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One of the therapies employed by practitioners of Traditional Chinese Medicine (TCM), cupping is a powerful, manual technique for breaking up localized congestion. While it does require some additional training, cupping is within the scope of practice for most practicing massage therapists. Armed with expert guidance and a basic understanding of TCM theory, bodyworkers can deliver a deep, therapeutic cupping treatment while giving their hands a respite from the rigors of their profession.

Cupping: Part I

What is Cupping?

Originally practiced to drain toxins from snakebites and skin lesions, cupping began by using hollowed out animal horns to suck poisons out of a recipient’s skin. As more was learned about human physiology, the therapeutic applications of cupping were applied to an increasing number of health conditions. Accompanying the progression of this therapy, the cups originally crafted from horns evolved to bamboo, then glass and sometimes plastic.

Records have proven that ancient cultures of China, Greece and Egypt regarded cupping as a medical practice as early as 28 A.D. Over the years, practitioners have relied on cupping’s strong suction to increase circulation for:

  • Tightened or painful muscles
  • Sprains or strains
  • Pinched nerves
  • Lung congestion
  • Menstrual irregularities
  • Inflamed breasts
  • Lactation dysfunction
  • Gastrointestinal disorders
  • Cough
  • Asthma

Cupping Variations

There are several cupping variations within a massage therapist’s scope of practice:

  • Fire Twinkling Method – The practitioner clamps, then ignites a piece of alcohol-soaked cotton, places the flame into a glass cup, removes it quickly, and then inverts the cup onto the skin. Because the flame consumes the cup’s oxygen, a strong suction is created.
  • Suction Pump Method – Usually composed of plastic, these cupping sets allow the practitioner to use a pump to remove oxygen from the cup, thus creating suction.
  • Stationary Cupping – This is when a cup is applied to a specific, congested location and left there for up to 15 minutes.
  • Running Cupping – This is when plenty of lubricant is applied to a broad area, a cup is adhered to the body, and then moved around without breaking the seal. Massage therapists can mimic several types of massage strokes by working with this technique.

Cupping Theory

Cupping is known for its ability to break up localized stagnation. Cupping is reputed to:

  • Drain excess fluids and toxins
  • Loosen adhesions
  • Lift connective tissue
  • Enhance circulation in stagnant musculature and fascia
  • Stimulate the peripheral nervous system

In terms of TCM theory, the stagnation can be of just about any type: blood, toxins, qi or dampness. The suction created by cupping draws stagnant toxins, heat, energy or fluid out of where it has accumulated and brings it to the body’s surface. Once under the skin, the offending culprit can more easily be eliminated via the body’s waste removal systems.

Based on cupping’s most popular applications, the following conditions benefit from stagnation dispersal. For clarity, this is further broken down by stagnation type:

  1. Blood Stagnation – Injuries, adhesions, menstrual irregularities
  2. Stagnant Toxins – Gastrointestinal disorders, rigid muscles, breast inflammation
  3. Qi Stagnation – Muscular pain, dysmenorrhea, pinched nerves
  4. Fluid Stagnation – Lung congestion, asthma, lactation dysfunction

Once an adhesion or congestion is pulled away from its source, fresh blood, energy and fluids rush in to expedite healing. Besides sparing the practitioner’s hands from demanding physical labor, this dramatic increase in circulation makes cupping a valuable complement to bodywork. By learning about TCM stagnation theories and becoming practiced in the art of cupping, massage therapists have a unique and effective tool to bring their clients closer to their health goals.

Cupping: Part II

Cupping Massage Techniques

More massage therapists than ever are embracing additional complementary approaches for healing. Likely a result of the increasing popularity of massage therapy and, thus, the greater demand for highly trained practitioners, cupping has sparked interest in many massage therapy practices. While there isn’t an abundance of scientific evidence proving cupping’s effectiveness, its ability to promote circulation is well-known to practitioners of Traditional Chinese Medicine (TCM). Bodyworkers wanting to learn more about the tradition of cupping can experiment with the massage cupping techniques described below.

Being familiar with several massage cupping techniques can help a bodyworker confidently include cupping in his/her range of services. Below are ten suggestions for effective massage cupping:

  1. The level of suction for running cupping should be gentler than that used for stationary cupping.
  2. Prior to applying cups for running cupping, administer plenty of oil to the area being cupped to facilitate smooth cup movement.
  3. When moving the cups, the movement should be smooth without the practitioner applying downward pressure, because that would inhibit the suction effect.
  4. The broad area of the back is one of the best surfaces for running cupping. The back can generally accommodate the larger cups.
  5. Imitating a long stroke with the cups can help drain fluid accumulation.
  6. Circular movements with a cup over a specific area can help release stubborn knots, adhesions and other types of rigid tissue.
  7. Applying a diluted essential oil to the skin immediately following running cupping will facilitate its absorption into the tissue.
  8. Long strokes along the ribs can improve ribcage expansion and benefit deep breathing.
  9. Vigorous circling with the cups on the gluteus maximus can help ease certain types of sciatica.
  10. Strong stationary cupping on the Lung Back Shu points can help relieve chest congestion, coughing and asthma.

Evidence

Although the clinical support endorsing massage cupping is sparse, centuries of successful case studies have perpetuated its use. Since cupping falls under the umbrella of Traditional Chinese Medicine, most of the research on this modality has been conducted within a TCM setting.

The variation known as wet-cupping has dominated a majority of cupping’s research, and wet-cupping does not fall under a massage therapist’s scope of practice. Wet-cupping is when the skin is pricked with a lancet, then covered with a cup to draw out the stagnant blood. Bypassing the research on wet-cupping, a couple of clinical trials evaluated massage or stationary cupping in isolation:

  1. Chronic Fatigue Syndrome – Chinese researchers observed the therapeutic effect of multiple, stationary cupping at the back-shu points on participants with chronic fatigue syndrome. By comparing their clinical symptoms before and after treatment with either cupping or acupuncture, the researchers found that cupping’s ability to reduce chronic fatigue symptoms far surpassed acupuncture’s effectiveness.
  2. Senile Dementia – Researchers evaluated the effect of running cupping (massage cupping) on participants with senile dementia. Running cupping was performed over the spine (the Governing Vessel channel) and along the sides of the spine (the Urinary Bladder channel). The investigators determined that running cupping improved dementia’s symptoms as evidenced by increased measures of bodily strength, memories, feelings and movement.

While these two studies represent just a small percentage of a bodyworker’s clientele, the empirical evidence supporting massage cupping has preserved its practice for centuries.

Using cups to massage the body can be incorporated into most bodywork sessions. By learning about this modality and practicing different running cupping techniques, practitioners can add another layer of therapeutic effectiveness to their treatments.

Because cupping gives massage therapists a break from deep tissue work while delivering a powerful therapeutic benefit, it is an ideal supplement to a massage therapy practice. While cupping is a relatively simple practice, there is a lot to learn about this method before mastering it. In addition to the flawless application and manipulation of cups, knowing what conditions it helps most and why cupping works, practicing therapists must know about cupping’s cautions and contraindications.

Cupping: Part III

The therapeutic benefits to massage cupping are far-reaching. However, practitioners who include cupping in their repertoire must log in a significant amount of practice before performing it on clients. In order to assure its effectiveness and maintain cupping’s safety, massage therapists must be extra careful to prevent burns, apply the right level of suction and be familiar with all of the associated contraindications.

Fire Cautions

Because it can provide a strong suction without causing tissue damage, the fire twinkling method is the traditionally preferred method of cupping by many practitioners. Nonetheless, when using the fire twinkling method, therapists must be attentive, quick and agile to prevent burning their clients. The following tips help prevent burns or fire hazards:

  • Protect – Since the practitioners must place the flame into the cup in close proximity to their clients for quick adherence, the client’s skin, hair, clothing and anything flammable (hair product, oils, linens) must be protected from catching fire. Being alert is crucial to providing such protection.
  • Plan – Logistical planning prior to cupping is essential to minimize any fire hazards. Once the flame is withdrawn from the cup, the cup is applied and the flame is blown-out, place the hot, alcohol-soaked cotton ball on a stable, non-flammable surface. Because the flame may not be 100 percent extinguished, practitioners must make sure it cannot re-ignite what it is resting on, or roll off onto something flammable. A wide porcelain bowl on a firm surface (not the massage table) is a good choice.
  • Timing – Choosing the amount of time the flame is held inside the cup can be a fine line between too short and too long. If the lit cotton is in the cup for too short a time, it will not create sufficient negative pressure for suction. If the lit cotton is in the cup for too long, the lip of the cup will become very hot and could burn the client. Until mastery over cupping is achieved, practitioners should always err on the flame occupying the cup for a shorter period of time. If insufficient suction occurs, the process can always be repeated.

Suction Cautions and Contraindications

Whether you choose the fire twinkling or suction pump method to apply the cups, the therapist must avoid cupping’s contraindications and be careful with the degree of suction used.

  • Bruising – While stationary cupping typically causes more bruising than massage cupping, either technique can leave large, unsightly bruises in the cups’ wake. To prevent surprised and angry recipients, make sure to discuss this possibility with your client prior to using this modality.
  • Degree of Suction – Getting strong enough suction is key to cupping’s effectiveness. Although, too strong of a suction could damage the tissue or even create a blister. Cupping’s intensity depends upon the following: the speed the cup is placed on the skin after the flame has been removed, the strength of the flame (certain alcohol burns hotter than others) and the size of the cup. Therefore, practicing the balance between these variables will help the therapist determine a safe cupping routine. Practitioners will find that it is very challenging to obtain suction over irregular angles, thin muscles or on areas with lots of body hair.
  • Contraindications – Just like any modality that strongly invigorates the circulation, there are some situations where cupping should be avoided. Cupping should not be done on a client with a fever, convulsions or cramps, over allergic skin conditions, ulcerated sores or large blood vessels. In addition, cupping is contraindicated on the abdomen or lower back of pregnant women or on those with a bleeding disorder.

Cupping is a relatively simple application that, when done correctly, can relieve many types of congestion in the body. Despite its simplicity, there is a great deal to learn about cupping before it can be safely administered. By reducing fire hazards, preventing burns, practicing timing, informing your client about the potential for bruising, refining your degree of suction and memorizing cupping’s contraindications, therapists are better prepared to add this valuable technique to their massage practice.

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Recommended Study:

Cupping Therapy: A Step-by-Step Approach