Cupping and Movement Together
By Paul Kohlmeier, BPE, RMT, R.Ac., Cupping Canada
For well over a decade, I have been using Cupping Therapy in my practice after learning about the technique in Chinese Medicine school. It wasn’t a big focus of the class, moreso, it was taught as an add-on for Acupuncture treatments with some therapeutic value in and of itself. One of the primary indications that we were taught for cupping was muscular tension and pain, which interestingly enough, is exactly what patients in my Massage Therapy practice were looking for relief from! While the focus from a Chinese Medicine practice was mainly on the use of fire cupping, we were also exposed to vacuum cups - the polycarbonate (hard plastic) ones with the little valves on the top. These were presented as being much safer to apply as there could be no accidental burns or broken glass - perfect for my Massage practice. After checking in with my liability insurance carrier, I learned that it was not a problem to add Cupping Therapy into my Massage practice as long as I kept within the scope of practice for Massage Therapy.
I often analyze my protocols for dealing with my patients. I want to know if I am effective, how patients think about the treatments I provide and how I interact with them. When it came to Cupping, I was taught to place the cups on the patient, leave them stationary in one place and let the vacuum do all the work. That approach worked well for some of my patients, however through feedback I came to realize that some of them felt they were not getting enough hands-on time while the cups were being left stationary. So, I began researching other types of Cupping Therapy that could benefit my patients while also providing them with more of the hands-on work that they were coming to my clinic to receive. This is when I started adding in some dynamic patterns of Cupping by moving the cups around on the patient’s body. This quickly took care of the negative feedback from my patients - a step in the right direction!
A few years later, while working with a patient, I wasn’t getting the results that we thought we could achieve for their overall treatment goals. I had been doing strictly massage with this patient and was thinking about adding Cupping to the treatments to see if we could overcome the plateau that we had reached. I had watched a video on social media where a personal trainer had placed cups on themselves and then went through some ROM exercises – an interesting concept! Up to this point, I had done some passive patient movement while Cupping, similar to what we do with myofascial work - pin a muscle/attachment/fascial line and stretch the limb away from it. Rather than grip tissue with my hand, I decided to use a cup to grip the tissue and then moved the cup away from the limb as I moved a joint passively. This ended up providing some amazing results and got me wondering what would happen if I got my patient to actively do the work instead of the cup?
I went through my regular treatment with the patient - including the normal assessment and reassessment process and not much had changed…we got to roughly the same plateau. I had allowed some extra time for this treatment and with my patient’s consent, I placed the cups and had the patient move and then removed the cups. I then reassessed again and we both looked at each other in surprise…they moved through their previous limit by a long shot! With such mind-blowing results, I wanted to be able to explain this and set out to undertake more research on Cupping combined with movement.
I would love to say that the research had observed this very thing and that the answer was there waiting for me. This, however, was not the case. In fact, Cupping and movement is barely mentioned in the available literature. In fact, there is not a great deal of research done on this mode of therapy period, even though it has been around for 3500+ years! There is, however, a growing body of research on manual therapies in addition to the neurological consequences of manual therapy and exercise. Let me introduce you to some of the ideas of how I explain this to patients and to colleagues.
First of all, there is some research that indicates Massage Therapy achieves good results and that Massage Therapy combined with movement therapy achieves better results. For an introduction to the research, take a look at the references cited below in the Bibliography. (H Negahban, 2013), (Preyde, 2000), (S Toprak Celenay, 2017)
So, it isn’t really a very big jump to ask our patients to move while we are doing a treatment. Some therapists do this already in manual therapy - we use our hands to pin a spot of tissue and then ask our patients to move a limb that is connected to that tissue. This seems to provide quick relief to the tension and discomfort that our patients are experiencing. My theory based on the research available is that the increase in neural information via the skin receptors is novel and safe as we are controlling the movement and the patient feels supported. Paul Ingram of painscience. com wrote, “If massage works, it’s mainly because of the neurology of touch…”. (Ingram, 2018) If we affect the brain when we treat, it is possible that there is a larger effect when we can get more information through to it.
Cupping with movement seems to increase the speed at which the tissue changes. It is likely a neurological effect, and I am interested in seeing where the explanation in science takes us. Until then, let’s get our patients moving while Cupping and see what happens!
Canadian RMT Conference
References: H Negahban, S. R. (2013). Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clinical Rehabilitation, 1126-36. Ingram, P. (2018, July 18). Does Massage Work. Retrieved from painscience.com: https://www.painscience.com/articles/does-massage-work.php#sec_scientific_case. K Mealy, H. B. (1986). Early Mobilization of Acute Whiplash Injuries. British Medical Journal , 656-7. McKinney, L. (1989). Early mobilization and outcome in acute sprains of the neck. British Medical Journal, 1006-8. Preyde, M. (2000). Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Canadian Medical Association Journal, 1815-20. S Toprak Celenay, B. A. (2017). A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial. Rheumatology International, 1799-1806.