Basics of Cupping therapy for Physical Therapist. Basic Practical Techniques.

2.  Cupping refers to any natural treatment method in which
suction cups are used in therapy.
 Cupping is one of the traditional treatment methods that do
not involve medicinal substances but nevertheless serve
as useful weapons in the fight against many diseases or
complaints. Applied correctly, the method is harmless and
does not cause any adverse side-effects. The results are
often fast and impressive because the body reacts within
hours to cupping at the proper location.
 The goal of cupping is to strengthen or activate the
organism’s self-healing powers, when these are not able to
do so on their own. Cupping stimulates and supports the
options that nature has provided the body with to resist
disease.

3.  "Cupping is a form of alternative medicine in
which cups are placed on the skin to create
suction. The pressure in the cup is reduced
by use of heat or suctioning out the air so the
skin and superficial layers are drawn out and
held in the cup.”
 Ancient Chinese practice.
 Taoist Herbalist: Ge Hong (281-341 A.D.)
 Animal horns
 Hippocrates Father of modern medicine.

4.  Mobilizes blood flow to promote healing.
 Promotes detoxification.
 Invigorates Qi.
 Regulates aspects of the autonomic NS.
 Deep relaxation of muscle fascia.

5.  TCM teaches that it is the stagnation of Qi and
blood that causes pain and disease. Cupping
invigorates local circulation of Qi and blood in
the area being treated, resolving swelling, pain,
and tension. By drawing impurities to the
surface, it removes toxins. From a Western
physiology perspective, cupping loosens
connective tissue or fascia and stimulated blood
flow to the surface. Cupping stimulates tissue
relaxation and better cell-to-cell communication.

6.  Incontinence
 OA
 Nerve Pain
 Hyper/hypo tension
 LBP
 Facial Paralysis
 Sciatica
 Shingles
 GI disorders
 Asthma
 Weight loss
 Respiratory Diseases
 Pain syndromes
 Headaches
 Gynecological
 Disorders
 Common Colds
 Insomnia
 Acne

7.  Skin that is inflamed
 High fever
 Convulsions
 Cramping
 Easy bleeding
 Pathological level of low platelets
 Abdominal area or low back area during
pregnancy
 Should not glide over boney prominences
 Best use is over fleshy areas

8.  Various types of Cupping involving different levels of
suction, heat and duration.
 Dry Cupping
 Wet Cupping
 • Medicinal bleeding
 Needle Cupping
 • Acupuncture
 • Dry needling
 Gliding
 • Massage cupping
 Cupping is the inverse of massage- cupping draws the
skin upwards (massage pushes the muscles downward)
which causes a relaxing and relieving sensation.

9.  Wet cupping- Muslim world.
 • Mild suction using cups, left for 3 minutes then
remove
 and make a small skin incision using a cupping
scalpel.
 Gliding- oil used to decrease friction (sometimes
medical oils with herbs)
 • Moxibustion- moxa made from dried mugwort.
Use with acupuncture or burned on pts skin.Warm
meridian points to promote flow of Qi. Pain control.
 • It is found that moxibustion alone and with
acupuncture may be effective in changing breech
presentation of babies by affecting the placental
release of estrogen and prostaglandins which leads
to uterine contractions thatchange the babies
positioning.

10.  1. Flammable substance is placed in a cup and set
on fire.
 2. As the fire burns out, the cup is places upside
down on the patients skin
 3. The air inside the cup is cooling which causes
the vacuuming effect.
 4. This causes the skin to rise and redden as blood
vessels expand.
 5. Generally left on the skin for 5-20 minutes.
 *Plastic cups used with suction pump vs. glass
cups with fire
 *Plastic cups are suitable for gliding cupping. They
have more control over the amount of suction and
are easier to use.

11.  "A circulating life force or energy whose
existence and properties are the basis of
much Chinese philosophy and medicine."
 • 5 Elements
 • Cyclic
 • Create
 • Destroy
 • Sickness due to imbalance
 of elements
 • Overproduction
 • Underproduction
 • Associated with symptoms or traits
 • Complementary forces not opposing
 • Everything is composed of both Yin &
Yang (ex: shadow)
 • Health and longevity

12.  Yin
 • Dark, cool, wet
 • Earth to heaven
 • Female
 • Solid organs
 • Negative force
 • Outward
movement
 • Towards periphery
 • Internal energy
Yang
• Light, warm, dry
• Heaven to Earth
• Male
• Hollow organs
• Positive force
• Inward movement
• Towards center
• Physical body

13.  Yin & Yang determine meridians
 Associated with body parts/ organs
 Manipulating meridians has effect on body
functions associated with that meridian
 Qi flows through meridians
 Used to balance the 5 elements

14.  Weak (Light) cupping
 Medium cupping
 Strong cupping
 Moving cupping
 Light-moving cupping
 Needle cupping
 Moxa (Hot Needle) cupping
 Empty (Flash) cupping
 Full (Bleeding/Wet) cupping
 Herbal cupping
 Water cupping.

15.  The action of Weak cupping is intended to remove
stagnation and at the same time tonify the weak Qi and
Blood, and is therefore termed a ‘tonifying’ method .
 The amount of flesh drawn into the cups should be
minimal and hardly raised.
 Weak cupping is the gentlest method of all and is
particularly suitable for debilitated adults, elderly patients
and young children, especially those under 7 years of age.
 Light cupping can be applied almost anywhere on the
body, and may cause a slight reddening of the skin, rather
than a deep, dark cupping mark or blister. Therefore the
duration of Weak cupping can be as long as 30 minutes.

16.  Medium cupping can be safely administered to
children over 7 years old, as well as to adults. With
Medium cupping the suction is firmer .
 However, there is a real danger of draining the
patient’s Qi if the cups are left on for longer than 30
minutes, leaving the patient lethargic.
 With this method the skin is pulled well into the cup,
creating a slight redness as mentioned earlier. If the
cups are left on for longer, the redness will turn to
dark red or purple, indicating a stronger application.

17.  The purpose of a Strong cupping treatment is to move Blood and Qi
and eliminate internal/ external pathogenic factors and stagnation
from patients
 The purpose of a Strong cupping treatment is to move Blood and Qi
and eliminate internal/ external pathogenic factors and stagnation
from patients
 A strong vacuum will be produced, giving a strong pulling sensation
of the skin inside the cup. Because of the strong nature of the pulling
action the skin will quickly turn red, and shortly after turn purple,
inside the cup.
 When using a Strong cupping method for the first time a very dark
red cupping mark is inevitable; this can take up to 15-20 days to
disappear completely. The cupping time should also be short:
between 5 and 10 minutes during the first session. This can be
increased up to 20 minutes in later applications.
 Fine capillaries under the skin can also break relatively easily with
strong suction, causing deeper and longer-lasting cupping marks.
This is also the only method of cupping that can cause blisters to
form rather quickly.

18.  The Strong cupping method should be
avoided on the face, stomach and abdomen,
and on children under the age of 16, the
elderly and frail, and during pregnancy.

19.  The object of this treatment technique is to apply Strong cupping
therapy to a much larger area of the body by the moving/sliding
action of the cup.
 Oil the skin liberally and apply a single medium-sized and
medium-strength cup to the treatment area .Control the suction
by gently moving the cup in any one direction.
 If the suction is strong, moving the cup will be difficult and any
attempt to do so will result in extreme pain. Grip the cup with
one hand while supporting the skin close to it with the other. Pull
and slide the cup alongside the meridian using long strokes. Do
not apply short, up-and-down movements as this may cause
unnecessary pain. If there is difficulty in moving the cup this is
an indication that the suction is too strong and needs to be
reduced. The primary objective of Moving cupping is to resolve
Stagnation, manipulate the excess pathogens and bring up the
Heat to the surface of the skin. After only a few strokes
pink/reddish cupping marks will appear alongside the line of
movement

20.  Avoid using the Moving method on an open
wound or lesion, as the skin must be smooth
and unbroken. This treatment is not
recommended for children under the age of
16, or for the frail and weak. The first
treatment should not exceed 5 minutes,
building up to a maximum of 20 minutes per
session.
 This is also the most powerful method for
manipulating the lymphatic circulation and
therefore requires particular attention when
dealing with any form of lymphoma

22.  It is Moving cupping with much reduced suction power.
 This technique is considered the only safe method in the
treatment of lymphatic drainage, as well as being the
exclusive cupping method in the treatment of cellulite
complaints .
 During the application of the Light-moving cupping
method, slight pinkish cupping marks appear on the skin,
normally following the direction and movement of the cup
 All Moving cupping techniques require special attention,
particularly when there is a broken skin surface, scratches,
cuts, bruise marks, open wounds or when skin moles are
present

23.  Needle cupping is mostly used for red and painful muscular areas as well as
the knee and elbow joints, where there is a need to stop the pain and
remove the excess pathogenic heat at the same time.
 The practitioner should administer the acupuncture treatment/Dry Needle as
intended under normal circumstances, leaving the needles in place as long
as necessary. One can reduce the acupuncture treatment time by 10-15
minutes if Needle cupping is intended to follow it.
 Following the acupuncture treatment, leave the needles in position and
apply oil to the surrounding skin.
 Medium and Strong application is necessary if the treatment is over the
joints and Weak to Medium if the treatment is over muscular areas. Retain
the cups in position for 10-15 minutes. Some blood may be drawn into the
cup through the needles; this is quite acceptable, especially if the suction is
Strong.
 This method is not recommended for children of any age.

25.  For acupuncture
practitioners only
 Hot Needle cupping is
used open the
obstruction and relieve
the pain, and moxa is
employed to heat the
needle and transfer
the heat to the
acupuncture point in
order to warm and
tonify that particular
energetic point.

26.  Empty cupping is also called Flash cupping for its speed during the
application. This is actually a Medium to Strong cupping method, but is
applied rapidly and the cups remain in place for a very short time, i.e.
less than 30 seconds. It is used to stimulate and move the Blood and
Qi in the weak and frail.
 Empty cupping is applied on the back as well as the front of the body,
and the technique is simple. Oil the area to be cupped, place up to 12
cups near at hand, light a large cotton wool ball and apply the cups
simultaneously Once all the cups are in place, start removing them
without delay, beginning with the first to be applied. When all have
been removed, reapply them immediately in different positions. This
can be repeated for between 5 and 10 minutes. Slight pinkish cupping
marks will appear all over the back, but these will fade away within a
day or two. This is a favorite cupping method for children. Stress-
related emotional conditions, tiredness, low fevers in children or the
elderly, feeling cold and feverish in the same group and
gastrointestinal problems can all be treated by the Empty cupping
method.

28.  Bleeding technique is employed in order to purge foul
blood, which was considered the source of disease, from
the body. Leeches were also widely used for the same
purpose. Today this method is used in the treatment of a
sudden increase in blood pressure, high fevers, Blood
stasis, and in discharging pus from boils and furuncles,
which represents Excess, with Blood-Heat, Blood-poison
and Stagnation. Bleeding cupping is also administered to
treat a variety of sports injuries. From this description it
can be seen that this method is only suitable for adults
with strong, Excess (Shi) energies, and not for children or
the elderly.

29.  Sterilise the point with alcohol and make a very small
incision (0.5 cm or the length of a rice grain) with a
surgical blade or, using a Plum-Blossom needle, firmly tap
the point for a short time to cause bleeding .
 Once the point is bled, choose a large cup (size 4 or 5)
and apply a Strong cupping method to the point. The blood
will quite quickly be observed being drawn slowly into the
cup . If the incision is adequate, between 20 and 100 ml of
blood can be drawn into the cup. However, if the patient is
taking any type of anticoagulant drug this may result in
more bleeding.
 Removing the cup also requires attention and care; refrain
from hurrying as this may cause the blood to spill or spray
from the cup. Within a maximum of 5 minutes the bleeding
should stop.

31.  For this method one requires a few bamboo cups .These
bamboo cups are boiled in water with herb for 30 min and
then with same procedure are applied over skin.
 The herbs are absorbed by the bamboo cups, which in
turn transfer their healing properties to the patient. This
method is usually employed when external pathogens
such as Cold, Damp and Wind attack the body, causing
stiffness and aching, particularly in the neck and shoulders
(common cold, asthma and cough). Although this
treatment is not recommended for children of any age, it is
particularly beneficial for the elderly .

33.  This is one of the least used and practiced
cupping methods.

34.  When circulation is sluggish or compromised in an injured or diseased area of
the body, insufficient oxygen gets to the cells, and there will be a local build-
up of waste products. When the skin is pressed, the blanching that occurs is
slow to fade. Suction pulls toxins, pathogenic factors, blood poison, dead
lymph and cellular debris from deep within the tissues to the surface. These
debilitating agents are then more easily expelled from the body. The deposits
dissipate from a few hours up to several weeks, depending on the amount of
stagnation and the patients post treatment activities.
 The quality of the pathogenic factors varies according to the severity of the
patient's blood stasis -- which correlates with the nature, severity and type of
condition they have. It can appear from a light pink to a dark purple, but is
usually a shade of red. Often tiny raised bumps will appear. Sometimes a
clear fluid will be drawn to the surface. These are all results of disease and
toxins being removed from deep within the tissues. The more discoloration
that surfaces – the greater level of stagnation and toxicity needing to be
purged from the body.

36.  Cupping frequently causes marks on the skin. This is due to
bringing blood to the surface, similar to a bruise. For patients
with bleeding disorders such as hemophilia or who are being
treated with anticoagulants, cupping may not be the best
treatment option. People with these conditions should discuss
the pros and cons of treatment with their acupuncturist or doctor
before receiving cupping. Cupping should not be performed on
skin sites with active inflammation, burns, infection, or
open wounds. Some discomfort can occur but should not be
considered a side effect. Moderate, temporary discomfort is
expected as stagnation is removed and connective tissue and
muscles are loosened.
 Practitioners (especially traditional Western health-care
providers) need to be aware of cupping as a treatment modality.
In children, the bruising and discolorations post-cupping can be
mistaken as a sign of child abuse

37.  The bruises for cupping
can last for a few days up
to two weeks. According to
TCM practitioner Casco, it
is expected that over
several weeks of repeated
cupping treatments the
bruising will decrease as
the stagnation resolves.
This indicates a successful
result of a cupping
treatment protocol.

38.  A Myofascial TP is a hyperirritable focal point within a taut
band of skeletal muscle fibres. On compression, it can
evoke typical referred pain and autonomic phenomena. A
Myofascial TP is located in skeletal muscle and its
associated fascia distinguished from a TP in other tissues
such as skin, ligament and periosteum.
 What Causes Trigger Points?
 Generally speaking, any action or movement that puts extra
load on the musculoskeletal system can be the culprit.
Persistent wrong posture while sitting or walking, carrying or
lifting heavy loads, accidents, strains, falls, overwork, overuse of
a particular muscle group and a stressful lifestyle can all
contribute to trigger point formation.

39.  During the cupping application a strong, negative pressure is created over the
trigger point. This in turn will result in the stimulation of the stagnant Blood or
Qi into movement towards the direction of the cup. The negative pressure will
also force oxygen-rich blood to flow into the trigger point, releasing the
muscular knot/lump. Sometimes trigger points are difficult to obliterate
completely, especially when dealing with long-established trigger points.
These may require more frequent cupping application, which can be as often
as three times per week.
 Because trigger points are located at the deeper layers of the muscle tissues,
a Strong cupping method is often required to be effectual.
 Typically a single cup is applied to the trigger point, with several additional
cups to the borders of the muscular structure or the path of pain. Not all
trigger points are suitable for cupping therapy owing to their anatomical
location. In these cases other methods of trigger point release should be
employed.
 One of the most suitable and effective types of cupping apparatus while
conducting trigger point cupping is the pistol handle cupping set.

40.  Active myofascial trigger point: A myofascial trigger point that causes a clinical
pain complaint. It is always tender, prevents full lengthening of the muscle,
weakens the muscle, refers a patient-recognized pain on direct compression,
mediates a local twitch response of muscle fibers when adequately
stimulated, and when compressed within the patient’s pain tolerance,
produces referred motor phenomena and often autonomic phenomena,
generally in its pain reference zone, and causes tenderness in the pain
reference zone.
 Latent myofascial trigger point: A myofascial trigger point that is clinically
quiescent (dormant) with respect to spontaneous pain; it is painful only when
palpated. A latent trigger point may have all the other clinical characteristics of
an active trigger point and always has a taut band that increases muscle
tension and restricts range of motion.
 Both types of trigger point share similar physical characteristics: well-defined,
tense, palpable myofascial tightness, with a distinct painful nodule when
pressed. An experienced tactile therapy practitioner has no difficulty in
identifying these tight nodules; as well as feeling taut or tense the patient will
always respond and react (sometime with extreme wrench) to the stimulation
of trigger points.

42.  Flat Palpation
 Using the padded aspect of the fingers or thumb and
proceeding at a right angle across the muscle fibers while
pressing them against the underlying tissue or bone. When
trigger points exist taut bands, exquisite, focal tenderness
(Trigger Points), and a twitch response will be detected.
 Pincer Palpation
 The muscle or muscles are rolled between the tips of the
digits to detect taut bands of fibers, to detect exquisite,
focal tenderness (Trigger Points), and to elicit local twitch
responses.
 Snapping Palpation
 Locate a taut band of muscle and place fingertip at right
angles. Begin moving your fingers back and forth to roll the
underlying fibers under the finger. This is just as plucking a
guitar string except contact with the surface is maintained.
The purpose of this method is to elicit a local twitch
response and is most effective when done near or on the
trigger point with the muscle at a neutral length or slightly
lengthened.

46. Thank You