Therapeutic cupping has garnered news headlines recently as a celebrity health and wellness fad—but cupping actually has a fascinating and diverse history.
It is estimated to be roughly 3,000 to 5,000 years old, found throughout countries such as China, Egypt, Bulgaria and North Africa. A common theme regarding the beliefs behind the benefits of cupping is that it provides better energy flow, releases toxins, heals disease, eases pain and rids the body of common ailments such as colds.
The mechanisms through which cupping facilitates these reported happenings—or if they even occur—has been the center of speculation for many years. There are camps of diehard believers, both practitioners and clients, and there are those who believe cupping is completely ineffective and has no valid research to support its claims.
With cupping’s popularity rising into mainstream therapeutic settings thanks to its use by Olympians such as swimmer Michael Phelps, some modern medical researchers are taking a closer look from a different vantage point in an attempt to understand and explain what might be happening physiologically and neurologically during cupping sessions.
Cupping and Pain Science
With any type of touch therapy, whether performed with our hands or with tools, we automatically incite a cascade of chemical, neurological, physical and emotional responses in our clients.
Much of the formal research on cupping has involved its use with athletes, in the area of pain relief. A 2018 research review published in the Journal of Alternative and Complementary Medicine looked at 11 trials involving nearly 500 athletes in various sports, and found a wide variation in conclusions.
“Cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups,” the authors wrote, going on to say they could not make a recommendation either for or against cupping’s efficacy or safety.
In another research study of 50 subjects, published in Complementary Medicine Research in 2017, the authors found that cupping “appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain.”
Cupping research has largely focused on the mechanical effects, with little attention given to the neurological aspects. In recent years, however, pain science leaders such as Lorimer Mosely and fascia researchers such as Robert Schleip have offered a new paradigm of thought to the way we understand our brain’s response to touch.
As it pertains to cupping, this sheds new light on the potential advantages of this ancient practice having a place in modern-day clinics. More than just another method of manual tooling, cupping can offer advantages in the realm of fluid dynamics, neurological effects and mobility because of the decompression it provides. Cupping directly affects the tissue being treated, and creates the potential for a global response by way of influencing the molecular properties of fluid and neurological responses to the external stimuli.
Practitioners of cupping believe there are three main categories of effect:
• Mechanical effects
• Fluid dynamics
* Neuro-chemical effects
The mechanical effects and benefits of cupping are fairly easy to observe and understand. Unlike the compressive characteristics of massage techniques, cupping primarily decompresses tissues and creates space between multiple layers. The mechanical stress created by cupping helps improve the interlayer gliding of tissues starting at the skin, moving through superficial and deep fascia and into the underlying tissues such as muscles, tendons, ligaments or organ structures.
This ability to decompress versus compress the tissue offers a unique method for mobilizing the underlying structures by creating interlayer space for both internal and external glide. Pain mitigation can effectively be applied through static external glide with optimal vectors and continued along a spectrum of progression, such as external glide coupled with passive and active mobilizations and movement patterns. These progressions can also be introduced in the absence of pain in order to influence mobility and movement patterning.
The most recognized effects of cupping are the large, blood-red, bruise-like circles on the surface of the skin. These appear because the vacuum effect between the cup and the skin creates enough negative pressure to draw blood to the surface of the skin.
As we continue to develop a greater understanding of the neuro-chemical effects, the colors of this bruising can actually provide us with valuable details regarding the stages of healing in the underlying tissues. This drawing of blood to the surface is what led ancient practitioners to believe in cupping’s ability to improve blood and energy flow, as well as rid the body of unwanted toxins; this is still widely believed by cupping clinicians and clients today.
Cupping’s ability to create space between the interstitial layers of tissue has a direct effect on the fluid content therein. An increase in molecules such proteoglycans, hyaluronic acid and glycosaminoglycans all contribute to the surrounding connective tissues’ ability to glide, thus improving the ability to mobilize the area being treated as well as improve blood and lymph flow.
Creating a change in fluid dynamics by way of decompression creates an opportunity for therapeutic intervention for clients who might not otherwise be able to tolerate pressure from traditional massage strokes or other treatment methods. It also has implications for tissue recovery methods due to its facilitating greater motility of blood and lymph flow.
The neurological and chemical aspect of touch is an ever-increasing wellspring of information, new understandings, hypotheses and implications for effective treatments.
The neuro-cognitive approach has shed light on the fact that chronic pain results in a disruption in our proprioceptive cognition in relation to the area affected. As a result, this “brain smudging” or “sensory blind spot,” terms coined by Steven Capobianco, DC, medical director for RockTape, causes a degradation of motor control and movement patterning.
We can use the example of the GPS on our smartphones to illustrate this phenomenon of body mapping and brain smudging. If our GPS loses its signal, we can’t navigate very well. The same can be said of the phenomenon of compensational movement patterns, poor proprioception and loss of efficient motor control.
When our brain dissociates from an area of the body due to chronic pain, it’s similar to our GPS losing its signal. That area of the body loses sensory awareness, which has a deleterious effect on how we move and even how we relate to that particular body part.
By using touch, such as cupping, the sensory map is improved, pain is decreased, and body awareness and motor control are improved by providing stimulus to mechanoreceptors underlying the skin. However, touch stimulus combined with functional context such as relevant movement patterns, whether passive or active depending on a client’s abilities, have a greater effect on improving the sensory representation for that area.
Studies have shown that touch therapy also increases the release of nerve growth factor, which aids in rewiring the brain for improved motor patterning and decreasing the loss of proprioception or brain smudge to areas of chronic pain and dissociation.
In regard to the chemical or immune benefits of cupping, enzymatic reactions occur due to the tissue strain to the sub-dermal tissue caused by cupping treatment. When this tissue strain occurs, bleeding just below the surface of the skin occurs, releasing hemoproteins containing heme.
While heme is important for healing, too much heme can actually cause greater tissue injury. As a result, hemoxygenase begins to degrade excessive amounts of heme to buffer any further damage. In this process of consuming heme, hemeoxygenase releases carbon dioxide, biliverdin, bilirubin and iron.
All three of these molecules, in low concentrations, have been found to have positive effects on pain and inflammation. Carbon dioxide in low concentration has been shown to decrease pain at the spinal cord level, and biliverdin and bilirubin have been found to serve as anti-inflammatories, anti-apoptotics and antioxidants.
These findings offer valid speculation regarding the discoloration of the tissue seen after cupping sessions. This discoloration is possibly an indicator of a healing response; the colors are induced by biliverdin and bilirubin, which bathe the tissues as a result of cupping treatment.
Cupping and Sensory Mapping
While the notion of touch used to create better sensory mapping isn’t a new conversation, the introduction of visual cueing is not frequently discussed in the realm of cupping. Often found in therapeutic treatments for amputee clients, visual observation of the applied intervention has been found to increase the neurological and sensory association with that area of the body.
By combining touch, movement and visual observation, we provide a rich environment of feedback for the client’s neurological system to process and re-assimilate back into the motor control system. A tactic as simple as using mirrors for clients to be able to see areas of their back being treated, or having them look at the cups on their skin while they move, can possibly stimulate a faster associative, neurological experience that contributes to their improvement as opposed to the traditional methods of disengagement during the session.
Discovering the Benefits of Cupping
Even though the practice of cupping is thousands of years old, we are still scraping the surface of understanding the intricacies of the science behind it. As with any treatment method, seek out reputable education before offering it as a service.
There is remarkable value in both the traditional insights as well as the emerging science behind all touch therapy. A thorough combination of understanding movement, pain science and the neurology of touch will have a huge impact on the effectiveness of your treatments.
Stacey Thomas, LMT, SFMA, FMS, NKT, ART, CF-L2, has been a movement specialist since 1997, and licensed as a sports massage therapist since 2005. You can usually find her teaching a RockTape class, speaking at national massage conventions or camping with her dog, Charlie.