The advantages of cupping therapy

Cupping can truly be a game-changer in your clinical practice! It's one of the most effective treatment tools to relieve pain immediately when used correctly! In most cases, your patients will feel better by the end of the same session. It's easy to use and doesn't require a lot of physical effort, as is sometimes the case with massage therapy. It's very easy to learn and understand. No special prior knowledge is required. All you need is a basic knowledge of the anatomy of the musculoskeletal system. The equipment is relatively inexpensive. You don't need to invest a fortune to use it in your daily practice. The procedure itself isn't painful and doesn't feel traumatic, as acupuncture, injections or chiropractic manipulation can be for some patients. It usually feels very relaxing and is suitable for most people.

How Does it work?

According to Chinese Medicine theory, human body is a network of channels, called meridians. In these meridians flow qi and blood, that supply energy and nourishment to every tiny part of the body. Once the meridian is stagnated for any reason, pain occurs and toxins gradually start to accumulate in the blocked area. Cupping forcefully removes this blockage, reestablishes the good flow of energy and nourishment and allows it to reach its destination. In addition, it helps to clear the already accumulated toxins in the treated area. Now let’s talk about the western interpretation of it. Oxygen and nutrients reach all body cells with blood flow. On the other hand, lactic acid and carbon dioxide produced by our cells (the so called cell waste), are also cleared by good and healthy blood flow. Muscle injury or overload usually causes different levels of fascial adhesions. This leads to limited motion, pain and reduction of blood flow. Limited blood flow causes insufficient supply of oxygen and nutrients and finally cell waste accumulation. Cupping stretches out the fascia, removes adhesions and helps to improve motion of the tissues. Likewise, it helps to pull out the accumulated cell waste from the deeper layers. At that time, cupping also significantly improves circulation and increases fresh blood flow to the treated area, where the cells start to receive a fresh supply of oxygen and nutrients. Then cell metabolism is re-established and the tissue gradually heals. The vacuum also stimulates the mechanosensitive fibers, thus leading to reduction of pain. In addition to pain management, certain theories propose that bruises, caused by cupping, trigger certain immune responses that for instance may help to deal with flu and respiratory diseases.

Ancient Cupping and Modern Cupping

Cupping therapy is one of the most ancient therapies that managed to survive until present day. It was developed more than 3000 years ago in different parts of the globe, starting in Egypt and China, two very powerful cultures of that time. Gradually, Cupping Therapy spread through the European and Asian continents. It was adopted by many civilizations as one of the main medical tools, along with bleeding techniques in Arabian cultures (nowadays called Al-Hijama or wet cupping). Acupuncture and manual techniques in China and her Asian neighbors and later in combination with western medicine in the European countries. Famous medical practitioners like Hippocrates and Abu Ali Ibn Sina advocated cupping in their practice. In the past, cupping was used to cure all kinds of diseases, including fever, digestive conditions, gynecological issues and skin problems (such as acne, boils and toxic lesions). Nowadays, cupping therapy is mostly useful with musculoskeletal diseases and pain management. Recently it became a very popular treatment in sports medicine, due to its high efficiency in reducing muscle fatigue after trainings. You probably saw the bluish cupping circles on some sportsmen during the Olympic games or other tournaments. Additionally, it effectively treats headaches & stress due to the deep muscle relaxation effect that it provides. And eventually, cupping is still popular and effective with treatment of the Flu & respiratory diseases.

Is Cupping Therapy safe?

Generally cupping is very safe but certain side effects are possible. The first and most common unwanted side reaction is pain aggravation. This mostly happens due to over stimulation, which means that you probably applied to much suction on the cups. So be especially careful on your first session with a new patient, because they can be more sensitive than you assessed. Likewise, be more careful with more sensitive areas, like the neck, upper trapezius line, sides of the trunk and the limbs. Also, be more careful when cupping near inflamed joints. In all these cases work slowly, gradually and gently. The second possible side effect is itching. It can appear during the procedure, immediately after, or a few hours later. To avoid this, you may use good quality aloe cream or shea butter as a lubricant for the cupping procedure and smear another layer of it by the end of the session. Usually, it’s enough. The last unpleasant reaction are blisters. They may appear if the suction is too strong and the cups are left on for too long. The general rule is to leave the cups on for 5-15 minutes. Personally, I don’t see any reason to leave them on for more than 10 minutes. To be more specific, it depends on your patient’s skin condition. In most cases, younger patients have better skin elasticity and can endure cupping for a longer time (12-15 minutes approximately), while the skin condition of older patients is usually less elastic and thinner and blisters can appear after 5-7 minutes, so be more careful with elders and keep your eyes on the cups. If blisters have appeared, you should cover them with gauze (goz), and without any other intervention they will heal gradually in several weeks. Tell the patient they may remove the gauze while showering and replace it with a new sterile one. Just make sure the blistered area is covered to avoid infection. Alternatively, if you are trained to work with needles - you can prick the blisters slightly with a syringe and sterilize with alcohol. Then the healing process will only take a few days. During the course I show and explain how to perform it in details.

Will it work?

The patient will probably ask you – “when should I feel better after the treatment?” and this question must be answered. In most acute cases the patient will feel immediate relief. By the end of the day their pain and discomfort may resume to some degree, but it would still be better that before the treatment. Guide them to avoid cold and wind exposure and intensive physical activity related to the painful area. Sometimes the pain will start to reduce about 2 days later, and your patient should be aware of that too. In more severe and stubborn cases it may take 5-6 sessions until the patient starts to feel the improvement. It is important to know that cupping treatment is most effective for muscle tissue. For nerve damage, inflammation due to rheumatic issues or joint degeneration, cupping is less effective, but can still provide some degree of relief. Although, some patients have nerve impingement or joint inflammation due to previous muscle spasm – cupping will then address the origin of the problem which is great!

Cupping Discolorations

What does cupping discolorations means and why do they appear? After each session cupping usually leaves dark marks on the skin for several days. The patient should be aware of that and not be scared if they see these dark circles. Some of them will disappear after 2-3 days, others may take more than a week. It depends on the patient’s tissue condition - if his tissues have a lot of toxicity inside, the marks will be darker and it will take longer to disappear. Although rarely, but possible that it would even take months for them to totally disappear. Through my whole career of 15 years practice I had only 2 patients that it took them several months to heal totally from the post cupping discoloration. It is worth to emphasize to them that the discoloration of the skin is not dangerous at all, but only an esthetic issue. After each cupping treatment the color should be slightly brighter, because the more you cup, the less toxicity is left inside the patient’s tissues. The color may be different from case to case and may also be different from spot to spot on the same patient. It may be slightly pink, red, bluish or dark purple. It may be a full circle, partial or spotty. During my studies in China I remember my teachers taught us to differentiate the color after cupping as a diagnostic tool – red color means moderate stagnation of energy, pink – deficiency of blood and energy, bluish - stagnation of blood, dark purple – severe stagnation of blood and toxins, spotty red – stagnation of heat and toxins. It may be important for Chinese Medicine therapists, because then they can adjust herbal treatment accordingly. For other therapists it’s mostly important to pay attention only where the discoloration is darker and more pronounced, because we may consider to cup around there again in the next session. In general, the darker the circles after the treatment – the better outcome you can expect. On the other hand if there is no discoloration at all – there is a lower chance of the patient improving and another sort of treatment may be needed (acupuncture, herbs, drugs ect.)

Massive Cupping VS Targeted Cupping

There are 2 different approaches to localising cupping - the first and simplest is massive cupping. In this approach, the therapist places many cups close together on the area to be treated. The aim of this application is to treat all the muscles associated with the injured area. the second approach is slightly more complicated and specifically targets the muscle knots or myofascial trigger points of the affected muscles. This technique requires some palpation skills to identify these knots and trigger points. I use the first method when the pain is widespread in a particular area and there are no specific painful points that I can identify. Sometimes I also use this method when time is short and I don't have the opportunity to properly identify painful muscle knots or trigger points. In most cases, I think the second approach is more effective. It has another very important advantage: the fewer cups there are in the area, – the more tissue each individual cup can pull, and deeper tissue is affected. This is particularly important when treating areas with deep problematic tissues, such as the gluteal muscles and back.

Can deep tissue be influenced with cupping?

In the past, fire cupping with glass cups was the main technique of cupping therapy and it was difficult to target specific tissue layers. In recent years, however, plastic vacuum and silicone cups made revolutionary progress in cupping therapy and opened up new therapeutic possibilities. It is now possible to control the vacuum and increase it depending on the depth of the targeted tissue layer. To reach the deep tissue, we should follow the following 4 steps: 1. Lubricate the skin with a rich ointment or cream so that the skin can slide better into the cup 2. Use a relatively large plastic vacuum cup 3. Use a single cup on specific area (if necessary, make another set in a neighbouring area, but not at the same time). 4. Gradually apply a strong vacuum. Do it in several sets so that the patient can get used to the sensation.

Cupping effect in modern scientific research

In both wet and dry cupping, the application of external suction leads to several physiological responses that contribute to the therapeutic effects of the therapy. These responses involve an increased blood volume, an elevated capillary filtration rate, and the expulsion of filtered and interstitial fluid into the treated area. The collected fluid contains elevated levels of disease-related and disease-causing substances, prostaglandins, and inflammatory mediators. The increased oncotic pressure in dry cupping is believed to stimulate lymphatic uptake, thereby facilitating the removal of accumulated fluids and waste products from the treated area. In wet cupping, the scratches made with a scalpel during the procedure lead to a different set of effects. These minor skin incisions stimulate inflammatory cell migration and trigger the release of endogenous opioids, which are natural substances that function as pain relievers and mood enhancers. As previously mentioned, this action contributes to an increase in both innate and acquired immunity, thereby enhancing the body's ability to fight infections and restore immune balance. Cupping therapy can target numerous anatomical sites, and the choice of these sites depends on the specific ailment or condition under treatment. Cupping is frequently administered to regions with abundant muscle tissue, such as the back, chest, abdomen, and buttocks. To minimize potential risks and increase the chances of favorable outcomes in cupping therapy, it is advisable to avoid anatomical sites with significant dense hair, limited tissue mass, and insufficient surface area for effective cup placement. (The article is based on NCBI publications https://www.ncbi.nlm.nih.gov/books/NBK538253/)

Online Learning VS Frontal Classes

Is it effective to learn cupping therapy online? Online courses have far more advantages than face-to-face classes: Firstly, you can repeat each lesson as many times as you like. Second, the lessons are organized in a thorough and time-saving manner. Thirdly, you can see the practical demonstrations from the best angles and in optimal close-up, so you won't miss a single detail. Fourth, you don't need to write, photograph or record anything. All information is organized and available to you 24/7. Finally, you can contact your instructor as often as you like with questions and for further advice.

Cupping of the upper and lower limbs, neck and face

Why was cupping mainly used on the back in the past, whereas today we also use it on the limbs and face? For the limbs and face you need smaller cups, and until a few decades ago the only cupping sets used in clinical practice were glass fire cups, so it was technically much more difficult and not popular to work with small glass cups. Since plastic cups came onto the market and then silicone cupping sets, working on thinner tissue such as arms, forearms, thighs and legs or neck and face has become much easier and more affordable. I personally prefer to work on the limbs and face with silicone cups because it's rims are softer and feel more comfortable for the patient, but plastic cups can also work effectively there.

Cupping with other therapies

Can cupping be combined with other forms of therapy? For example, with deep tissue massage, chiropractic manipulations, acupuncture or reflexology? The answer is clearly yes! And this is one of the biggest advantages of cupping! In my practice, I combine cupping with acupuncture and Twina massage, sometimes even simultaneously. For example, I place needles distally on the hands and feet si3+bl62/65 and perform a cupping massage along the back at the same time. Or I cup the lower back and perform a Twina massage on the glutes and thighs at the same time. The shoulders, neck or back can also be cupped and a foot reflexology massage performed at the same time. There is plenty of scope for creativity in cupping treatments. It can enhance any type of treatment and take your clinical results to a much higher level!

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Cupping in sports medicine

Recently cupping became a very popular treatment in sports medicine, due to its high efficiency in reducing muscle fatigue after trainings. Cupping stretches out the fascia, removes adhesions and helps to improve motion of the tissues. Likewise, it helps to pull out the accumulated cell waste from the deeper layers. At that time, cupping also significantly improves circulation and increases fresh blood flow to the treated area, where the cells start to receive a fresh supply of oxygen and nutrients. Then cell metabolism is re-established and the tissue gradually heals. The vacuum also stimulates the mechanosensitive fibers, thus leading to reduction of pain.