Dry Cupping Therapy and Muscle Energy Technique on Upper Crossed Syndrome

Effect of Combined Dry Cupping Therapy and Muscle Energy Technique on Upper Crossed Syndrome Patients. A Randomized Control Study

This study evaluated and compared the therapeutic efficacy of combining Dry Cupping therapy with the Muscle Energy Technique (MET) against each intervention applied independently, focusing on three core parameters: Neck Disability Index (NDI), Craniovertebral Angle (CVA), and Sagittal Shoulder-C7 Angle (SSA).

Study Overview

• Status: Active, not recruiting
• Conditions: Upper Crossed Syndrome; Muscle Energy Techniques
• Intervention / Treatment: Procedure: combined therapy teatment; Procedure: cupping therapy group; Procedure: muscle energy techniques group; Procedure: control group

Detailed Description

This study evaluated and compared the therapeutic efficacy of combining Dry Cupping therapy with the Muscle Energy Technique (MET) against each intervention applied independently, focusing on three core parameters: Neck Disability Index (NDI), Craniovertebral Angle (CVA), and Sagittal Shoulder-C7 Angle (SSA).

Methods: A pre-test post-test double-blinded randomized controlled trial design was employed. Seventy-six adults (aged 20-40 years) diagnosed with UCS were randomly allocated into four equal experimental groups (n = 19 per group): Group A received combined dry cupping and MET with conventional therapy; Group B received dry cupping with conventional therapy; Group C received MET with conventional therapy; and Group D received conventional therapy alone. Interventions were conducted over an 8-week period. Primary outcomes included functional impairment via the Arabic version of the NDI, and objective sagittal alignment parameters (CVA and SSA) measured using precision photometry via the Kinovea software application.

• Study Type: Interventional
• Enrollment (Actual): 76
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt
    • Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participant inclusion was restricted to individuals between 20 and 40 years of age.
• The exact diagnostic criteria required a baseline craniovertebral angle (CVA) of less than 48 degrees.
• a sagittal shoulder-C7 angle (SSA) of less than 52 degrees.

Exclusion Criteria:

• acute post-surgical conditions
• structural spinal deformities (e.g., severe fixed structural scoliosis)
• cervical radiculopathy, or localized dermal infections contradicting cupping application.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A (Combined group); Group A (Combined group): This group of nineteen subjects received combined dry cupping therapy, Muscle energy techniques, and conventional physical therapy.	Procedure: combined therapy teatment; 19 subjects received combined dry cupping therapy, Muscle energy technique, and conventional physical therapy for eight weeks.; Dry cupping was applied to the regional hypertonic target sites. Standard plastic cups ranging from 25 to 50 mm were placed directly over each subject's levator scapulae trigger point (SI-14) and upper trapezius trigger point (GB-21) bilaterally. The treatment duration was set at exactly 8 minutes per session.; Muscle Energy Technique The Post-Isometric Relaxation (PIR) manual protocol targeted the hypertonic muscles of the upper crossed syndrome quadrant, including the upper trapezius, levator scapulae, sternocleidomastoid, scalenes, and suboccipital groups. Participants were placed in a supine position on the treatment table with their head free from the edge of the plinth, supported by the physical therapist.; conventional physical therapy treatment
Experimental: Group B (Cupping group); Group B (Cupping group): This group of nineteen subjects received dry cupping therapy and conventional physical therapy.	Procedure: cupping therapy group; 19 subjects received combined dry cupping therapy and conventional physical therapy for eight weeks.; Dry cupping was applied to the regional hypertonic target sites. Standard plastic cups ranging from 25 to 50 mm were placed directly over each subject's levator scapulae trigger point (SI-14) and upper trapezius trigger point (GB-21) bilaterally. The treatment duration was set at exactly 8 minutes per session.; conventional physical therapy treatment
Experimental: Group C (MET group); Group C (MET group): This group of nineteen subjects received Muscle energy techniques and conventional physical therapy.	Procedure: muscle energy techniques group; 19 subjects received combined Muscle energy technique, and conventional physical therapy for eight weeks.; Muscle Energy Technique The Post-Isometric Relaxation (PIR) manual protocol targeted the hypertonic muscles of the upper crossed syndrome quadrant, including the upper trapezius, levator scapulae, sternocleidomastoid, scalenes, and suboccipital groups. Participants were placed in a supine position on the treatment table with their head free from the edge of the plinth, supported by the physical therapist.; conventional physical therapy treatment
Active Comparator: Group D (Control group); Group D (Control group): This group of nineteen subjects received conventional physical therapy alone	Procedure: control group; 19 subjects received only conventional physical therapy for eight weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Disability Index (NDI)	Perceived functional limitations resulting from regional impairment were measured using the validated Arabic version of the NDI questionnaire. This instrument evaluates 10 clinical sections (including activities of daily living, concentration, and pain profiles) scored from 0 to 5 per item, yielding a cumulative score out of 50. Higher aggregate indices represent greater functional disability.	At baseline and re assessed following 8 weeks
craniovertebral angle (CVA)	This biomechanical index reflects the architectural severity of forward head posture. It is defined as the angle formed between a horizontal line drawn through the spinous process of C7 and an intersecting line extending from the tragus of the ear to the C7 landmark. CVA was measured using precision digital photogrammetry via the Kinovea software application.	At baseline and re assessed following 8 weeks
Sagittal Shoulder-C7 Angle (SSA)	This geometric marker quantifies shoulder roundedness and anterior protraction. It is formed by the intersection of a horizontal reference line passing through the lateral aspect of the acromion with a line drawn from the C7 spinous process to the lateral acromion. SSA was measured using precision digital photogrammetry via the Kinovea software application.	At baseline and re assessed following 8 weeks

Collaborators and Investigators

• Sponsor: Amira saad mohamed

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2026
• Primary Completion (Estimated): June 18, 2026
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: June 13, 2026
• First Submitted That Met QC Criteria: June 13, 2026
• First Posted (Actual): June 17, 2026

Study Record Updates

• Last Update Posted (Actual): June 17, 2026
• Last Update Submitted That Met QC Criteria: June 13, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Oculocerebral hypopigmentation syndrome type Preus; Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: 012/006489

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No