## 4 Discussion
### Limitations/Suggestions  
This study has several limitations. First, the exact level of negative pressure applied during dynamic cupping was not measured. According to a systematic review by [PERSON] et al. (2020) [32], the pressure levels used in cupping therapy vary widely, ranging from 60 mmHg to 750 mmHg, depending on the device, technique, and study design. However, without direct measurement of the pressure in this study, it is difficult to standardize the intervention or compare our results with those of other studies. Future research should include the objective measurement of negative pressure to ensure consistency and reproducibility.  
Second, the study only assessed the immediate effects of the intervention. Longer intervention periods and follow-up assessments are needed to evaluate the sustained effects of dynamic cupping. Additionally, the sample consisted only of healthy participants with a normal range of motion. While asymptomatic individuals do exhibit a certain degree of mechanosensitivity, this sensitivity tends to increase with injuries affecting the somatosensory component of the peripheral nervous system [8]. Therefore, the lack of any underlying pathology may have influenced the results of the investigation.  
Third, the use of the ULNT1 as the sole evaluation tool may not fully capture the effects of dynamic cupping on nerve mechanosensitivity. Although ULNT1 is a well-established method for assessing median nerve mechanosensitivity, incorporating additional evaluation tools, such as pain threshold testing, neurophysiological studies, or blood flow measurements, could provide a more comprehensive assessment of the intervention's effects. Future studies should consider using a combination of evaluation methods to better understand the mechanisms underlying the effects of dynamic cupping.  
Fourth, the study design included a control group to account for potential confounding factors, such as natural variability in nerve mechanosensitivity over time or placebo effects. However, the inclusion of a placebo group or sham cupping intervention could have further strengthened the study design by controlling for the non-specific effects of cupping therapy. Future randomized controlled trials should consider incorporating placebo or sham interventions to better isolate the specific effects of dynamic cupping.  
Further research is needed to clarify the effectiveness of dynamic cupping in improving mechanosensitivity. Randomized controlled trials should include more groups, such as a placebo group and additional intervention techniques, whether combined with cupping or not. These studies should also involve longer session durations and intervention periods, such as 10 or 15 min over the course of a week, with different intensities (one or three pumps), as well as follow-up assessments. Additionally, it would be beneficial to enroll participants with symptoms related to nerve pain and disability to evaluate the effects of dynamic cupping on peripheral nerves that exhibit increased mechanosensitivity.  
For example, future studies could explore the effects of dynamic cupping in patients with carpal tunnel syndrome, cervical radiculopathy, or other nerve-related conditions. Combining cupping therapy with other interventions, such as neural mobilization or acupuncture, may also provide synergistic effects on mechanosensitivity and pain relief [17,31].  
Finally, the application of dynamic cupping along the median nerve pathway may have also affected surrounding tissues, including tendons, blood vessels, and other nerves (e.g., ulnar and radial nerves). While we focused on the median nerve, the non-specific nature of cupping therapy makes it difficult to isolate its effects solely on the nerve. Future studies should consider using more targeted interventions or additional evaluation tools, such as nerve conduction studies or quantitative sensory testing, to better understand the specific effects of cupping on nerve function and mechanosensitivity.