Cupping has been used around the world throughout civilized times, and this culturally diverse healing modality has yielded therapeutic benefits to countless recipients of all ages.
From coughs and colds or indigestion to stress relief or muscle aches and pains, cups are truly incredible tools whose applications can be altered to bring potential relief to a multitude of ailments.
However, just like any therapeutic tool, there is much to know about client evaluation before choosing what cupping application will work best, both in safety and efficacy. With proper intake assessment and logical application choices, almost every client can receive and benefit from some form of therapeutic cupping, including the geriatric population.
How Massage Cupping Works
Cupping has recently become more popular in the bodywork industry, and massage therapists are enjoying the efficacy of these great tools for clients of all ages. When applied, cupping therapy evokes some primary, physiological responses, including negative pressure, vasodilation and enhanced fluid exchanges. This combination allows for potentially beneficial results from cupping; these are all welcome additions to the massage therapist’s existing practice.
Cupping potentially offers improved circulation, softened muscle tension and tissue mobilization, ultimately improving not only the results for clients, but also easing the therapist’s effort. Just as with any manual therapy, there are some key elements to consider that will ensure the safest, most effective results.
With cupping, it is important to assess the client’s general health, body composition and lifestyle—and someone’s age can naturally affect each of these elements. There are no “one size fits all” applications for cups, and it is especially important to use cups safely and mindfully when working with the geriatric population.
The Geriatric Client
The term geriatric can apply to anyone aged 65 years or older. While this number defines the age group, it by no means dictates protocol in bodywork. Each client should be assessed according to how they individually present, rather than a standard for care delineated by age.
For example, one client who is 66 and has an impeccably healthy lifestyle, engages in vigorous daily exercise routines and receives weekly massage therapy may receive stronger cupping comfortably and with great benefit. Another 65-year-old client may be far more sensitive to cupping due to different body composition, lack of regular bodywork and exercise, and lifestyle choices, so cupping should be less in strength, suction pressure and duration of application.
I have a 96-year-old client, Sophie Tylman (pictured), who received medium-pressure cupping easily during her first session since her body was healthy and strong (for her age). Also, she was very familiar with cups from her childhood.
“My parents arrived in America from Greece in the 1920s,” she said. When I was younger, my grandmother and relatives did cupping often. When I was 9 or 10 years old my grandmother introduced me to cupping.
“Not realizing how it truly worked, I would cup my grandmother when she was in pain, and my mother when she had headaches. I also was cupped by my family until I was about 18 years old.”
The older the client, the more likely it is some common denominators of cautionary evaluation will exist. These include soft tissue considerations, overall health and lifestyle, medical conditions and considerations, and previous exposure to massage therapy and bodywork.
Once the senior client is evaluated, it is up to the therapist to choose the style of cupping that will work best.
Using Cups with Geriatric Clients
Here are some primary elements to consider when using cupping with geriatric clients:
• Soft Tissue Considerations. Our skin, muscle and overall body composition changes as we age. Skin loses tone and elasticity due to collagen and elastin changing, muscle tone diminishing and general body composition declining. With all these combined changes, the body’s soft tissues will not respond to cupping—or massage therapy—the same way it did in a client’s younger years. Therefore, it is imperative to consider someone’s soft tissue integrity when choosing a method of therapeutic cupping.
Cupping lifts and stretches tissue, so the thinner or more fragile the skin, the lighter or less aggressive methods of cupping should be. Without the collagenous support and elasticity younger skin possesses, it is far easier to damage older, more delicate skin due to tissue distortion that naturally occurs with cupping.
Vascular integrity is also a major element to consider. Veins are more superficial than arteries, so it is imperative to be aware of any vascular irregularities. Use caution if considering cupping over any superficially exposed vascular regions, such as the extremities. Furthermore, never use a cup directly over any varicose veins, as this can only worsen an already distorted, damaged vein.
In general, any thinner or seemingly translucent skin indicates an overall delicate tissue environment, so before attempting to use cups, be sure to evaluate the client’s soft tissue and use your best judgment.
If cups are used too strongly or too long on someone with thin, frail skin and muscle tone, bruising—not cupping marks—will occur more easily. It can also be painful to receive and could lead to more potentially adverse reactions, like further tissue damage. Bruising is not a positive result with cupping; and for older clients, bruising can potentially progress into more complicated issues.
• Overall Health and Lifestyle. Diet, hydration, exercise and medical conditions all play a role in evaluating a client; it is equally important to consider these elements with cupping. For example, diet and hydration are major contributing factors to consider. Someone with more hydrated skin and healthy muscle tone will be more positively receptive to the effects of cupping than someone who is less active or dehydrated.
Exercise and physical activity also play a role when choosing how best to use cups for elderly clients. Moreover, previous massage therapy experience will offer additional insight on the best way to approach elderly clientele. The more delicate or restricted the client, the lighter and gentler the cupping should be, if cupping is used at all.
• Medical Conditions and Considerations. In older clients there is the likelihood of medical conditions and associated medications to acknowledge when it comes to client evaluation for bodywork, and this is just as important when choosing to use cups. Taking blood thinners could cause someone to bruise easily, therefore lighter suction pressure or shorter durations of application time should be used for such a client.
Alternatively, any pain relievers could alter someone’s perception of physical discomfort. Applying cups too aggressively could lead to tissue damage, as the client may not be aware of discomfort due to the analgesic effects of medications.
• Cognitive Functions and Mental Awareness are also elements to consider when working with older clients. If a client has disoriented cognitive functions, they may not be aware of any discomfort during their session. It is important to establish verbal feedback cues with the client before beginning, but it is just as important to be visually aware of the client’s reactions to any applied cups.
While verbal cues are best, this is not always easily available, whether the client is prone, possibly hard of hearing, or suffering from cognitive losses. It is important to monitor clients’ reactions at the site of application for any motor responses like twitching or wincing; and when they are supine, you can also pay attention to the look on their face when you use cups.
Recommended Suction Pressure & Cupping Techniques
When choosing the best cupping application for geriatric clients, the two variables to consider are suction pressure and technique of cup application:
• Suction Pressure. Once a cup is applied, it begins taking effect with negative pressure. Even the lightest suction pressure will have a direct effect on all the tissues below it and around it, and often will yield some great results. The stronger the suction pressure, the more the soft tissues are lifted, stretched and ultimately grabbed up into the cup. If someone applies excessively strong suction pressure with a cup, bruising will happen.
Just as a bruise is the direct result of a traumatic impact, so too can a bruise occur if a cup is used incorrectly. Bruises occur from cupping when they are applied too strongly or aggressively as it is a negative pressure, presenting traumatic contact with the body. If done too strongly with older clients, especially, the potential for bruising is much greater.
Be sure to start with lighter suction pressure, progressing to more pressure only when the client’s response is comfortable and welcoming. It is easier to add pressure than it is to take it away, and oftentimes damage occurs when too much pressure is initially applied with cups.
• Cupping Techniques. Stationary cups are the most familiar and standard method of applying a cup, but this application does not work best for everyone. Stationary cups have a strong influence on local blood flow and lymph movement; if someone has poor circulation or issues with fluid retention, a stationary cup may prove to be unbeneficial, potentially harmful.
If choosing to use a stationary cup, perhaps consider shorter periods of retention time. For massage therapists, less than three minutes per single cup application is recommended; any stationary cup applied for longer than five minutes crosses into more medicinal applications of cupping, which ventures beyond the scope of practice for a massage therapist. The active session time of using cups can be longer, but one stationary cup, in one location, at one time, should be used for a shorter length of time to respect not only professional parameters but also the circulatory functions of the client.
Moving cups are great to use, but lighter suction should be applied if soft tissue integrity is poor. If skin is loose, you may need to anchor the skin with one hand as you slowly move the cup with another, or you may not be able to slide a cup at all. However you choose to move a cup, be sure client feedback is positive, with no reports of painful or uncomfortable sensations, as this could indicate tissue damage is occurring.
Lift-and-release is a unique variation of introducing cupping to the body. This technique is especially beneficial for elderly clients who may be pressure-sensitive, or if they might not be comfortable with stationary or moving cups.
This style of cupping involves applying and immediately releasing the cup repeatedly, either in the exact same location, like over a trigger point; over an entire area, like the shoulders; or when traveling along any line of tension where moving cups are uncomfortable, like along the iliotibial band, up the leg. This dynamic technique allows most people to receive benefit from cupping, especially when a stationary or moving cup may not be best suited for them.
Consider Cupping for Senior Clients
Cupping is a wonderful modality that can be enjoyed by almost anyone, at any age. Just as each person ages in their own way, it is important to meet that person where they are, in that moment and point of life, with therapeutic cupping to avoid harm and achieve maximum benefit.
About the Author
Shannon Gilmartin, CMT, has been a massage therapist since 2000, and working with cupping and teaching internationally since 2004. She has been interviewed many times, has published numerous articles, and authored The Guide to Modern Cupping Therapy: Your Step-by-Step Source for Vacuum Therapy. She co-owns Modern Cupping Therapy Education Company.