THE EFFECTS OF DIFFERENT CUPPING THERAPY TECHNIQUES ON HAMSTRING EXTENSIBILITY IN COLLEGE AGE MALES Lauren Taylor Holt A thesis submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Exercise and Sport Science (Athletic Training) in the College of Arts & Sciences. Chapel Hill 2019 Approved by: Meredith Petschauer William Prentice Melissa Kay © 2019 Lauren Taylor Holt ALL RIGHTS RESERVED ii ABSTRACT Lauren Taylor Holt: The Effects of Different Cupping Therapy Techniques on Hamstring Extensibility in College Age Males (Under the direction of Meredith Petschauer) Context: Hamstring injuries are one of the most common injuries in sports and have been connected to lack of flexibility.1 Several techniques have been researched but each has limitations in a clinical setting. Cupping therapy has limited research but provides clinical utility that needs further exploration. Objective: Examine the effects of movement and stationary cupping on hamstring range of motion (ROM). Design: Experimental cross-over. Patients: 41 physically-active males (age=20.9±1.0). Intervention: Participants were randomly assigned to the stationary or movement group. Treatments included: movement cupping, movement control, stationary cupping, and stationary control. Main Outcome Measures: 90/90 passive knee extension ROM and perceived tightness measured pre and post intervention. Results: For ROM, the comparison of means showed no significance for group (p=0.306) or treatment (p=0.072) interactions. Perceived tightness significantly improved from pre to post when comparing cupping to the controls (p<0.0001). Conclusion: Although ROM did not increase significantly, participants reported decreased tightness. iii TABLE OF CONTENTS ABSTRACT ................................................................................................................................ iii TABLE OF CONTENTS ............................................................................................................. iv LIST OF TABLES ....................................................................................................................... ix LIST OF FIGURES ..................................................................................................................... x LIST OF ABBREVIATIONS ........................................................................................................ xi CHAPTER 1: INTRODUCTION .................................................................................................. 1 Aims and Hypothesis .............................................................................................................. 2 Aim 1: ..................................................................................................................................... 2 Aim 2: ..................................................................................................................................... 3 Aim 3: ..................................................................................................................................... 3 CHAPTER 2: REVIEW OF LITERATURE .................................................................................. 4 Increasing Range of Motion .................................................................................................... 4 Stretching ........................................................................................................................... 4 Self-Myofascial Release ..................................................................................................... 5 Instrument Assisted Soft Tissue Mobilization ...................................................................... 6 Cupping .................................................................................................................................. 7 Techniques ......................................................................................................................... 7 Pain .................................................................................................................................... 8 Perceived function .............................................................................................................. 9 Blood Flow .........................................................................................................................10 Range of Motion ................................................................................................................11 CHAPTER 3: METHODS ..........................................................................................................13 iv Design ...................................................................................................................................13 Participants ............................................................................................................................13 Instrumentation and Variables ...............................................................................................14 Range of Motion ................................................................................................................14 Questionnaires ...................................................................................................................15 Cupping .............................................................................................................................16 Procedure ..............................................................................................................................17 Data Analysis ........................................................................................................................18 CHAPTER 4: RESULTS ...........................................................................................................19 Participants ............................................................................................................................19 Range of Motion ....................................................................................................................19 Perceived Tightness ..............................................................................................................20 CHAPTER 5: DISCUSSION ......................................................................................................21 Range of Motion ....................................................................................................................21 Perceived Tightness ..............................................................................................................22 Clinical Implications ...............................................................................................................23 Limitations .............................................................................................................................23 Conclusion.............................................................................................................................24 LEGEND TO FIGURES ............................................................................................................26 REFERENCES .........................................................................................................................38 ix LIST OF TABLES Table 1. Treatment Protocols ..................................................................................................27 Table 2. Movement Intervention Timing ..................................................................................28 Table 3. Hamstring Range of Motion and Perceived Tightness Results ..................................29 Table 4. Post-Intervention Questionnaire ................................................................................30 ix LIST OF FIGURES Figure 1: Group Randomization and Cross-Over Design. .........................................................31 Figure 2: Range of Motion Starting Position. .............................................................................32 Figure 3: Cupping Locations. ....................................................................................................33 Figure 4: Cupping Application. ..................................................................................................34 Figure 5: Range of Motion Mean Results Pre to Post. ...............................................................35 Figure 6: Perceived Tightness Mean Results Pre to Post. .........................................................36 Figure 7: Perceived Tightness Means Comparing Cupping and Control....................................37 x LIST OF ABBREVIATIONS ANCOVA Analysis of Covariance DS Dynamic Stretching EQ-5D EuroQol Health Index FAT Fascial Abrasion Technique IASTM Instrument Assisted Soft Tissue Mobilization LEFS Lower Extremity Functional Score NDI Neck Disability Index PNF Proprioceptive Neuromuscular Facilitation ROM Range on Motion SF-36 Short Form Survey SMR Self Myofascial Release SS Static Stretching VDT Video Display Terminal xi CHAPTER 1: INTRODUCTION Hamstrings injuries are among the most common in sport.2–4 Decreased flexibility and a previous history can increase the risk for hamstring injuries.1 Males are also more at risk due to increased hamstring stiffness compared to females.5,6 Full hamstring range of motion (ROM) must be maintained to return to play post injury4