Dry Cupping Therapy and Muscle Energy Technique on Upper Crossed Syndrome

This study evaluated and compared the therapeutic efficacy of combining Dry Cupping therapy with the Muscle Energy Technique (MET) against each intervention applied independently, focusing on three core parameters: Neck Disability Index (NDI), Craniovertebral Angle (CVA), and Sagittal Shoulder-C7 Angle (SSA).

Methods: A pre-test post-test double-blinded randomized controlled trial design was employed. Seventy-six adults (aged 20-40 years) diagnosed with UCS were randomly allocated into four equal experimental groups (n = 19 per group): Group A received combined dry cupping and MET with conventional therapy; Group B received dry cupping with conventional therapy; Group C received MET with conventional therapy; and Group D received conventional therapy alone. Interventions were conducted over an 8-week period. Primary outcomes included functional impairment via the Arabic version of the NDI, and objective sagittal alignment parameters (CVA and SSA) measured using precision photometry via the Kinovea software application.

• combined therapy teatment (Procedure): 19 subjects received combined dry cupping therapy, Muscle energy technique, and conventional physical therapy for eight weeks. 1. Dry cupping was applied to the regional hypertonic target sites. Standard plastic cups ranging from 25 to 50 mm were placed directly over each subject's levator scapulae trigger point (SI-14) and upper trapezius trigger point (GB-21) bilaterally. The treatment duration was set at exactly 8 minutes per session. 2. Muscle Energy Technique The Post-Isometric Relaxation (PIR) manual protocol targeted the hypertonic muscles of the upper crossed syndrome quadrant, including the upper trapezius, levator scapulae, sternocleidomastoid, scalenes, and suboccipital groups. Participants were placed in a supine position on the treatment table with their head free from the edge of the plinth, supported by the physical therapist. 3. conventional physical therapy treatment
• cupping therapy group (Procedure): 19 subjects received combined dry cupping therapy and conventional physical therapy for eight weeks. 1. Dry cupping was applied to the regional hypertonic target sites. Standard plastic cups ranging from 25 to 50 mm were placed directly over each subject's levator scapulae trigger point (SI-14) and upper trapezius trigger point (GB-21) bilaterally. The treatment duration was set at exactly 8 minutes per session. 2. conventional physical therapy treatment
• muscle energy techniques group (Procedure): 19 subjects received combined Muscle energy technique, and conventional physical therapy for eight weeks. 1. Muscle Energy Technique The Post-Isometric Relaxation (PIR) manual protocol targeted the hypertonic muscles of the upper crossed syndrome quadrant, including the upper trapezius, levator scapulae, sternocleidomastoid, scalenes, and suboccipital groups. Participants were placed in a supine position on the treatment table with their head free from the edge of the plinth, supported by the physical therapist. 2. conventional physical therapy treatment
• control group (Procedure): 19 subjects received only conventional physical therapy for eight weeks.

Primary outcomes

• Neck Disability Index (NDI) [At baseline and re assessed following 8 weeks]: Perceived functional limitations resulting from regional impairment were measured using the validated Arabic version of the NDI questionnaire. This instrument evaluates 10 clinical sections (including activities of daily living, concentration, and pain profiles) scored from 0 to 5 per item, yielding a cumulative score out of 50. Higher aggregate indices represent greater functional disability.
• craniovertebral angle (CVA) [At baseline and re assessed following 8 weeks]: This biomechanical index reflects the architectural severity of forward head posture. It is defined as the angle formed between a horizontal line drawn through the spinous process of C7 and an intersecting line extending from the tragus of the ear to the C7 landmark. CVA was measured using precision digital photogrammetry via the Kinovea software application.
• Sagittal Shoulder-C7 Angle (SSA) [At baseline and re assessed following 8 weeks]: This geometric marker quantifies shoulder roundedness and anterior protraction. It is formed by the intersection of a horizontal reference line passing through the lateral aspect of the acromion with a line drawn from the C7 spinous process to the lateral acromion. SSA was measured using precision digital photogrammetry via the Kinovea software application.

Sex: All, ages: 20 Years to 40 Years

Inclusion Criteria:

* Participant inclusion was restricted to individuals between 20 and 40 years of age.
* The exact diagnostic criteria required a baseline craniovertebral angle (CVA) of less than 48 degrees.
* a sagittal shoulder-C7 angle (SSA) of less than 52 degrees.

Exclusion Criteria:

* acute post-surgical conditions
* structural spinal deformities (e.g., severe fixed structural scoliosis)
* cervical radiculopathy, or localized dermal infections contradicting cupping application.