Cupping therapy, an ancient practice with roots deep in tradition and folk wisdom, has been used for centuries across various cultures. While its long history speaks to its enduring appeal, a modern understanding requires delving into the science behind this unique modality. This is where biomechanics comes in, shedding light on the physical forces at play during a cupping session.
As highlighted in the foundational work of Tham, Lee & Lu (2006), studying cupping from a biomechanical perspective provides valuable insights into how it affects the body's tissues. At the heart of cupping is the creation of a vacuum, which generates a distinct feeling of skin tension. Understanding the scale and distribution of the forces that accompany this vacuum is key to effective and comfortable treatment.
Compression and Tension: A Balancing Act
When a cup is applied to the skin, a ring of compression is created directly under the rim. The design of the cup's edge, whether rolled on solid cups or flat on softer silicone cups like RockPods, is crucial in dispersing this compressive force. A sharper rim would concentrate the pressure, potentially causing discomfort, especially in painful areas. This underscores the importance of selecting a cup with a suitable edge and size to comfortably span the treatment area. While the cup lifts the skin, this lift is achieved by compressing the tissue at the perimeter.
Within the cup, the skin and underlying tissues experience decompression as they are drawn upwards. This increase in subcutaneous space has been observed in ultrasonography studies However, it's vital to recognize that this decompression is accompanied by tensile stress on the tissues, including the delicate capillary network. This tension is what can lead to the characteristic reddening or ecchymosis seen after cupping, particularly with sustained or high vacuum applications.
Interestingly, the maximum tensile stress on the skin occurs just inside the rim. This is because the skin is simultaneously anchored by the cup's edge and pulled upwards by the vacuum. This specific distribution helps explain the common pattern of ecchymosis, which often starts as a ring of redness before filling in the central area.
Delving Deeper: Recent Biomechanical Insights
Since the initial biomechanical investigations, further research has continued to explore the mechanical effects of cupping on soft tissues. Studies have investigated how different pressures and durations of cupping influence muscle stiffness and skin blood flow. For instance, research has indicated that specific cupping parameters can affect the stiffness of deeper muscle layers (using elastographic ultrasound) and influence peak and total skin blood flow response depending on the pressure and duration applied (Li et al 2022).
Furthermore, the impact of cupping on soft tissue elasticity has been explored, with some studies using novel devices to quantify changes in tissue elasticity following cupping application. These investigations contribute to a growing body of evidence seeking to understand the tangible mechanical changes that occur within the tissues during and after cupping therapy.
Beyond Static: The Impact of Movement
While static cupping primarily affects the tissue directly beneath the cup, the application of movement, a technique often utilized with flexible silicone cups like RockPods, introduces a new dimension. Moving the cups while they are applied to the skin, sometimes referred to as "shearing" or "dynamic cupping," is likely to broaden the distribution of tensile stress through the skin and deeper tissues. This dynamic application can be a valuable tool for therapists working on tissue mobility and fascial manipulation, potentially influencing a larger area than static application alone.
Optimizing Treatment with Biomechanics in Mind
A solid understanding of the biomechanics of cupping empowers practitioners to deliver more comfortable and effective treatments. When using tools like RockPods, considering the following can enhance the therapeutic outcome:
- Minimize Compression: Be mindful of the compressive force under the cup's rim. Choose cups with appropriately designed edges and select a size that avoids direct pressure on particularly tender spots.
- Control Vacuum and Duration: The degree of vacuum and the duration of application influence the level of tensile stress and the likelihood of ecchymosis. Adjusting these factors based on the client's sensitivity, the specific goals of the treatment, and insights from research on pressure and duration effects is crucial.
- Leverage Cup Size: Wider cups may achieve a deeper transmission of tensile force compared to smaller cups at the same vacuum pressure.
- Utilise Movement Thoughtfully: When incorporating dynamic cupping with RockPods, understand that the shearing motion can expand the treated area and influence tissue tension in different ways. Avoid excessive friction under the rim during movement to prevent skin irritation.
By integrating the biomechanical principles of cupping with the practical application of modern tools like RockPods, therapists can move beyond traditional doctrine and provide evidence-informed treatment that is both effective and comfortable for their clients. Understanding the forces of compression and tension, their distribution, and how they are influenced by factors like cup size, vacuum pressure, duration, and movement allows for a more precise and beneficial application of this ancient therapy, supported by ongoing scientific investigation.
Daniel is the author of: A Practitioner's Guide to Clinical Cupping
And lead educator for the UK RockPods cupping course
References:
Li Y, Mo PC, Jain S, Elliott J, Bleakney A, Lyu S, Jan YK. (2022) Effect of durations and pressures of cupping therapy on muscle stiffness of triceps. Front Bioeng Biotechnol;10:996589. doi: 10.3389/fbioe.2022.996589. PMID: 36466351; PMCID: PMC9712727.
Tham, L.M., Lee, H.P. and Lu, C., 2006. Cupping: from a biomechanical perspective. Journal of biomechanics, 39(12), pp.2183-2193.