Dry cupping involves placing a suction cup over the skin to create local negative pressure to help enhance blood flow [1]. Traditionally, suction is created by heating the air inside the cup so that the cup attaches to the skin by creating a pressure difference [2]. Studies have evaluated the effectiveness of cupping therapy in various diseases including musculoskeletal pain such as chronic low back pain as well as the treatment of gastrointestinal and skin problems [3, 4]. Recently, cupping therapy has become widely popular among athletes and is used to improve athletic performance, increase blood flow, and reduce pain [4]. During therapy, the local tissues are subjected to a negative pressure difference, which causes the tissues to be compressed in contact with the edge of the cup and pulled up into it. When blood vessels are exposed to this pressure difference, they dilate, increasing local blood flow to the site. Improving physical function has theoretically been attributed to increased local circulation caused by cupping therapy [4-6]. Few studies have been performed on the effects of cupping therapy on increasing power, balance and speed, and understanding its mechanisms. In this regard, this study aims to investigate the effect of Dry Cupping (DC) on strength, anaerobic power, cognitive function, and mood in athletes.

In this counterbalanced quasi-experimental study with randomized crossover design, 12 male athletes (mean age= 22.25±1.8 years; weight= 84.2±14.8 kg, and height= 1.8±0.1 m) were participated. After obtaining written consent, they randomly experienced two separate conditions (ten minutes of DC or no intervention) in two sessions at the same time of day, one week apart. DC protocol was according to the instructions of previous studies on its optimal parameters and was performed by a trained massager in two positions, sleeping on stomach and back sleeping. After oiling the skin with vaseline, warm glass cups (heated with a cotton ball soaked in alcohol) with a diameter of 3.5-5.5 cm were placed over the skin moving in a rotating model. DC was applied one time on each subject [7]. The criterion for correct DC was that the skin should be pulled up about 1-2 cm into the cup and the skin of the site should be purple [8]. After each intervention, muscle strength of back and leg using a dynamometer (SIHAN, Seoul, Korea) [9, 10], anaerobic power using the 30-second Wingate Test [11, 12], mood status using Profile of Mood States (POMS) questionnaire [13, 14], and cognitive function using Tower of London (TOL) test [15, 16] were measured. The collected data were analyzed in SPSS v.16 software by using Shapiro-Wilk test and paired t-test considering a significance level of 0.05.

Compared to the non-intervention condition, DC significantly increased the mean power (t11=-2.625, p= 0.024), but had no significant effect on muscle strength (t11=1.106, p=0.293) and peak power (t11=-1.389, p= 0.192). Figures 1 and 2 compare the muscle strength, peak power and mean power under two conditions (Figure 1). 



The results also showed that the DC significantly increased the TOL test scores (planning and problem solving abilities) compared to non-intervention condition (t11=-2.602, p= 0.025). The DC also significantly reduced mental fatigue (t11=2.209, p=0.049). However, there was no significant difference in tension, vigor, happiness, anger, depression, confusion and calmness between the two conditions of with and without DC (p>0.05) (Figure 2). 



4. Conclusion
The findings of this study showed that, despite the slight improvement, DC could not significantly improve muscle strength and peak anaerobic power in athletes, but it was effective in improving mean anaerobic power. This increase has been attributed to better pumping of blood to the muscles, increased access to oxygen, improved muscle metabolism (decreased H) and neuromuscular changes (electromyographic median frequency changes) [17, 18].
Findings of this study revealed the effect of DC on a significant reduction in fatigue. Other negative mood states including tension, depression, confusion, and anger also decreased after DC, but this decrease was not statistically significant. Positive mood states including happiness, calmness and vigor also improved after DC, which was not statistically significant. The balloon improves the local immune status by dilating the blood vessels [19]. This improvement involves the simultaneous regulation of cellular immunity and cytokines, which may be associated with symptoms of fatigue [20]. Moreover, the DC can regulate serotonin, dopamine and epinephrine levels by altering the local metabolic status, thereby controlling mood [20]. After DC, TOL test score (the ability to plan and solve problems) was significantly higher compared to the non- intervention condition. According to previous studies, positive mood, especially reduced fatigue, may increase the range of attention and lead to improved cognitive processes, which is probably due to the effect on the receptor activity of the parietal cortex and frontal lobe [21, 22].

This study has an ethical approval obtained from the Yazd University (Code: IR.YAZD.REC.1400.055).

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

All authors equally contributed to preparing this article.

The authors declare no conflict of interest.

The authors would like to thank the athletes participated in the study and the staff of Raspina Massage Center for their cooperation.
 

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