Manual Therapy: Functional Cupping Applications

Manual Therapy

How to add another tool to your manual therapy capabilities: functional cupping

About ten years ago, Pieter de Smidt was looking to add to his array of manual therapy skills for soft tissue treatment. 

de Smidt, PT, DPT, Cert. MDT, MTC, owner of Reset-Wellness Physical Therapy in Houston, TX, was well-versed in instrument-assisted soft tissue mobilization (IASTM), which still proved painful for some patients. But after seeing the benefits of ‘distracting’ the tissues by using taping, he decided to expand that repertoire. 

“Cupping seemed to be an obvious answer,” recalled de Smidt. “I figured maybe we should try distracting the tissue rather than always tearing the tissue. This was something people could tolerate.”

These days, de Smidt still tends to start with an IASTM-based treatment, but if this proves painful, he can do a simple contrast with IASTM on one side and cupping on another, and asking the patient which feels more comfortable. 

What is Functional Cupping?

While cupping may be somewhat new as a modality of manual therapy in Western medicine, the concept itself has been traced back as far as 1500 B.C., when the ancient Egyptians were said to have utilized the process. A specially-designed cup — don’t just pick up any instrument — is applied to the skin for a few minutes under suction, allowing it to affect the underlying tissue, particularly the fascia.

Functional cupping works by applying the cups in relevant areas followed by initiating dynamic, functional movement and affecting positive change in movement restrictions. The goal is to restore movement while decreasing pain in areas of previous restriction. Simplified, the cup is placed where restriction is felt, allowing the practitioner to move the body to the outer limits of that particular movement. As a result, tissues begin to soften, increasing the range of movement. 

Best of all, the client or patient has a strong degree of control over their own movement with the cups in place, and can dictate and control their own levels of discomfort. Many times, people assume cupping is a painful experience due to the prevalence of dark, purple spots that will appear on a person’s skin in areas where the cups were applied. However, this is simply the result of blood flowing to the affected area due to the suction pressure. Some believe the darkness of these spots has relevance as to how the injury is progressing, though this theory is not commonly held in Western medicine.

The Process

One advantage of using cupping as a form of manual therapy is the numerous possibilities it offers for utilization. de Smidt typically begins with short-duration (1-2 minutes) cupping, leaving the cups in a static manner on the body to see how the patient responds, followed by removal to see how the patient’s skin responds. If all is proceeding normally, the process calls for the addition of more cups, or leaving the initial cups in place for a longer duration. 

“Functional cupping is different when compared to what’s done with traditional Chinese medicine,” explained de Smidt. “We introduce movement as soon as possible. Patients will have the cups on and do exercises as well.”

When the cup is applied, the patient benefits from the contrast of compression underneath the rim of the cup, while the skin and underlying tissue within the cup is stretched. Localized blood flow to that area creates the dark marks that are often seen on the skin (de Smidt emphasized that these may look like bruises, but they’re not painful.) “You’ll see metabolic changes as a result of the change in blood flow, and you start to see healing as a result of different enzymes that are pulled into the tissues,” he said.

Depending on the enzymes pulled into the affected area, the coloration of the aforementioned marks on the skin may vary.

“Lastly, you get a neurophysiological change via feedback to the brain,” explained de Smidt. “There’s a lot of stretching, but it’s not threatening input to the brain. It helps to calm the area, which allows us to remap the sensory cortex.”

Types and Sizes of Cups

de Smidt doesn’t utilize glass cups, nor does he practice the art of setting fire to the cups, which was (and still is) a common practice in traditional Chinese medicine. “No glass cups for me. There’s too much risk of something breaking, or the damage that could be done with the fire,” he clarified. “People can use it, but I don’t teach it.”

Instead, de Smidt teaches by using plastic cups with a pump to increase the suction, or silicone cups. 

Cup size depends on the size of the affected body part. de Smidt allowed that larger cups can be, on average, a bit more comfortable. You won’t see many, if any, cups larger than about a two-inch diameter.

de Smidt referred to the 2008 Olympics, when Michael Phelps made cupping popular while winning a record-setting eight gold medals. In a sport like swimming, where competitors must swim multiple heats or races in one days, cupping can help in recovery as well as with any sort of musculoskeletal pain. Basketball players, who can play multiple nights in a row, have also been known to utilize cupping in their own recovery.

Open wounds are the main contraindication. “I don’t want to treat an incision that hasn’t fully healed,” explained de Smidt. “But if the skin is intact, the incision is healed, then you can apply cupping.”

But the root cause is reduction of pain, and that’s why most populations will come in to see de Smidt. “That’s the number-one reason people come to see us,” he admitted. “”Cupping can reduce pain, and help with tissue expandability. Anyone with restricted movement or pain with movement is strongly indicated for cupping.

If you would like to learn more from Dr. de Smidt about cupping, follow this link.

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