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Over the past several years I have learned to incorporate cupping into my practice. Let’s just say I am a fan. It has turned into a great treatment technique to have at my disposal whether working with patients dealing with persistent chronic pain or high-level athletes (Everyone remembers Michael Phelps at the Olympics?). So, what’s with the new craze?  That’s just the thing, it’s not new, not even close. Cupping is an ancient form of alternative medicine in which specialized cups are placed over an area of the body with the application of suction or negative pressure. Cupping can be used in various techniques, from various forms of ideology, to treat different ailments and conditions.

I am a manual therapist and use cupping in a manner that aligns with my other manual therapy treatments including myofascial manipulation, joint and soft tissue mobilization, instrument assisted soft tissue manipulation, or trigger point dry needling. I often pair several different techniques together for maximal benefit and to further progress that new-found mobility with corrective exercises.

So how does cupping work?

When I think about cupping, I tend to split my reasoning for its use into two different categories: myofascial and neuromuscular.

Myofascial cupping involves a more mechanical approach in which I am looking to manipulate the soft tissue in the area of pain. That can be done through static cupping, where the cups are placed and left to sit for a period of time. It can also be done through gliding, where I will use some type of lotion to slide/glide the cup along the area of restriction or pain. These techniques will stretch and mobilize the superficial layers of skin/fascia improving pain, mobility, and circulation to that area.

The second category, neuromuscular, gets a bit more into the neuroscience and neurophysiology of the technique. When I place a cup on the skin, even with the intent to focus on neuromuscular control or muscle activation, it provides the same suction and stretching to the top layers just like I said earlier with the myofascial approach. The difference comes from what I am trying to accomplish by putting the cups on. The theory being that when the cup is put on the skin your brain has new sensory input to consider. Let’s compare this to wearing a glove. When you initially put on a glove, you are more aware of your hand because your brain feels the glove and over time the brain will acclimate and forget it is even there.

So, let’s say someone has low back pain when they bend over. I may apply some of my rubber cups and have them do the movement again, many times they say it feels better. So, what has happened? Was it the suction? Was it placebo? The reality is that pain is so complex we cannot fully understand it. BUT, we do have some solid research and understanding of the mechanisms that might make this possible.

One is the brain. The more feedback and a better sense of the area being cupped helps to calm the nervous system’s alarm and thus less pain. The secondary component to that is the actual skin right under the cups. The skin and just below the interstitium, there are thousands of tiny receptors and nerve endings that take all the different kinds of sensation we feel during the day and send it to the brain. We can use manual therapy or cupping to get those receptors working for us. There are certain ones that respond to the low load stretch from the cup allowing the brain to help relax that area. Other receptors respond to vibration or fast rubbing, such as to massage or use of a “Theragun”.

What does cupping therapy look like?

Now that you have an idea behind the physiologic benefits of cupping, you may be asking: what does the actual process of cupping look like? Depending on the area and type of cup being used, the procedure can be a little different. My rubber cups look kind of like a plunger with a little rubber knob on top. I place the cup over the area I am working on and press the top down to create a vacuum, or negative pressure, and therefore create a good seal. Once in place, I often have the patient complete a movement to mobilize the muscle under the distracted or stretched layers of skin and fascia above.  I also use plastic cups that require a hand-held tool that basically attaches to the cup and acts like a reverse pump and pulls air out of the cup and thus suction. These cups tend to be a little more aggressive with the amount of suction that can be applied. I typically use these while the patient is stationary and relaxed while laying down on their back, stomach, or seated.  Typically, I use several cups, again depending on whether it is a large or small area.  The amount of time I leave cups on depends on what I am trying to accomplish with that client. Sometimes it can be up to 10-15 minutes, and other times it’s only a couple of minutes. The longer the cups are applied the more likely there will be some redness or bruising. Now, don’t be afraid of the bruising as it is part of the process and is even believed to play a role in the healing process.  Plus, they say everyone looks good in leopard print.

As you can see, cupping therapy along with other various manual therapy techniques help change how our brain is perceiving an area of pain. We can use these techniques to help a person move with less discomfort while improving the quality of that movement, while ultimately creating a pain-free movement pattern. Because well, that’s the goal. Move more, move often, and move without pain.

Now, I can talk all day about manual therapy, the neuroscience of pain, cupping, dry needling… you get the point. So, here’s my short and sweet: cupping is an excellent technique that when used appropriately can be a game changer for your issues. Is it for everyone? Unfortunately, no, but I have used it safely and effectively for several years and am confident that we can find a way to keep you ACTIVE!

By Stephen Worrel PT, DPT, MTC, OCS, FAAOMPT