to investigate the effect of motion-based game exercise program and stretching exercise program on static and dynamic standing balance in elderly women. Methods : Subjects participated in the exercise program was 40 eldery women took part in this study. The average age of the elderly was 70.60 years. All subjects could walk without an assistive device. All subjects were participated in this study during 4 weeks(3 days per week, 30min/day). All participants were assessed on berg balance scale(BBS), functional reach test(FRT), timed up&go test(TUG). Results : The data were analyzed using paired t-test. After 4 weeks exercise training, the result of this study were as follows: The BBS of the elderly was significant difference between test-retest(p
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Cupping Therapy " is the topic chosen for the fourth editorial of this newly launched journal. The aim of this editorial is to deepen this interesting topic, little analyzed in the present literature, in order to explain the technique and deal with the evidence of the effects of cupping therapy in musculoskeletal disorders, and some possible relation to sports performance.
Article
PURPOSE: This study aims to examine the effects of trunk flexion on the kinetic characteristics of the lumbar according to the degree of hamstring flexibility. METHODS: This study has as its subjects 29 young adults and divides them into the group (NSRTG, n
Article
Low back pain is a common musculoskeletal disorder affecting 80% of people at some point in their lives. It is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment. Cupping is used in the treatment and cure of a broad range of conditions; general physical as back pain and mental well-being. This study aimed to evaluate effectiveness of cupping therapy (Al-Hijama) on management of persistent non-specific lower back pain and client disability. Subjects & Methods, The study was conducted at Islamic Al-Hijama Centre - Yanbu City - Al Madinah Al Munawarah - Kingdom of Saudi Arabia. Thirty adult clients diagnosed with nonspecific low back pain were enrolled in the study with inclusive and exclusive criteria; Data collection tools: Client assessment sheet; American Pain Society Client Outcome Questionnaire and Oswestry Low Back Pain Disability Questionnaire, Results, sample included (86.7%) males used wet cupping therapy (76.7%), there were highly statistical significant for assessment of pain pre and post cupping therapy; and client's ability to manage everyday life. Conclusion, cupping therapy is effective in relieving persistent non- specific lower back pain and client disability; no adverse effects were reported from subjects after the treatment. It is recommended that using cupping therapy for enhance disability and decrease pain of lower back pain.
Article
Purpose: This study examined the effect of the strengthening exercise and stretching exercise to decrease symptom patellofemoral pain syndrome (PFPS). Methods: The Anterior Knee Pain Scale (AKPS) and Clark's test performed for diagnosis of intrinsic PFPS among young adults. Selected thirty young adults subjects who aged 20~26 years participated in the study. Participants were randomly assigned to strengthening, stretching, or control groups. Strengthening group consisted of quadriceps, hamstring and iliotibia band training used elastic band. Stretching group consisted of quadriceps, hamstring and iliotibia band trainings used stretching exercises program. Participants received 50-minute individualized exercise sessions, 3 times a week for 6 weeks. Results: The results were as follow: there were significantly difference stretching exercise group by all muscles on muscular strength test (p
Article
To determine if stretching for a constant total time with differing repetition durations and number of repetitions over a 6-week period produced different changes in hamstring flexibility measured by knee extension range of motion (ROM). Randomized Control Trial. University laboratory. 34 volunteers, 18-25 years old with tight hamstrings as determined by a greater than 30° loss of knee extension with hip flexed to 90° participated in the study. Change in knee extension ROM was assessed in participants who were randomly assigned to a control, or to a stretching group of either 10 s for 9 repetitions or 30 s for 3 repetitions, for a total stretch time of 90 s. Each group stretched 6 days a week for 6 weeks. Pre to post stretch comparison indicated both stretching groups were successful in increasing joint ROM (11.6 ± 5.25°-13.4 ± 5.36°) over the control (F = 19.77, p < 0.003). However, there was no significant difference between the stretching groups (p = 0.9). Stretching for 6 weeks for total of 90 s showed increased joint ROM regardless of the number of repetitions or the duration of each individual stretch.
Article
Evidence from recent RCT's has shown that naturopathic reflex therapies such as massage, Gua Sha massage, cupping, wet packs, or rhythmic embrocation etc. are helpful in reducing symptoms of chronic pain. These bodily oriented therapies are likely able to influence chronic pain not only through brain mechanisms such as expectation or the feeling of well-being, but also through mechanisms at the level of the peripheral nociceptor and the spinal cord. However, the neurobiological basis of these effects has rarely been investigated even though the accumulating knowledge of the pathophysiology of chronic pain syndromes allows for developing specific hypotheses. This essay discusses specific reflex therapies (cupping, Gua Sha massage, classical massage, and rhythmic embrocation) and their possible mechanisms of action via ascending pathways to the brain. © 2013 S. Karger GmbH, Freiburg.