Orthopedic cupping massage has emerged as a new, distinct form of bodywork.

The practice of cupping has highly evolved since Michael Phelps’ 2016 Rio Olympic cupping marks exploded over the internet.

A growing number of massage therapists have purchased and intuitively used cups in their respective practices over the past five years. What transpired was a bodywork evolution. The playbook of traditional meridian cupping was set aside, and orthopedic cupping massage emerged as a new distinct form of bodywork.

Orthopedic cupping massage stretches and releases soft tissue restrictions, which can create a human domino effect of better tissue metabolism and greater range of motion that can lead to better athletic performance and other health-related benefits.

While stationary cups applied along meridians are still practiced today with Traditional Chinese Medicine (TCM), orthopedic cupping massage provides a new bodywork approach.

Aim for These 10 Points with Orthopedic Cupping Massage

Orthopedic cupping massage can be:

1. Easy to provide for a massage therapist who does not know the body’s meridians.

2. Modified for client comfort.

3. Practiced at a sporting event and other on-the-go settings.

4. Applied as a spot treatment.

5. Effective to stretch soft tissues in an opposite direction from mainstream bodywork.

6. Provided in difficult-to-work areas.

7. Utilized with passive and active joint range of motion.

8. Similar to myofascial skin rolling.

9. Less unsightly than the marks caused with stationary cupping.

10. Exercised within most massage therapy scopes of practice.

Here’s how the 10 points of orthopedic cupping massage work:

1. Practice with Anatomy instead of Meridians

Orthopedic cupping massage is practiced with anatomical references. Superficial soft tissues are stretched and manipulated with cupping movements to improve orthopedic function. Cups are generally moved from a superficial muscle’s origin to insertion and vice versa, in a variety of skillful applications.

2. Vary Pressure and Intensity for Client Comfort

A practitioner can choose from over a dozen skillful massage techniques, such as circling or twisting with the cups, for client needs or comfort. Different techniques have different pressures and intensity levels. Working within a client’s tolerance is essential to successful bodywork, especially when a client is already in pain.

When plastic cups with a hand pump are used, the practitioner can also control the intensity and pressure of the treatment by the amount of air that the practitioner pumps into or releases within the cup.

Between techniques, cup choices and applications, orthopedic cupping massage provides a practitioner exceptional control over how much soft tissue can be manipulated or stretched.

3. Sporting Events and On-the-Go Settings

Orthopedic cupping massage can be applied in different positions and settings beyond standard prone or supine table massage, which may provide greater or easier access for the practitioner as well. Examples include:

• A client who is in severe back pain and unable to climb onto or lie on a massage table could lean slightly forward in almost any chair for a practitioner to work cups up and down the erector spinae of the back.

• An athlete could lie supine on the ground with their lower leg raised over the seat of a chair for orthopedic cupping massage on a shin splint.

• A frozen shoulder client might be more comfortable while sitting in a chair instead of lying on a table.

4. Spot Treatments

Orthopedic cupping massage is most useful when it is applied to chronically tense areas. It puts cups in motion over orthopedic dysfunction such as scoliosis, tennis elbow or frozen shoulder, to stretch shortened and contracted tissues.

5. Stretch Soft Tissue in an Opposite Direction

Orthopedic cupping massage is a great alternative for practitioners who feel stuck with bodywork that is mostly applied in one direction. Most bodywork applications such as neuromuscular therapy (NMT), deep tissue massage or trigger-point therapy would focus on a practitioner applying pressure downwards, into the body.

Conversely, cupping provides reverse suction to pull soft tissues upwards, in an opposite direction. Orthopedic cupping massage additionally requires the practitioner to pull the cups with upwards and outwards movements with their hands, to generate the greatest amount of tolerable stretch to the underlying tissues.

Because orthopedic cupping massage stretches soft tissue in an opposite direction, it can also be used as a warm-up or in conjunction with deeper tissue modalities.

6. Difficult Bodywork Areas

A small cup can also provide extensive work within small work areas, such as the thenar eminence. Orthopedic cupping massage may be the only bodywork where a practitioner would not send their own thumbs to hell while sending their client’s thumb to heaven when working in such an arduous area.

7. Passive and Active Range of Motion Application

Orthopedic cupping massage can be additionally utilized with active or passive joint range of motion. With shin splints, a small cup can massage inferior to superior and back, along the lateral side of the mid to upper tibia. To increase the stretch of the underlying soft tissue, the ankle joint can be actively or passively flexed and extended during this anterior tibialis work.

8. Similar to Myofascial Skin Rolling

The intention in this evolving bodywork is to simply lift and separate the underlying soft tissues, like myofascial skin rolling—both are applied in motion. The difference between orthopedic cupping massage and skin rolling is that the cups can grasp a greater amount of underlying tissue with better comfort for the client than what a practitioner might achieve with their hands alone.

9. Less Cupping Marks and Bruising

Another win for orthopedic cupping massage is a client should have less bruising or marks than traditional stationary cupping applications. A little pinking of the skin is natural when suction or friction movements are applied; however, purposely causing hematomas or sending a client home full of bruises should never be the goal.

A practitioner is likely pressing down instead of pulling up on the cups during movement, performing too much work in the affected area, using too much suction or unnecessarily aggressive techniques if there are excessive marks or bruising during orthopedic cupping massage.

10. Scope of Massage Therapy Practice

Orthopedic cupping massage primarily uses plastic and silicone cups which are within most massage therapy scopes of practice because the client’s soft tissue is constantly being massaged with a tool in movement, which is the cup.

Stationary TCM cupping application with fire and glass cups along meridians are regularly considered beyond a massage therapist’s scope of practice and are not considered to be within a standard orthopedic cupping massage application.

Choosing the Right Cups for Cupping Massage

Investing in a set of cups will always depend on how they are used and for what purpose. Plastic and silicone cupping sets are normally the finest choice for cupping massage practice. Practitioners who are busy or want to provide the best service may want to use both.

The Two Primary Plastic Cupping Sets Available Today

Plastic cupping sets are usually the least expensive option of all cupping materials. The two primary sets of plastic cups that are on the market today include:

Plastic cupping sets that come in a convenient carrying case (manufactured in Korea) and sell for around $40 with online retailers:

• Will usually have air valved cups and a hand pump.

• May only have a limited range of cup sizes.

• Are made of sturdy plastic.

• Are advertised as dishwasher proof with a quick boil to sanitize.

• Plastic cupping sets that come in a box (manufactured in China) and sell for around $25 with online retailers:

• Will usually have air valved cups and a hand pump.

• Usually provide the greatest amount of cup sizes of all, which is one of the most critical factors to provide the best cupping massage. Your clients will come in all forms, shapes and sizes – practitioners will need cups for the same.

• Usually contain two curved rim cups which will allow better suction for rounded areas of the body such as the upper trapezius, forearms and lower legs.

• Often include replacement parts and an extensive instruction/treatment manual for practitioners who know their meridians.

• Will require hand washing with soap and water to sanitize although the lesser quality plastic can crack with frequent use.

• Are around half the price of plastic carrying case cups and less expensive than almost any other option, so it is a justifiable expense to replace boxed cupping sets more often.

Plastic Cup, Hand Pump and Air Valves

Most plastic cupping sets utilize a manual hand pump and air valves which provide a practitioner the greatest amount of suction control, which conversely establishes the amount of pressure felt by the client.

Controlling the amount of suction within the cup is critical to a client’s comfort. Applying too much suction in cupping massage could tear skin and other soft tissues, while not enough suction might result in a less effective treatment. Also, an air valve allows a practitioner to release the cup’s suction without pulling or ripping the cup off the skin.

The hand pump and air valve of a plastic cup operate as follows:

Hand Pump

• The practitioner can control the amount of suction within the cup by the number of pumps that are applied with the hand pump over the cup’s air valve. The practitioner can make a quarter pump, half pump, two pumps, three and three-quarter pumps, whatever custom amount of pumps the practitioner and client wish, to create the perfect amount of suction.

• The practitioner can also add suction with the hand pump while a plastic cup remains in suction on the client. This is different than almost any other cupping material available. Silicone, glass or bamboo cups would all need to be released and reapplied to gain greater suction, and there is no guarantee that reapplication with these other materials would gain greater suction than their original application.

• Flexible tubing is often provided with a hand pump, so if a practitioner is having a hard time generating suction between the hand pump and cup, they can use flexible tubing between the two for an alternative application.

• Practitioners can continually pump a cup over an area where a cup is not holding suction as well. For example, it is extremely difficult to maintain suction when working on small areas such as lateral epicondylitis aka tennis elbow; however, with a manual pump, a practitioner can apply the cup to the affected area and continually pump the cup to generate this reverse suction and all of its health benefits for a happy client.

• Air valves can be manipulated to reduce or release suction within the cup. Best practices require a cup’s suction to be reduced or released with an air valve because it can be precarious or painful to remove a cup from the skin without.

Plastic Cups with Twist Suction

There are plastic cups on the market that have a twist pump within the cup that allows a practitioner to manually screw clockwise or counterclockwise to increase or decrease suction instead of use a hand pump.

While it is nice to forego the extra equipment of a hand pump with a twist cup, the lack of an air valve which can immediately release suction makes these twist cups less desirable.

It is critical to be able to immediately release a cup from a client’s skin without having to rip it off for best client safety and comfort.

Silicone Cups

Silicone cups work best around the medial or lateral epicondyle for knee injuries and other prominent superficial bony areas. Silicone cups do not have an air valve or precise suction control. It’s a one and done application. So, if there is too much suction, then the silicone cup must be released and reapplied until the suction is appropriate or comfortable for the client.

The reason why a practitioner would use a silicone cup instead of plastic is because of its pliability. The plastic cups are made of hard plastic. A client might find it uncomfortable to have a hard plastic cup work around the large protruding epicondyles of their knee; however, this same work with a silicone cup may be tolerable and sometimes enjoyable because of the silicone cup’s softer material.

Because bodywork such as orthopedic cupping massage is used for many clients who are already in pain, a practitioner can alternate between plastic cups that can quickly adjust suction to softer silicone cups around bony tissue, with the goal to always work within a client’s comfort level.

Cups That Might Not Be Within a Massage Therapist’s Scope of Practice

On a final note, glass, bamboo and animal horn cups all require fire or other application methods that are not generally approved by massage licensing boards.

Cupping massage with plastic or silicone cups is usually accepted within a massage therapist’s scope of practice; however, you should always check with your licensing board prior to starting a new modality for compliance

Getting Started

Orthopedic cupping massage is one of bodywork’s latest and greatest techniques where East meets wWst and turned into best! A professional continuing education class in cupping should provide necessary information such as contraindications, endangerment sites, precautions, sanitation and techniques.

Practitioners should also check with their licensing board to ensure that cupping is not specifically excluded and that massage with a tool is allowed within their scope of practice.

Orthopedic cupping massage can expand your practice and treatment options with a $25–$40 set of cups, so it is fairly easy to get started once you are properly trained.

About the Author:

Selena Belisle is a retired professional athlete and the founder of CE Institute LLC in Miami, Florida. She has practiced massage therapy for over 30 years and received Traditional Chinese Medicine certifications from the Beijing Hospital in Beijing, China, and the New England School of Acupuncture. You can learn more about her training and CE classes at CeInstitute.com.