Wood, Sarah ORCID: 0000-0001-6533-1597 (2021) Efficacy of Myofascial Decompression for Musculoskeletal Conditions. Research Master thesis, Victoria University.

Abstract

Musculoskeletal pain is highly prevalent and a significant contributor to global disability and disease, with most countries reporting neck and low back pain as a leading cause of disability. The use of the complementary therapy, dry cupping and its modified technique, myofascial decompression are becoming an increasingly popular modality utilised by manual and physical therapists in western clinical practice, aimed at reducing musculoskeletal pain and improving mobility. The aim of this thesis was to investigate the efficacy of dry cupping techniques in the treatment of musculoskeletal pain and improving range of motion. Firstly, this research critically evaluated the evidence from randomised controlled trials through a systematic review and meta-analysis to determine the efficacy and safety of western dry cupping methods. A systematic literature search was performed from March until April 2018, for randomised controlled trials (RCT) pertaining to musculoskeletal pain or reduced range of motion, treated with dry cupping. Outcomes were pain, functional status, range of motion and adverse events. Risk of bias and quality of evidence was assessed using the modified Downs & Black checklist and GRADE. A total of 21 RCTs with 1049 participants were included. Overall, the quality of evidence was fair, with a mean Downs & Black score of 18/28. Low-quality evidence revealed that dry cupping had a significant effect on pain reduction for chronic neck pain (MD, -21.67; 95% CI, -36.55, to -6.80) and low back pain (MD, -19.38; 95%CI, -28.09, to -10.66). Moderate-quality evidence suggested that dry cupping improved functional status for chronic neck pain (MD, -4.65; 95%CI, -6.44, to -2.85). For range of motion, low quality evidence revealed a significant difference when compared to no treatment (SMD, -0.75; 95%CI, -0.75, to 0.32). Dry cupping was found to be effective for reducing pain in patients with chronic neck pain and non-specific low back pain. However, definitive conclusions regarding the effectiveness and safety of dry cupping for musculoskeletal pain and range of motion were unable to be reached due to the low to moderate quality of evidence. Secondly, this research aimed to test the feasibility of a randomised controlled crossover trial comparing dry cupping techniques to provide recommendations for future research. The study compared myofascial decompression (dry cupping with active movement) with static dry cupping (dry cupping with no movement) and an active movement protocol (control) and assessed pressure pain threshold and range of motion. This study’s findings suggest that dry cupping techniques improve both pain threshold and range of motion; however, it is unknown whether myofascial decompression is superior to active movement only and could be investigated in future studies. This thesis provides a critical review of the available evidence for the use of dry cupping therapy for musculoskeletal conditions. For definitive conclusions on the efficacy of dry cupping, further systematic reviews and meta-analyses are required as larger dry cupping randomised controlled trials are published. Furthermore, this thesis provides a basis for future research to be undertaken, specifically investigating the efficacy of myofascial decompression for the treatment of musculoskeletal pain and improving range of motion.

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