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Article

Immediate Effects of Dynamic Cupping on Shoulder Active Range of Motion of Senior Male Handball Players: A Randomized Controlled Trial

by
Ricardo Cardoso
1,
Adérito Seixas
1,2,*,
Isabel Moreira-Silva
1,3,
Joana Azevedo
1 and
Diogo Duarte
1
1
FP-I3ID, FP-BHS, Escola Superior de Saúde Fernando Pessoa, 4200-256 Porto, Portugal
2
LABIOMEP, INEGI-LAETA, Faculdade de Desporto, Universidade do Porto, 4200-450 Porto, Portugal
3
CIAFEL, Faculdade de Desporto, Universidade do Porto, 4200-450 Porto, Portugal
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(1), 126; https://doi.org/10.3390/app15010126
Submission received: 1 December 2024 / Revised: 16 December 2024 / Accepted: 25 December 2024 / Published: 27 December 2024
(This article belongs to the Special Issue Current Approaches to Sport Performance Analysis)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background: Shoulder injuries are common among handball players and have been associated with adjustments in shoulder mobility with decreased flexibility. The aim of the study is to analyze the immediate effects of dynamic cupping on shoulder active range of motion (AROM) of senior male handball players. Materials and Methods: A total of 80 senior male handball players completed a socio-demographic and clinical questionnaire. They were then randomly divided into two groups: the Intervention Group (IG; n = 40), which received dynamic cupping therapy, and the Control Group (CG; n = 40), which did not receive any intervention. Shoulder AROM, including flexion, extension, abduction, adduction, horizontal adduction, horizontal abduction, internal rotation, and external rotation, was assessed in both groups before the intervention (M0) and after the intervention (M1). Results: After the intervention, the IG showed a statistically significant increase in AROM for all shoulder movements. In contrast, the CG only demonstrated significant improvements in internal rotation (p = 0.042), adduction (p = 0.011), horizontal abduction (p = 0.004), and horizontal adduction (p = 0.005). Additionally, the IG exhibited a statistically significant increase in shoulder AROM across all movements compared to the CG at M1. Conclusions: The findings of this study support that dynamic cupping enhances shoulder AROM in senior male handball players.

1. Introduction

Handball is a team sport in which the aim of each team is to invade the opponent’s field, occupying common spaces, with the continuous struggle for ball possession and goal pursuit. The attack and defense sequences of both teams go through complex and unpredictable tactical and technical plans that may influence the players’ technical and tactical behaviors [1,2,3,4].
These dynamic and high-intensity demands place significant stress on players’ shoulders, particularly during overhead movements common in handball. Shoulder adaptations resulting from such practice include increased medial rotation torque and an increased range of motion in external rotation. However, this is often accompanied by a decrease in total shoulder range of motion and internal rotation range of motion. These factors can contribute to changes in shoulder mobility, particularly in handball players who experience reduced flexibility [5].
Shoulder injuries are common among handball players and can be attributed to the movements performed, such as spine rotational motion and various projection angles required by these positions, frequent jumps and falls, as well as a high degree of contact with opposing players [6].
Over time, there has been a growing interest in the application of ancient treatment techniques, such as cupping therapy [7]. Although scientific evidence on the use of cupping by athletic populations is scarce [8], existing research suggests that cupping may be beneficial for a variety of musculoskeletal conditions [7]. By improving local microcirculation and enhancing the transport of metabolic by-products such as lactate, cupping can aid post-exercise metabolic recovery [9]. Therefore, the use of cupping therapy may be beneficial for handball players who are predisposed to shoulder injuries.
Cupping therapy is a non-invasive, negative pressure mechanical massage technique, performed using a suction cup that sucks the skin when pumping with a cupping gun. This process triggers a local aspiration on the skin, creating a vacuum inside the suction cup positioned on its surface, using negative pressure to promote increased blood circulation [10,11,12].
There are several ways to perform cupping therapy, such as dry or static, sliding, dynamic, intermittent, or scarifying suction cups. In 2013, cupping therapy was classified into five categories, which were updated in 2016. The updated classification categorized cupping therapy into six categories [13].
According to Klecan (2018) [14], the three main types of cupping therapy are dry cupping, wet cupping, and massage cupping. Dry cupping or static cupping consists of performing a single suction on the skin. Wet cupping involves making small incisions in the skin so that there is bleeding and, afterwards, the suction cup is positioned above the incision to induce more bloodletting. Massage cupping or dynamic cupping involves suctioning the skin and moving the suction cup along the surface of the skin, while maintaining suction [14]. Dynamic cupping involves the creation of negative vacuum pressure combined with positive pressure from the superficial massage performed by the suction cup. This technique aims to enhance blood and lymph flow, facilitating the removal of toxins and improving cellular nutrition [15,16].
The reported effects of cupping include increased perfusion to the skin [17], reduced tension in the fascia and muscle [18], promoting the relaxation of tense structures, decreasing muscle activity, and inducing analgesia [19,20], biomechanical alteration of the skin [7], increased pain threshold [20,21], reduced inflammation [22], reduced stress, by inducing deep relaxation in the patient [21], and modulation of the cellular immune system [23].
To our knowledge, there is no published studies on the effects of cupping on the active range of motion (AROM) of the shoulder in senior male handball players. Thus, the aim of the present study is to verify the immediate effects of dynamic cupping on shoulder AROM of senior male handball players.

2. Materials and Methods

This report adhered to the CONSORT guidelines for reporting clinical trails (Supplementary Materials).

2.1. Ethical Considerations

The protocol was approved by Fernando Pessoa University’s Ethics Committee (FISIO-3-29072019) and registered in ClinicalTrials.gov (NCT06226961). During the initial face-to-face meeting with each participant, signed informed consent was obtained following the World Medical Association Declaration of Helsinki (Ethical Principles for Medical Research Involving Human Participants) [24]. This process ensured the anonymity and confidentiality of the data, which will only be used for the purposes of this research. Participants were also informed that they had the right to withdraw from the study at any time, without any consequences or the need for justification. The collected data were archived separately from informed consent and will be deleted when they no longer serve any research purpose.

2.2. Sample Selection

Four handball teams (two in Portugal and two in France) were invited to take part in the present study, and subsequently, an email was sent to the direction of each team.
The convenience sample consisted of 80 senior handball players, aged 18 to 39 years old. All included participants were healthy senior handball players in competition, with at least three training sessions per week.
The exclusion criteria were as follows: a history of injury, fracture, or surgical intervention in the upper limb within the six months prior to the study; any vestibular, neurological, or cardiorespiratory diseases; reported pain in the upper limb or spine; and the presence of contraindications for cupping, such as deep venous thrombosis, active infections, or open wounds [25].

2.3. Protocol

Participants completed a Sociodemographic and Clinical Questionnaire to accurately characterize the sample and identify any possible exclusion criteria. The Sociodemographic and Clinical Questionnaire included: personal data (two items), training habits (one item), and clinical background (nine items).
All data collection was performed prior to players’ training. The necessary information regarding the procedures to be performed, as well as the clarification of any doubts that might arise, were provided to all participants. After completing the socio-demographic and clinical questionnaire, the players were randomly assigned to two designated groups, the Intervention Group (IG; n = 40) (dynamic cupping therapy) and the Control Group (CG; n = 40) (no intervention group), using GraphPad online tool (https://www.graphpad.com/quickcalcs, accessed on 1 February 2024), which ensures unbiased allocation by generating a random sequence. This randomization process minimizes the risk of systematic bias in group assignments and enhances the validity of our findings. However, the use of a convenience sample consisting of 80 senior male handball players introduces potential limitations. The representativeness of this sample may be constrained, potentially affecting the generalizability of the results. The implications of this limitation are discussed further in the Section 4.
First, anthropometric measurements were performed using a stadiometer (Seca® Medical Scales and Measuring Systems®, Birmingham, UK) to record their height and a scale (Seca® Medical Scales and Measuring Systems®, Birmingham, UK) to measure their weight.
The following evaluation parameters were collected by a physiotherapist investigator. The average time to assess each participant was 20 min.
Data were collected in two moments: initial moment (M0) and after the application of cupping for IG or after a resting period for CG (M1).
The study was carried out on the dominant upper limb. To identify the dominant upper limb, a test was carried out in which a ball was thrown at the athlete and the athlete had to return the ball through a pass using the upper limb [26]. Then, the initial evaluation moment (M0) was performed, which consisted of goniometric evaluation of shoulder active range of motion (AROM). For each movement, the players were asked to perform the movement for the first time on the non-dominant side to understand the movement without making compensations.
In goniometry assessment, a 30,48 cm plastic BASELINE® universal goniometer (Model 12–1000; Fabrication Enterprises, White Plains, NY, USA) was used for all goniometric measurements, following the methodology used by Marques (1997) [27]. Participants were instructed to perform various active movements with the dominant upper limb. Assessments for shoulder flexion, extension, abduction, and adduction were conducted while the participants stood, with a focus on minimizing compensatory movements. For the assessment of abduction and horizontal adduction, participants remained seated on a Posturarte® Olympic massage table (Posturarte, Braga, Portugal). Internal and external rotation movements were also assessed while the participants were lying supine on the same type of table, ensuring no inclination. Any measurements were considered invalid if the participant compensated using another body part. Three measurements were taken for each movement, and the average of these three was used for analysis [27,28]. In the investigation by Kolber and Hanney (2012) [29], the authors evaluated the reliability and concurrent validity of digital inclinometric and goniometric measurements of active shoulder flexion, abduction, and external and internal rotation. The literature suggests that both techniques are reliable, as evidenced by reliability coefficients that exceeded 0.90 (the threshold recommended for making clinical decisions), as well as good concurrent validity statistics.
After M0, participants in the CG group remained at rest, sitting on the massage table for 10 min. The participants in the IG group were submitted to the application of dynamic cupping.
For the dynamic cupping protocol, participants were instructed to remain seated on a massage table with their feet supported. The technique was applied to the entire shoulder, including the anterior, lateral, and posterior surfaces, as well as the surrounding muscles, specifically the upper trapezius and pectoralis major. Cupping was performed using a plastic cupping cup (5.08 cm in diameter) from K.S. Choi Corp® (Los Angeles, CA, USA) and a pistol grip hand pump from the same brand. The dynamic cupping lasted ten minutes and was conducted at a slow pace. It began with the application of a small amount of massage cream (ATL®, Carnaxide, Portugal) over the entire shoulder to create an ideal sliding surface. Then, two pumps created a vacuum with the suction cup and slid in the direction of the muscle fibers around the shoulder, as well as transversely.
After the intervention/control, all participants performed the second assessment (M1), which consisted of the same procedures as M0. All participants received the intervention (CG or IG) as planned.

2.4. Statistical Procedures

The data were analyzed using the Statistical Package for the Social Sciences® (SPSS v.25.0) software for Windows. The Kolmogorov–Smirnov test was used to assess the distribution of the studied variables, and since the variables did not follow a normal distribution pattern, non-parametric tests were selected. Descriptive characteristics of the participants (age, BMI) and studied variables were presented as median and interquartile range (IQR). The Mann–Whitney’s U-test was used for intergroup analysis. The Wilcoxon test was used to assess the differences between the values obtained within groups before and after the intervention (M0 and M1). To analyze the effect size, the rank-biserial correlation coefficient was used. Absolute values < 0.3 were considered small effect sizes, ≥0.3 and <0.5 were considered medium effect sizes, and ≥0.3 and ≤1 were considered large effect sizes. A p-value equal or lower than 0.05 was considered significant.

3. Results

The biometric characteristics of the sample variables are summarized in Table 1, for both groups. No differences were found between study groups considering age and body mass index.
A flow diagram of this parallel randomized controlled trial is presented in Figure 1.
Comparing the two groups at M0, no differences were found regarding the AROM of the shoulder in all movements, except for the horizontal abduction movement (p = 0.019) (Table 2).
Dynamic cupping significantly increased senior male handball athlete shoulder AROM when the intervention was applied (M1) in all movements. Regarding CG, significant differences were found in the movements of internal rotation (p = 0.042), adduction (p = 0.011), horizontal abduction (p = 0.004), and horizontal adduction (p = 0.005) in M1. No differences were found in CG, considering the movements of flexion, extension, external rotation, and abduction.
Compared to CG in M1, IG demonstrated a statistically significant increase in senior male handball athlete shoulder AROM in all movements.
Descriptive plots of intervention and control groups AROM before (M0) and after intervention (M1) are presented in Figure 2 and Figure 3, respectively.

4. Discussion

This study aimed to verify the immediate effects of dynamic cupping on shoulder AROM of senior male handball players.
In this investigation, compared to the control group, dynamic cupping demonstrated a statistically significant increase in senior male handball athlete shoulder AROM in all movements.
According to the systematic review of Bridgett et al. (2018) [8], the relationship between cupping and range of motion remains unclear, although they report that increased range of motion seems to occur due to muscle relaxation induced by cupping. Despite not being in the same anatomical region, the results observed in this study are in line with the investigation by Markowski et al. (2014) [30]. The authors found that static cupping significantly improved the flexion AROM of the lumbar spine and straight leg raise in the left leg. According to the authors, the results of the intervention are due to a decrease in muscle tension, because cupping promotes the improvement of blood circulation, which maximizes metabolic exchanges. In their study, it was demonstrated that the increased range of motion in these patients was similar to the effects of thermotherapy on muscle tissue, with acute vasodilatation that prompted increased blood flow, facilitating cell and muscle regeneration and increased AROM.
In another study, Smith (2015) [31] assessed shoulder AROM using goniometry in healthy subjects. The movements assessed were flexion, abduction, internal rotation, and external rotation. To assess the movements, the author used a different methodology (evaluation in the supine position). Comparing to the control group, cupping significantly improved the internal and external rotation movements. However, the participants in this study were not athletes; the author only assessed internal and external rotation of the shoulder, and the intervention was performed with static cupping for 5 min, where four plastic cupping cups (5 cm in diameter) were applied to the medial border of the scapula and in the inferior and superior angles of the scapula. A last plastic cupping cup (with a 7.6 cm in diameter) was placed under the scapular spine, in the infraspinatus muscle.
In the study of Sadek (2016) [32], static cupping with scarification was compared to a control group on low back pain of soccer players. The outcome measures were the Sorensen’s Test and the AROM of the lumbar spine assessed through goniometry. The authors found that compared to a control group, cupping caused significantly improvements in the Sorensen’s Test, as well as the flexion and extension active movements of the lumbar spine. In the intragroup analysis, cupping significantly improved all outcome measures, while in the control group, no differences were found.
The observed improvements in shoulder AROM following dynamic cupping therapy are likely due to several physiological mechanisms. First, dynamic cupping enhances local blood flow by creating a vacuum effect, which promotes vasodilation and improves tissue perfusion. This increase in blood circulation delivers more oxygen and nutrients to the affected area, aiding in muscle recovery and reducing stiffness. Second, the technique facilitates myofascial release by loosening adhesions and improving the viscoelastic properties of the fascia and muscle tissue. This reduces mechanical restrictions and enhances mobility. Third, dynamic cupping may stimulate peripheral nerve endings, modulating the sensory input to the central nervous system and promoting muscle relaxation. Finally, the combination of negative and positive pressure applied during dynamic cupping likely reduces muscle tension and improves elasticity, contributing to the observed increases in joint mobility.
The increase in shoulder AROM may also be influenced by changes in the biomechanical properties of the skin and muscle (viscoelastic properties), which enhance joint mobility [7,15,16,17]. These mechanisms provide a clear explanation of the pathways through which dynamic cupping achieves its effects, aligning with similar results observed in prior research.
However, the present results suggest that AROM in the control group significantly improved in some shoulder movements. This fact can be influenced by the activation of different muscle groups between the moment M0 and moment M1, since in each assessment, it is repeated three times and only the immediate effects were sought (the time difference between M0 and M1 is a short period). Repeating the assessments in M0 and M1 can lead to an increase in the AROM in both groups, due to changes in the viscoelastic properties of the structures. Elasticity is an essential property of muscle tissue, contributing to its ability to stretch and maintain tissue integrity during movement [33]. The resistance to muscle traction during stretching is influenced by structural proteins such as titin, which help modulate the elastic and viscoelastic properties of skeletal muscle fibers [34]. During muscle stretching, titin changes its configuration according to the type of fiber, modulating its resistance and elasticity according to the function of the muscle fiber [33,35].
However, it was found that the increase in AROM values was significantly higher in the experimental group compared to the control group. This significant difference underscores the unique effects of dynamic cupping, particularly its ability to reduce fascial and muscle tension while improving blood flow and cellular nutrition.
The results of this study indicate that dynamic cupping therapy may have a positive effect on AROM. This technique could be integrated into regular training or rehabilitation programs to address mobility restrictions, reduce muscle stiffness, and potentially enhance athletic performance. Coaches, physiotherapists, and sports medicine professionals may consider incorporating dynamic cupping as a non-invasive, time-efficient modality to complement other therapeutic and performance-enhancing practices.
The present study presents some limitations that should be acknowledge, namely the choice of a convenience sample and the assessment of only the short-term effects of cupping. The use of a convenience sample, although practical, introduces potential biases that warrant consideration. This sampling approach limits the generalizability of the findings to broader athletic populations or other age groups. While randomization mitigates allocation bias within the study, the convenience sample may inadvertently favor participants with specific characteristics (e.g., access to handball teams in selected regions).

5. Conclusions

Dynamic cupping improved shoulder AROM of senior male handball players in the short term. However, more studies are needed, with a good methodological basis, to confirm or refute the results obtained in this investigation and highlight the mechanisms underlying these effects. It is suggested that future studies analyze the long-term effects of cupping, especially randomized controlled studies with more groups (containing a placebo group and other intervention techniques combined or not with cupping), including intervention in females and in other samples (e.g., athletes from other sports). The assessment of the effects of different types of cupping (e.g., static and dynamic), with different intervention duration sessions (e.g., 5, 10, 15, and 20 min), longer intervention period (one week or two weeks), and with longer follow-ups. Future studies should aim to recruit more diverse and representative samples to strengthen the applicability of the results and long-term follow-ups should be implemented. Additionally, comparative studies examining the combined effects of dynamic cupping with other physiotherapeutic modalities, such as stretching or manual therapy, could provide deeper insights into its synergistic benefits.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app15010126/s1, checklist: CONSORT 2010 Checklist.

Author Contributions

Conceptualization, R.C., A.S. and D.D.; methodology, R.C., A.S. and D.D.; formal analysis, R.C. and A.S.; investigation, R.C. and D.D.; resources, R.C., A.S., I.M-S., J.A. and D.D.; data curation, R.C., A.S. and D.D.; writing—original draft preparation, R.C. and D.D.; writing—review and editing, R.C., A.S., I.M.-S. and J.A.; visualization, R.C., A.S., I.M.-S. and J.A.; supervision, R.C.; project administration, R.C., A.S., I.M.-S., J.A. and D.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Fernando Pessoa University (FISIO-3-29072019, approved 29 July 2019).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on reasonable request from the corresponding author.

Conflicts of Interest

The authors declare that they have no competing interests.

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Applsci 15 00126 g001
Figure 1. CONSORT flow diagram.
Figure 1. CONSORT flow diagram.
Applsci 15 00126 g001
Applsci 15 00126 g002
Figure 2. Descriptive plots of intervention group AROM (°) before (M0) and after intervention (M1): Panel (A)—Flexion; (B)—Extension; (C)—Internal rotation; (D)—External rotation; (E)—Adduction; (F)—Abduction; (G)—Horizontal adduction; (H)—Horizontal abduction.
Figure 2. Descriptive plots of intervention group AROM (°) before (M0) and after intervention (M1): Panel (A)—Flexion; (B)—Extension; (C)—Internal rotation; (D)—External rotation; (E)—Adduction; (F)—Abduction; (G)—Horizontal adduction; (H)—Horizontal abduction.
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Figure 3. Descriptive plots of control group AROM (°) before (M0) and after intervention (M1): Panel (A)—Flexion; (B)—Extension; (C)—Internal rotation; (D)—External rotation; (E)—Adduction; (F)—Abduction; (G)—Horizontal adduction; (H)—Horizontal abduction.
Figure 3. Descriptive plots of control group AROM (°) before (M0) and after intervention (M1): Panel (A)—Flexion; (B)—Extension; (C)—Internal rotation; (D)—External rotation; (E)—Adduction; (F)—Abduction; (G)—Horizontal adduction; (H)—Horizontal abduction.
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Table 1. Comparison between the groups in terms of biometric characteristics.
Table 1. Comparison between the groups in terms of biometric characteristics.
VariablesnControl Group
Median (IQR)		Experimental Group
Median (IQR)		p
Age (years)4019.5 (9.8)19.0 (8.8)0.589
Body mass index (kg/m2)4024.8 (4.3)24.9 (7.6)0.885
Table 2. Intra- and intergroup differences in shoulder AROM before (M0) and after intervention (M1).
Table 2. Intra- and intergroup differences in shoulder AROM before (M0) and after intervention (M1).
Variables (°)nGroupM0M1p #e.s. #
Median (IQR)Median (IQR)
Flexion40CG178.0 (18.8)178.0 (17.8)0.8780.041 (−0.451; 0.513)
40IG170.0 (17.8)180.0 (8.0)0.001 *−0.983 (−0.993; −0.959)
p †0.5250.012 *
e.s. †0.079 (−0.173; 0.322)−0.301(−0.512; −0.056)
Extension40CG45.0 (16.8)45.5 (17.3)0.728−0.080 (−0.491; 0.360)
40IG45.0 (10.0)50.0 (5.8)0.001 *−0.987 (−0.994; −0.971)
p †0.2770.010 *
e.s. †0.141 (−0.113; 0.377)−0.329 (−0.535; −0.087)
Internal rotation40CG72.0 (20.0)73.0 (18.6)0.042 *−0.453 (−0.730; −0.049)
40IG65.0 (18.0)80.0 (13.25)0.001 *−0.995 (−0.998; −0.990)
p †0.3420.009 *
e.s. †0.123 (−0.130; 0.361)−0.336 (−0.540; −0.095)
External rotation40CG85.0 (16.0)83.0 (18.0)0.518−0.150 (−0.543; 0.297)
40IG85.5 (18.0)90.0 (1.5)0.001 *−0.994 (−0.997; −0.987)
p †0.5430.001 *
e.s. †0.078 (−0.175; 0.321)−0.469 (−0.643; −0.249)
Abduction40CG172.0 (22.3)175.0 (20.8)0.091−0.429 (−0.743; 0.042)
40IG170.0 (20.0)180.0 (7.25)0.001 *−0.953 (−0.979; −0.896)
p †0.9380.013 *
e.s. †0.010 (−0.240; 0.259)−0.313 (−0.521; −0.069)
Adduction40CG30.0 (12.0)32.0 (11.0)0.011 *−0.542 (−0.774; −0.181)
40IG30.0 (14.5)40.0 (9.25)0.001 *−1.000 (−1.000; −1.000)
p †0.5970.001 *
e.s. †0.068 (−0.184; 0.312)−0.526 (−0.685; −0.318)
Horizontal abduction40CG31.0 (15.8)33.0 (14.0)0.004 *−0.667 (−0.852; −0.334)
40IG40.0 (14.0)48.0 (10.0)0.001 *−0.965 (−0.984; −0.928)
p †0.019 *0.001 *
e.s. †−0.303 (−0.514; −0.058)−0.637 (−0.765; −0.462)
Horizontal adduction40CG115.5 (14.8)120.0 (13.0)0.005 *−0.778 (−0.919; −0.461)
40IG120.0 (7.25)120.0 (0.0)0.001 *−1.000 (−1.000; −1.000)
p †0.0600.002 *
e.s. †−0.227 (−0.451; 0.024)−0.341 (−0.544; −0.101)
* Significant values (p ≤ 0.05); # For intragroup significance—Wilcoxon test; † For intergroup significance—Mann-Whitney U-test; (°) degrees. Abbreviations: CG: Control group, IG: Intervention group, M0: pre-intervention moment, M1: post-intervention moment, n: sample size; e.s.: effect size (95% Confidence Interval).
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Cardoso, R.; Seixas, A.; Moreira-Silva, I.; Azevedo, J.; Duarte, D. Immediate Effects of Dynamic Cupping on Shoulder Active Range of Motion of Senior Male Handball Players: A Randomized Controlled Trial. Appl. Sci. 2025, 15, 126. https://doi.org/10.3390/app15010126

AMA Style

Cardoso R, Seixas A, Moreira-Silva I, Azevedo J, Duarte D. Immediate Effects of Dynamic Cupping on Shoulder Active Range of Motion of Senior Male Handball Players: A Randomized Controlled Trial. Applied Sciences. 2025; 15(1):126. https://doi.org/10.3390/app15010126

Chicago/Turabian Style

Cardoso, Ricardo, Adérito Seixas, Isabel Moreira-Silva, Joana Azevedo, and Diogo Duarte. 2025. "Immediate Effects of Dynamic Cupping on Shoulder Active Range of Motion of Senior Male Handball Players: A Randomized Controlled Trial" Applied Sciences 15, no. 1: 126. https://doi.org/10.3390/app15010126

APA Style

Cardoso, R., Seixas, A., Moreira-Silva, I., Azevedo, J., & Duarte, D. (2025). Immediate Effects of Dynamic Cupping on Shoulder Active Range of Motion of Senior Male Handball Players: A Randomized Controlled Trial. Applied Sciences, 15(1), 126. https://doi.org/10.3390/app15010126

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