Dry Cupping, Ischemic Compression, or Their Combination for the Treatment of Trigger Points: A Pilot Randomized Trial

Mohammad Nasb, Xu Qun, Charith Ruckmal Withanage, Xie Lingfeng, Chen Hong, Mohammad Nasb, Xu Qun, Charith Ruckmal Withanage, Xie Lingfeng, Chen Hong

Abstract

Background: Chronic neck pain (NP) attributed to myofascial pain syndrome is one of the particularly common skeletal muscle disorder associated with the hyperirritable zone in the taut band of muscle. Trigger points (TPs) are the physical interpretation of the myofascial pain syndrome. In the United States, 30%-85% of pain patients have been affected by myofascial TPs. Objectives: To reveal preliminary evidence on the clinical efficacy of ischemic compression therapy, dry cupping, and their combination on improving the TPs' pressure pain threshold (PPT), neck range of motion (NROM), and neck disability index (NDI) in patients with TPs and nonspecific NP. Besides, assess the feasibility of conducting a randomized clinical trial (RCT). Design: A randomized pilot study was conducted on 24 patients with TPs and nonspecific NP. Patients were randomly assigned to three groups: the cupping group, the ischemic compression group, and the combination therapy group. PPT, NROM, and NDI were assessed before and after 4 weeks of treatment. Results: The results showed a statistically significant improvement in NDI, PPT, and NROM compared with values before the treatment (p < 0.05) in all groups. Although no significant difference was detected between ischemic compression (IC) and dry cupping, the combination approach showed significantly higher and faster improvement (p < 0.05). Conclusions: It is feasible to conduct a main RCT. Both IC and dry cupping may hold promise in treating TPs; a combination of the two therapies may provide superior improving rate.

Keywords: ischemic compression; physical therapy; rehabilitation; trigger point.

Conflict of interest statement

No competing financial interests exist.

Figures

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FIG. 1.
Study flow chart.

References

    1. McLean SM, May S, Klaber-Moffett J, et al. . Risk factors for the onset of non-specific neck pain: A systematic review. J Epidemiol Community Health 2010;64:565–572
    1. Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial Pain and Dysfunction: Upper Half of Body (Vol. 1). Philadelphia, PA: Lippincott Williams & Wilkins, 1999
    1. Fernández-de-Las-Peñas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Manual Ther 2007;12:29–33
    1. Gerwin RD. Diagnosis of myofascial pain syndrome. Phys Med Rehabil Clin N Am 2014;25:341–355
    1. Alvarez DJ, Rockwell PG. Trigger points: Diagnosis and management. Am Fam Physician 2002;65:653–662
    1. Kisilewicz A, Janusiak M, Szafraniec R, et al. . Changes in muscle stiffness of the Trapezius muscle after application of ischemic compression into myofascial trigger points in professional basketball players. J Hum Kinet 2018;64:35–45
    1. Choi YH, Jung SJ, Lee CH, Lee SU. Additional effects of transcranial direct-current stimulation and trigger-point injection for treatment of myofascial pain syndrome: A pilot study with randomized, single-blinded trial. J Altern Complement Med 2014;20:698–704
    1. Moraska AF, Schmiege SJ, Mann JD, et al. . Responsiveness of myofascial trigger points to single and multiple trigger point release massages: A randomized, placebo controlled trial. Am J Phys Med Rehabil 2017;96:639–645
    1. Tang L, Li Y, Huang Q-M, Yang Y. Dry needling at myofascial trigger points mitigates chronic post-stroke shoulder spasticity. Neural Regen Res 2018;13:673–673
    1. Behrangrad S, Kamali F. Comparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for patellofemoral pain syndrome in young adults: A double-blind randomized clinical trial. J Bodyw Mov Ther 2017;21:554–564
    1. Cao H, Li X, Liu J. An updated review of the efficacy of cupping therapy. PLoS One 2012;7:e31793.
    1. Cagnie B, Dewitte V, Coppieters I, et al. . Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: A cohort study. J Manipulative Physiol Ther 2013;36:482–489
    1. Cagnie B, Castelein B, Pollie F, et al. . Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: A systematic review. Am J Phys Med Rehabil 2015;94:573–583
    1. Bialosky JE, Bishop MD, Price DD, et al. . The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Ther 2009;14:531–538
    1. Lone AH, Ahmad T, Anwar M, et al. . Leech therapy-a holistic approach of treatment in unani (greeko-arab) medicine. Anc Sci Life 2011;31:31.
    1. Bridgett R, Klose P, Duffield R, et al. . Effects of cupping therapy in amateur and professional athletes: Systematic review of randomized controlled trials. J Altern Complement Med 2018;24:208–219
    1. Simons DG. Diagnostic criteria of myofascial pain caused by trigger points. J Musculoskelet Pain 1999;7:111–120
    1. Kumbhare DA, Elzibak AH, Noseworthy MD. Assessment of myofascial trigger points using ultrasound. Am J Phys Med Rehabil 2016;95:72–80
    1. Mikkelsson M, Latikka P, Kautiainen H, et al. . Muscle and bone pressure pain threshold and pain tolerance in fibromyalgia patients and controls. Arch Phys Med Rehabil 1992;73:814–818
    1. Park G, Kim CW, Park SB, et al. . Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Rehabil Med 2011;35:412–417
    1. Vernon H. The neck disability index: State-of-the-art, 1991–2008. J Manipulative Physiol Ther 2008;31:491–502
    1. Young IA, Cleland JA, Michener LA, et al. . Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil 2010;89:831–839
    1. Young BA, Walker MJ, Strunce JB, et al. . Responsiveness of the neck disability index in patients with mechanical neck disorders. Spine J 2009;9:802–808
    1. Toprak M, Alptekin HK, Turhan D. Correction to: P-12 assessment of symmetrigraph and global postural system results for the posture analysis of the healthy individuals. Chiropr Man Therap 2018;26:20–20
    1. Cramer H, Lauche R, Hohmann C, et al. . Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Complement Med Res 2011;18:327–334
    1. Chi LM, Lin LM, Chen CL, et al. . The effectiveness of cupping therapy on relieving chronic neck and shoulder pain: A randomized controlled trial. Evid Based Complement Alternat Med 2016;2016:1–7
    1. Gemmell H, Miller P, Nordstrom H. Immediate effect of ischaemic compression and trigger point pressure release on neck pain and upper trapezius trigger points: A randomised controlled trial. Clin Chiropr 2008;11:30–36
    1. Wilke J, Vogt L, Banzer W. Immediate effects of self-myofascial release on latent trigger point sensitivity: A randomized, placebo-controlled trial. Biol Sport 2018;35:349–354
    1. Aguilera FJM, Martín DP, Masanet RA, et al. . Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: A randomized controlled study. J Manipulative Physiol Ther 2009;32:515–520
    1. Hou CR, Tsai LC, Cheng KF, et al. . Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002;83:1406–1414
    1. Hong SH, Wu F, Lu X, et al. . Study on the mechanisms of cupping therapy. Zhongguo Zhen Jiu 2011;31:932–934
    1. Lauche R, Cramer H, Hohmann C, et al. . The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: A randomised controlled pilot study. Evid Based Complement Alternat Med 2012;2012:1–10
    1. Emerich M, Braeunig M, Clement HW, et al. . Mode of action of cupping—Local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Ther Med 2014;22:148–158
    1. Kim KH, Kim TH, Hwangbo M, Yang GY. Anaemia and skin pigmentation after excessive cupping therapy by an unqualified therapist in Korea: A case report. Acupunct Med 2012;30:227–228
    1. Ganesh GS, Singh H, Mushtaq S, et al. . Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points. J Bodyw Mov Ther 2016;20:477–483

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