Effect of durations and pressures of cupping therapy on muscle stiffness of triceps

Abstract

Cupping therapy has been used for the alleviation of muscle soreness in athletes. However, clinical studies of cupping therapy show conflicting results. Lack of standardized guidelines of the dose-response relationship of cupping therapy, such as appropriate cupping duration and negative pressure, limits the adoption of cupping therapy in clinical practice. The objectives of this study were to investigate the effect of various pressures and durations of cupping therapy on reducing muscle stiffness. The 2 × 2 factorial design with the repeated measures and counterbalanced design was used to test four cupping protocols, including two negative pressures at −225 and −300 mmHg and two durations at 5 and 10 min, in 12 healthy young people. B-mode and elastographic ultrasound was used to assess muscle stiffness of the triceps before and after cupping therapy. The region of interest of elastographic image was divided into the superficial and deep layers for assessing the effect of cupping therapy on stiffness of various depths of the triceps. Normalized stiffness was calculated as a ratio of pre-cupping stiffness divided by post-cupping stiffness of each participant. The two-way analysis of variance (ANOVA) was used to examine the main effects of the pressure and duration factors and the interaction effect between the pressure and duration factors. The results showed that there were no interactions between the pressure and duration factors (overall layer p = 0.149, superficial layer p = 0.632, and deep layer p = 0.491). The main effects of duration of the overall, superficial and deep layers were p = 0.538, p = 0.097 and p = 0.018, respectively. The results showed that 10-min cupping at -300 mmHg is more effective on reducing stiffness of the deep layer of the triceps compared to 5-min cupping (p = 0.031). This study provides the first evidence that the dose of cupping therapy could significantly affect changes of triceps stiffness and the deep layer of the muscle is more sensitive to cupping therapy compared to the superficial and overall layers.

Using texture analysis of ultrasound images to assess the effect of cupping therapy on muscle quality of the triceps

“…This was part of a larger project investigating microvascular and biomechanical responses following cupping therapy [ 29 ]. The data collection was performed between December 3, 2019 and July 12, 2022.…”

“…Every subject has signed the informed consent before participating in the experiment. Because no prior studies on the texture analysis of ultrasound images after cupping therapy, the sample size estimation was based on our previous study indicating that cupping therapy was effective on reducing muscle stiffness [ 29 ]. Thus, a very large effect size (0.4) [ 30 ] and the power of 0.8 were chosen for achieving a sample size of 12 for this study.…”

“…The cupping duration was selected between 5 to 10 min according to several clinical studies [ 8 , 35 ]. The selections of these negative pressures and durations are based on common settings of cupping therapy for effectively inducing muscular and microvascular responses [ 8 , 9 , 29 ]. Therefore, these settings were selected to ensure the intensity of cupping therapy would be sufficient to induce changes in muscle texture [ 8 ].…”

Using near‐infrared spectroscopy to investigate the effects of pressures and durations of cupping therapy on muscle blood volume and oxygenation

“…The pressure factor included two levels at À225 and À300 mmHg and the duration factor included two levels at 5 and 10 min. The selection of these values of cupping pressure and duration were based on common combinations in clinical practice [5,20]. The applied negative pressure usually ranges from À225 to À300 mmHg with a duration from 5 to 10 min [5,20].…”

“…The selection of these values of cupping pressure and duration were based on common combinations in clinical practice [5,20]. The applied negative pressure usually ranges from À225 to À300 mmHg with a duration from 5 to 10 min [5,20]. Each participant completed four protocols including (A) À225 mmHg for 5 min, (B) À225 mmHg for 10 min, (C) À300 mmHg for 5 min, and (D) À300 mmHg for 10 min.…”