Dry cupping for plantar fasciitis: a randomized controlled trial

The impact of massage and dry cupping on dysrhythmia in cardiac patients: A randomized parallel controlled trial

BACKGROUND

Heart disease is the leading cause of death in many countries around the world and is linked to numerous complications. In addition to conventional pharmacological treatments, complementary and alternative medicines like massage and dry cupping are employed to help manage the disease and its symptoms. This study aimed to compare the effects of massage and dry cupping on dysrhythmia in patients with heart diseases.

METHODS

This randomized parallel controlled clinical trial study was conducted in two critical care units of Shafa hospital in Kerman, southeastern Iran, in 2019-2020. A total of 90 eligible patients were allocated into three groups: massage (n = 30), dry cupping (n = 30), and control (n = 30) using a stratified block randomization method. In the massage group, the head and face were massaged for three consecutive nights, while the dry cupping group received dry cupping between the fifth cervical vertebra and the second thoracic vertebra for the same duration. Each intervention session lasted 15 min. Data collection tools included a socio-demographic and clinical characteristics questionnaire, a form for hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation), and a form for assessing dysrhythmia using electrocardiogram readings. Dysrhythmia in the participants was evaluated after each session.

RESULTS

The results within each group indicated a statistically significant difference in the prevalence of dysrhythmia in the dry cupping group after the intervention (P < 0.05), but this difference was not statistically significant in the massage and control groups. However, when comparing between the groups, no significant difference was found among the three groups. Additionally, there was no significant difference in the type of dysrhythmia between the groups (P > 0.05).

CONCLUSION

While there was no difference in the type of dysrhythmia between the three groups, the additional reduction of dysrhythmia in the dry cupping group could hold clinical significance. Further studies are recommended to validate or refute the findings of the present study.

Heel Pain - Plantar Fasciitis: Revision 2023

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain. J Orthop Sports Phys Ther 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303.

Healthcare usage and cost for plantar fasciitis: a retrospective observational analysis of the 2010-2018 health insurance review and assessment service national patient sample data

BACKGROUND

Plantar fasciitis (PF) is the most common cause of heel pain in adults, and the number of patients and medical expenses are increasing annually. However, studies on this condition are lacking. There is a need to investigate universally administered PF treatment and the associated costs. Therefore we analyzed the South Korean Health Insurance Review and Assessment Service data to investigate the distribution and healthcare usage of patients with PF.

METHODS

A cross-sectional retrospective observational design was used in this study. Patients diagnosed with PF (ICD-10 code M72.2) between January 2010 and December 2018 in South Korea, of whom 60,079 had used healthcare at least once, were included in the study. We assessed healthcare usage and cost due to PF, treatment method, and visit route. All statistical analyses were performed with descriptive statistics using SAS 9.4 version.

RESULTS

The number of treated cases of PF and patients with PF was 11,627 cases and 3,571 patients in 2010, respectively, which increased annually to 38,515 cases and 10,125 patients by 2018, respectively. The 45-54-year-old age group had the highest number of patients; the patient population was predominantly women. Physical therapy was used frequently in Western medicine (WM) institutions, where > 50% of the medicines prescribed to outpatients were analgesics. In contrast, acupuncture therapy was most commonly used in Korean medicine (KM) institutions. A high percentage of patients who visited a KM institution, followed by a WM institution, and then returned to the same KM institution had visited the WM institution for radiological diagnostic examination.

CONCLUSION

This study analyzed nine years of period data from a patient sample of claims data from the Health Insurance Review and Assessment Service to examine the current status of health service use for PF in Korea. We obtained information on the status of WM/KM institution visits for PF treatment, which could be useful for health policymakers. Study findings regarding treatments often used in WM/KM, the frequency of treatments, and their costs could be used as basic data by clinicians and researchers.

Effect of Massage and Dry Cupping on Hemodynamic Parameters of Cardiac Patients: A Randomized Controlled Trial

Objective

The aim of this study was to compare the effects of massage versus dry cupping in addition to routine care on hemodynamic parameters of cardiac patients in critical care units.

Methods

The present study was a parallel randomized controlled clinical trial that was conducted in the critical care units of Shafa Hospital in Kerman, Iran, from 2019 to 2020. Ninety eligible patients)aged 18-75 years, no cardiac arrest in the past 72 hours, no severe dyspnea, no fever, and no cardiac pacemaker) were divided into massage (n = 30), dry cupping (n = 30), and control (n = 30) groups using the stratified block randomization method. The massage group received routine care and a head and face massage for 3 consecutive nights from the second day of admission. The dry cupping group received routine care and dry cupping between the third cervical vertebra and the fourth thoracic vertebra for 3 consecutive nights. The control group received only routine care, which included daily visits by the attending physician, nursing care, and medication. Each intervention session was performed for 15 minutes. The data collection tools included the sociodemographic and clinical characteristics questionnaire and the hemodynamic parameters form (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and saturation of peripheral oxygen). The hemodynamic parameters were measured each night before and after the intervention.

Results

The mean systolic blood pressure, heart rate, respiratory rate, and oxygen saturation level showed no significant difference among the 3 groups. The mean diastolic blood pressure of the 3 groups varied significantly over time. The mean diastolic blood pressure of the massage group decreased significantly on the third day of intervention, while it did not change significantly in the 2 groups of dry cupping or control (P < .05).

Conclusion

According to the results of this study, dry cupping had no effect on regulating hemodynamic parameters, while only diastolic blood pressure was reduced significantly after massage on the third day of intervention. Therefore, our study did not show effects of massage and dry cupping on regulating hemodynamic parameters.

Effectiveness of Dry Cupping as a Treatment for Plantar Fasciitis: A Critically Appraised Topic

CLINICAL SCENARIO

Plantar fasciitis is a very common pathology experienced by a wide array of individuals in the United States. Patients most commonly experience tightness and pain along the plantar aspect of their foot and on the medial side of the heel. A variety of treatment methods have been used to improve the pain levels and function of patients with plantar fasciitis. An emerging treatment method for plantar fasciitis is dry cupping, where negative pressure is created to increase blood flow to the injured area and facilitate the healing process.

CLINICAL QUESTION

Is there evidence to suggest dry cupping is effective at improving pain and function for patients experiencing plantar fasciitis when compared with therapeutic exercise or electrical stimulation?

SUMMARY OF KEY FINDINGS

Three studies examining the effectiveness of dry cupping for the treatment of plantar fasciitis were included in this review. Two studies compared dry cupping to therapeutic exercises and stretching, and 1 study used electrical stimulation.

CLINICAL BOTTOM LINE

There is moderate evidence to support the use of dry cupping to improve pain and function in patients with plantar fasciitis.

STRENGTH OF RECOMMENDATION

There is level B evidence to support dry cupping as an effective treatment method for improving pain and function in patients with plantar fasciitis as compared with therapeutic exercise and electrical stimulation.

Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review

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.

Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis

OBJECTIVE

To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis.

METHODS

We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence.

RESULTS

A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control.

CONCLUSIONS

Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.

Association between trigger points in hamstring, posterior leg, foot muscles and plantar fasciopathy: A cross- sectional study

BACKROUND

Plantar Fasciopathy (PF) is soreness or irritability experienced underneath infero-medial aspect of the heel. It is a multifactorial disorder where myofascial involvement also seems to be associated with it, in which, muscles of posterior thigh, leg and foot muscles are affected. Trigger points in these muscles may interfere with biomechanics and normal functioning of the lower limb.

OBJECTIVE

To find an association between trigger points of the posterior thigh, leg and foot muscles and plantar fasciopathy.

STUDY DESIGN

A cross sectional study.

METHODS

100 patients with plantar fasciopathy who fulfilled inclusion criteria were included in this study. They were examined for trigger points by manual palpation in posterior thigh, leg and foot muscles. Totally 15 muscles were examined on both affected and unaffected side.

RESULTS

Results showed that myofascial trigger points were more prevalent in medial gastrocnemius (98%, Chi-square: 110.07, p < 0.05, Phi-0.74), quadratus plantae (83%, Chi-square:126.96, p < 0.05, Phi- 0.79), soleus (69%, Chi-square: 28.88, p < 0.05, Phi-0.38), tibialis posterior (46%, Chi-square 41.98 p<0.05%, Phi-0.50), abductor hallucis (42%, Chi-square: 43.61 p<0.05% Phi-0.46), flexor halluces longus (41%, Chisquare: 39.25, p < 0.05, Phi-0.44) than other muscles on the affected side. Whereas, on the unaffected side, trigger points were more prevalent among peroneus longus (50%, Chi-square: 26.14, p < 0.05, Phi-0.36) followed by medial gastrocnemius (26%, Chisquare: 110.07, p < 0.05, Phi-0.74).

CONCLUSION

Plantar fasciopathy is strongly associated with trigger points of medial gastrocnemius, quadratus plantae followed by soleus, tibialis posterior, abductor hallucis and flexor hallucis longus.

Dry cupping for musculoskeletal pain and range of motion: A systematic review and meta-analysis

OBJECTIVES

This review evaluated the efficacy and safety of western dry cupping methods for the treatment of musculoskeletal pain and reduced range of motion.

METHODS

A systematic literature search was performed until April 2018 for randomised controlled trials (RCTs) pertaining to musculoskeletal pain or reduced range of motion, treated with dry cupping. Outcomes were pain, functional status, range of motion and adverse events. Risk of bias and quality of evidence was assessed using the modified Downs & Black (D&B) checklist and GRADE.

RESULTS

A total of 21 RCTs with 1049 participants were included. Overall, the quality of evidence was fair, with a mean D&B score of 18/28. Low-quality evidence revealed dry cupping had a significant effect on pain reduction for chronic neck pain (MD, -21.67; 95% CI, -36.55, to -6.80) and low back pain (MD, -19.38; 95%CI, -28.09, to -10.66). Moderate-quality evidence suggested that dry cupping improved functional status for chronic neck pain (MD, -4.65; 95%CI, -6.44, to -2.85). For range of motion, low quality evidence revealed a significant difference when compared to no treatment (SMD, -0.75; 95%CI, -0.75, to -0.32).

CONCLUSION

Dry cupping was found to be effective for reducing pain in patients with chronic neck pain and non-specific low back pain. However, definitive conclusions regarding the effectiveness and safety of dry cupping for musculoskeletal pain and range of motion were unable to be made due to the low-moderate quality of evidence. Further high-quality trials with larger sample sizes, long-term follow up, and reporting of adverse events are warranted.

Standards for reporting interventions in clinical trials of cupping (STRICTOC): extending the CONSORT statement

BACKGROUND

The standards for reporting interventions in clinical trials of cupping (STRICTOC), in the form of a checklist and explanations for users, were designed to improve reporting of cupping trials, particularly the interventions, and thereby facilitating their interpretation and replication.

METHODS

A group of clinical experts, methodologists, epidemiologists, and editors has developed this STRICTOC checklist through a comprehensive process, including registration of this guideline, literature review, solicitation of comments, consensus meeting, revision, and finalization.

RESULTS

The STRICTOC checklist includes 6 items and 16 sub-items, namely cupping rationale, details of cupping, treatment regimen, other components of treatment, treatment provider background, and control or comparator interventions. Illustrative examples of each item are also provided.

CONCLUSIONS

It is intended that the STRICTOC, in conjunction with both the main Consolidated Standards of Reporting Trials (CONSORT) Statement and extension for nonpharmacologic treatment, will raise the reporting quality of clinical trials of cupping.Trial registration We have registered this study on the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network: http://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials/#STRICTOC.