Effectiveness of Instrument-assisted Soft-tissue... : Indian Journal of Community Medicine (2025)

INTRODUCTION

Neck pain is a common musculoskeletal problem worldwide.^[1] With notable rates of recurrence and chronicity, coupled with varying recovery patterns across episodes throughout one’s lifetime,^[2] mechanical neck pain (NP) typically manifests insidiously and is generally attributed to multifactorial origins.^[3,4] Identified modifiable factors contributing to the onset of mechanical NP encompass smoking,^[5,6] poor posture, anxiety, depression, neck strain, and participation in certain sporting or occupational activities.^[7]

The societal impact of neck pain is considerable, characterized by a prevalence ranging from 16.7% to 75.1% within the general population.^[8] This prevalence is particularly elevated among women in high-income countries and urban settings,^[9] with a noteworthy incidence observed in office workers, particularly those engaged in prolonged computer use.^[10]

Dry cupping

Cupping, a therapeutic technique used for numerous ailments, has a history spanning thousands of years.^[11] The process involves creating a vacuum within a plastic or glass cup by suctioning out the air when the cup is placed on the skin. Typically, the cups can be used either at rest or during movement. Cupping therapy demonstrates efficacy in alleviating pain and inflammation,^[12] enhancing blood circulation, and serving as a modality for relaxation, well-being, and deep tissue massage. It is characterized by its safety, noninvasiveness, and cost-effectiveness as a treatment option.^[13] In addition, cupping is associated with the rejuvenation of body organs, fostering the healing process, and fortifying the immune system. This therapeutic approach finds application in the treatment of various conditions, including blood disorders such as anemia and hemophilia, as well as rheumatic diseases such as arthritis and fibromyalgia.

Notably, on the skin, the therapy promotes improved metabolism in skin tissue, enhances the functioning of sebaceous and sweat glands, accelerates the healing process, and bolsters overall skin resistance.^[14] In the realm of muscles, cupping stimulates blood flow and facilitates lymphatic drainage, contributing to enhanced muscle function. Similarly, the impact extends to joints, where increased blood flow and heightened secretion of synovial fluid may contribute to improved joint health. Within the digestive system, cupping therapy induces heightened peristalsis and an increased secretion of digestive fluids, fostering more efficient digestion and excretion processes. The therapy’s influence on the blood includes improved circulation, positively affecting the functioning of red blood cells (RBC) and white blood cells (WBC). Cupping stimulates sensory nerves in the skin, contributing to an improved autonomic nervous system (ANS). Various theories have been posited to elucidate the effectiveness of dry cupping therapy. Some hypotheses propose that the manipulation of negative pressure generated through a vacuum mechanism enables cupping to draw the skin and underlying tissues upward into the center of the cup, thus creating a distractive effect.^[15]

INSTRUMENT-ASSISTED SOFT-TISSUE MOBILIZATION

Research has delved into the cellular-level advantages of instrument-assisted soft-tissue mobilization (IASTM). The induction of an inflammatory response, triggered by microtrauma to the targeted tissues during IASTM, prompts heightened fibroblast proliferation, increased collagen synthesis, and the maturation and remodeling of disorganized collagen fiber matrix. Consequently, the application of IASTM leads to the breakdown of scar tissues, adhesions, and facial restrictions, thereby facilitating a more organized and functional tissue structure.^[16] The fibroblast stands as a pivotal cell within the extracellular matrix (ECM), orchestrating crucial processes related to the repair, regeneration, and maintenance of soft tissues. The ECM serves as the milieu where these essential activities transpire. Fibroblasts play a key role in synthesizing the ECM, composing critical elements such as collagen, elastin, proteoglycans, and various other substances. Beyond their synthetic functions, fibroblasts exhibit the remarkable ability to function as mechanotransducers, enabling them to detect and respond to biophysical strain, encompassing compression, torque, shear, and fluid flow, through a mechanochemical response.

In a study conducted by Gehlsen et al.,^[17] the effects of three distinct pressures of instrument-assisted soft-tissue mobilization (IASTM) on rat Achilles tendons were explored. Their findings concluded that fibroblast production exhibited a direct proportionality to the magnitude of IASTM pressure applied by the clinician. This observation was further supported by Davidson et al., who used electron microscopy to analyze tissue samples after IASTM application, ultimately affirming a significant increase in fibroblast production within rat Achilles tendons. These investigations collectively highlight the dynamic role of fibroblasts in responding to IASTM and underscore the potential implications for tissue healing and remodeling.

Numerous studies have demonstrated the clinical efficacy of instrument-assisted soft-tissue mobilization (IASTM), revealing notable enhancements in various key parameters post-treatment. In a study by Melham et al., a college football player exhibited significant improvement in range of motion after undergoing 7 weeks of IASTM in conjunction with physical therapy.^[18] In addition, the same research team observed a reduction and structural remodeling of scar tissue surrounding the lateral malleolus after the application of IASTM.

Another study by Wilson et al. reported positive outcomes in terms of pain reduction and improvements in the impairment scale at both the 6- and 12-week marks after IASTM application for patellar tendonitis.^[19] These findings collectively underscore the clinical benefits of IASTM, encompassing enhancements in range of motion, reduction of scar tissue, and alleviation of pain and impairment, thereby supporting the therapeutic utility of IASTM in various musculoskeletal conditions.^[1]

MATERIALS AND METHODS

Study design: Comparative study

Study setting: Private Physiotherapy Clinic, Aurangabad.

Sample size: Group A: 15 subjects

Group B: 15 subjects

Number of subjects: Thirty subjects between the age group of 20 and 45 years were taken. Of it, 2 males and 28 females are there.

Group A was advised IASTM in addition to stretching exercises, and Group B was treated with dry cupping in addition to stretching exercises.

Selection criteria:

Inclusion criteria:

• Subjects between the age of 20 and 45 years.
• Patients of both male and female.
• Patients with neck pain more than 2 weeks.
• Visual analog scale intensity 5 or more

Exclusion criteria:

• History of traumatic injury, e.g., fracture cervical spine.
• Operative history, e.g., operated for disc prolapse treatment.
• Patients with chronic infections, e.g., alkylosing spondylitis, and osteomyelitis.
• Patients contraindicated to the treatment protocol.

Outcome measures:

• Universal goniometer
• Visual analog scale

Instrumentation:

• Silicone cups [Figure 1]
• M2T blade [Figure 2]

Duration of the study:

• 4 weeks

Interventions:

Instrument-assisted soft-tissue mobilization:

For IASTM, the patient was seated in a comfortable stoop sitting position. A lubricant (Vaseline) was applied to the skin around the neck before treatment, and M2T blade was used. The initial step involved using the M2T blade to precisely identify areas of restriction within the upper trapezius (upper trapezius).^[20] Subsequently, using the M2T blade at a 45-degree angle and using treatment and gentle strokes were applied along the muscle. This sweeping technique extended from the muscle’s origin to its insertion, lasting for an approximate duration of 3 minutes.^[21] Importantly, the application of these strokes was executed with careful attention to ensure that no discomfort or pain was induced during the procedure. This procedure was repeated twice a week for four weeks.^[22] Participants were given instructions to apply an ice pack to the designated area in the event that they experienced any sensations of burning after the session.

Subsequent to the instrument-assisted soft-tissue mobilization (IASTM) session, each participant underwent a passive stretching exercise targeting the upper trapezius. This exercise entailed laterally flexing the head toward the left side, maintaining the position for a duration of 30 seconds, and repeating this sequence three times. Adjustments were made to increase neck flexion when deemed appropriate, thereby intensifying the tension of the stretch. In addition, participants were encouraged to incorporate a self-stretching exercise, into their routine five times a week as part of a home program.

Dry cupping

For dry cupping, the patient was seated in a comfortable stoop sitting position. A lubricant was applied. Silicone cup was used for the treatment purpose. Vacuum pumps were used to withdraw air from the cup, creating negative pressure and securing it firmly to the skin [Figure 1].^[23] Each participant underwent a passive stretching exercise targeting the upper trapezius.

STATISTICAL ANALYSIS AND RESULTS

Demographic data, i.e., age, weight, height, and outcomes data [Figure 3], i.e., visual analog scale score, and neck range of motion were collected and statistically analyzed using SPSS VERSION 24.0.

Data analysis

N = Number of patients

M = Median

S.D = Standard deviation

Data were entered in Microsoft Excel and analyzed using SPSS version 24.0^th.

DISCUSSION

The comparative study aimed to investigate the effects of two interventions, instrument-assisted soft-tissue mobilization (IASTM) and dry cupping, on individuals experiencing neck pain. The study design included evaluations of both pain levels and cervical flexion and lateral flexion range of motion before and after the treatment sessions for both groups.

The findings revealed significant improvements in both groups, with the dry cupping group showing superior outcomes compared with the IASTM group. The visual analog scale (VAS) scores, reflecting pain perception, demonstrated a more substantial reduction in the dry cupping group compared with the IASTM group. In addition, the range of motion (ROM) assessments indicated greater improvements in both flexion and lateral flexion in the dry cupping group.

Several factors could contribute to the observed differences in outcomes. Dry cupping has been traditionally recognized for its therapeutic effects, including pain reduction, improved blood circulation, and relaxation. The negative pressure created by cupping is believed to influence various physiological systems, promoting tissue healing and enhancing overall well-being. The distraction effect created by cupping may contribute to improved range of motion and reduced pain perception.

On the other hand, IASTM involves the use of instruments to mobilize soft tissues, targeting specific areas of restriction. Although IASTM has shown efficacy in various studies, the present findings suggest that, in the context of this study, dry cupping yielded more pronounced benefits.

The limitations of the study include the relatively small sample size. In addition, individual variations in response to interventions, as well as the subjective nature of pain assessment, should be considered. Future research with larger sample sizes, long-term follow-ups, and a more comprehensive control group could provide further insights into the comparative effectiveness of these interventions.

CONCLUSION

The study concludes that the dry cupping is more beneficial as compared to instrument-assisted soft-tissue mobilization for treatment of neck pain [Graphs 1-2]. The results of our study suggested that a session of dry cupping therapy is an effective treatment method for the immediately reducing discomfort and pain [Graphs 3-4].

In conclusion, the research findings underscore the potential efficacy of dry cupping as a therapeutic intervention for individuals experiencing neck pain. The study, using a comparative design with instrument-assisted soft-tissue mobilization (IASTM), revealed that dry cupping demonstrated superior outcomes in terms of pain reduction, as measured by visual analog scale (VAS) scores, and improvements in range of motion (ROM) compared with IASTM [Table 1] and [Graphs 5-8].

The observed benefits in the dry cupping group may be attributed to the traditional therapeutic effects associated with cupping, including the creation of negative pressure, which is believed to influence physiological systems, promote tissue healing, and enhance overall well-being. The distraction effect induced by cupping could contribute to the observed enhancements in range of motion and reduced pain perception.

Although IASTM has demonstrated efficacy in various musculoskeletal conditions, this study suggests that, in the specific context of neck pain, dry cupping yielded more pronounced and immediate benefits.

These research findings contribute to the evolving understanding of complementary interventions in managing musculoskeletal conditions. The demonstrated benefits of dry cupping in this study warrant further exploration and validation in diverse populations and clinical settings. Integrating such evidence into clinical practice may enhance the spectrum of available therapeutic options for individuals with neck pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES