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Simple vacuum cup to identify the primary myofascial restriction: the root cause of pain elsewhere
  1. Lenny Thinagaran Vasanthan1 and
  2. Manigandan Chockalingam2
  1. 1Physiotherapy Unit, Physical Medicine and Rehabilitation Department, Christian Medical College Vellore, Vellore, Tamil Nadu, India
  2. 2Occupational Therapy, National University of Ireland Galway, Galway, Ireland
  1. Correspondence to Lenny Thinagaran Vasanthan; lennyv{at}


Identification of the primary source of pain determines the success of musculoskeletal pain management. A detailed history and physical examination are the current gold standards for identifying musculoskeletal pain source in day-to-day clinical practice. This process, at times, may potentially result in inadequate/inappropriate identification of the pain source. In this case report, we present the usefulness of a simple and inexpensive vacuum cup. We found that this accurately identified the primary pain source, distant from and unrelated to the site of pain presentation in a 30-year-old man with back pain. Routine use of this simple technique in conjunction with the regular musculoskeletal examination may better identify primary restrictions in the body tissues. Based on our experience, we propose that this approach has the potential to offer better outcomes in the treatment of musculoskeletal pain in the future.

  • back pain
  • physiotherapy (rehabilitation)
  • musculoskeletal syndromes

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  • Contributors The primary author LTV was the treating physiotherapist for the reported patient in the case report. LTV is responsible for the concept, acquisition and interpretation of data presented and obtaining the patient consent in this case report. Both authors (LTV and MC) were responsible for drafting and analysing the initial work, revising it critically for important intellectual content and final approval of the version to be published. Both authors (LTV and MC) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.