Comparison of Instrument-Assisted Soft Tissue Mobilisation and Myofascial Decompression (Cupping Therapy) on Sprint Speed and Flexibility in Fast Bowlers with Tight Hamstrings

INTRODUCTION

Hamstring tightness is a prevalent problem among athletes, especially fast bowlers in cricket. It can significantly impair performance and increase the risk of injury.^[1] A shortened range of motion caused by hamstring tightness can hinder sprint speed and overall functional ability. Therefore, addressing hamstring tightness is crucial for enhancing athletic performance and reducing the risk of injury.^[2] Cupping therapy and Instrument-Assisted Soft Tissue Mobilisation (IASTM) have gained popularity for improving myofascial mobility and enhancing strength levels.^[3] IASTM employs specialised tools to apply targeted pressure on soft tissue, which its proponents claim can improve blood flow, break up scar tissue, and promote muscle fibre alignment. This technique may enhance the ability of fascial layers to glide over one another, which is essential for maintaining muscle flexibility and functionality. It has been shown to affect tissue hydration and fluid balance.^[4] In cupping therapy, an ancient alternative medicine technique, cups are placed on the skin to create suction. This suction purportedly promotes blood circulation, alleviates muscle tension, and aids in healing. By increasing interstitial space and separating the fascial layers, the method aims to improve muscle performance and reduce stiffness.^[5]

The effectiveness of IASTM and cupping therapy, particularly in enhancing flexibility and sprint speed among fast bowlers with hamstring tightness, has not been thoroughly studied, despite their common usage.^[6] The research hypothesis aims to address this gap by conducting a comprehensive analysis comparing these two therapies. This study examines the effects of IASTM and cupping therapy on improving sprint speed and hamstring flexibility in rapid bowlers. Given the significance of these factors for athletic performance, the findings may greatly influence the treatment strategies used by sports therapists and trainers. A battery of evaluations, which included assessments both before and after the Active Knee Extension Test (AKET)^[7] and the 20-metre sprint test, was utilised.^[8]

The purpose of this study is to present actual data regarding the rapid results of IASTM and cupping therapy. The findings will be beneficial in creating tailored treatment plans that address hamstring tightness and enhance quick bowlers’ ability to recover from injuries. We aim to contribute to the growing body of literature in sports medicine and treatment by examining such mechanisms and their effects from a comparative perspective, as well as providing valuable advice and evidence-based recommendations for both athletes and physicians.

MATERIAL AND METHODS

Research Plan: The current investigation was planned as a single-blind, prospective comparative study.^[9] The trial has been approved by the Institutional Ethics Committee and is listed in the Clinical Trials Registry with reference number CTRI/2023/05/052261 [Figure 1].

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Figure 1:

Study’s consistent flow diagram. IASTM: Instrument-assisted soft tissue mobilisation.

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Setting and Participants: The study was conducted at three cricket academies in South Bangalore: Basavanagudi Cricket Academy, Jain Cricket Academy, and Vivekananda Cricket Academy. A total of 102 fast bowlers aged between 18 and 25 years were initially approached for participation. Those who met the inclusion criteria were enrolled in the study. The inclusion criteria were as follows: participants had to be male fast bowlers between the ages of 18 and 25 years, exhibit hamstring tightness indicated by a knee flexion angle greater than 20 degrees on the AKET, and have no contraindications to IASTM and cupping therapy.^[10] Participants were excluded if they had any musculoskeletal injuries or conditions affecting the lower extremities, neurological disorders, systemic diseases, or were taking medications that could affect muscle function or blood circulation.^[11]

Measurements: Outcomes AKET: Figure 2 - The test leg was to be put over an adaptable leg rest while the subject lay supine on the plinth. Custom leg rests were made for each participant so that the tested leg would always be in a 90° flexion between the knee and hip. The femur was then aligned with the vertical sidebar to maintain 90° hip flexion throughout the test. To guarantee consistency, the inclinometer was calibrated to zero on a vertical wall before each measurement. After that, the individual was told to keep their head on the table for the entire test and plantar flex their ankle to a suitable position. Throughout the process, the researchers kept an eye on the participants’ posture to make sure nothing was done to skew the results.

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Figure 2:

Active knee extension test.

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Throughout the test, an aide ensured the stability of the adjustable leg rest to prevent hip extension beyond 90° of flexion. The participant was instructed to maintain a 90° hip flexion and a flexed ankle while fully extending the tested knee. The measurement angle was recorded using a goniometer placed on the tibial tuberosity at the point of maximum knee extension. If the participant altered hip position, dorsiflexed the ankle, flexed the cervical spine, or failed to hold the terminal position long enough for the investigator to record the result, the test was repeated.^[12] The 20-meter sprint test was used to assess sprint performance. Participants began at the starting line and ran 20 meters at maximum speed. Each participant completed two additional trials with a 60-second active recovery period between runs. The fastest time from the three trials was recorded for analysis. Assessments were conducted at baseline and again after four weeks of intervention.^[13] The assessments were carried out both at baseline and four weeks following the intervention.

After obtaining informed consent, participants’ demographic data (name, age, gender, and address) and anthropometric measurements (height, weight, and BMI) were recorded. Hamstring tightness was assessed using the AKET, and individuals with a flexion angle greater than 20° were included in the study. Participants were then randomly assigned to two groups using a computer-generated randomisation method.^[14] Group 1 received three sessions of instrument-assisted soft tissue mobilisation (IASTM) per week for a maximum of 15 minutes per session, for 4 weeks, on the affected lower limb [Figure 2].^[15]

Group 2 underwent static cupping therapy for 15 minutes, twice a week, over four weeks on the affected lower limb, combined with 10 repetitions of active knee flexion. Both groups received up to 10 minutes of cryotherapy after each session [Figure 3].^[16]

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Figure 3:

IASTM for hamstring muscle. IASTM: Instrument-assisted soft tissue mobilisation.

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Analytical Statistics: In this study, the continuous variables were described using means and standard deviations, whereas the categorical variables were described using frequencies and percentages. We looked at the distribution’s normality and the equality of variances of the continuous variables by applying Levene’s and Kolmogorov-Smirnov tests, respectively. To assess initial between-group differences in morphological variables and descriptive data, a Student’s t-test was conducted for continuous variables. Descriptive statistics were analysed using Microsoft Excel (Version 2209, Microsoft Corporation, Albuquerque, NM, USA, 2019), while inferential statistics were performed using TIBCO Statistical Software (Version 13).^[17]

RESULTS

Table 1 presents a statistical comparison of two groups—the IASTM Group and the Cupping Therapy Group—based on baseline characteristics: age, height, weight, BMI, pre-intervention AKE angle, and pre-intervention 20-meter sprint time.

The mean age for the IASTM group (N = 22) was 20.05 years (SD = 2.149), while the cupping therapy group (N = 23) had a slightly higher mean age of 20.83 years (SD = 2.48). The p-value (0.39) indicated no significant difference between the groups. In terms of height, the IASTM group had a mean of 177.5 cm (SD = 8.568), whereas the cupping therapy group averaged 171.22 cm (SD = 7.804). The p-value (0.864) suggested no significant difference in height between the groups.

With respect to weight, the IASTM group had a mean of 67.27 kg (SD = 12.326), while the cupping therapy group averaged 64.09 kg (SD = 10.122). The p-value (0.586) indicated no significant difference in weight. Similarly, the BMI for the IASTM group was 21.23 kg/m² (SD = 3.022), and the cupping therapy group had a mean BMI of 21.78 kg/m² (SD = 2.533), with a p-value of 0.243, again showing no significant variation between groups.

For the pre-AKE angle, the IASTM group recorded a mean of 46.45° (SD = 8.45), while the cupping therapy group had a slightly higher mean of 47.74° (SD = 5.594). This difference was statistically significant (p = 0.034). Regarding Pre-20-meter Sprint Test times, the IASTM group had a mean time of 4.36 seconds (SD = 0.458), whereas the cupping therapy group demonstrated a faster mean time of 4.03 seconds (SD = 0.309). This difference was also statistically significant (p = 0.031), indicating an initial disparity between the groups.

Given the significant baseline differences in pre-AKE angle and Pre-20-meter Sprint Test times, caution was exercised in interpreting post-intervention outcomes. Nevertheless, the homogeneity observed in baseline characteristics such as age, height, weight, and BMI supported the internal validity of the study and strengthened the reliability of the comparisons drawn.

Table 2 presents the results of the AKE angle and 20-meter sprint test for the two study groups at baseline and four weeks post-intervention. Mean values (x̄) and standard deviations (SD) were reported for both groups, along with corresponding p-values: p* for within-group comparisons over time and p** for between-group comparisons.

Group 1 (IASTM) had a baseline mean AKE angle of 46.5° (SD = 8.45), which increased to 62.4° (SD = 8.49) after four weeks. This change was statistically significant (p < 0.001), indicating a meaningful improvement in hamstring flexibility. Group 2 (Cupping Therapy) started with a baseline mean of 47.7° (SD = 5.59) and improved to 64.2° (SD = 4.98) at the end of the intervention period, with a significant p-value of 0.020. The between-group comparison for AKE angle change (p** = 0.385) revealed no statistically significant difference, suggesting that both interventions were similarly effective in improving hamstring flexibility.

In the 20-meter sprint test, Group 1 showed a baseline mean time of 4.36 seconds (SD = 0.458), which decreased to 4.29 seconds (SD = 0.408) after four weeks. This reduction was statistically significant (p < 0.001), indicating improved sprint performance. Group 2 had a baseline sprint time of 4.03 seconds (SD = 0.309), which slightly decreased to 3.97 seconds (SD = 0.264); however, this change was not statistically significant (p = 0.065).

Despite the lack of significant within-group improvement in Group 2, the between-group comparison of sprint performance changes over the four weeks yielded a statistically significant p-value (p** = 0.004). Furthermore, ANCOVA (analysis of covariance) analysis adjusting for baseline sprint differences demonstrated a significant post-intervention improvement favouring Group 2 (p < 0.001). These findings suggest that relative to IASTM, cupping therapy may offer a greater benefit in enhancing sprint performance. Nonetheless, the absence of significant within-group improvement in Group 2 warranted further investigation into the underlying mechanisms contributing to this effect.

The adjusted mean differences at four weeks were reported to control for the baseline variance. This provides a fairer comparison between the groups’ post-intervention outcomes. ANOVA was performed [Table 3].

DISCUSSION

This study aimed to evaluate the impact of cupping therapy on AKE angle and IASMT efficiency on the 20-meter Sprint Test following a 4-week intervention period. The results provide insightful information about the uses and relative advantages of these therapy approaches for improving athletic performance and flexibility. AKE Angle Improvement: Following the 4-week intervention period, there were notable improvements in AKE angles for both the IASMT and cupping therapy groups. Group 1 IASMT showed an increase from the baseline. These improvements show that both therapies significantly increase the range of motion in the hamstrings and the ability to extend the knee. Since there was no discernible difference in the amount of AKE improvement across the groups, it appears that IASMT and cupping therapy are equally effective at increasing AKE angles. The significant within-group benefits are in line with previous research findings. Ward et al. found that IASMT helped improve the range of motion and reduce discomfort in patients with musculoskeletal issues.^[4] This is corroborated by Ahmad et al.’s findings, which indicate that cupping therapy may significantly improve flexibility and reduce discomfort in those with tight hamstrings.^[19] The observed increases in AKE angle suggest that the treated soft tissues may benefit physiologically from IASMT and cupping therapy. The joint range of motion is likely improved due to the decompression of myofascial tissues following these procedures, which also promotes blood flow and flexibility. These results are consistent with previous research by Dergaa et al. and Osailn et al., which highlights the validity and efficiency of both methods in treating musculoskeletal tightness and improving joint mobility.^[15,20] Performance on the 20-meter Sprint Test indicated improvements in both intervention groups over four weeks. However, it is important to note that there was a significant difference in baseline sprint times between the groups (p=0.004; p=0.004; p=0.004). To account for this, the post-intervention outcomes were analysed using ANCOVA, adjusting for baseline sprint times. The results suggest that both interventions contributed to performance gains, with the adjusted post-intervention outcomes favouring the cupping therapy group.^[22] These results suggest that while both interventions enhanced sprint performance, cupping therapy may be more beneficial. This validates the study conducted by Mohamed. et al., which found that cupping therapy may help athletes recover and perform better physically.^[5] This improvement may be due to improved blood flow and decreased muscular stiffness, which improve muscle function and accelerate sprint times. Moreover, a study by Rodrigues et al. supports the notion that IASMT can improve soft tissue mobility and reduce muscular stiffness to promote athletic performance.^[24] According to the study’s findings about the improvements in sprint performance, combining IASMT and cupping therapy may be beneficial for athletes who seek to optimise their performance by lowering myofascial restrictions and boosting muscular flexibility.

CONCLUSION

The study findings indicate that both IASTM and cupping therapy significantly improve hamstring flexibility, while sprint performance improvements were more pronounced in Group B when analysed using ANCOVA. However, as the within-group change in Group B was not statistically significant, the results should be interpreted with caution. Future research should explore the physiological mechanisms underlying these findings and further validate the effectiveness of cupping therapy in enhancing sprint performance.

To gain a deeper understanding of the diverse subjective impacts of these treatments, future studies ought to incorporate a control group of placebo recipients. Long-term follow-up studies are also recommended to determine the duration of these advantages. Investigating the optimal dosage and intervention settings depending on patient requirements may help to boost the efficacy of these treatments further.