Suction Decompression of the Carpal Tunnel

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.

Is There a Role of Cupping Therapy in the Treatment of Carpal Tunnel Syndrome in Primary Care Setting?

Carpal tunnel syndrome (CTS) is a clinical syndrome, which causes significant morbidity. It is currently managed conservatively with splinting or steroidal injections. Where conservative management is unsatisfactory, surgical decompression is carried out. Because of dangerous complications of surgical procedures and increasing economical burden of CTS condition, safe, traditional, cost effective conservative adjunct option is being evaluated in this review article. Cupping therapy is an ancient but increasingly popular therapy for a variety of pathologies. Studies over the last decade have indicated potential therapeutic value of cupping therapy for the management of CTS. Whilst there is some biomedical rationale supporting the usage of cupping therapy in CTS the evidence is not sufficient to support the inclusion of cupping therapy in management of carpal tunnel syndrome in formal pathways. High quality trials with increased participant numbers, development of blinded study options and a regulatory body for cupping therapy are required so that cupping therapy can be established as a potent therapeutic option for CTS. The review was conducted to examine the efficacy of cupping therapy in management of CTS.

Effect of Pressures and Durations of Cupping Therapy on Skin Blood Flow Responses

Cupping therapy has been widely used in treating musculoskeletal impairments. However, there is no specific guideline on selecting the intensity of cupping therapy, including the pressure and duration. The objective of this study was to investigate the effect of different pressures and durations of cupping therapy on skin blood flow responses. A 2 × 2 factorial design, including two negative pressures at -225 and -300 mmHg and two durations at 5 and 10 min, was tested in 12 healthy participants. The four protocols of cupping therapy were tested in four different days. Skin blood flow was measured using laser Doppler flowmetry on the left triceps (the SJ12 acupoint). Skin blood flow after cupping therapy was expressed as a ratio of skin blood flow before cupping therapy. The results showed that -300 mmHg caused a significant increase in peak skin blood flow (16.7 ± 2.6 times) compared to -225 mmHg (11.1 ± 2.2 times, p < 0.05) under 5-min duration. The largest difference in skin blood flow is between -300 mmHg for 5 min (16.7 ± 2.6 times) and -225 mmHg for 10 min (8.1 ± 2.3 times, p < 0.01). Our findings demonstrated that a higher value (300 mmHg) of negative pressure is more effective on increasing skin blood flow compared to a lower value (225 mmHg). Also, a shorter duration (5 min) causes a larger peak and total skin blood flow compared to a longer duration (10 min). This study provides the first evidence showing the effect of pressures and durations of cupping therapy on skin blood flow responses.