read a Western physiological explanation describing how cupping works brings a smile to this Eastern paradigm instructor’s face.
My years of teaching this material, getting scrutinized by peers, presenting what many peers called snake oil and then witnessing science describe how acupuncture and cupping create true physiological effects is gratifying and validating.
The archaic Eastern-versus-Western medicine debate is moving aside in favor of integration of health perspectives from both sides of the Atlantic.
A Popular Modality
Cupping has seemingly become a new gotta-try-it therapy, yet this therapy has existed for centuries. Just as hot stone therapy became the must-try massage add-on of the 1990s, the conversation about cupping has flourished in the massage industry.
Cupping has become a modality of choice for many massage therapists. Cupping has captivated the imagination of clients and therapists alike. Images of Olympic athletes with the circular markings upon their bodies, for example, had people buzzing about cupping therapy. Demonstrations have been shown on television about how this therapy worked.
After the 2016 Olympic Games, my school received at least five inquiries a day by therapists who wanted to know where they could learn cupping, and I heard similar stories from my peers in massage education.
“Cupping is a great therapy when practiced by somebody who has had proper training in how to safely and effectively utilize it,” said acupuncturist Nicole Berrios, who practices in Phoenix, Arizona. “As an acupuncturist, I love seeing therapies like cupping becoming more popular.”
As with any advanced technique, proper precautions must be taken when performing massage cupping to ensure client safety—and keep the therapist free from liability issues.
In the months after the Olympic Games, for example, I saw several clients who had developed scar tissue from improperly performed cupping sessions, which featured scar tissue. I performed techniques such as myofascial release, transverse friction and multi-directional friction to alleviate the scar tissue. I also educated clients about cupping and decided to write this article for you, the massage therapist, to start a conversation around cupping in our field.
“I personally feel that so long as one has proper training, any practitioner should be able to provide this service, including massage therapists,” said Berrios. “The more trained practitioners who can provide cupping, the more this benefits the [client] as they have will have more options available to them.”
A Brief History of Massage Cupping Techniques
Cupping was devised in China and based upon material in a text called A Handbook of Prescriptions for Emergencies written by Taoist herbalist Ge Hong in 300 A.D. This manual provided early explanations of massage cupping techniques to decongest chi blockage and open up the body’s meridian pathways.
In theory, cupping works by way of creating a vacuum, or suction, force to draw blood to the skin surface. This force impacts dermal and subcutaneous blood vessels. With acute injurious tissue these vessels will tend to dilate, causing a redness, or erythema, to occur. With tissue that is chronically injurious, the region becomes a purple color as blood stagnates in this region.
Some cupping therapists say blood vessel dilation draws toxins to the skin surface to be released from the body through the skin. Since blood is said to be the conveyer of chi in traditional Chinese medicine theory this fits the Chinese medicine mode of healing practices.
Other cupping therapists explain the therapeutic benefits from a Western physiological standpoint, indicating that increasing blood supply locally helps increase oxygen delivery and metabolic waste removal.
Hyperemia benefits tissue restoration and healing, especially with the negative pressure force created, and negative pressure force will help create space among the underlying subcutaneous tissues. This increased space will allow for more fluid exchange and expedite healing.
Since this practice stems from traditional Chinese medicine, a sound background of theory pertaining to this medicine practice seems congruent to effective practice. (Acupuncturists spend at least four years in their schooling to thoroughly understand all aspects of traditional Chinese medicine, including performing cupping. What surprises me most about the recent wave of cupping training is the lack of traditional Chinese medicine insight provided.)
Many massage therapists are learning cupping by watching online instructional videos. I am often asked by massage therapists, “I just purchased a cupping set, I don’t want to attend a class, do you know of a video I can watch online for free to learn how to use these cups?” These inquiries concern me.
There are two concerning trends among many massage therapists in learning cupping: a) not attending a formal class in how to perform cupping therapy safely; and b) an online class not adequately preparing a therapist unskilled in Chinese medicine how to best use this massage cupping technique.
8 Types of Cupping
Of the eight types of cupping, just three—massage cupping, vacuum cupping and facial cupping—are within the legal scope of practice of massage therapists. (However, before offering any type of cupping, check your local and state laws.)
Here are the types of cupping being used today:
1. Fire cupping employs the usage of either a cotton ball soaked in alcohol or simply alcohol alone to create a flash fire within the cup. The fire and heat are quickly eliminated before cup inversion is performed. This intensifies the negative-pressure force.
2. Dry cupping uses cups to create a vacuum over the skin. A combustible material such as moxa or alcohol is lit, placed into the cup, then inverted over the region. The hot-to-cold effect creates a vacuum affecting subcutaneous tissue. Skin is then allowed to rest for 10 to 20 minutes. To avoid burning the skin, a therapist must quench the flame immediately.
3. Wet cupping begins similarly to dry cupping with the cup remaining on the skin for three to five minutes. The therapist then makes tiny incisions on the skin to extract drops of blood from the body. In theory, this blood possesses toxic elements that need to be eliminated. A sterile, antibiotic dressing is affixed to prevent infectious spread.
4. Chinese cupping employs the use of needles, either heated or unheated, to further extract blood and heat from a pathogenic site. The needle may be a traditional single-edged acupuncture needle or more sophisticated multi-pronged, thicker needles.
5. Liquid cupping employs bamboo cups filled approximately one-third with a water-based herbal solution. This solution is said to bathe and cleanse the skin of impurities.
6. Massage cupping mobilizes the cups upon the skin, gliding over various pathogenic regions. Therapeutic massage oil may be placed upon the skin to help the cups glide upon the skin surface.
7. Vacuum cupping, also called air cupping, uses a pump designed to thrust air out of the cup. The therapist sterilizes the selected region, then applies an herbal oil or cream. A therapist may control the thrusting of air out of the cup with a valve atop the cup.
8. Facial cupping is employed in the esthetics and massage fields. The facial skin is prepared with an application of herbal oils or creams. Specially designed glass cups are engaged to stimulate greater blood flow upon the facial structures. In theory, collagen and elastic fibers are restored to aid in a client receiving a more youthful appearance. The skin of the face is thinner; therefore, this method necessitates less suction force.
Standards are Necessary
Cupping embodies a frustration experienced by many professionals in our industry: There are many therapists attending courses to properly use this massage cupping technique; however, there is a sizeable population willing to use cupping with no training or barely minimal training. With no standard of practice established by a governing body, my claim of barely minimal training may seem subjective; after all, the continuing education arena entails a multitude of opinions and perspectives on what barely minimum training really means.
Varying treatment goals will determine the extent of cupping treatment methods performed—and massage therapists must have personal accountability to ensure treatments are employed in accordance with their level of hands-on training.
Online video training has inherent limitations that need to be acknowledged and often includes gaps in learning that a formal teacher fill in.
The trend of therapists wanting to learn cupping highlights a greater issue in a lack of standards to establish safe practice. I believe governing bodies such as the National Certification Board of Therapeutic Massage and Bodywork could aid continuing education teachers greatly by creating national standards of practice in the design of effective and safe cupping classes. It is my sincere hope that educators would welcome the guidance and wisdom of the governing organizations in this manner.
Without such standards, clients will not be guaranteed a safe standard when seeking a cupping therapist. Some clients will receive excellent services with expected physiological reactions. Other clients will have sessions from less-than-adequately trained therapists and present with significant tissue damage.
The ethics of continuing education demand standards to aid teachers in presenting advanced bodywork in the safest manner possible.