Immediate and Delayed Effects of Cupping Therapy on Reducing Neuromuscular Fatigue

Application of near-infrared spectroscopy to assess the effect of the cupping size on the spatial hemodynamic response from the area inside and outside the cup of the biceps

Cupping therapy is a popular intervention for improving muscle recovery after exercise although clinical evidence is weak. Previous studies demonstrated that cupping therapy may improve microcirculation of the soft tissue to accelerate tissue healing. However, it is unclear whether the cupping size could affect the spatial hemodynamic response of the treated muscle. The objective of this study was to use 8-channel near-infrared spectroscopy to assess this clinical question by assessing the effect of 3 cupping sizes (35, 40, and 45 mm in inner diameter of the circular cup) under -300 mmHg for 5 min on the muscle hemodynamic response from the area inside and outside the cup, including oxyhemoglobin and deoxy-hemoglobin in 18 healthy adults. Two-way factorial design was used to assess the interaction between the cupping size (35, 40, and 45 mm) and the location (inside and outside the cup) and the main effects of the cupping size and the location. The two-way repeated measures ANOVA demonstrated an interaction between the cupping size and the location in deoxy-hemoglobin (P = 0.039) but no interaction in oxyhemoglobin (P = 0.100), and a main effect of the cup size (P = 0.001) and location (P = 0.023) factors in oxyhemoglobin. For the cupping size factor, the 45-mm cup resulted in a significant increase in oxyhemoglobin (5.738±0.760 μM) compared to the 40-mm (2.095±0.312 μM, P<0.001) and 35-mm (3.134±0.515 μM, P<0.01) cup. Our findings demonstrate that the cupping size and location factors affect the muscle hemodynamic response, and the use of multi-channel near-infrared spectroscopy may help understand benefits of cupping therapy on managing musculoskeletal impairment.

Repertoire of timescales in uni - and transmodal regions mediate working memory capacity

Working memory (WM) describes the dynamic process of maintenance and manipulation of information over a certain time delay. Neuronally, WM recruits a distributed network of cortical regions like the visual and dorsolateral prefrontal cortex as well as the subcortical hippocampus. How the input dynamics and subsequent neural dynamics impact WM remains unclear though. To answer this question, we combined the analysis of behavioral WM capacity with measuring neural dynamics through task-related power spectrum changes, e.g., median frequency (MF) in functional magnetic resonance imaging (fMRI). We show that the processing of the input dynamics, e.g., the task structure's specific timescale, leads to changes in the unimodal visual cortex's corresponding timescale which also relates to working memory capacity. While the more transmodal hippocampus relates to working memory capacity through its balance across multiple timescales or frequencies. In conclusion, we here show the relevance of both input dynamics and different neural timescales for WM capacity in uni - and transmodal regions like visual cortex and hippocampus for the subject's WM performance.

Using multi-channel near-infrared spectroscopy to assess the effect of cupping therapy on the spatial hemodynamic response of the biceps muscle: A preliminary study

BACKGROUND

The local hemodynamic response after cupping therapy has been considered as a contributing factor for improving muscle tissue health; however, the effects of cupping pressure and duration on the spatial hemodynamic response have not been investigated.

OBJECTIVE

The objective of this study was to investigate the hemodynamic response inside and outside the cupping cup under various pressures and durations of cupping therapy.

METHODS

A 3-way factorial design with repeated measures was used to investigate the main and interaction effects of the location (areas inside and outside the cup), pressure (-225 and -300 mmHg) and duration (5 and 10 min) on the hemodynamic response of the biceps muscle. A functional near-infrared spectroscopy was used to assess hemodynamic changes in 18 participants.

RESULTS

A significant three-way interaction of the location, pressure, and duration factors was observed in oxyhemoglobin (p= 0.023), deoxy-hemoglobin (p= 0.013), and blood volume (p= 0.013). A significant increase was observed in oxyhemoglobin, blood volume, and oxygenation compared to pre-cupping (p< 0.05) in the area outside the cup.

CONCLUSION

Our findings indicate that an appropriate combination of cupping pressure and duration can effectively affect the spatial hemodynamic response of the biceps.

Effect of Lactobacillus plantarum PS128 on neuromuscular efficiency after a half-marathon

Introduction: Lactobacillus plantarum PS128 (PS128) could be considered an antioxidant supplement to reduce muscle fatigue and improve exercise capacity recovery after vigorous exercise. Purpose: The purpose of this study is to investigate the effect of PS128 on muscle fatigue and electromyography (EMG) activity after a half-marathon (HM). Methods: The experimental design used a repeated-measures design with a double-blind approach. The participants either took two capsules of PS128 for 4 weeks as the PS128 group (PSG, n = 8) or took two capsules of a placebo for 4 weeks as the placebo group (PLG, n = 8) to ensure counterbalancing. The time points of the maximal voluntary isometric contraction (MVIC) and EMG activity test were set before probiotics were taken (baseline), 48 h before HM (Pre), and immediately at 0 h, 3 h, 24 h, 48 h, 72 h, and 96 h after HM. Results: EMG activity included median power frequency (MDF), integrated EMG (iEMG), and neuromuscular efficiency (peak torque/iEMG). The MVICs of knee extensors, analyzed by using an isokinetic dynamometer, showed a decrease from the Pre to 0 h (p = 0.0001), 3 h (p < 0.0001), 24 h (p < 0.0001), 48 h (p < 0.0001), 72 h (p = 0.0002), and 96 h (p = 0.0408) time points in the PLG. Sidak's multiple comparisons tests showed that the PLG was significantly lower than the PSG at 0 h (p = 0.0173), 3 h (p < 0.0001), 24 h (p < 0.0001), 48 h (p < 0.0001), 72 h (p < 0.0001), and 96 h (p = 0.0004) time points. The MDF of vastus medialis oblique (VMO) in the PLG was significantly decreased 24 h after HM and significantly lower than that in the PSG at all times points after HM. The iEMG of VMO in the PLG was significantly decreased 48 h after HM and significantly lower than that in the PSG at 0 h, 3 h, 24 h, 48 h, and 72 h after HM. Conclusion: The PS128 supplementation may prevent the decrease in MDF, iEMG, and peak torque after vigorous exercise. Recreational runners may consider implementing a probiotic supplementation regimen as a potential strategy to mitigate muscle fatigue following HM.

Using cross-correlation analysis of multi-channel near infrared spectroscopy to assess the hemodynamic response to cupping therapy

Cupping therapy is a common intervention for the management of musculoskeletal impairment. Previous studies have demonstrated that cupping therapy can improve muscle hemodynamic responses using single-channel near-infrared spectroscopy (NIRS). However, the effects of cupping therapy on spatial hemodynamic responses as well as the correlation between oxyhemoglobin and deoxy-hemoglobin are largely unknown. The cross-correlation function (CCF) algorithm was used to determine the correlation between time-series NIRS signals from inside and outside the cup as well as time-series oxyhemoglobin and deoxy-hemoglobin under 4 cupping intensities, including -225 and -300 mmHg for 5 and 10 min. The main finding was that the maximum CCF values of oxyhemoglobin was significantly higher than those in deoxy-hemoglobin (p < 0.05). Furthermore, it was found that there was a correlation between deoxy-hemoglobin with a longer duration and a larger magnitude of negative pressure. This is the first study investigating time-series hemodynamic responses after cupping therapy using cross-correlation function analysis of multi-channel NIRS signals.

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

Cupping therapy has been widely used to manage musculoskeletal impairment. However, the effects of pressure and duration of cupping therapy on the hemodynamic activity of the muscle have not been investigated. A 2 × 2 repeated measures factorial design was used to examine the main effect and interaction of pressure (-225 and -300 mmHg) and duration (5 and 10 min) on biceps muscle blood flow using near-infrared spectroscopy in 18 participants. The results showed that a significant interaction is between pressure and duration on deoxy-hemoglobin (p = 0.045). A significant main effect of pressure is on oxyhemoglobin (p = 0.005) and a significant main effect of duration is on oxyhemoglobin (p = 0.005). Cupping therapy at -300 mmHg for 10 min results in a higher oxyhemoglobin (6.75 ± 2.08 μM) and deoxy-hemoglobin (1.71 ± 0.78 μM) compared to other three combinations. Our study provides first evidence that the pressure and duration factors of cupping therapy can significantly affect muscle blood volume and oxygenation.

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

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.

Acupuncture or cupping plus standard care versus standard care in moderate to severe COVID-19 patients: an assessor-blinded, randomized, controlled trial

Background

: Non-pharmacological strategies that have been proposed by complementary medical systems, can be effective in management of COVID-19.

Methods

: This study was designed as a three-arm, assessor-blinded, randomized controlled trial. A total of 139 hospitalized COVID-19 patients were randomly assigned into three groups: (1) acupuncture (ACUG), (2) cupping (CUPG), and (3) control (CTRG). All participants received conventional treatment. The primary study endpoint included changes in respiratory signs including oxygen saturation (SpO₂) and respiratory rate (RR). The secondary endpoints were COVID-19-related hospitalization duration and serious adverse events such as intensive care unit (ICU) admission, intubation or death, all up to day 30. Also, improvements in cough, dyspnea, chest tightness, oxygen demand, anorexia, headache, weakness, sore throat, and myalgia were evaluated.

Results

: Forty-two patients in ACUG, 44 patients in CUPG, and 42 patients in CTRG completed the trial. After 3 days, SpO₂ and RR improved significantly in CUPG and ACUG compared with CTRG (effect size: 8.49 (6.4 to 10.57) and 8.51 (6.67 to 10.34), respectively: p<0.001). Compared with CTRG, patients in CUPG and ACUG recovered faster (mean difference: 6.58 (4.8 to 8.35) and 9.16 (7.16 to 11.15), respectively) and except for two patients in ACUG who were admitted to ICU, none of patients in ACUG or CUPG needed ICU or intubation (p<0.001 in comparison to CTRG). Amelioration of clinical COVID-19 related symptoms reached a high level of statistical significance in CUPG and ACUG in comparison with CTRG (p<0.01).

Conclusion

: Cupping and acupuncture are promising safe and effective therapies in management of COVID-19.

Application of Surface Electromyography in Exercise Fatigue: A Review

Exercise fatigue is a common physiological phenomenon in human activities. The occurrence of exercise fatigue can reduce human power output and exercise performance, and increased the risk of sports injuries. As physiological signals that are closely related to human activities, surface electromyography (sEMG) signals have been widely used in exercise fatigue assessment. Great advances have been made in the measurement and interpretation of electromyographic signals recorded on surfaces. It is a practical way to assess exercise fatigue with the use of electromyographic features. With the development of machine learning, the application of sEMG signals in human evaluation has been developed. In this article, we focused on sEMG signal processing, feature extraction, and classification in exercise fatigue. sEMG based multisource information fusion for exercise fatigue was also introduced. Finally, the development trend of exercise fatigue detection is prospected.

Possible mechanism and Atorvastatin-based treatment in cupping therapy-related subdural hematoma: A case report and literature review

Subdural hematoma (SDH) is one of the most lethal types of traumatic brain injury. SDH caused by Intracranial Pressure Reduction (ICPR) is rare, and the mechanism remains unclear. Here, we report three cases of SDH that occurred after substandard cupping therapy and are conjected to be associated with ICPR. All of them had undergone cupping treatments. On the last cupping procedure, they experienced a severe headache after the cup placed on the occipital-neck junction (ONJ) was suddenly removed and were diagnosed with SDH the next day. In standard cupping therapy, the cups are not usually placed on the ONJ. We speculate that removing these cups on the soft tissue over the cisterna magna repeatedly created localized negative pressure, caused temporary but repeated ICPR, and eventually led to SDH development. The Monro-Kellie Doctrine can explain the mechanism behind this - it states that the intracranial pressure is regulated by a fixed system, with any change in one component causing a compensatory change in the other. The repeated ICPR promoted brain displacement, tearing of the bridging veins, and development of SDH. The literature was reviewed to illustrate the common etiologies and therapies of secondary ICPR-associated SDH. Despite the popularity of cupping therapy, its side effects are rarely mentioned. This case is reported to remind professional technicians to fully assess a patient's condition before cupping therapy and ensure that the cups are not placed at the ONJ.

Evaluation of the effectiveness and safety of cupping therapy in the treatment of asthma: A protocol for systematic review and meta-analysis

BACKGROUND

Asthma is one of the most common chronic airway diseases and is characterized by wheezing, dyspnea, chest tightness, and coughing. These symptoms reduce the patient's quality of life and limit physical activity in daily life. However, there is no systematic review of the efficacy of cupping therapy in the treatment of asthma. To evaluate the efficacy and safety of cupping in the treatment of asthma, we conducted a systematic review and meta-analysis of published randomized clinical trials of cupping in the treatment of asthma.

METHODS

We will search the following Chinese and English databases: China National Knowledge Infrastructure, China Science and Periodical Database, Wanfang Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library. All of the above electronic databases will be searched from inception to August 22, 2021. In addition, we will manually search for conference papers, ongoing experiments, and internal reports to supplement the studies retrieved via electronic search. We will use the Review Manager 5.4 provided by Cochrane Collaboration Network for statistical analysis.

RESULTS

The study will prove the effectiveness and safety of cupping in the treatment of asthma.

CONCLUSION

We plan to submit this systematic review to a peer-reviewed journal.

INPLASY REGISTRATION NUMBER

INPLASY202180104.

Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions

Background

Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns.

Methods

A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated.

Results

Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016).

Conclusions

This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

Effects of Various Physical Interventions on Reducing Neuromuscular Fatigue Assessed by Electromyography: A Systematic Review and Meta-Analysis

Introduction: Various interventions have been applied to improve recovery from muscle fatigue based on evidence from subjective outcomes, such as perceived fatigue and soreness, which may partly contribute to conflicting results of reducing muscle fatigue. There is a need to assess the effectiveness of various intervention on reducing neuromuscular fatigue assessed by a quantitative outcome, such as electromyography (EMG). The objective of this review and meta-analysis was to evaluate the effectiveness of different interventions and intervention timing for reducing fatigue rates during exercise. Methods: The literature was searched from the earliest record to March 2021. Eighteen studies with a total of 87 data points involving 281 participants and seven types of interventions [i.e., active recovery (AR), compression, cooling, electrical stimulation (ES), light-emitting diode therapy (LEDT), massage, and stretching] were included in this meta-analysis. Results: The results showed that compression (SMD = 0.28; 95% CI = -0.00 to 0.56; p = 0.05; I ² = 58%) and LEDT (SMD = 0.49; 95% CI = 0.11 to 0.88; p = 0.01; I ² = 52%) have a significant recovery effect on reducing muscle fatigue. Additionally, compression, AR, and cooling have a significant effect on reducing muscle fatigue when conducted during exercise, whereas a non-effective trend when applied after exercise. Discussion: This meta-analysis suggests that compression and LEDT have a significant effect on reducing muscle fatigue. The results also suggest that there is a significant effect or an effective trend on reducing muscle fatigue when compression, AR, cooling, and ES are applied during exercise, but not after exercise.