Immediate Effect of Dynamic Cupping on Pain in Teachers with Mechanical Neck Pain: An Experimental Study

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154 Indian Journal of Physiotherapy and Occupational Therapy, April-June 2020, Vol. 14, No. 02
Immediate Effect of Dynamic Cupping on Pain in
Teachers with Mechanical Neck Pain: An Experimental Study
Rachana Jani1, Krupa Tank2
1MPT Musculoskeletal and Sports Sciences, Assistant Professor, Shree D. M. Patel Collage of Physiotherapy,
Amreli, 2MPT Musculoskeletal (Ortho) Assistant Professor, School of Physiotherapy RK University, Rajkot
Abstract
Background: Mechanical neck pain occurs due to prolonged loading on neck, poor posture, stress and
changes in connective tissues. Cupping therapy is ancient medical treatment, which use suction on skin.
Dynamic cupping gives combine effect of cupping and massage. Which relive muscle tension by increasing
microcirculation.
Aim: To nd immediate Effect of dynamic cupping on pain in teachers with mechanical neck pain.
Material and Method: 40 male and female teachers with mechanical neck pain were included in the study
and treated with dynamic cupping. Numeric Pain Rating Scale and Pain Pressure Threshold were taken for
pain intensity Measurement.
Result: Paired t test was used for Intra group analysis. Signicant difference was observed in pain intensity
bychanges in score of in Numeric Pain Rating Scale and Pain Pressure Threshold (p< 0.05) immediately and
after 280 minutes of treatment.
Conclusion: Hence, we conclude that there is a signicant reduction in pain after the treatment with dynamic
cupping in teachers with mechanical neck pain. So, dynamic cupping can be used clinically in patients with
mechanical neck pain.
Keywords: Mechanical Neck Pain, Teachers, Cupping Therapy, Dynamic cupping, Pain Pressure Threshold
(PPT), Numeric Pain Rating Scale (NPRS).
Corresponding Author:
Dr. Rachana Jani
MPT (Musculoskeletal and Sports Sciences), Assistant
Professor, Shree D. M.Patel college of Physiotherapy,
Municipal girls’ school campus, Nr. Gandhi bag,
Amreli -365601, Gujarat, India
e-mail: rachanajani15@gmail.com
Introduction
International association of pain dene neck pain as
a pain arising from anywhere from superiorly through
nuchal line to inferiorly by rst thoracic vertebra and
laterally up to shoulder1. Its prevalence in general
population is up to 50% and in teachers up to 56.8%2.
Neck pain can arise due to some pathology
including different type of infection, fracture and
degeneration. Among this majority of people suffering
from mechanical neck pain because of poor posture
and prolonged loading on neck, stress and changes in
connective tissues3.
As well as pain between occiput, thoracic vertebrae
and shoulder is also considering as a neck pain.4
alteration of activity of cervical extensor muscles like
splenius capitis, trapezius 5 and trigger point in head,
neck and shoulder6 play relevant role in patients with
mechanical neck pain6.
There are intrinsic (i.e., concurrent medical
or psychosocial factors) and extrinsic factors (i.e.,
occupational, ergonomic, or medico legal issues) that

Indian Journal of Physiotherapy and Occupational Therapy, April-June 2020, Vol. 14, No. 02 155
affects the neck pain. Lack of knowledge about neck
pain is an important issue7.
Cervical region is more mobile than thoracic and
lumber and also bear less weight. Load on cervical
region is depends on position of head and body. When we
awake or asleep neck moves 600 times in all movements
of exion, extension, rotation. Alteration in this normal
rhythm cause biomechanical changes in neck region8.
There are many therapies are available to treat
the neck pain like Myofascial Release, Muscle
Energy Technique, massage, dry needling, Cupping,
mobilization etc. From last few years there is growing
evidences of cupping therapy in neck pain3.
There are 10 types of different cupping method
viz.10Weak/light cupping, Medium cupping, Strong
cupping, moving cupping, Needle cupping, Moxa/hot
needle cupping, Empty/ash cupping, Full/bleeding
cupping, Herbal cupping and Water cupping.
Before years suction was creating by ame placing
into cup, after few second it will heat the air than removed
the ame and quickly apply the cup on skin. So, that the
skin is drawn into cup by negative pressure and the cup
was made up of glasses they also used bamboo, horn,
brass etc. Now a day’s suction will be creating by hand
pump, electrical pump or soft silicon pump8.
In Ayurveda also mention use of cupping therapy
by AcharayaSushruta named as a raktmoshana in
‘Pradhanakarma’, it implies on blood rene from blood
stream11, 12. The main aim of this therapy is elimination
of vitiated blood from the body.
Thought of act of cupping is mainly by increase
blood circulation and relive painful muscle tension.
There are growing evidences of cupping therapy for
decreasing pain and increasing pain pressure threshold.
Few studies show long lasting effects of dynamic cupping
in various conditions. But there is lack of evidence for
its immediate and short term effect. So, here need of
the study is to nd out post immediate effect and effect
after 280 minutes of dynamic cupping on pain & PPT in
teachers with mechanical neck pain.
Material and Method
• Study design: A Pre post experimental study
• Study setting: Varies Schools of Savarkundla, Dist:
Amreli
• Study duration: 6 months
• Sampling technique: Purposive sampling
• Study population: School Teachers
• Sample size: 40
• Inclusion Criteria13,34:
1. Teachers of age between 30-60 years,
2. Neck pain according to Van schalkuyk &
parkinsmith‘s criteria for mechanical neck pain
since at least previous 3 months.
3. Average neck pain intensity had to be 4 points
or more on a 0-10NPRS.
4. Teachers who had more than 5 years of
experience.
• Exclusion Criteria13:
1. Having conditions other than mechanical neck
pain.
2. Patient who is not willing to participate.
Procedure: Ethical clearance for the study was
obtained from the ethics committee Approved by
CDSCO, School Of Physiotherapy, RK University,
Rajkot and CTRI registration was done for the proposed
research. A written informed consent of all the subjects
was taken prior to the study.
Those who fullled the inclusion and exclusion
criteria were taken up for the study. The whole
procedure of the study was explained to all the subjects.
Prior to treatment both outcome measures, Numerical
pain rating scale35 and Pressure pain sensitivity33 were
measured. And after immediately and after 280 minutes
of treatment, again assessment was taken for these
subjects.
Intervention: Patient was lied prone on couch with
their upper torso unclothed, covered with massage oil
than placed cup on skin and suction was created by pump.
Than drawn over skin along the spine from cervical to
thoracic up to lateral border maintain the suction within
skin throughout the procedure. The cup massage was
conducted for approximately 3–5 minutes. Patients were
informed that the treatment area may become patchy and
there are chances of ecchymosis on the same area.

156 Indian Journal of Physiotherapy and Occupational Therapy, April-June 2020, Vol. 14, No. 02
Findings: The present study was carried out to nd
out immediately and after 280 minutes effect of dynamic
cupping on pain in teachers with mechanical neck pain.
Data was analyzed using SPSS software version 21 and
Microsoft excel. Before applying statistical tests data
was screened for normal distribution. All the outcome
measures were analyzed at baseline and after immediate
of treatment and after 280 minutes of treatment. Intra
group analysis was done for all the outcome measures.
Table 1: Intra group analysis for Numeric Pain
Rating Scale
Mean SD p- value
Pre 6.30 1.11 0.00
Post immediate 4.08 0.85 0.00
Post 280 minutes 1.90 1.17 0.00
Table 2: Intra group analysis for Pain Pressure
Threshold
Mean SD P- value
Pre 7.83 1.11 0.00
Post immediate 1.65 1.7 0.00
Post 280 minutes 12.24 2.61 0.00
Here, the intra group analysis of NPRS and PPT
was done by using paired‘t’ test. Where the ‘p’value
is < 0.05. Hence Null Hypothesis H0 is rejected. So,
both outcomes are considered to be improved after
intervention.
Discussion
The intent of the study was to nd out and compare
the effectiveness of dynamic cupping in teachers with
mechanical neck pain. Baseline measurements of pain
(NPRS score, Pain Pressure Threshold) were taken
immediately after treatment and after 280 minutes
of treatment. The result of the present experiment
indicate that pain of teachers with mechanical neck pain
diminished signicantly after dynamic cupping that
accepts the Experimental hypothesis.
In present study, when the mean NPRS score and
PPT score were analyzed within group, it was statistically
signicant.
The exact Mechanism of pain reliving is unclear but
there are several theories are available including.
1. Chemical transmitters, such serotonin, endorphin,
cortisol that block pain.
2. Nociceptor activation and counter irritation.
3. Placebo effect, research nding suggested that
placebo device is more effective in pain reliving
compare to placebo pill.13
It might be reasonable to assume that dynamic
cupping increase PPT at that spot because dynamic
cupping leads to increased microcirculation in local
areas that decreases the hypersensitivity of spasm related
ischemia in neck muscles.12
On the other hand negative pressure generated by
application of cupping therapy. Cup give mechanical
effects including relief of muscle pain, recovery from
adhesions release muscle.16
The study shows similar effects of M. Teut, A
Ullaman et al (2018)28suggesting that pulsating cupping

Indian Journal of Physiotherapy and Occupational Therapy, April-June 2020, Vol. 14, No. 02 157
decrease pain in patients with chronic back pain. Where
M. Imam And Mohmmad Ishtiyaque et al, (2018)29
suggesting thatoil cupping massage was effective and
safe treatment for patients with frozen shoulder. Felix J.
Saha, Stefan Schumann et al, (2017)13 studied that the
effects of cupping massage in patients with chronic neck
pain and they concluded that cupping massage appears to
be effective in reducing pain and increasing function and
quality of life in patients with chronic non-specic neck
pain. They use NPRS, NDI,PPT in outcome measure
which is also relevant to the present study.
NPRS is a reliable and valid subjective scale which
Depends on patients feeling. It can be used to assess the
pain in different condition such as James and Ian at Al
(2018)used NPRS to assess the pain after the applying
cupping with neural glides for peripheral neuropathic
planter foot pain. Similarly Mohhamad Bilal and
Rafeeq Alam Khan (2016) studied therapeutic
effectiveness of hijama in sciatica pain by using
NPRS for pain measurement. In present study after the
treatment patients felt better and which shows signicant
reduction in NPRS score.
PPT is objective scale, at a point where we feel more
pain, that area is more sensitive than other area. Because
of spasm or tenderness there is increased activity of
nociceptors in the particular point. When we give
pressure to painful point all nociceptorsgets activated
and give feeling of pain. When we give cupping therapy
it activates mechanoreceptors as well as increases
vasodilatation of that area which decreases nociceptive
activity. Ebru And Arzu (2016)31 studied reliability
and responsiveness of algometry for measuring pressure
pain threshold in patients with knee osteoarthritis and
found that PPT is reliable tool for the pain measurement.
M. Emerich, M. Braeunig et al, (2014)26 measured the
metabolic changes in the tissue under the cupping glass
and pressure pain threshold. It was found that cupping
is effective to increase the lactate/pyruvate ratio after
160 minutes, indicating an anaerobic metabolism in the
surrounding tissue with immediate increased pressure
pain thresholds in some areas.
Limitation and Future scope: In this Study PPT
was checked for only one spot, further study could
include many spot and Pain can be assessed with other
outcomes as well.
Conclusion
The study concludes that dynamic cupping is having
signicant effect for reducing pain immediately as well
as after 280 minutes in mechanical neck pain. It can be an
effective regime for the mechanical neck pain treatment.
Acknowledgement: Nil
Source of Funding: Self
Conict Of Interest: Nil
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