{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:15Z","timestamp":1785732375658,"version":"3.56.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 113-2221-E-214-004-MY2"],"award-info":[{"award-number":["NSTC 113-2221-E-214-004-MY2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged smartphone use is associated with forward head posture, increased trapezius stiffness, and altered autonomic nervous system regulation. Dry cupping applies localized negative pressure-mediated mechanical stimulation that may influence myofascial properties and autonomic activity; however, its interactive effects of pressure and duration remain unclear. This study investigated the effects of different pressure and duration combinations of dry cupping on autonomic modulation indexed by heart rate variability (HRV) and trapezius tissue compliance in smartphone users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty-two university students were classified into the smartphone addiction and control groups. A counterbalanced crossover design was implemented, in which each participant received four cupping protocols: \u02d7300 mmHg or \u02d7450 mmHg applied for 5 or 15\u00a0min. HRV, trapezius soft tissue compliance measured using a real-time monitoring system, and functional questionnaires were assessed before and after each intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HRV spectral indices indicated reduced sympathetic activity and did not reach statistical significance for parasympathetic activity (p=0.062) following cupping. Compared to 5-min sessions, 15-min protocols significantly increased total power as well as both low- and high-frequency components. Trapezius tissue compliance showed the highest improvement after \u02d7300 mmHg applied for 15\u00a0min. Functional disability scores remained unchanged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this subclinical population, dry cupping modulated autonomic activity and improved trapezius tissue compliance in a duration-dependent manner, with 15-minute applications generally producing greater effects than 5-minute applications. Treatment duration exerted a greater influence than pressure intensity, with moderate pressure sustained for 15\u00a0min producing the most pronounced autonomic and biomechanical responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1812427","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:11Z","timestamp":1785731171000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Duration-dependent effects of dry cupping on autonomic modulation and trapezius tissue compliance in smartphone users: a dose-finding study"],"prefix":"10.3389","volume":"17","author":[{"given":"Chien-Liang","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, I-Shou University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Manousakas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, I-Shou University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Shia","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Chung-Hwa University of Medical Technology","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1097\/PHM.0000000000001625","article-title":"Using elastographic ultrasound to assess the effect of cupping size on stiffness of triceps muscle","volume":"100","author":"aan","year":"2021","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"B2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.jams.2018.02.001","article-title":"Cupping therapy: an overview from a modern medicine perspective","volume":"11","author":"Aboushanab","year":"2018","journal-title":"J. Acupunct Meridian Stud."},{"key":"B3","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1016\/j.jtumed.2018.09.001","article-title":"Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates","volume":"13","author":"Akodu","year":"2018","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"B4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.jtcme.2018.03.003","article-title":"The medical perspective of cupping therapy: effects and mechanisms of action","volume":"9","author":"Al-Bedah","year":"2019","journal-title":"J. Tradit. Complement Med."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2174\/0117450179295575240520064919","article-title":"Clinical manifestations' spectrum of smartphone addiction: moving from an addiction toward a clinical syndrome","volume":"20","author":"Alwazzeh","year":"2024","journal-title":"Clin. Pract. Epidemiol. Ment. Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1089\/acm.2013.0291","article-title":"Wet cupping therapy restores sympathovagal imbalances in cardiac rhythm","volume":"20","author":"Arslan","year":"2014","journal-title":"J. Altern. Complement Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/s00424-014-1536-9","article-title":"Mechanotransduction in the muscle spindle","volume":"467","author":"Bewick","year":"2015","journal-title":"Pflugers Arch."},{"key":"B8","first-page":"73","article-title":"The effects of cupping therapy on reducing fatigue of upper extremity muscles\u2014A pilot study","volume-title":"Advances in Intelligent Systems and Computing","author":"Chen","year":"2018"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2015.00376","article-title":"Immediate effects of smoking on cardiorespiratory responses during dynamic exercise: arm vs leg ergometry","volume":"6","author":"Chen","year":"2015","journal-title":"Front. Physiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2545","DOI":"10.2147\/PRBM.S469240","article-title":"Altered heart rate variability during mobile game playing and watching self-mobile gaming in individuals with problematic mobile game use: implications for cardiac health","volume":"17","author":"Chin","year":"2024","journal-title":"Psychol. Res. Behav. Manag"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242371","article-title":"Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome","volume":"15","author":"Chiu","year":"2020","journal-title":"PloS One"},{"key":"B12","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1142\/S1013702518300010","article-title":"Musculoskeletal disorder and pain associated with smartphone use: a systematic review of biomechanical evidence","volume":"38","author":"Eitivipart","year":"2018","journal-title":"Hong Kong Physiother. J."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0000000000000981","article-title":"Cupping therapy: from traditional therapy to cardiac remedy","author":"El Ghazawi","year":"2025","journal-title":"Cardiol. Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.mehy.2014.04.001","article-title":"Percutaneous excretion of iron and ferritin (through Al-hijamah) as a novel treatment for iron overload in beta-thalassemia major, hemochromatosis and sideroblastic anemia","volume":"83","author":"El Sayed","year":"2014","journal-title":"Med. Hypotheses"},{"key":"B15","doi-asserted-by":"publisher","first-page":"193","DOI":"10.4239\/wjd.v11.i5.193","article-title":"Evaluation of oxidative stress levels in obesity and diabetes by the free oxygen radical test and free oxygen radical defence assays and correlations with anthropometric and laboratory parameters","volume":"11","author":"G\u0103man","year":"2020","journal-title":"World J. Diabetes"},{"key":"B16","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/j.1748-1716.1976.tb10284.x","article-title":"Local reflex in microcirculation in human subcutaneous tissue","volume":"97","author":"Henriksen","year":"1976","journal-title":"Acta Physiol. Scand."},{"key":"B17","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/BF00580976","article-title":"Tissue compliance in superficial tissues along body axis in man","volume":"387","author":"Kirsch","year":"1980","journal-title":"Pflugers Arch."},{"key":"B18","doi-asserted-by":"publisher","first-page":"992","DOI":"10.3109\/14397595.2014.886984","article-title":"An evaluation of oxidative stress and antioxidant capacity in patients with myofascial pain syndrome","volume":"24","author":"Koca","year":"2014","journal-title":"Mod. Rheumatol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"H2233","DOI":"10.1152\/ajpheart.1999.277.6.H2233","article-title":"Effect of aging on gender differences in neural control of heart rate","volume":"277","author":"Kuo","year":"1999","journal-title":"Am. J. Physiol."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6882-11-63","article-title":"The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain\u2014a randomized controlled pilot study","volume":"11","author":"Lauche","year":"2011","journal-title":"BMC Complement Altern. Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1364\/BOE.8.000223","article-title":"Significant and sustaining elevation of blood oxygen induced by Chinese cupping therapy as assessed by near-infrared spectroscopy","volume":"8","author":"Li","year":"2017","journal-title":"Biomed. Opt. Express"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2022.996589","article-title":"Effect of durations and pressures of cupping therapy on muscle stiffness of triceps","volume":"10","author":"Li","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B23","first-page":"773","article-title":"Psychometric evaluation of the Taiwan version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire","volume":"103","author":"Liang","year":"2004","journal-title":"J. Formos Med. Assoc."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0098312","article-title":"Development and validation of the smartphone addiction inventory (SPAI)","volume":"9","author":"Lin","year":"2014","journal-title":"PloS One"},{"key":"B25","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.ctcp.2017.09.008","article-title":"Cupping therapy: an analysis of the effects of suction on skin and the possible influence on human health","volume":"29","author":"Lowe","year":"2017","journal-title":"Complement Ther. Clin. Pract."},{"key":"B26","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1089\/acm.2019.0231","article-title":"Dry cupping, ischemic compression, or their combination for the treatment of trigger points: a pilot randomized trial","volume":"26","author":"Nasb","year":"2020","journal-title":"J. Altern. Complement Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00381-017-3388-z","article-title":"Association of evening smartphone use with cardiac autonomic nervous activity after awakening in adolescents living in high school dormitories","volume":"33","author":"Nose","year":"2017","journal-title":"Childs Nerv. Syst."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/j.metabol.2009.05.022","article-title":"FORT and FORD: two simple and rapid assays in the evaluation of oxidative stress in patients with type 2 diabetes mellitus","volume":"58","author":"Pavlatou","year":"2009","journal-title":"Metabolism"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2170\/jjphysiol.37.1","article-title":"The modulation of visceral functions by somatic afferent activity","volume":"37","author":"Sato","year":"1987","journal-title":"Jpn. J. Physiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"682","DOI":"10.4085\/1062-6050-236-19","article-title":"Dry cupping therapy for improving nonspecific neck pain and subcutaneous hemodynamics","volume":"55","author":"Stephens","year":"2020","journal-title":"J. Athl Train"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1016\/j.ctim.2014.10.008","article-title":"Wet-cupping removes oxidants and decreases oxidative stress","volume":"22","author":"Tagil","year":"2014","journal-title":"Complement Ther. Med."},{"key":"B32","first-page":"309","article-title":"The influence of dry cupping of differing intensities on heart rate variability","volume-title":"Advances in Intelligent Systems and Computing","author":"Tang","year":"2019"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: standards of measurement, physiological interpretation, and clinical use","volume":"93","year":"1996","journal-title":"Circulation"},{"key":"B34","doi-asserted-by":"publisher","first-page":"184","DOI":"10.13702\/j.1000-0607.2007.03.011","article-title":"Preliminary observation of different negative pressure of cupping therapy on skin blood flow","volume":"32","author":"Tian","year":"2007","journal-title":"Acupunct Res."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06168-5","article-title":"Relationships between cervical sagittal posture, muscle endurance, joint position sense, range of motion and level of smartphone addiction","volume":"24","author":"Torkamani","year":"2023","journal-title":"BMC Musculoskelet. Disord."},{"key":"B36","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.jmpt.2008.08.006","article-title":"The neck disability index: state-of-the-art, 1991\u20132008","volume":"31","author":"Vernon","year":"2008","journal-title":"J. Manipulative Physiol. Ther."},{"key":"B37","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1300\/j094v04n04_09","article-title":"The Neck Disability Index: a study of reliability and validity","volume":"14","author":"Vernon","year":"1991","journal-title":"J. Manipulative Physiol. Ther."},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2020.608509","article-title":"Effect of pressures and durations of cupping therapy on skin blood flow responses","volume":"8","author":"Wang","year":"2020","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1097\/BRS.0b013e3181c6ea1b","article-title":"Translation and validation study of Chinese versions of the Neck Disability Index and the Neck Pain and Disability Scale","volume":"35","author":"Wu","year":"2010","journal-title":"Spine"},{"key":"B40","first-page":"385","article-title":"Effect of time and pressure factors on the cupping mark color","volume":"29","author":"Zhao","year":"2009","journal-title":"Zhongguo Zhen Jiu"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1812427\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:13Z","timestamp":1785731173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1812427\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":40,"alternative-id":["10.3389\/fphys.2026.1812427"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1812427","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1812427"}}