The Use of Cupping Massage in Musculoskeletal Medicine

The Use of Cupping Massage in Musculoskeletal Medicine

Cupping has been practiced in most cultures in one form or another throughout history but the true origin of cupping therapy remains uncertain (Qureshi et al 2017). It is a technique where a vacuum is created in a cup, drawing the skin up and decompressing the layers of the epidermis and subcutaneous superficial fascia. 

Cupping massage is a modern version of a traditional therapy, frequently carried out using plastic cups and a manual hand-pump to create the vacuum. The vacuum draws the soft tissue perpendicular to the skin, providing a tensile force, which can be left in one site or moved along the tissue. The practitioner can control the intensity of the desired suction from 80 mmHg to 250 mmHg.

The biological mechanism and clinical effects of cupping are still not well researched, the skin, subcutaneous tissue and fascia are all embedded with mechanosensitive nerve fibers, so the application of cupping invokes a number of neurophysiological responses (Chen et al. 2017).

The most common sites of application are the back, chest, abdomen and hips. The cups are typically left in place for 5-15 minutes depending on the client’s reaction and sensitivity. To cover a wider area, cupping massage can also be used with varying amounts of suction.

Why Does Cupping Work?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neurodynamics, contextually aided recovery, neuromodulation and mechanotherapy.

Is Cupping Safe?

Cupping is generally considered a safe therapy with minor side effects such as erythema, edema, and ecchymosis in a characteristic circular arrangement. The longer a cup is left on the skin and the higher tensile stress inside of the cup, the more of a circular mark is created this is due to capillary dilation. Cupping encourages blood flow to the cupped region (hyperemia), often the patient may feel warmer and/or hotter as a result of vasodilatation taking place, slight sweating may occur.

Summary

Cupping is a technique where a vacuum is created in a cup, drawing the skin and subcutaneous superficial fascia up into the cup. The use of cupping originated as early as 3000 B.C.E in a pre-scientific era and much of the reasoning once used to explain the effects do not make sense in the light of what we know today. Anecdotally cupping is used to alleviate pain, whether cupping works via a placebo effect, counter irritation or mechanotransduction are all up for discussion.


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Bialosky, J.E., Beneciuk, J.M., Bishop, M.D., ... George, S.Z. (2017). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/29034802

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Ge, W., Leson, C., Vukovic, C. (2017). Dry cupping for plantar fasciitis: a randomized controlled trial. J Phys Ther Sci. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/28603360

Lowe, D.T. (2017). Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health. Complement Ther Clin Pract.
https://www.ncbi.nlm.nih.gov/pubmed/29122256

Qureshi, N.A., Ali, G.I., Abushanab, T.S., ... Al-Bedah, A.M.N. (2017). History of cupping (Hijama): a narrative review of literature. J Integr Med.
https://www.ncbi.nlm.nih.gov/pubmed/28494847

Rozenfeld, E., & Kalichman, L. (2016). New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of Bodywork and Movement Therapies.
https://www.ncbi.nlm.nih.gov/pubmed/26891653 

Wang, Y.T., Qi, Y., Tang, F.Y., ... Sun, H.T. (2017). The effect of cupping therapy for low back pain: A meta-analysis based on existing randomized controlled trials. J Back Musculoskelet Rehabil. 
https://www.ncbi.nlm.nih.gov/pubmed/28946531