CUPPING THERAPY FOR CUPPING THERAPIST....

cupping therapy

1. WORKSHOP ON CUPPING THERAPY Dr. Azmath Khan Physiomatix

2. What is cupping therapy? How can I utilize in my practice ? How can I convince my patient for cupping therapy ? How can I generate remuneration using this? How good clinician will I be utilizing this? Dr. Azmath Khan Physiomatix What I am going to learn here?

3. Cupping therapy is one of the oldest and most effective method of alternative medicine. It involves the application of hollow cups on the patient’s body by creating a local suction on the skin. When hollow cups are applied on the skin with the help of a vacuum, a negative pressure is created which in turn produces effects on the myofascia. Dr. Azmath Khan Physiomatix What is Cupping Therapy?

4. There are 3 major physiological responses with cupping: NEGATIVE PRESSURE VASODILATION ENHANCED FLUID EXCHANGE in blood, interstitial fluid and lymph. The combination of these responses allows some incredible reactions to take place. Dr. Azmath Khan Physiomatix PHYSIOLOGY OF CUPPING

5. Altering the pain signal processing. Using counter irritation or pain to reduce pain. Stimulating the immune system with artificial local inflammation. Stimulating the increased blood circulation through the release of nitric oxide. Increasing the flow of lymph in the lymphatic system. Decreases uric acid and both types of cholesterol. Dr. Azmath Khan Physiomatix CUPPING AND REVIEWS

6. Changing the molecular structure and function of hemoglobin. Increasing the level of immune products such as interferon and tumor necrotizing factor. Changing the molecular structure and function of hemoglobin. Increasing the level of immune products such as interferon and tumor necrotizing factor. Dr. Azmath Khan Physiomatix Contd.

7. Dr. Azmath Khan Physiomatix PARTS OF CUP

8. Dr. Azmath Khan Physiomatix Parts of suction gun

9. Cupping is broadly classified into 2 types. 1. Dry Cupping. 2. Wet Cupping/ Hijama . Methods of cupping: Fire cupping. Massage cupping. Flash cupping. Dr. Azmath Khan Physiomatix Types of cupping

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11. It involves creating suction by placing the cups on the skin with the help of a vacuum gun. The cups vary in sizes and shapes (6 size of cups ) The most commonly used are the plastic cups followed by bamboo, fire, silicone, bronze. In the ancient days, horn were used for cupping which later got replaced with plastic cups. Dr. Azmath Khan Physiomatix Dry cupping

12. This type of cupping can be given to sensitive patients on their first session, for facial toning, geriatric and pediatric population. It doesn’t leave any marks. Half a vacuum gun pull is applied to achieve weak or light cupping. It can also be given to patients with muscle tightness and pain due to neurological origin. Duration : 10-12 minutes . Dr. Azmath Khan Physiomatix Light cupping

13. This type of cupping can be done for pain, trigger point release and while performing sliding or massage cupping . 1-2 full vacuum gun pull is applied. It leaves a light mark which fades off in 2-3 days. Duration : 5-8 minutes. Dr. Azmath Khan Physiomatix Medium cupping

14. 2-3 full vacuum gun pull is applied. This type of cupping can be done on the bulky areas of the body to reduce pain in the areas with huge muscles (gluteus, back ). This should be avoided on face, pediatric and geriatric population. This leaves mark which fades off in a week. Duration : 3-5 minutes . Dr. Azmath Khan Physiomatix Strong cupping

15. The process of flash cupping is similar to that of dry cupping except that flash cupping involves quick repeated application of cups with minimal retention. It helps in reducing local congestion and stimulate the circulation over a broader area. This type of cupping can specifically be used for sensitive patients in their first session and to have reduced post cupping marks. Dr. Azmath Khan Physiomatix Flash cupping

16. Hijama is an ancient Islamic practice. It was practiced by prophet Muhammad (PBUH) and he encouraged others to do so. Hijama involves placing cups on the body with a vacuum gun to create a negative pressure after which cups are left on the skin for a few minutes; now the cups are removed, small incisions are made with a surgical blade and cups are reapplied. After a few minutes cup is removed and the area is cleaned . Plastic cups are used in Hijama which should be discarded after every use. Dr. Azmath Khan Physiomatix Hijama (wet cupping therapy)

17. The suction in fire cupping is created by heating the air inside the cup with an open flame, then placing it against the skin. A cotton ball is soaked in 70% alcohol which is used for creating suction. Glass cups are used in fire cupping which is transparent and thus makes it easy to monitor the temperature inside the glass. The cotton soaked in 70% alcohol is clamped by a pair of forceps, lit with a lighter or a matchstick. The flaming cotton ball is then placed into the cup; quickly removed and the cup is placed on the skin. As the air inside the cup cools, it contracts and draws the skin slightly inside. Dr. Azmath Khan Physiomatix Fire cupping

18. By adding fire to the inside of the cup, oxygen is removed (which is replaced by and equal volume of carbon dioxide) and a smaller amount of suction is created by the air cooling down again and contracting. Oil may be applied to create a better seal. After removing the cup it is common to notice a dark patch which is caused because of rupture of the capillaries under the skin, but are not the same as a bruise caused by blunt force trauma. This type of cupping is commonly used for cellulite reduction along with the other cupping techniques. Dr. Azmath Khan Physiomatix contd .

19. Light or medium suction is used in this type of cupping . This is of 2 types ; unidirectional and bi-directional . Application of oil is necessary in this type of cupping. Cups are placed on the skin with a light to medium suction and slowly moved to and fro along the muscle fibers.(this is two directional ). In unidirectional dynamic cupping, cups are placed on the skin; moved in one direction towards the lymph nodes and the cup is taken off. Cups are reapplied with light to medium cupping, again moved towards the lymph nodes . While performing dynamic cupping, always stabilize the area distally with the left hand wherein the movement of the cup should be done with the right hand. Dr. Azmath Khan Physiomatix Sliding cupping/ Massage cupping/ Dynamic cupping

20. Easy application. No bruises are left post cupping session. Light to medium suction is created by the silicone cups. It helps in increasing the blood circulation. This type of cupping is widely used for facial toning, cellulite loss , and relaxation. Application of moisturizer or oil is necessary in this type of cupping before and after the therapy. Dr. Azmath Khan Physiomatix Silicone cupping

21. This type of cupping has a same plastic cups; the only difference is the suction here is created automatically with a suction machine. The process of cupping remains the same, this is preferred for dynamic cupping and Hijama . The automatic suction machine is used for hairy areas of the body. Dr. Azmath Khan Physiomatix Automatic suction cupping

22. Needle cupping is a combination of Dry cupping and Dry needling. It can be practiced only when both Dry needling and Dry cupping is known to the practitioner. It starts with palpation, inserting an appropriate needle on the trigger point above which the Dry cup is placed. This type of cupping has additional benefits and faster results when treating a trigger point along with an associated muscle spam or a tightness. Dr. Azmath Khan Physiomatix Needle cupping

23. The electrodes are connected to the cups and the same is applied on the patient’s body with the suction created manually by the vacuum gun. It can be used with TENS.. The effects are same as that of the modalities except that there are additional benefits of cupping which in turn gives faster results. Dr. Azmath Khan Physiomatix Electro cupping

24. Musculoskeletal conditions are the second largest contributor to disability worldwide with low back pain being the single leading cause of disability globally. Musculoskeletal conditions and injuries are not just conditions of older age – they are relevant across the life-course. Between one in three and one in five people live with a painful and disabling musculoskeletal condition. Dr. Azmath Khan Physiomatix Cupping in MSK conditions

25. Promotes overall skeletal muscle health. Promotes lengthening of tight muscles. Encourages lymph movement. Stimulates Peristalsis. Supports body temperature regulation. Dr. Azmath Khan Physiomatix HOW CUPPING AFFECTS SKELETAL SYSTEM

26. Promotes muscle recovery . Relieves inflammation. Work proximal to the affected area in case of acute inflammation and on the affected area in chronic inflammation. Works with limited range of motion by offering tissue hydration and lifting up the restricting structures. Dr. Azmath Khan Physiomatix

27.  Uncooperative patient  DVT  On the pulsating areas  Directly over an ulcer/ Open wounds  Cannot give consent due to age, language or cognitive  Pregnancy  Hemophilia  Pacemaker  Medical emergency Contagious skin conditions ( eg : Chicken pox, herpes blisters, unknown rashes etc.). DO NOT apply over bulging or herniated disc. Avoid cupping on fracture sites (4 weeks). Avoid scraping cups over any bones; this can be painful; also avoid moles or skin tags as this can tear the tissue. Dr. Azmath Khan Physiomatix CONTRAINDICATIONS

28.  Any pain due to musculoskeletal disorders.  Muscle spasm/ tightness/ stiffness.  Trigger points.  Reduced blood flow  Swelling and edema/lymphatic drainage.  Restricted ROM  Arthritis both osteo and rheumatoid.  Ankylosing spondylitis. Dr. Azmath Khan Physiomatix INDICATIONS

29.  Cupping therapy is relatively safe. The side effects are infrequently reported but not rare.  Skin rupture  Blister  Ecchymosis, swelling  Ice burn  Occluded circulation  Blood pressure fluctuation, fainting Dr. Azmath Khan Physiomatix ADVERSE EFFECTS

30.  Increases blood circulation  Decreases pain  Relieves muscle spasm  Increases flexibility  Removes toxins from the body - Hijama  Helps in cellulite reduction  Activates lymphatic system  Improves micro circulation  Boosts collagen production  Opens and shrinks the pores  Reduces stretch marks and scars  Activates the immune system Dr. Azmath Khan Physiomatix BENEFITS

31. Dr. Azmath Khan Physiomatix What to expect after cupping?

32. Trigger point It increases the circulation (similar to ischemic compression but with a more direct approach) and reduces the mechanical tension associated with the trigger point. Breaking down of the pain-spasm-pain cycle by flushing out the metabolites further helps in trigger point deactivation. Dr. Azmath Khan Physiomatix THERAPEUTIC EFFECTS OF CUPPING THERAPY

33. The negative pressure brings fluid from circulation to tissues. Increased fluid in the myofascia aids in better movement. The myofascial decompression breaks down micro adhesion and aids in stretching of the tight areas. EX: Upper trapezius in chronic neck issues. The separations of the layers result in better sliding of different layers of muscles. Cupping also reduces muscle spasm by both mechanical effects as well as neural stimulation. The combined effects of cupping can produce better activation of the muscle and improved performance. Dr. Azmath Khan Physiomatix Effect on muscle

34. Nervous system Mechanoreceptors are stimulated by cupping. It produces analgesia and inhibits muscle spasm. Activation of ANS can produce local as well as generalized relaxation. Circulation The areas cupped gets improved circulation in terms of both blood as well as lymph. Dr. Azmath Khan Physiomatix

35. Scar tissue Cupping expands the contracted scar tissue and increases the local circulation, the local circulation which helps in formation of stretchable collagen; alignment of the collagen can be achieved with dynamic cupping therapy. Skin/non contractile soft tissue Changes in stretchability of the collagen tissue produces improved texture of the skin and reduces wrinkles. The immediate hyperaemia is beneficial for the health of the skin and other soft tissue. Negative pressure improves the health of the pores and regulates oil production. Many observers have reported toning, rejuvenation and lifting of the skin following use of cupping therapy. Dr. Azmath Khan Physiomatix

36. Pain modulation A beta primary afferent receptors travel to higher centers via dorsal column. At the same time the A Beta nerve fibers inhibit the cells of substantia gelatinosa of rolando (SGR) and block the transmission of pain. This is known as segmental modulation. The fast A Beta fibers of dorsal column also give collaterals to peri aqueductal gray matter (PAG) of mid brain. PAG in turn activates nucleus raphe magnus (NRM) to medulla which stimulates ST cells and inhibits SGR. Dr. Azmath Khan Physiomatix

37. Reflex inhibition : “head zones”- Reflex paths from skin to organ : British neurologist Henry Head discovered that reflex path exists between the body’s surface and vice versa. He realized that patients with gall bladder disorders tend to be particularly sensitive to pain at the costal arches and at certain regions on the back. Kidney patients experience skin and muscle pain in the lower back on the affected side or frontally in the area around the bladder. Henry head discovered that the painful and hypersensitive skin areas almost always lie on the same side of the body as diseased organ. These observations led to the discovery of cutivisceral reflex . Dr. Azmath Khan Physiomatix

38. Nitric oxide theory Ferid Murad and Robert F. Furchgott who discovered nitric oxide were awarded the noble price of medicine in 1998. The substance is very important substance released in the body from any trauma and released also during and after cupping therapy. The functions of nitric oxide are vasodilation; this gives more blood to the areas (has 2-way vasodilation effect) muscle relaxation which cures muscle spasms and anti-thrombotic which protects the blood vessels from thrombosis . Dr. Azmath Khan Physiomatix

39. Changes in immune system Cupping produces minor injury and subcutaneous bleeding. This is reported to have immunomodulatory effects. Dr. Azmath Khan Physiomatix

40. Patient preparation Explanation and consent Patient positioning and exposure according to the area to be treated, draping the other areas. Ask the patient to shave the area to be treated if required Adequately moisturize the area to be treated. Dr. Azmath Khan Physiomatix CUPPING PROCESS

41. Tray. Gloves. Oil. Cotton. Antibacterial solution (if required). Cups and vacuum gun For fire cups - lighter, forceps, alcohol solution, fire cups, gloves, oil, cotton, antibacterial solution. Dr. Azmath Khan Physiomatix Cupping apparatus preparation

42. Moisturize the area to be treated and place the cups on the targeted area. Attach the vacuum gun. Now according to light, medium or strong cupping apply the suction. Let the cups stay for a few minutes then remove the cups by loosening the nozzle at the top. Dr. Azmath Khan Physiomatix Procedure for dry cupping

43. Apply oil adequately. Apply cups on the targeted area with a light or medium suction(strictly not to use strong cupping), now pull the cup slowly with your right hand whereas use your left hand to stabilize the skin of the starting point of cupping. Move the cups to and fro or draining it in the lymph nodes. Dr. Azmath Khan Physiomatix Dynamic/massage/ moving cupping

44. Apply oil adequately. Carefully take a cotton swab and use a forceps to dip in the spirit. Now ignite the cotton with a lighter (keep the alcohol solution away from the bed), create suction in the glass cups using this and apply the cups on the targeted area . Dr. Azmath Khan Physiomatix Fire Cupping

45. Number of cups :- Depends on the area of concern and type of cupping. When treating shoulder 6-8 cups, neck 5-6 cups, large areas like back 10-12 cups or as required, calf 3-4 cups. When using dynamic cupping only one cup is used and for static cupping multiple cups can be used together. Size of cups :- Size of the cups depends on the area to be treated. Larger cups gives much better and uniform suction whereas smaller cups gives sensory stimulation . Frequency :- One session in a gap of 2-3 days is preferable but cupping can still be done daily or on alternative days if treating different areas and different types of cupping. Dr. Azmath Khan Physiomatix DOSAGE

46. Duration :- Static cupping -5-20 minutes Dynamic cupping – 2-5 minutes Flash cupping – 2-5 minutes Fire cupping – 5- 15 minutes Number of sessions :- 5-10 sessions Dr. Azmath Khan Physiomatix

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