Cupping

Therapy
A Brief Overview

2023 Orthopedic Symposium

Dr. Heather Henrichs, DC
Professor, Nebraska Methodist College
Dr. Joshua Owen, DC
Assistant Professor, Nebraska Methodist College October 26, 2023
Learning Objectives

01. Understand historical use of cupping therapy.

02. Relate importance of fascia and inflammation.

03. Differentiate forms cupping therapy.

04. Discuss clinical uses of cupping therapy.

Treatment Spectrum

Role of Complementary
Inferred that health care method chosen is used together with
allopathic medical practices

Role of Alternative
Inferred that health care method chosen is used in place of
allopathic medical practices
 Cupping Therapy
Soft tissue modality using subatmospheric
pressure tissue pull created by suction

Meridians & Qi Circulation & Immunity Mobility & Healing

(Aboushanab & AlSanad, 2018)

(Al-Bedah et al., 2019)
(Cao et al., 2010)
(Mehta & Dhapte, 2015)
(Shabi Furhad & Bokhari, 2019)
Historical Perspectives
A worldwide ancient medicine practice

1500-1550 BC 400 BC 186 BC 850-1030 AD

Egyptian Greek Chinese Arabic & Islamic

Ebers Hippocrates & Han Muhammed

Papyrus Herodotus Dynasty ‘Hijama’
(Aboushanab & AlSanad, 2018)
(Al-Bedah et al., 2019)
(Cao et al., 2010)
(Mehta & Dhapte, 2015)
(Shabi Furhad & Bokhari, 2019)
Healthcare in The
21st Century 1993
Office of
National Institutes of Health places Alternative
value toward Complementary and Medicine
1998
Alternative Medicine (CAM) focus National
Center
Patient centered interest is noted
Movement to provide more validation and
CAM 2000s
standardization to use of these approaches 5 Year
to healthcare Plans and
Research
Integrative focus was a means of 2014
bringing conventional and Rebranded
complementary together in a to NCCIH
coordinated manner

(NCCIH Timeline, n.d.)

(10 Most Common Complementary Health
Approaches among Adults—2012, 2012)
Other Trends
A Favorable Landscape

(Schleip et al., 2021)

WHAT IS FASCIA?

Network of connective
tissue formed into
various layers such as a
sheaths or sheets or
aponeuroses

(Tortora & Derrickson, 2019)

Extracellular Matrix

Sum of extracellular substances

within the space between the
connective tissue
Often produced by fibroblasts
Made of protein fibers and
ground substance

(Myers et al., 2017)

(Tortora & Derrickson, 2019)
Functional Roles of Fascia

(Schleip et al., 2021)

WHERE IS FASCIA?
Located superficially within skin and
then deeper throughout subcutaneous
tissues
Further provides encasement,
attachment points, and separation of
muscles and viscera

(Schleip et al., 2021)

Fascia Layers

(Schleip et al., 2021)

Fascia as a System

Integrates function
Framework for all body systems to operate
in coordinate manners

Responsiveness
Neural sensing and demonstrates elements
of plasticity and viscoelasticity

(Myers et al., 2017)

(Schleip et al., 2021)
(Stecco et al., 2018)
Myers et al., 2017)
Broad Comparison of
Myofascial Therapy Mechanisms
Many forms of myofascial therapy,
myofascial release, or myofascial trigger
point therapy exist today
Manually performed
Instrument assisted soft tissue
mobilization (IASTM)
Majority of these techniques utilize
a compressive pressure approach
Cupping is focused on a negative pressure
suction or vacuum pressure that creates
lift of the myofascial tissue/s
(Aboushanab & AlSanad, 2018)
(DaPrato, 2015)
(World Health Organization, 2007)
Biomechanical Model of Cupping

Multi-layered finite model to

predict stress response of
tissues to cupping
Vacuum pressure, cup diameter, rim radius/curve,
ramping time of pump action, friction coefficient
and time of application

Compressive pressure exists at

rim of cup with sharper rim
Increased vacuum pressure and
cup size achieves acupuncture
analgesia

(Tham et al., 2006)

(DaPrato, 2015)
(DaPrato, 2015)
Similar Outcomes
Myofascial Therapy
Inflammatory Response

Induction of vasodilation

Pain Modulation

Alternative therapy for pain management

Patient Satisfaction

Improved flexibility and healing

(Ajimsha et al., 2020)

(Dommerholt et al., 2020)
(Mohamed et al., 2022)
Inflammatory
Response
Starlings Law of
Capillary Exchange

(Tortora & Derrickson, 2020)

Cupping Hematoma
Cellular Level

Capillary Permeability Inflammatory

Changes Mechanism
Structural or functional change in Chemical mediators promote
ENDOTHELIAL TISSUE ALTERED PERFUSION

Edema
ACCUMULATION OF FLUID
within body tissues

(Huether et al., 2020)

(Rozenfeld & Kalichman, 2016)
Inflammatory Measures of Cupping
The skin surface temp increase
related to vacuum pressure is
demonstrated as statistically
significant (P < 0.001) based
infrared thermal imaging
Other findings in mammalian
study using photoacoustic
microscopy to show microvascular
changes demonstrating
vasodilation and increased
hemoglobin and oxygen
consumption to tissue surrounding
cupping site (Chi et al., 2016)
(Liu et al., 2022)
(Zhou et al., 2020)
Trajectory of Healing
A Favorable Landscape

(Park & Barbul, 2004)

Who can perform
cupping therapy?
Variety of healthcare providers
Acupuncturists
Athletic Trainers Tips to Ask a Providers
Chiropractors Have you completed a certification
Massage therapists course?
Medical doctors How often do you use this modality?
What is your patient satisfaction?
Osteopathic doctors
What safety precautions do you use?
Physical therapists

*Does not require specific license

(Stephens et al., 2022)

Techniques of Cupping Therapy
Static Cupping
Stationary and sustained distraction of tissue in target location
Timing and monitoring is essential to manage
Minimize overlap of treated areas

Dynamic Cupping
Sliding across region or affected area
Requires use of an emollient to improve comfort
More diffuse soft tissue mobilization
(Cao et al., 2010)
(Mehta & Dhapte, 2015)
(Mohamed et al., 2022)
Types of Cupping Therapy

(Mehta & Dhapte, 2015)

(Shabi Furhad & Bokhari, 2019)
(Liu et al., 2022)
(Aboushanab & AlSanad, 2018)
Types of Tools/Cups

(Mehta & Dhapte, 2015)

(Aboushanab & AlSanad, 2018)

Procedure Tips
Frequency
Generally no more than 1x week to allow full
hematoma recovery/healing

Pressure, Number, & Timing

Adjust based on patient tissue tolerance and
speed of inflammatory reaction
Proper Documentation
Number, size, location of cups, pressure rating
applied, along with subjective information
Combine
Can utilize additional IASTM or therapy
modalities to enhance healing or comfort
Patient Education
Very important to clearly and thoroughly
educate patients/family on expectations of
treatment
In healthier patients, petechiae/bruising will
subside in about 5-7 days
In patients with more soft tissue, circulatory
dysfunction or more long-standing nature of
dysfunction, the discoloring may need 2 weeks
to disappear

(Al-Shidhani & Al-Mahrezi, 2020)

(Aboushanab & AlSanad, 2018)
(Fousekis, 2013)
 Physiologic Benefits
Clinical practice and researched

Pain Modulation Inflammatory Healing Increased Function

Decrease on Verbal Analog Scale,
Neck or Oswetry Disability Index
scoring
Gate theory of pain
Measurable increases of skin surface Increased range of motion and
temperature to indicate healthy mechanical functionality
inflammatory response Reported improved quality of life in
Lowering of inflammatory markers subjective findings
(Al-Shidhani & Al-Mahrezi, 2020)
(Chi et al., 2016)
(Charles et al., 2019)
(Liu et al., 2022)
Lauche et al., 2012)
(Ma et al., 2018)
(Pontes et al., 2020)
(Rachana & Krupa, 2020)
(Rozenfeld & Kalichman, 2016)
(Wang et al., 2020)
(Zhou et al., 2020)
Common conditions that could benefit from
cupping therapy
Neck and Low Back Pain Carpal tunnel
Sciatica Pre and post-operative conditions
ITB syndrome Athletic stress and injury
Adhesions/ scars Plantar fasciitis
TMJ dysfunction Scoliosis
Chronic Pain Lymphatic drainage
Arthritis Poor circulation
Neuralgia Fibromyalgia
Trigger points Migraines
(Aboushanab & AlSanad, 2018)
(Cao et al., 2010)
(Mehta & Dhapte, 2015)
(Mohamed et al., 2022)
 Contraindications
Infectious skin diseases Precaution considerations:
Skin ulcer area Diabetes if patient has skin
Systemic viral or bacterial infection problems
Presence of a tumor of “local”
Patients that bruise easily
malignancy
always caution patients
Presence of metastatic cancer
that there is risk for
Significant amounts of superficial
edema bruising
Hemophilia or blood disorders Age of patient
Psychological unwillingness to Location
application of vacuum therapy
Blood thinners
Recent surgery/incision area
Pregnancy
(Aboushanab & AlSanad, 2018)
(Cao et al., 2010)
(Mehta & Dhapte, 2015)
References
Thank you
Questions or Comments

402.354.7166 Dr. Henrichs

heather.henrichs@methodistcollege.edu

402.354.7040 Dr. Owen

joshua.owen@methodistcollege.edu