“What are those circular bruises on Michael Phelps back?” – said every viewer of the 2016 Rio Summer Olympics.

Cupping is a form of soft tissue mobilization that has technically been around for over 3,000 years. Just recently, a physical therapist at Block Sports Chiropractic and Physical Therapy took a continuing education course through Rocktape® (Functional Movement Taping(FMT)).  Since then, it has been a successful modality in our Smithtown, NY and Selden, NY locations. In this blog, we will discuss what cupping is, how it works on the body, different forms and how it may help you with pain and muscle tightness.

When did cupping start?

Cupping actually dates back to the ancient times, when they used it as a way to cleanse the body and rid the body of toxins. The earliest record is believed to have been in 1550 B.C. when archaeologists pin pointed cupping in hieroglyphics in ancient Egypt. CRAZY! Researchers found evidence stating cupping has been used in history to treat “pains, bites, headaches, infections and other lesions.” Since its beginnings, several forms of cupping have been implemented and used by various groups to get the same result. Today, mostly plastic, silicone, rubber or glass cups are used during cupping treatment, however, back in the ancient days, it is believed that animal horns and metal were used. Also, there used to be a common form of cupping called “Wet Cupping” where small incisions were made and blood was drawn out of body. It is safe to say that at Block Sports Chiropractic and Physical Therapy, we only use dry cupping using FMT RockPods – made from silicone, and use self-suctioning to connect to the skin. Acupuncturists often use a glass cups and flames to allow for sticking to the skin. Both create valuable benefits to the human body.

How does cupping work?

Cupping has been proven to act as a massage and helps to decrease pain, inflammation and soft tissue restrictions while increasing blood flow and relaxation. There are multiple theories about how RockPods and cupping helps the human body.

Mechanical Decompression –

When the cup is connected the body and the skin is “suctioned” to the cup, this allows for what we call decompression. What this means is that the layers of soft tissue below the skin are allowed to separate and glide better on each other. In case you did not know, under the skin falls superficial fascia, deep fascia and muscle tissue. When these tissues are adhered together and moving poorly on one another, it can create trigger points and eventually pain and immobility in that body part. It is important to note too, that every part of the human body is intertwined in fascia and fascial patterns. Therefore, when fascia is not working correctly, it can manifest into a wide variety of not only musculoskeletal issues, but systemic (digestive, cardiac, renal, etc) complications. Cupping allows for the decompression of these layers, especially the fascia, which in turn creates more mobility of underlying structures and subsequently decreases trigger points and pain and improves overall body functioning.

Fluid Pump/Blood Flow Response –

Cupping also plays an important role in improving blood flow to the problematic area. Tight muscles are often correlated to slow blood flow and blood flow restrictions. The vacuum effect of the cupping can help restore blood flow by bringing blood back to the capillary rich fascia. This in fact causes warmth in the area and an influx of healing cells to “clean up” the region. One article states that: “without changes in blood flow, healing cannot take place and any changes are short term.” Therefore, you can see how important the blood flow response during cupping therapy is.

Neurological Response –

If you read any of our previous blogs, you have read about the Pain Gate Control Theory. If you haven’t, I will briefly explain it. The gate control theory states that by providing a non-painful stimulus to the area of pain, the brain is practically “tricked” into interpreting that response rather than the pain. Therefore, the sensory input to the brain is the non-painful provocation, instead of processing the pain. In this case, cupping is the non-painful stimulus that distracts the brain from processing your pain. Another neurological response created from cupping is an increase in proprioception in that area of use. In fact, it has been demonstrated that two-point discrimination improves after cupping technique. This means that the body is interpreting touch and position sense better, allowing the body to perform and heal better.

Chemical Response –

Similar to the above explanation of the blood flow response, the vacuum effect of the cup allows for an influx of various healing chemicals in the body. With the dilation of capillaries, comes a cascade of events eventually leading to the production of enzyme Heme-Oxygenase-1 (HO-1). HO-1 has been found to have antioxidant and anti-inflammatory effects in the human body.

Does it hurt? Is it safe?

Cupping theory should not be painful to the patient. However, it can feel uncomfortable and it has been described exactly how you would expect it to be described – like your skin is being suctioned up by the cup. Sometimes the treatment area can be tender or sore afterward, however, sharp pain and serious complications are unlikely.

Cupping via Rockpods (the product used at Block Sports Chiropractic and Physical Therapy), is very safe. In fact, these silicone cups are the of the safest and easiest cups to use. They eliminate the use of flame, are easy to clean, easy to apply, mold to various body parts and also allow for varying pressure grades. The practitioner can vary between three different pressure grades to make sure the patient is as comfortable as possible during the treatment.

What are the round marks left behind?

To bring Michael Phelps back into the picture, the round marks left behind are believed to be indicative of the amount toxins that were present in the area. As previously explained, the suction from the cup allows for decompression and increased circulation. Consequentially, toxins trapped in the various deep layers are allowed to come to the surface. Therefore, the darker/stronger the color left behind, often correlates with the amount of stress in the region. You may experience soft, pink marks on the skin that disappear relatively quickly. These are just immune/histamine responses from the nature of having a cup stuck to you. These are completely normal and are typically more pink and last longer on those with sensitive skin.

How is it used? What is the protocol?

Here at Block Sports Chiropractic and Physical Therapy, we use cupping as described in the RockPod course. We typically use graded exposure, meaning we start with lighter pressure and fewer cups, and build up to stronger pressure and several cups – all as tolerated by the patient.

There are three grades of pressure: 1) Pre-plunge – the safest/least amount of suction, 2) Plunge – moderate amount of pressure and 3) Inversion – the strongest amount of suction. (order of videos below)

The cups are applied for approximately 30-90 seconds, at max 2-3 minutes. During this time, the practitioner use various techniques. They can either leave the cups as is and let them sit there for the full time, or they can grab onto the cup and use it to find directional restrictions and push through those. Finally, they can also have the patient move through various motions (typically the stretch the tissue that the cups were applied to) to help create greater stretch and soft tissue mobilization.

Research:

We are going to admit that the research and evidence on cupping, especially with RockPods, isn’t the greatest. Not because it proves it wrong, but because there is not an exceptional amount of randomized control trials. However, the research out there is promising. Several articles support its use in diagnoses such as: plantar fasciitis, chronic neck pain, chronic back pain, lateral and medial epicondylitis and tendonitis. Additionally, similar to foam rolling, it can be beneficial prior to and immediately following athletic competition to improve soft tissue mobility and myofascial movements.

Is it right for you?

Cupping can be used for anyone! Especially because of its ability to be graded differently to tolerance, cupping can benefit nearly anyone that walks into our Smithtown, NY or Selden, NY clinics. It can be used for acute pain after motor vehicle accidents (MVAs), patients with chronic neck and back pain, athletes, weekend warriors and even children. We often refrain from using on our geriatric patients, simply because of decreased tissue strength and possibility of blood thinner use. Other suggested contraindications include:

  • Open wounds
  • Bleeding disorders or blood thinner use
  • Vericose vein locations
  • Abdomen of pregnant women
  • Dermatitis or other skin disorders
  • Hernias
  • Congestive Heart Failure or Renal failure
  • Infections

SOURCES:

  • Bently, B. Mending the fascia with modern cupping. The Lantern. 2013; 10(3): 4-23.
  • FMT RockPods Course Manual.
  • Kim JI, Lee MS, Lee DH, Boddy K, Ernsy E. Cupping for treating pain: A systematic review. Evid Based Complement Alternat Med. 2011; XX: 1-7.
  • Lauche R, Cramer H, Hohmann C, et al. The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: A randomised controlled pilot study. Evid Based Complement Alternat Med. 2012; XX: 1-10.
  • Lowe, CT. Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health. Complement Ther Clin Pract. 2017; 29: 162-168.
  • Qureshi NA, Ali GI, Abushanab TS, et al. History of cupping (Hijama): A narrative review of literature. J Integr Med. 2017; 15(3): 172-180.
  • Rozenfield E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of Bodywork & Movement Therapies. 2015; XX: 1-6.