A 16 year old male football player presented with right anterior knee pain of 3 days duration that was accompanied by tenderness, mild swelling and painful walking after falling down to the ground during a sport game. Right knee joint X-ray revealed no bone fractures or displacement. Orthopedic evaluation revealed no suspicion of a meniscus lesion or cruciate ligaments injuries and there was no need for additional investigations, or an MRI. Biochemically, liver and kidney function tests were normal. Response to non-steroidal analgesics was not satisfactory. The patient was experiencing severe pain upon knee squatting and was not able to do regular walking and knee bending during regular walking. Treatment was initiated using Al-hijamah (wet cupping therapy of prophetic medicine). Al-hijamah works via clearing the tissues and blood from causative pathological substances e.g. pain-causing substances as inflammatory substances, prostaglandins, substance P and others according to the evidence-based Taibah mechanism (Taibah theory). Importantly, cupping therapy was reported to increase the production of heat shock proteins and endogenous opioids (β-endorphins) that act as pain-killers. Cupping therapy is also reported to decrease the serum level of the pain-related substance P. Some previous studies have reported that skin puncturing during Al-hijamah increased the release of endogenous opioids such as endorphins, enkephalins, and dynorphins, which intensified the cupping therapy-induced analgesic effects. Al-hijamah was performed via applying a single medium-sized cup at the tender area at the frontal lower aspect of the right patella that included the whole painful area. The pain immediately resolved and the patient took rest for about 2 days and returned to normal activities including a return to playing football. The patient reported complete resolution of the symptoms in one week’s time with no symptoms recurrence on follow up for several months later. In conclusion, Al-hijamah is a wonderful promising conservative management for treating minor sports trauma and associated pain.

Al-hijamah, anterior knee injuries, tenderness, sucking cups, X-ray