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Cupping may have the longest medical history, possibly dating back 5,000 years. Something this old, still used today, must have some significant impact and treatment benefits. It has taken us centuries to try to understand the science behind cupping and when to use different strategies. One thing that cannot be denied is cupping’s effectiveness in treating pain and influencing movement in the human body.
Many practitioners have been exposed to static forms of cupping. This methodology centralizes around the concept that the cup is static on someone’s body, and the result can be amplified by either pulling on the cup to create a glide to myofascial layers or by having the person move their body under the pressure of the cup. In both of these cases, the cup doesn’t move.
There are other forms of cupping that have been used with great effectiveness, and there have been recent technological advances to combine cupping with other strategies. We are going to describe two additional forms of cupping that can be well-utilized in the clinic for pain treatment, mobility deficits, or increased body awareness and motor control.
Glide Cupping
Gliding a cup on the skin surface creates a lifting effect on the myofascial tissue that can follow fascial lines and create a wave effect along that line of tissue. Some cups are designed to glide on the skin and some are not. Most gliding cups have a narrow rim to allow for a good lock to the surface but do not roll up when the cup moves on the skin surface. (I prefer the Rockpods Glide.)
Glide cups usually are applied with less pressure than static cupping. This can be manipulated based on goal, but less suction allows the cup to glide easier on the skin.
The first step in glide cupping is to apply an emollient to the skin along the surface area you are targeting treatment. Then apply the cup with about half as much suction as usual static application. Once we have the cup in place, it is appropriate to scan the tissue using the gliding strategy. In this case, you gently move the cup across the target area at a consistent pace. Pay attention to the cup slowing down as you move it, and watch for changes in the lift of the skin tissue.
If you notice areas where the cup slows down or areas of tissue do not lift as much as adjacent areas, this could suggest a lack of glide between myofascial layers. This is often an indication for treatment and focused attention to improve that regional glide. Oftentimes this restriction will translate to mobility restrictions in an adjoining joint or limb causing dysfunction.
Once you have identified a restricted area, you can treat it the same way that you scanned the area. We commonly limit treatment to under five minutes on a target zone, but you can make a clinical decision for best practice. When treating a pain condition, it may be best to use this basic glide method; however, there are some advanced strategies used to enhance motion.
The first and less invasive strategy is to glide the cup as the subject moves the limb in a restricted direction. With this strategy, you would glide the cup in the same direction as the myofascial line movement to create an assisting force. For example, if the client is performing shoulder flexion, and you are targeting the posterior scapula, the client would flex the shoulder and you could apply the glide force in the same direction as scapula upward rotation because that is the desired result.
Another, slightly more aggressive, glide approach is to glide the cup in the opposite direction of the desired movement. This creates a pulling back of the superficial layer on the deep layer and creates a greater amount of shear force. This is often more uncomfortable for the client but can force greater amounts of glide between fascial layers and generate more total motion.
The glide strategies can be great options for pain relief or motion recovery. Don’t hesitate to play with them in your practice and see the impact you have on your clients.
Vibration Cupping
Vibration has exploded onto the scene recently but has been around for quite a while. We have used vibration heavily over the past 20 years in professional sports in the form of a vibrating plate and more recently with a vibration gun or foam roller. Now we can combine vibration with cupping with new technology from Rockpods Vibe.
If you like the pain-relieving benefits of vibration but have concerns about the high compression forces of vibration guns or foam rollers, vibration cups are an excellent alternative. A favorite feature of cups is the idea that is our only tool that lifts tissue as opposed to compressing it. Most tools we use compress tissue, whether it be our hands, IASTM, foam rollers, or vibration guns. Compression, of course, causes some trauma to the tissue and may not be indicated in certain conditions, like a contusion or acute strain, or sprain. Pain-relieving cups combined with vibration can be great in these scenarios.
The benefits of vibration are extensive and clearly many people like the feeling, based on the number of products sold and marketed to our clients. The science of vibration is becoming better understood, so we can now apply it more strategically than ever.
Research is beginning to show trends that lower hertz (around 75 Hz) are more correlated with relaxation or down-regulation of the nervous system. On the other end of the spectrum, higher levels of speed (125 Hz) tend to be more associated with heightened awareness and alertness of the nervous system. With this information, you may choose to use higher levels of vibration to prepare for exercise or activity. Think about a warmup strategy, and compare the higher vibration to using a lower frequency to support recovery and relaxation of the myofascial tissue.
We are also seeing that the higher frequencies are associated with pain reduction and improved body mapping or body awareness. These two concepts are highly associated with chronic pain patients, and where pain is present, they tend to have poor body awareness or joint position sense. With vibration’s demonstrated improvements in these categories, higher frequencies should be considered when targeting pain.
These specially designed cups still offer great lifting effect on the tissue and have a built-in vibration device. They are not designed as well for gliding, but operate best in a static application; however, the benefits appear magnified when providing an external glide force while the client is static. The force you apply here is a shear force, not great enough to glide the cup, but great enough to shear the skin and the underlying myofascial tissue.
If your primary objective is to gain motion, and motion is restricted by muscle spasm or tone, consider this: Apply the cup over the target tissue and set the vibration to a lower frequency (75 Hz). Then apply a shear force to push the cup to the end range of the tissue. This shear force combined with slower frequencies has been shown to stimulate Ruffini receptors, and support tissue relaxation and down-regulation. This can be a great strategy on low back pain or muscle spasms, and you may also want to use it on tight muscles. It can be done prior to stretching to maximize mobility and after a workout to maximize recovery.
The ancient history of cupping combined with new technology has created fantastic opportunities to help your clients move better and return to higher levels of function!
About the Author
Tony Mikla, DPT, MSTP, CSCS, wrote this article on behalf of ROCKTAPE. Mike is a sports physical therapist, performance coach, and researcher. He speaks and teaches nationally on sports physical therapy. He previously served as the physical therapy manager at EXOS, as the medical director for the Sacramento Sports Commission, and as adjunct faculty in physical therapy at Sacramento State and Northern Arizona universities.