Cupping as a Modality

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Following the 2016 Summer Olympics, myofascial decompression is all the rage

Many stayed up late watching the nonstop coverage of the 2016 Summer Olympics in Rio de Janeiro. We heard about the winners, the losers and the amazing feats of physical athleticism.

But what was even bigger than Michael Phelps’ 21st gold medal? What is the hottest talk in the rehabilitation world? The answer is “cupping.”

Professional athletes work their bodies non-stop. Preparing for an event of this nature, in addition to game-day performance, cool-down and maintenance of one’s fitness level, can take a lot out of them.

We live in a very physical world, and even our jobs require some level of fitness to get through the day unscathed and injury-free. We often think of athletes as the ones needing treatment, but day-to-day jobs can lead to overuse and strain that might need some TLC.

Myofascial decompression (MFD), otherwise known in Traditional Chinese Medicine (TCM) as “cupping,” is all the rage right now. It’s been on every news channel and has gone viral on social media. It leaves its mark, so it shows that an athlete was the lucky recipient of the this trending technique.

What exactly is cupping, and why do athletes wear those bruises so proudly?

TCM focuses on “chi” or energy pathways (meridians) in the body. Cupping is used to help the body and organ systems operate and feel better by unblocking stagnant chi along the meridians. An area of stagnation along the meridian correlates with an organ or system dysfunction. The darker the color under the cup the better, as it is unblocking and moving energy into that area of dysfunction to help heal it.

MFD has turned TCM into a western form of medicine. MFD incorporates this treatment, but also focuses on the more anatomical aspects of the human body. MFD targets mechanical connective tissue change, trigger points, myofascial tissue, scars and postural issues. It also incorporates movement patterns and neuromuscular re-education. Goals of MFD are to release and reorganize soft tissues, restore movement, improve circulation and reduce the perception of pain.

MFD involves the use of cups (glass, silicone or plastic), a hand-held pneumatic pump (TCM uses a flame, heat or lighter) and instrument-assisted soft-tissue mobilization (buffalo horn, metal or plastic). Cups are placed on the skin with a negative pressure, which allows them to pull up on the underlying skin. This is the “decompressive” nature of the treatment, as it creates a lift and reduces the pressure of the tight overlying tissues.

Superficial blood vessels might break, and fluids are drawn to the area, hence the bruising effect. This is not always necessary, however, as it depends on the assessment of what is needed and the application of the cups. TCM aims for the bruising after-effect; MFD aims for fascial re-organization and restoration of movement.

There are multiple types of application for MFD, including static, gliding and with range of motion. The physical therapist should assess the patient’s condition and trial a technique. The findings of the evaluation determine what type of application might work best.

Treatment concludes with flushing the area of excess fluids using instrument-assisted soft-tissue mobilization. Icing is avoided for up to two hours after treatment. Cupping marks can last 7-10 days, so clinicians should receive consensus from clients before therapy.

The area just inside the cup and around the rim generates the highest forces, so application can be painful but does not have to be.

Neuromuscular re-education must occur after this treatment, especially if administered in conjunction with a range-of-motion activity. Cupping will restore mobility and reduce pain, so subjects must retrain movement patterns and restore stability in the area.

Cupping in TCM has been around for thousands of years. Given its popularity at the Olympics, there is sure to be an uptick in continuing education seminars, treatments and research.

Though there is not a lot of evidence yet, the treatment has already been around for several years and is in use in rehabilitation clinics.

During the 2008 Olympics, kinesiology tape gained significant popularity for mainstream use, and there was an increase in educational seminars (albeit with a lack of solid evidence) after it was seen on Olympic athletes. Clearly, MFD has been approved for use by the U.S. Olympic Training Centers, and it will probably continue down the same path.

Either way, patients do feel better after treatment. If the perception of pain goes down and patients believe it works, cupping will probably become the next lasting new-age treatment to be found in rehabilitation clinics around the world.

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About Author

Karena Wu, DPT, MS, COMT, CSCS, CKTP, CPI, FMS & SFMA

Karena Wu is president of ActiveCare Physical Therapy in New York City, and member of the Association of Volleyball Professionals (AVP) medical board.

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