The therapeutic applications of cupping have been documented through several thousand years of clinical experience. Cupping is used extensively in TCM and has now been adapted for other health-care modalities, including massage therapy and chiropractic. Massage cupping intensifies the therapeutic aspect of traditional cupping and is an effective addition to any spa, healing facility or private practice. The cups are inexpensive, the therapy is fun and result-oriented, and the client response is remarkable.

A Cup of History
Cupping developed over time from the original use, by various indigenous peoples, of hollow animal horns to drain toxins out of snakebites and skin lesions. Horns evolved into bamboo cups, which were eventually replaced by glass. Therapeutic applications evolved with the refinement of the cup itself, and with the cultures that employed cupping as a health-care technique.

The Chinese expanded the use of this technique to surgery, to divert blood flow from the surgery site. Cupping eventually developed into a separate therapy under the TCM umbrella, with healers trained specifically in this technique. Other ancient cultures, including the Egyptians and early Greeks, embraced the therapeutic value of cupping. The technique eventually spread throughout Europe and later to the Americas.

Cupping was common in households of the 18th, 19th and early 20th centuries. Indeed, many people still remember Grandma cupping their back for congestion and colds. European and American doctors used cupping into the late 1800s, and cupping sets were still carried by medical-supply companies well into the 1940s. Breast cupping became common for inflamed breasts and lactation dysfunctions, and the familiar breast pump evolved from this practice.

With this rich history of medical application, how does cupping fit into current health practices? Massage cupping, or the use of glass cups, held by suction, to massage the body, can be added into almost any massage or bodywork session. The action on the nervous system is sedating, and clients will often experience a deep state of relaxation.

"After a number of sessions of massage cupping, I have experienced cumulative and lasting benefits," says Julie Hanson, a cupping client in Asheville, North Carolina, who suffered chronic muscle spasms in her shoulders and neck due to a torque in her spine.

"[The spasms] seemed exhaustingly permanent and have never been relieved by traditional methods of massage," she says. "Cupping, however, has produced marked improvements in posture and muscle position that are nothing short of exhilarating."

A favorite area for massage cupping is on the broad area of the back. Larger cups are used for this, and a strong vacuum will mimic the rolling action of deep-tissue massage without any discomfort. The movement may be long and intended to drain fluid, or circular and stimulating for stubborn knots and areas of rigid tissue. The skin will turn red with strong massage cupping, indicating that circulation has been brought to the surface.

Application of liniments, analgesics, plant hydrosols and essential oils immediately after the treatment will facilitate the absorption of the product deep into the tissue. The increased local blood supply to the muscles and skin will bring nourishment and allow for toxins to be carried away through the veins. Clients often feel deep warmth during the session and a tingling sensation long after the treatment has ended.

Massage cupping is not an irritant to the skin or body. It draws the inflammation out, yet does not add to it. This technique is excellent when used as a contrast therapy with cold compresses or liniments. The cups may also be manipulated to mimic other massage techniques without the normal stress on the hands of the therapist.

A Typical Session
The supplies that are needed for this technique are minimal: cups; isopropyl or de-natured alcohol; cotton balls; a candle and lighter; and clamps to hold the cotton. Place the candle (in a holder) on a towel, and light it. Hold a cotton ball in the clamps and add 5-10 drops of alcohol. Move the cotton over the candle flame to light it, and then insert it into a glass cup to create a vacuum. Quickly move the cup over to the area to be worked on, remove the cotton ball and invert the cup onto the body. The heat creates a seal that adheres to the body. If the seal breaks, simply repeat the process. If using a manual vacuum set, place the cup on the body and activate the pump to remove air.

There are two main uses of cupping: stationary and in massage. Stationary cupping is used in TCM to clear stagnation of blood; to facilitate the release of pathogenic factors; and to dispel internal heat. Cups are placed on the skin and left for five to 15 minutes. Four to six cups may also be applied and then removed cyclically in a technique called flash cupping. Both methods are commonly used for treating lung congestion and for removing heat from the body. The stimulation on the back, over the lungs, activates the ciliary escalator of the lungs and facilitates expectoration of congested material. The other action is to bring heat from the lungs to the surface of the skin to be eliminated. Stationary cupping sometimes results in rings and circles on the back as toxins and blood move to the surface.

Cupping used for massage is the more common form among practitioners of Western healing arts. Before applying the cups, administer plenty of oil on the areas to be cupped, to facilitate smooth movement. Take this opportunity to palpate areas of tension and congestion. Place the cup on the area, grasp it with one or two hands, and begin to glide it over the skin. The movement should be smooth, without pressing down, as this will inhibit the suction effect.

Pressure Matters
Always ask the client if the pressure is uncomfortable in any way. Almost all areas of the body may be worked on, including the neck, shoulders, middle and low back, and sacrum. The stomach, hips and thighs require a gentler suction.

Watch closely to determine the circulatory reaction and adjust the suction as needed. It is a good idea to start with a medium to light pressure and increase slowly. Marks may occur with very strong cupping - and while this may be considered beneficial in TCM, this is usually not the way to send a client home from her massage. Be sure to acquire proper training and then practice on family, friends and co-workers before working on clients.

Remember that the intensity of the cupping depends on a few factors:
1) How quickly the cup is placed on the skin after the flame is removed.
2) The strength of the flame (certain alcohol burns hotter than others).
3) The size of the cup.
4) If using a vacuum set, the pump will determine the suction.

There are additional safety considerations to be aware of when integrating cupping into your practice. Most of them are common sense, yet ought to be seriously considered. This is one of the greatest reasons to acquire adequate training before starting to work on clients.

Cup Creatively
Some of the most enjoyable aspects of this technique are the subtle nuances of the movements. Creativity provides a variety of methods, and alteration of pressure and speed produce amazingly different sensations.

The edge of the cup can be used to "scoop" in a cross-fiber movement, and vigorous circles feel marvelous on the hips, thighs and shoulders. Long strokes down the sides of the spine and along the ribs provide ease of movement for ribcage expansion and breathing. Stubborn neck tension is soothed with a gentle approach.

Clients respond to the experience with positive feedback, often reporting that the treatment stayed with them longer than most sessions and was cumulative in its effects.

"I had pain in my upper arms for over 20 years in a specific spot where the mid-deltoid meets the lateral side of the biceps," says Gail Gordon, another cupping client in Asheville, North Carolina. "Within three months [of monthly cupping sessions] the pain was completely gone. I have more range of motion than I have had in years in that area."

Numerous conditions respond beautifully to massage cupping, including fibromyalgia, anxiety, insomnia, post-injury trauma, chronic pain, post-surgery adhesions, cellulite and sluggish colon.

Brenda Sinners, a massage-cupping practitioner in Ocean Isle, South Carolina, says cupping visibly improved one client’s knee injury.

"I only did a bit of the cupping around her knee, but that led me to her hip, around the piriformis, of the same side," she says. "I actually parked it there for a few minutes when she said she could feel it in her knee. When she got up, her knee was less swollen, plus she could walk with no limp."

Therapist Benefits
Another beneficial aspect of cupping is the ease for the practitioner. This method allows respite for the hands from repetitive movement and enables the therapist to get deeper without discomfort to the client or herself.

Massage cupping continues to evolve as new equipment is located and creative applications are discovered. A small micro-cup set has led to a new technique used to drain and lift the face, loosening tight facial muscles and stimulating blood flow to the skin. Temporomandibular joint (TMJ) disorders also respond well. This is a quick yet effective addition to a facial, massage or body treatment.

Adding massage cupping to a treatment should result in an additional charge of $5-15 per session, with no increase in time or cost for the practitioner.

One way to begin to learn more about this incredible therapy is to experience it. There are not many massage-cupping practitioners at this time, yet interest is growing as more therapists are exposed to this technique. Massage cupping is sure to prove itself a viable addition to our efforts in assisting our clients on their healing path.