Instrument Assisted Soft Tissue Mobilization and Dry Cupping
Instrument Assisted Soft Tissue Mobilization and Dry Cupping: Do They Effect Passive Range of Motion in Young Adults? 1 Diorio P. , 1 Figueroa M. , 1 William Paterson University, Wayne, NJ Results Abstract A Paired Sample T-Test comparing pre- and post- measurements showed a significant increase in PROM immediately after both IASTM and DC were applied each session. However, an ANOVA with Repeated Measures found that there was no significant difference between increases in PROM caused by IASTM vs DC immediately after application. As shown in Table 1, a separate Paired Sample TTest found no significant difference between post-treatment 1 and pretreatment 2 measurements in the IASTM group; meaning that the PROM achieved from treatment 1 was retained over the course of days leading to treatment 2. A Paired Sample T-Test comparing posttreatment 1 and pre-treatment 2 measurements in the DC group found significant differences; meaning that any PROM gained was not retained after treatment. Introduction: The purpose of this study was to examine the effects of dry cupping (DC) and Instrument Assisted Soft Tissue Mobilization (IASTM) on passive range of motion (PROM) in order to examine the quantitative efficiency of these modalities in musculoskeletal rehabilitation. Methods: Thirty-seven participants, male (n= 18) and female (n= 19), between the ages of 18 -26, were randomly assigned into two groups, IASTM and DC. Two sessions were scheduled 3 -5 days apart, where therapeutic intervention was applied for five minutes over the quadriceps muscles. Knee flexion PROM of the dominant leg was assessed using a goniometer before and after application. Results: A Paired Sample T-Test comparing pre- and post- measurements showed a significant increase in PROM immediately after both IASTM and DC were applied. However, an ANOVA with Repeated Measures found that there was no significant difference between increases in PROM caused by IASTM vs DC. A T-Test revealed that on average the IASTM group retained more PROM between sessions. Conclusion: In conclusion, both therapeutic techniques were seen to acutely increase knee flexion PROM. Thus, helping support their use as therapeutic tools in musculoskeletal rehabilitation programs. Clinicians should use their own judgment on which technique would be most beneficial specifically for each case. Discussion/Conclusion Introduction Muscle tightness and restricted range of motion (ROM) are common in individuals who participate in sport or individuals who are recovering from injury. 1 Without optimal ROM individuals could suffer from a decrease in mobility, muscular gains, and overall quality of life. For athletes, specifically, a decreased ROM could lead to improper biomechanical movements which in turn could lead to further injury. With that being said, it is vital for sufficient ROM to be achieved after sustaining an injury. While sufficient ROM is important for athletic performance, it is also vital for daily activities such as walking and running. 2 Thankfully, there are many strategies that can be used to regain and maintain full ROM. However, not many studies analyze the quantitative statistics of how effective the techniques of Dry Cupping Therapy and Instrument Assisted Soft Tissue Mobilization are as useful tools to increase range of motion. This study revealed significant acute increases in knee flexion PROM after both IASTM and DC were applied to the anterior thigh. It is important to state that there was no significant difference in PROM between groups before the study began, therefore making these findings more credible. However, this study also revealed that IASTM may improve PROM for a longer period when compared to DC. This may be accredited to the larger treatment area and amounts of mechanical stress placed on the target tissue during IASTM treatment sessions. Most other studies analyzing the effects of IASTM and DC do so by combined these techniques with exercises and stretching which may skew the data. 3, 4 The pre- and post- data from this study, strictly using IASTM and DC without other intervention practices, may help to provide insight on the use of both therapeutic techniques in the rehabilitative setting for completing goals such as improving ROM. Figure 1. Dry Cupping applied to the anterior thigh Methods Thirty-seven participants, male (n= 18) and female (n= 19), between the ages of 18 -26, were randomly assigned into two groups, IASTM and DC. Two sessions were scheduled 3 -5 days apart, where therapeutic intervention was applied for five minutes over the quadriceps muscles. Both therapeutic interventions were applied bilaterally with the participant lying in the supine position or seated with the knee near full extension resting on a table. IASTM therapy was applied for 5 minutes longitudinally along each respective participants’ rectus femoris muscle. The “Long Bar” tool and IASTM Emollient, by Myofascial Tools , were used for every IASTM session to create consistency. Dry cupping therapy was administered for 5 minutes with three vacuum cups placed along the participants rectus femoris muscle (1 proximal, 1 middle, 1 distal). The size of the cups decreased as they traveled distally, down the thigh. The cupping set used was the Kang. Zhu Vacuum Cupping Set with 24 cups by Beijing Carezoe Medical Appliance Co. , Ltd. During all sessions, 3 vacuum pumps per cup were used to generate a consistent amount of suction. A small amount of lotion was applied to the skin in order to help create a strong vacuum seal against the skin. Before and after each therapeutic intervention, two measurements of PROM of knee flexion were taken from all participants dominate leg. The averages of these measurements were calculated using Microsoft Excel and then transferred into SPSS 25 for further data analysis. The increases of ROM in this study were only improved by a few degrees. However, in the grand scheme of things, individuals who are recovering from injury or simply need to improve their ROM may see immense benefits with these interventions. This study observed the effects of these therapeutic techniques over only two sessions, while in most rehabilitation programs such techniques would be applied multiple times over the course of a few weeks. Based of the findings of this study, it can be assumed that repeated treatments would cause continuous increases in ROM. Figure 2. IASTM being applied to the anterior thigh with the ”Long Bar” tool. References Paired Sample T-Test Mean Post 1 - Pre 2 Mean Diff. (º) Std. Deviation (º) Sig. (2 -tailed) IASTM Posttreat 1 ave - Pretreat 2 ave 138. 2º - 136. 9º 1. 3º 3. 1º 0. 100 DC. Posttreat 1 ave - Pretreat 2 ave 137. 6º - 135. 4º 2. 2º 2. 7º 0. 002 1. Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. Journal of Bodywork and Movement Therapies. 2015; 19(4): 690 -696. 2. Gamboa A, Craft D, Matos J, Flink T, Mokris R. Functional Movement Analysis Before and After Instrument. Assisted Soft Tissue Mobilization. International Journal of Exercise Science. 2019; 12(3): 46 -56. 3. Cage SA, Gallegos DM, Warner BJ. Utilization of Cupping Therapy in the Treatment of Vascular Thoracic Outlet Syndrome in a Collegiate Pitcher: A Case Study. Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association. 2017; 3(2)1 -5. 4. Mac. Donald N, Baker R, Cheatham S. The Effects of Instrument Assisted Soft Tissue Mobilization on Lower Extremity Muscle Performance: A Randomized Controlled Trial. The International Journal of ports Physical Therapy. 2016; 11(7)1040 -1047. Acknowledgements Table 1: Combined Paired Sample T-test of post-treatment 1 vs pre-treatment 2 knee flexion PROM measurements for IASTM and DC groups. Significance reveals the level of difference in PROM lost between sessions 1 and 2 for both groups. (p < 0. 05) I’d like to thank everyone who has helped me complete this study and for all those who have supported me during my time at William Paterson University. Special thanks to Dr. Figueroa who served as a fantastic advisor through the entire thesis process and was always there to help me get through crazy questions and the extensive data crunching that was needed to complete this study. I would also like to thank all my previous professors and mentors during my undergraduate career at West Chester University of Pennsylvania as well as those here during my time at William Paterson. I’d also like to extend a huge thank you to the volunteer participants who made this study possible.
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