Effectiveness of instrument-assisted soft tissue mobilization and cupping applications in individuals with cervical disc gerniation: A randomized controlled trial

Year 2025, Volume: 42 Issue: 1, 32 - 39, 28.03.2025

Beste İncekulak , Ömer Şevgin , Beyzanur Dikmen Hoşbaş

Abstract

This study investigated the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and cupping therapy on neck awareness, grip strength, pain, balance, and sleep quality in patients with cervical disc herniation. This study was conducted with 27 individuals with cervical disc herniation aged between 18 and 65. The participants were randomly assigned to the intervention (n=13) or control group (n=14). While both groups received conservative treatment, the intervention group also received both IASTM and cupping therapy once a week on non-consecutive days. Intervention efficacy was evaluated by the Fremantle Neck Awareness Questionnaire to evaluate neck awareness, a Visual Analogue Scale to assess pain, a hand dynamometer to quantify grip strength, the Jenkins Sleep Scale to evaluate sleep quality, and the Single Leg Standing Test to determine balance. All assessments were made at baseline and the end of treatment. No significant discrepancy was identified between the intervention and control groups regarding pain, neck awareness, grip strength, sleep quality, and balance scores, both at rest and during activity. A significant difference was observed in all measures for the intervention group in the initial and final test comparisons. In the control group, a significant variation was detected in the VAS score for both rest and activity conditions and no significant difference was observed in the neck awareness, grip strength, sleep quality and balance scores. In the intervention group, neck pain decreased, neck awareness, grip strength and sleep quality increased, and balance improved after IASTM and cupping therapy. Alternative modalities such as IASTM and cupping therapy may be beneficial for individuals with cervical disc herniation; however, further research is recommended.

Keywords

Cupping therapy, Graston technique, pain, cervical disc herniation.

References

• 1. Safiri S, Kolahi A-A, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. bmj. 2020;368.
• 2. Sharrak S, Al Khalili Y. Cervical disc herniation. 2019.
• 3. Schoenfeld AJ, Weiner BK. Treatment of lumbar disc herniation: Evidence-based practice. International journal of general medicine. 2010:209-14.
• 4. Andreula C, Muto M, Leonardi M. Interventional spinal procedures. European journal of radiology. 2004;50(2):112-9.
• 5. Pampati K, is an Interventional IDM, Manchikanti L. A randomized, double-blind, active control trial of fluoroscopic cervical interlaminar epidural injections in chronic pain of cervical disc herniation: results of a 2-year follow-up. Pain Physician. 2013;16:465-78.
• 6. Amiri-Arimi S, Bandpei MAM, Rezasoltani A, Javanshir K, Biglarian A. Asymmetry of cervical multifidus and longus colli muscles size in participants with and without cervical radicular pain. Journal of Manipulative and Physiological Therapeutics. 2020;43(3):206-11.
• 7. Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN. Normal functional range of motion of the cervical spine during 15 activities of daily living. Clinical Spine Surgery. 2010;23(1):15-21.
• 8. Liu F, Fang T, Zhou F, Zhao M, Chen M, You J, et al. Association of Depression/anxiety symptoms with neck pain: a systematic review and meta‐analysis of literature in China. Pain research and Management. 2018;2018(1):3259431.
• 9. Cohen SP, editor Epidemiology, diagnosis, and treatment of neck pain. Mayo Clinic Proceedings; 2015: Elsevier.
• 10. Gebremariam L, Koes BW, Peul WC, Huisstede BM. Evaluation of treatment effectiveness for the herniated cervical disc: a systematic review. Spine. 2012;37(2):E109-E18.
• 11. El-Hafez HM, Hamdy HA, Takla MK, Ahmed SEB, Genedy AF, Al Shaymaa S. Instrument-assisted soft tissue mobilisation versus stripping massage for upper trapezius myofascial trigger points. Journal of Taibah University medical sciences. 2020;15(2):87-93.
• 12. 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):690-6.
• 13. McMurray J, Landis S, Lininger K, Baker RT, Nasypany A, Seegmiller J. A Comparison and Review of Indirect Myofascial Release Therapy, Instrument-Assisted Soft Tissue Mobilization, and Active Release Techniques to Inform Clinical Decision Making. international journal of athletic therapy & training. 2015;20(5).
• 14. Wagner J, Olson K. A novel treatment tool to address soft tissue dysfunction. Journal of Hand Therapy. 2015;28(3):314-8.
• 15. Crothers AL, French SD, Hebert JJ, Walker BF. Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropractic & manual therapies. 2016;24:1-9.
• 16. Abdel-Aal NM, Elsayyad MM, Megahed AA. Short-term effect of adding Graston technique to exercise program in treatment of patients with cervicogenic headache: a single-blinded, randomized controlled trial. Eur J Phys Rehabil Med. 2021;57(5):758-66.
• 17. Kim D-H, Lee B-H. The effects of mechanical stimulation using graston on changing trigger point pressure pain threshold and muscle tone of the same spinal segment in neck disk patient. The Journal of the Korea Contents Association. 2019;19(10):198-205.
• 18. Davies CC, Brockopp DY. Use of ASTYM® treatment on scar tissue following surgical treatment for breast cancer: a pilot study. Rehabilitation Oncology. 2010;28(3):3-12.
• 19. Qureshi NA, Ali GI, Abushanab TS, El-Olemy AT, Alqaed MS, El-Subai IS, et al. History of cupping (Hijama): a narrative review of literature. Journal of integrative medicine. 2017;15(3):172-81.
• 20. Romeyke T, Stummer H. Evidence-based complementary and alternative medicine in inpatient care: take a look at Europe. Journal of evidence-based complementary & alternative medicine. 2015;20(2):87-93.
• 21. Lee MS, Choi T-Y, Shin B-C, Kim J-I, Nam S-S. Cupping for hypertension: a systematic review. Clinical and experimental hypertension. 2010;32(7):423-5.
• 22. Farhadi K, Schwebel DC, Saeb M, Choubsaz M, Mohammadi R, Ahmadi A. The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial. Complementary therapies in medicine. 2009;17(1):9-15.
• 23. Yuan Q-l, Guo T-m, Liu L, Sun F, Zhang Y-g. Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis. PloS one. 2015;10(2):e0117146.
• 24. Hansen IR, Barbero M, Falla D, Larsen MH, Kraft MN, Søgaard K, et al. Pain extent is more strongly associated with disability, psychological factors, and neck muscle function in people with non-traumatic versus traumatic chronic neck pain: a cross-sectional study. European journal of physical and rehabilitation medicine. 2019;55(1):71-8.
• 25. Deshmukh Jr NS, Phansopkar P. Effect of the Graston Technique and Cupping Therapy on Pain and Functions in Individuals With Medial Tibial Stress Syndrome: A Randomized Clinical Trial. Cureus. 2023;15(11).
• 26. Bush HM, Stanek JM, Wooldridge JD, Stephens SL, Barrack JS. Comparison of the Graston technique® with instrument-assisted soft tissue mobilization for increasing dorsiflexion range of motion. Journal of sport rehabilitation. 2020;30(4):587-94.
• 27. Revill S, Robinson J, Rosen M, Hogg M. The reliability of a linear analogue for evaluating pain. Anaesthesia. 1976;31(9):1191-8.
• 28. Ohnhaus EE, Adler R. Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain. 1975;1(4):379-84.
• 29. Jenkins CD, Stanton B-A, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. Journal of clinical epidemiology. 1988;41(4):313-21.
• 30. Duruöz MT, Çağrı Ü, Ulutatar F, Toprak CS, Gündüz OH. The validity and reliability of Turkish version of the Jenkins sleep evaluation scale in rheumatoid arthritis. Archives of Rheumatology. 2018;33(2):160.
• 31. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment: prevalence and correlates. Archives of general psychiatry. 1985;42(3):225-32.
• 32. Onan D. Kronik Boyun Ağrılı Hastalarda Boyun Farkındalığının, Fremantle Boyun Farkındalık Anketi İle Değerlendirilmesi: Türkçe Versiyon, Geçerlilik ve Güvenirlik Çalışması. 2018.
• 33. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):6
• 34. Bohannon RW, Larkin PA, Cook AC, Gear J, Singer J. Decrease in timed balance test scores with aging. Physical therapy. 1984;64(7):1067-70.
• 35. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association. 2016;60(3):200.
• 36. Unuvar BS, Gercek H, Aytar A, Aytar A. Immediate Effects of Kinesio Tape and Instrument-Assisted Soft Tissue Mobilization on Pain and Proprioception in Chronic Neck Pain: A Randomized Controlled Trial. Journal of Chiropractic Medicine. 2024;23(3):93-101.
• 37. Gercek H, Unuvar BS, Umit Yemisci O, Aytar A. Acute effects of instrument assisted soft tissue mobilization technique on pain and joint position error in individuals with chronic neck pain: a double-blind, randomized controlled trial. Somatosensory & motor research. 2023;40(1):25-32.
• 38. Lambert M, Hitchcock R, Lavallee K, Hayford E, Morazzini R, Wallace A, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews. 2017;22(1-2):76-85.
• 39. Seffrin CB, Cattano NM, Reed MA, Gardiner-Shires AM. Instrument-assisted soft tissue mobilization: a systematic review and effect-size analysis. Journal of athletic training. 2019;54(7):808-21.
• 40. Imai K, Ikoma K, Chen Q, Zhao C, An K-N, Gay RE. Biomechanical and histological effects of augmented soft tissue mobilization therapy on Achilles tendinopathy in a rabbit model. Journal of manipulative and physiological therapeutics. 2015;38(2):112-8.
• 41. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013;18(5):16-21.
• 42. Portillo-Soto A, Eberman LE, Demchak TJ, Peebles C. Comparison of blood flow changes with soft tissue mobilization and massage therapy. The Journal of Alternative and Complementary Medicine. 2014;20(12):932-6.
• 43. Torlak MS, Atıcı E, Cıbık M. Effects of Transcutaneous Occipital Nerve Stimulation and Instrument-Assisted Soft Tissue Mobilization in Chronic Migraine. Journal of Manipulative and Physiological Therapeutics. 2022;45(6):436-47.
• 44. Gulick DT. Influence of instrument assisted soft tissue treatment techniques on myofascial trigger points. Journal of bodywork and movement therapies. 2014;18(4):602-7.
• 45. MacDonald N, Baker R, Cheatham SW. The effects of instrument assisted soft tissue mobilization on lower extremity muscle performance: a randomized controlled trial. International journal of sports physical therapy. 2016;11(7):1040.
• 46. Stroiney DA, Mokris RL, Hanna GR, Ranney JD. Examination of self-myofascial release vs. instrument-assisted soft-tissue mobilization techniques on vertical and horizontal power in recreational athletes. The Journal of Strength & Conditioning Research. 2020;34(1):79-88.
• 47. Kivlan BR, Carcia CR, Clemente FR, Phelps AL, Martin RL. The effect of Astym® Therapy on muscle strength: a blinded, randomized, clinically controlled trial. BMC musculoskeletal disorders. 2015;16:1-10.
• 48. Sevier TL, Stegink-Jansen CW. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ. 2015;3:e967.
• 49. Gandhi H, Kazi S, Sanghvi S. Effect of IASTM versus kinesiotaping on maximal grip strength in healthy adults: a single blinded randomized controlled comparative study. Int J Sci Res. 2021;10(2):731-43.
• 50. Riemann BL, Lephart SM. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability. Journal of athletic training. 2002;37(1):80.
• 51. Loy RE, Orynbayev M, Xu L, Andronache Z, Apostol S, Zvaritch E, et al. Muscle weakness in Ryr1I4895T/WT knock-in mice as a result of reduced ryanodine receptor Ca2+ ion permeation and release from the sarcoplasmic reticulum. Journal of General Physiology. 2011;137(1):43-57.
• 52. Gray SR, De Vito G, Nimmo MA, Farina D, Ferguson RA. Skeletal muscle ATP turnover and muscle fiber conduction velocity are elevated at higher muscle temperatures during maximal power output development in humans. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2006;290(2):R376-R82.
• 53. Lauche R, Cramer H, Hohmann C, Choi K-E, Rampp T, Saha FJ, et al. The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: a randomised controlled pilot study. Evidence‐based Complementary and Alternative Medicine. 2012;2012(1):429718.
• 54. Arslan M, Yeşilçam N, Aydin D, Yüksel R, Dane Ş. Wet cupping therapy restores sympathovagal imbalances in cardiac rhythm. The Journal of Alternative and Complementary Medicine. 2014;20(4):318-21.