Research Summary
MyoFitness Research Team International Journal of Sports Physical Therapy, 2020
Acute Outcomes of Myofascial Decompression (Cupping Therapy) Compared to Self-Myofascial Release on Hamstring Pathology After a Single Treatment
Authors: Warren AJ, LaCross Z, Volberding JL, O’Brien MS
Published in: International Journal of Sports Physical Therapy, 2020; 15(4): 579-592
DOI: 10.26603/ijspt20200579
Study design: Pilot randomised controlled trial
This pilot randomised controlled trial compared two widely used soft tissue interventions applied to collegiate athletes who had been diagnosed with hamstring pathology: myofascial decompression (MFD), commonly known as cupping therapy, and self-myofascial release (SMR) using a foam roller combined with moist heat.
Seventeen collegiate athletes (13 male, 4 female, average age 20.6 years) with confirmed hamstring pathology were randomly allocated to one of two groups. The study was designed to examine what happens immediately after a single treatment session. Both interventions were delivered once only, and outcomes were measured directly after treatment.
Hamstring tightness, restriction, and pathology are among the most common presentations in myotherapy, physiotherapy, and remedial massage clinics. Understanding which soft tissue techniques produce the greatest short-term change in flexibility and patient-rated outcomes informs clinical decision-making and treatment planning.
The MFD group received cupping therapy using plastic cups applied with a pump to create a vacuum on the hamstring musculature. Cups were applied for 5 minutes. Importantly, active mobilisation was performed during the cupping by having participants perform knee flexion and extension movements while the cups were in place. This is the key clinical distinction from static cupping, combining negative pressure tissue decompression with active movement to achieve greater fascial and neuromuscular effect.
The SMR group received a moist heat pack followed by 5 minutes of foam rolling on the hamstring musculature. Participants rolled their bodyweight over a dense foam cylinder in a self-directed manner to mobilise the posterior thigh soft tissues. Foam rolling is one of the most commonly prescribed home care and warm-up techniques in sports rehabilitation and gym-based programs.
Both treatments produced improvements in hamstring flexibility and patient-rated outcomes. However, the cupping therapy group demonstrated greater improvements across the key measures, and the difference in how patients felt about the treatment was statistically significant.
The cupping group showed greater improvements in active hamstring range of motion after a single session, supporting its use where immediate gains in posterior chain mobility are the treatment goal.
Participants in the MFD group reported an enhanced treatment effect for perceived hamstring flexibility. This subjective experience of benefit matters clinically, as therapeutic alliance and patient confidence in a technique influence adherence and outcomes.
No adverse effects were reported in either group. Cupping therapy was well tolerated by all participants, consistent with its established safety profile when applied by a trained practitioner.
A single session of cupping therapy produced greater improvements in hamstring flexibility and a better patient experience than a single session of foam rolling. Both interventions were safe. Patients found cupping more effective and preferred it.
Hamstring pathology, posterior chain restriction, and reduced hip flexion range of motion are everyday presentations in myotherapy, physiotherapy, and remedial massage clinics. They appear across almost every patient population: runners and cyclists, desk workers with shortened hip flexors, gym-goers with overloaded posterior chains, people recovering from hamstring strains, and older clients managing cumulative movement restriction.
This study adds to the evidence base for myofascial decompression as a clinical intervention, not just a complementary technique, and has specific implications for how practitioners in these disciplines approach soft tissue treatment.
Cupping (MFD) is within the scope of a myotherapist’s clinical toolkit. This study supports its use as a first-line or adjunct intervention for hamstring pathology, producing acute flexibility gains that complement trigger point therapy, dry needling, and manual muscle release within the same session.
Foam rolling is frequently prescribed as home care between remedial massage appointments. This research suggests cupping therapy in-clinic may produce superior short-term flexibility outcomes compared to foam rolling alone, giving remedial massage therapists trained in cupping a meaningful clinical advantage in managing posterior chain presentations.
MFD with active mobilisation aligns with physiotherapy principles of combining manual techniques with movement. The active knee flexion and extension performed during cupping in this study mirrors how physiotherapists use movement-based approaches alongside soft tissue work, and supports integrating cupping into rehabilitation protocols for hamstring pathology and lower limb mobility restoration.
For athletes where hamstring flexibility and posterior chain function directly affect performance and injury risk, this study supports the use of cupping as an efficient single-session intervention. The immediate gains in active range of motion are particularly relevant in the context of pre-competition preparation, between training sessions, or in early-phase injury management.
The study is a pilot randomised controlled trial with a small sample (17 participants), which limits the generalisability of the findings and statistical power. The participants were collegiate athletes with diagnosed hamstring pathology, so the results may not translate directly to sedentary populations, older adults, or those with different injury profiles. The study measured acute (immediate post-treatment) outcomes only, so nothing can be concluded about sustained or long-term effects from a single session. Larger trials with follow-up measures are needed to extend these findings.
These limitations do not diminish the clinical relevance of the findings, but they are important context when applying this research in practice. The study adds weight to what many practitioners already observe clinically: cupping produces meaningful, immediate changes in soft tissue mobility that patients notice and value.
This randomised controlled trial provides evidence that a single session of myofascial decompression (cupping therapy) with active mobilisation produces greater acute improvements in hamstring flexibility and a better patient-rated treatment experience than a single session of moist heat and foam rolling in collegiate athletes with hamstring pathology. The technique was safe, well tolerated, and preferred by participants.
For myotherapists, physiotherapists, and remedial massage therapists managing hamstring pathology, posterior chain restriction, or lower limb mobility deficits, this study supports cupping therapy as a clinically effective, evidence-backed intervention worth including in treatment where it is within scope and clinically indicated.
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Acute Outcomes of Myofascial Decompression (Cupping Therapy) Compared to Self-Myofascial Release on Hamstring Pathology After a Single Treatment and Warren AJ, LaCross Z, Volberding JL, O’Brien MS. International Journal of Sports Physical Therapy, 2020; 15(4): 579-592.
