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Because cupping gives massage therapists a break from deep tissue work while delivering a powerful therapeutic benefit, it is an ideal supplement to a massage therapy practice. While cupping is a relatively simple practice, there is a lot to learn about this method before mastering it. In addition to the flawless application and manipulation of cups, knowing what conditions it helps most and why cupping works, practicing therapists must know about cupping’s cautions and contraindications.

For background information on cupping, read TCM, Cupping and Massage: Part I and TCM, Cupping and Massage: Part II.

The therapeutic benefits to massage cupping are far-reaching. However, practitioners who include cupping in their repertoire must log in a significant amount of practice before performing it on clients. In order to assure its effectiveness and maintain cupping’s safety, massage therapists must be extra careful to prevent burns, apply the right level of suction and be familiar with all of the associated contraindications.

Fire Cautions

Because it can provide a strong suction without causing tissue damage, the fire twinkling method is the traditionally preferred method of cupping by many practitioners. Nonetheless, when using the fire twinkling method, therapists must be attentive, quick and agile to prevent burning their clients. The following tips help prevent burns or fire hazards:

  • Protect – Since the practitioners must place the flame into the cup in close proximity to their clients for quick adherence, the client’s skin, hair, clothing and anything flammable (hair product, oils, linens) must be protected from catching fire. Being alert is crucial to providing such protection.
  • Plan – Logistical planning prior to cupping is essential to minimize any fire hazards. Once the flame is withdrawn from the cup, the cup is applied and the flame is blown-out, place the hot, alcohol-soaked cotton ball on a stable, non-flammable surface. Because the flame may not be 100 percent extinguished, practitioners must make sure it cannot re-ignite what it is resting on, or roll off onto something flammable. A wide porcelain bowl on a firm surface (not the massage table) is a good choice.
  • Timing – Choosing the amount of time the flame is held inside the cup can be a fine line between too short and too long. If the lit cotton is in the cup for too short a time, it will not create sufficient negative pressure for suction. If the lit cotton is in the cup for too long, the lip of the cup will become very hot and could burn the client. Until mastery over cupping is achieved, practitioners should always err on the flame occupying the cup for a shorter period of time. If insufficient suction occurs, the process can always be repeated.

Suction Cautions and Contraindications

Whether you choose the fire twinkling or suction pump method to apply the cups, the therapist must avoid cupping’s contraindications and be careful with the degree of suction used.

  • Bruising – While stationary cupping typically causes more bruising than massage cupping, either technique can leave large, unsightly bruises in the cups’ wake. (To review the difference between these cupping variations, read TCM, Cupping and Massage: Part I.) To prevent surprised and angry recipients, make sure to discuss this possibility with your client prior to using this modality.
  • Degree of Suction – Getting strong enough suction is key to cupping’s effectiveness. Although, too strong of a suction could damage the tissue or even create a blister. Cupping’s intensity depends upon the following: the speed the cup is placed on the skin after the flame has been removed, the strength of the flame (certain alcohol burns hotter than others) and the size of the cup. Therefore, practicing the balance between these variables will help the therapist determine a safe cupping routine. Practitioners will find that it is very challenging to obtain suction over irregular angles, thin muscles or on areas with lots of body hair.
  • Contraindications – Just like any modality that strongly invigorates the circulation, there are some situations where cupping should be avoided. Cupping should not be done on a client with a fever, convulsions or cramps, over allergic skin conditions, ulcerated sores or large blood vessels. In addition, cupping is contraindicated on the abdomen or lower back of pregnant women or on those with a bleeding disorder.

Cupping is a relatively simple application that, when done correctly, can relieve many types of congestion in the body. Despite its simplicity, there is a great deal to learn about cupping before it can be safely administered. By reducing fire hazards, preventing burns, practicing timing, informing your client about the potential for bruising, refining your degree of suction and memorizing cupping’s contraindications, therapists are better prepared to add this valuable technique to their massage practice.

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