Cupping therapy

Basics of Cupping therapy for Physical Therapist. Basic Practical Techniques.

1. CUPPING THERAPY Navinderpal Singh Professor Jammu College of Physiotherapy

2. What is Cupping Cupping refers to any natural treatment method in which suction cups are used in therapy. Cupping is one of the traditional treatment methods that do not involve medicinal substances but nevertheless serve as useful weapons in the fight against many diseases or complaints. Applied correctly, the method is harmless and does not cause any adverse side-effects. The results are often fast and impressive because the body reacts within hours to cupping at the proper location. The goal of cupping is to strengthen or activate the organism’s self-healing powers, when these are not able to do so on their own. Cupping stimulates and supports the options that nature has provided the body with to resist disease.

3. "Cupping is a form of alternative medicine in which cups are placed on the skin to create suction. The pressure in the cup is reduced by use of heat or suctioning out the air so the skin and superficial layers are drawn out and held in the cup.” Ancient Chinese practice. Taoist Herbalist: Ge Hong (281-341 A.D.) Animal horns Hippocrates Father of modern medicine.

4. Benefits Mobilizes blood flow to promote healing. Promotes detoxification. Invigorates Qi. Regulates aspects of the autonomic NS. Deep relaxation of muscle fascia.

5. TCM teaches that it is the stagnation of Qi and blood that causes pain and disease. Cupping invigorates local circulation of Qi and blood in the area being treated, resolving swelling, pain, and tension. By drawing impurities to the surface, it removes toxins. From a Western physiology perspective, cupping loosens connective tissue or fascia and stimulated blood flow to the surface. Cupping stimulates tissue relaxation and better cell-to-cell communication.

6. Indications Incontinence OA Nerve Pain Hyper/hypo tension LBP Facial Paralysis Sciatica Shingles GI disorders Asthma Weight loss Respiratory Diseases Pain syndromes Headaches Gynecological Disorders Common Colds Insomnia Acne

7. Contraindications Skin that is inflamed High fever Convulsions Cramping Easy bleeding Pathological level of low platelets Abdominal area or low back area during pregnancy Should not glide over boney prominences Best use is over fleshy areas

8. Technique Various types of Cupping involving different levels of suction, heat and duration. Dry Cupping Wet Cupping • Medicinal bleeding Needle Cupping • Acupuncture • Dry needling Gliding • Massage cupping Cupping is the inverse of massage- cupping draws the skin upwards (massage pushes the muscles downward) which causes a relaxing and relieving sensation.

9. Wet cupping- Muslim world. • Mild suction using cups, left for 3 minutes then remove and make a small skin incision using a cupping scalpel. Gliding- oil used to decrease friction (sometimes medical oils with herbs) • Moxibustion- moxa made from dried mugwort. Use with acupuncture or burned on pts skin.Warm meridian points to promote flow of Qi. Pain control. • It is found that moxibustion alone and with acupuncture may be effective in changing breech presentation of babies by affecting the placental release of estrogen and prostaglandins which leads to uterine contractions thatchange the babies positioning.

10. Steps 1. Flammable substance is placed in a cup and set on fire. 2. As the fire burns out, the cup is places upside down on the patients skin 3. The air inside the cup is cooling which causes the vacuuming effect. 4. This causes the skin to rise and redden as blood vessels expand. 5. Generally left on the skin for 5-20 minutes. *Plastic cups used with suction pump vs. glass cups with fire *Plastic cups are suitable for gliding cupping. They have more control over the amount of suction and are easier to use.

11. Qi "A circulating life force or energy whose existence and properties are the basis of much Chinese philosophy and medicine." • 5 Elements • Cyclic • Create • Destroy • Sickness due to imbalance of elements • Overproduction • Underproduction • Associated with symptoms or traits • Complementary forces not opposing • Everything is composed of both Yin & Yang (ex: shadow) • Health and longevity

12. Yin & Yang Yin • Dark, cool, wet • Earth to heaven • Female • Solid organs • Negative force • Outward movement • Towards periphery • Internal energy Yang • Light, warm, dry • Heaven to Earth • Male • Hollow organs • Positive force • Inward movement • Towards center • Physical body

13. Meridians Yin & Yang determine meridians Associated with body parts/ organs Manipulating meridians has effect on body functions associated with that meridian Qi flows through meridians Used to balance the 5 elements

14. Methods of Cupping Therapy Weak (Light) cupping Medium cupping Strong cupping Moving cupping Light-moving cupping Needle cupping Moxa (Hot Needle) cupping Empty (Flash) cupping Full (Bleeding/Wet) cupping Herbal cupping Water cupping.

15. Weak (Light) Cupping The action of Weak cupping is intended to remove stagnation and at the same time tonify the weak Qi and Blood, and is therefore termed a ‘ tonifying ’ method . The amount of flesh drawn into the cups should be minimal and hardly raised. Weak cupping is the gentlest method of all and is particularly suitable for debilitated adults, elderly patients and young children, especially those under 7 years of age. Light cupping can be applied almost anywhere on the body, and may cause a slight reddening of the skin, rather than a deep, dark cupping mark or blister. Therefore the duration of Weak cupping can be as long as 30 minutes.

16. Medium Cupping Medium cupping can be safely administered to children over 7 years old, as well as to adults. With Medium cupping the suction is firmer . However, there is a real danger of draining the patient’s Qi if the cups are left on for longer than 30 minutes, leaving the patient lethargic. With this method the skin is pulled well into the cup, creating a slight redness as mentioned earlier. If the cups are left on for longer, the redness will turn to dark red or purple, indicating a stronger application.

17. Strong Cupping The purpose of a Strong cupping treatment is to move Blood and Qi and eliminate internal/ external pathogenic factors and stagnation from patients The purpose of a Strong cupping treatment is to move Blood and Qi and eliminate internal/ external pathogenic factors and stagnation from patients A strong vacuum will be produced, giving a strong pulling sensation of the skin inside the cup. Because of the strong nature of the pulling action the skin will quickly turn red, and shortly after turn purple, inside the cup. When using a Strong cupping method for the first time a very dark red cupping mark is inevitable; this can take up to 15-20 days to disappear completely. The cupping time should also be short: between 5 and 10 minutes during the first session. This can be increased up to 20 minutes in later applications. Fine capillaries under the skin can also break relatively easily with strong suction, causing deeper and longer-lasting cupping marks. This is also the only method of cupping that can cause blisters to form rather quickly.

18. The Strong cupping method should be avoided on the face, stomach and abdomen, and on children under the age of 16, the elderly and frail, and during pregnancy.

19. Moving Cupping The object of this treatment technique is to apply Strong cupping therapy to a much larger area of the body by the moving/sliding action of the cup. Oil the skin liberally and apply a single medium-sized and medium-strength cup to the treatment area .Control the suction by gently moving the cup in any one direction. If the suction is strong, moving the cup will be difficult and any attempt to do so will result in extreme pain. Grip the cup with one hand while supporting the skin close to it with the other. Pull and slide the cup alongside the meridian using long strokes. Do not apply short, up-and-down movements as this may cause unnecessary pain. If there is difficulty in moving the cup this is an indication that the suction is too strong and needs to be reduced. The primary objective of Moving cupping is to resolve Stagnation, manipulate the excess pathogens and bring up the Heat to the surface of the skin. After only a few strokes pink/reddish cupping marks will appear alongside the line of movement

20. Avoid using the Moving method on an open wound or lesion, as the skin must be smooth and unbroken. This treatment is not recommended for children under the age of 16, or for the frail and weak. The first treatment should not exceed 5 minutes, building up to a maximum of 20 minutes per session. This is also the most powerful method for manipulating the lymphatic circulation and therefore requires particular attention when dealing with any form of lymphoma

21. Light-moving Cupping It is Moving cupping with much reduced suction power. This technique is considered the only safe method in the treatment of lymphatic drainage, as well as being the exclusive cupping method in the treatment of cellulite complaints . During the application of the Light-moving cupping method, slight pinkish cupping marks appear on the skin, normally following the direction and movement of the cup All Moving cupping techniques require special attention, particularly when there is a broken skin surface, scratches, cuts, bruise marks, open wounds or when skin moles are present

22. Needle Cupping Needle cupping is mostly used for red and painful muscular areas as well as the knee and elbow joints, where there is a need to stop the pain and remove the excess pathogenic heat at the same time. The practitioner should administer the acupuncture treatment/Dry Needle as intended under normal circumstances, leaving the needles in place as long as necessary. One can reduce the acupuncture treatment time by 10-15 minutes if Needle cupping is intended to follow it. Following the acupuncture treatment, leave the needles in position and apply oil to the surrounding skin. Medium and Strong application is necessary if the treatment is over the joints and Weak to Medium if the treatment is over muscular areas. Retain the cups in position for 10-15 minutes. Some blood may be drawn into the cup through the needles; this is quite acceptable, especially if the suction is Strong . This method is not recommended for children of any age.

23. Moxa (Hot Needle) Cupping For acupuncture practitioners only Hot Needle cupping is used open the obstruction and relieve the pain, and moxa is employed to heat the needle and transfer the heat to the acupuncture point in order to warm and tonify that particular energetic point.

24. Empty (Flash) Cupping Empty cupping is also called Flash cupping for its speed during the application. This is actually a Medium to Strong cupping method, but is applied rapidly and the cups remain in place for a very short time, i.e. less than 30 seconds. It is used to stimulate and move the Blood and Qi in the weak and frail. Empty cupping is applied on the back as well as the front of the body, and the technique is simple. Oil the area to be cupped, place up to 12 cups near at hand, light a large cotton wool ball and apply the cups simultaneously Once all the cups are in place, start removing them without delay, beginning with the first to be applied. When all have been removed, reapply them immediately in different positions. This can be repeated for between 5 and 10 minutes. Slight pinkish cupping marks will appear all over the back, but these will fade away within a day or two. This is a favorite cupping method for children. Stress-related emotional conditions, tiredness, low fevers in children or the elderly, feeling cold and feverish in the same group and gastrointestinal problems can all be treated by the Empty cupping method.

25. Full (Bleeding/Wet) Cupping Bleeding technique is employed in order to purge foul blood, which was considered the source of disease, from the body. Leeches were also widely used for the same purpose. Today this method is used in the treatment of a sudden increase in blood pressure, high fevers, Blood stasis, and in discharging pus from boils and furuncles, which represents Excess, with Blood-Heat, Blood-poison and Stagnation. Bleeding cupping is also administered to treat a variety of sports injuries. From this description it can be seen that this method is only suitable for adults with strong, Excess (Shi) energies, and not for children or the elderly.

26. Sterilise the point with alcohol and make a very small incision (0.5 cm or the length of a rice grain) with a surgical blade or, using a Plum-Blossom needle, firmly tap the point for a short time to cause bleeding . Once the point is bled, choose a large cup (size 4 or 5) and apply a Strong cupping method to the point. The blood will quite quickly be observed being drawn slowly into the cup . If the incision is adequate, between 20 and 100 ml of blood can be drawn into the cup. However, if the patient is taking any type of anticoagulant drug this may result in more bleeding. Removing the cup also requires attention and care; refrain from hurrying as this may cause the blood to spill or spray from the cup. Within a maximum of 5 minutes the bleeding should stop.

27. Herbal Cupping For this method one requires a few bamboo cups .These bamboo cups are boiled in water with herb for 30 min and then with same procedure are applied over skin. The herbs are absorbed by the bamboo cups, which in turn transfer their healing properties to the patient. This method is usually employed when external pathogens such as Cold, Damp and Wind attack the body, causing stiffness and aching, particularly in the neck and shoulders (common cold, asthma and cough). Although this treatment is not recommended for children of any age, it is particularly beneficial for the elderly .

28. Water Cupping This is one of the least used and practiced cupping methods.

29. Skin Reactions in Cupping When circulation is sluggish or compromised in an injured or diseased area of the body, insufficient oxygen gets to the cells, and there will be a local build-up of waste products. When the skin is pressed, the blanching that occurs is slow to fade. Suction pulls toxins, pathogenic factors, blood poison, dead lymph and cellular debris from deep within the tissues to the surface. These debilitating agents are then more easily expelled from the body. The deposits dissipate from a few hours up to several weeks, depending on the amount of stagnation and the patients post treatment activities. The quality of the pathogenic factors varies according to the severity of the patient's blood stasis -- which correlates with the nature, severity and type of condition they have. It can appear from a light pink to a dark purple, but is usually a shade of red. Often tiny raised bumps will appear. Sometimes a clear fluid will be drawn to the surface . These are all results of disease and toxins being removed from deep within the tissues . The more discoloration that surfaces – the greater level of stagnation and toxicity needing to be purged from the body. 

30. Side Effects of Cupping Cupping frequently causes marks on the skin. This is due to bringing blood to the surface, similar to a bruise. For patients with  bleeding disorders  such as  hemophilia  or who are being treated with anticoagulants, cupping may not be the best treatment option. People with these conditions should discuss the pros and cons of treatment with their acupuncturist or doctor before receiving cupping. Cupping should not be performed on skin sites with active inflammation,  burns , infection, or open  wounds . Some discomfort can occur but should not be considered a side effect. Moderate, temporary discomfort is expected as stagnation is removed and connective tissue and muscles are loosened. Practitioners (especially traditional Western health-care providers) need to be aware of cupping as a treatment modality. In children, the  bruising  and discolorations post-cupping can be mistaken as a sign of child abuse

31. How long do cupping bruises last? The  bruises  for cupping can last for a few days up to two weeks. According to TCM practitioner Casco, it is expected that over several weeks of repeated cupping treatments the bruising will decrease as the stagnation resolves. This indicates a successful result of a cupping treatment protocol.

32. Myofascial Trigger Points Cupping Therapy A Myofascial TP is a hyperirritable focal point within a taut band of skeletal muscle fibres. On compression, it can evoke typical referred pain and autonomic phenomena. A Myofascial TP is located in skeletal muscle and its associated fascia distinguished from a TP in other tissues such as skin, ligament and periosteum. What Causes Trigger Points? Generally speaking, any action or movement that puts extra load on the musculoskeletal system can be the culprit. Persistent wrong posture while sitting or walking, carrying or lifting heavy loads, accidents, strains, falls, overwork, overuse of a particular muscle group and a stressful lifestyle can all contribute to trigger point formation.

33. The Practical Application of Cupping Therapy on Myofascial Trigger Points During the cupping application a strong, negative pressure is created over the trigger point. This in turn will result in the stimulation of the stagnant Blood or Qi into movement towards the direction of the cup. The negative pressure will also force oxygen-rich blood to flow into the trigger point, releasing the muscular knot/lump. Sometimes trigger points are difficult to obliterate completely, especially when dealing with long-established trigger points. These may require more frequent cupping application, which can be as often as three times per week. Because trigger points are located at the deeper layers of the muscle tissues, a Strong cupping method is often required to be effectual. Typically a single cup is applied to the trigger point, with several additional cups to the borders of the muscular structure or the path of pain. Not all trigger points are suitable for cupping therapy owing to their anatomical location. In these cases other methods of trigger point release should be employed. One of the most suitable and effective types of cupping apparatus while conducting trigger point cupping is the pistol handle cupping set.

34. How to Locate an Active Trigger Point Active myofascial trigger point: A myofascial trigger point that causes a clinical pain complaint. It is always tender, prevents full lengthening of the muscle, weakens the muscle, refers a patient-recognized pain on direct compression, mediates a local twitch response of muscle fibers when adequately stimulated, and when compressed within the patient’s pain tolerance, produces referred motor phenomena and often autonomic phenomena, generally in its pain reference zone, and causes tenderness in the pain reference zone. Latent myofascial trigger point: A myofascial trigger point that is clinically quiescent (dormant) with respect to spontaneous pain; it is painful only when palpated. A latent trigger point may have all the other clinical characteristics of an active trigger point and always has a taut band that increases muscle tension and restricts range of motion. Both types of trigger point share similar physical characteristics: well-defined, tense, palpable myofascial tightness, with a distinct painful nodule when pressed. An experienced tactile therapy practitioner has no difficulty in identifying these tight nodules; as well as feeling taut or tense the patient will always respond and react (sometime with extreme wrench) to the stimulation of trigger points.

35. Trigger point examination Flat Palpation Using the padded aspect of the fingers or thumb and proceeding at a right angle across the muscle fibers while pressing them against the underlying tissue or bone. When trigger points exist taut bands, exquisite, focal tenderness (Trigger Points), and a twitch response will be detected. Pincer Palpation The muscle or muscles are rolled between the tips of the digits to detect taut bands of fibers, to detect exquisite, focal tenderness (Trigger Points), and to elicit local twitch responses. Snapping Palpation Locate a taut band of muscle and place fingertip at right angles. Begin moving your fingers back and forth to roll the underlying fibers under the finger. This is just as plucking a guitar string except contact with the surface is maintained. The purpose of this method is to elicit a local twitch response and is most effective when done near or on the trigger point with the muscle at a neutral length or slightly lengthened.

36. Common Trigger point locations

37. Palpation of Trigger point

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