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Beware the Hipsterization of Cupping in Massage Therapy

August 16, 2016 by Tania Leave a Comment

[Written while listening to this. Comments are welcome below.]

boy-1299608_640 Cupping gone wild. Nice try, Michael Phelps, but Gwenyth Paltrow did it first . And I tried cupping before it was cool. So there.

Before playing devil’s advocate, please know that I am ultimately pro-cupping (if it’s appropriate) and always have been. But I do not offer it as a service because I prefer working with my hands. I have received great cupping treatments which have brought me relief. I’ve also experienced painful cupping, which I did not enjoy at all and left me unnecessarily covered in purple circles without helping. And I’ve also had cupping which was meh and left me wishing someone would have just manually manipulated my tissues like I wanted. So does cupping work? Well, sometimes or maybe. And it depends. This is the only thing we can honestly say about cupping so far based on evidence and physiology. More on that later, but for now please have a look at just a tiny fraction of commentary which inspired this post:

What’s wrong with this picture? Um, EVERYTHING. The “bottom line” is LOTS of damage can occur, considering the bandwagon-ism of the other comments. Truth is we don’t know exactly why cupping appears to work and chances are many other modalities can work just as well, sans bruising. That’s fair.

Let’s be honest-er

Do I personally need evidence for everything I choose to practice? NO. Because there is not yet an answer for everything, but with a little legwork and critical thinking there is access to great working hypotheses. It is important to know the difference between a fact and a good guess. When whatever I’m doing is based on an educated guess, I clearly tell clients “I don’t know/not sure/as far as we know this could be how xyz works (or not), but I’m happy you feel better somehow”. This is being honest and clients respect that (for the record, I am guilty of having made many false claims before I knew better and was called out on them). Clients can google cupping and in 30 seconds find way more evidence against it than for it (this does not mean it does not help on some level- but the mechanisms by which it has claimed to work have been dismantled by Physiology 101 so we must move on to another hypothesis… be patient, we will get there). We are accountable for the explanations we choose to give, so let’s be honest-er.
Do I need evidence if I am going to make claims to the public about how, why, or if something works? Oh, hell yes. Otherwise, that is called making up stories and our profession needs to stop doing that if we want to move forward.

I’m all for continuing education and expanding treatment options that may work for somebody. What I’m not for is people running out and hurting their clients because the dangers of cupping are being under-touted and lost in dazzling paparazzi camera flashes. I’m also not for people spreading misinformation about when and how it may or may not work (that is in essence, lying). And lastly, I’m not for the hubris that comes along when people under-tout and misinform and are not even aware that they may be unaware (aka the Dunning-Kruger effect). Yet all of these things have happened overnight with the Phelping of cupping and it’s a little disconcerting.

It’s just another recovery modality. There’s nothing really particularly special about it.” -Keenan Robinson, Phelps’s trainer

But Michael Phelps tho!

Guess what? Michael Phelps was winning bucket loads of gold medals before he ever did cupping. So, maybe he’s just a great athlete and maybe cupping isn’t magic? What about all the other gold medalists who don’t employ cupping and still excel in their sports? Just pointing out the holes in this logic. With this same thinking we should also see the use of recreational cannabis explode as well; Michael Phelps smokes lots of pot, therefore, mega bong hits must be the reason behind his record-breaking gold medal collection. Does that mean we now have to become weed dealers in order to help our clients? In this New York Times article (it is one people have been citing to support the purported miraculous je ne sais quoi of cupping), even Phelps’s personal trainer, Keenan Robinson, is quoted saying, “It’s just another recovery modality. There’s nothing really particularly special about it”. So let’s all slow the roll and step back a bit for the sake of ethical and safe practices.

The newest ancient sensation sweeping the nation

Literally OVERNIGHT, the price of cupping sets doubled on Amazon. Enrollment in cupping continuing ed courses has skyrocketed and so has the amount of MTs and others who now offer cupping out of the clear blue sky. Cupping has been featured front and center on every news website and even the ABMP is seizing the opportunity to wrangle up some extra CE cup-sized dollars. Laymen are cupping themselves until they implode into self-inflicted vacuums. It’s raining cups, hallelujah. Sure, this can be all good in the right hands. But what is not good are the false claims and careless practices that will burst in the Cupping Bubble of 2016. Think sub-prime mortgages, but with ancient healing cups. We all know how that ended.

Just like massage can be harmful, cupping can be harmful. Which is why I’m writing this. Our profession is full of hubris and skewed “truths” and serious massage professionals know this all too well (review the screenshot I posted up top and that’s just the tip of the iceberg). It is the sole reason why our profession is not where it could and should be. Sure, cupping may help some people sometimes, but many people have also been injured (I dare you to Google “dangers of improper cupping”). Professionals hopping on the cupping bandwagon like, “CUPPING IS THE MOST AMAZING THING EVERRRR. CUPPING WILL CURE YOU OF EVERYTHING!! CUPPINGCUPPINGCUPPING! I WILL NEVER NEED TO USE MY HANDS AGAIN, BWAHAHAHA!”, quite frankly, scare me.

Seriously, everybody chill. Cupping has been around almost as long as, well, cups. Why is it like a thing all of a sudden? Because the media has propelled the public into demanding it whether it may or may not be effective for them. And there are irresponsible practitioners beginning to do the same at an alarming rate. It’s ironic to witness an ancient practice become a modern fad that loses all respect for the art itself and laughs at science because Michael Phelps. It is CAM sensationalism at its finest. But at what cost?

Pros and cons

What do you want first? The good news or bad news? Let’s do bad first so we can end this on a positive note. Please allow me to highlight only a couple of the epic fails in cupping therapy (and there are many more which go unreported):

Exhibit A (photo on right): Popular treatment known as cupping therapy leaves man with seven holes in his back

“Oh, but that’s fire cupping“, you say. “I would never do that”, you say. “I use the suction-cup-pump thingies which are totes safe”. Well, then allow me to show you Exhibit B: The Horrors of Improper Massage Therapy (all about suction cupping gone wrong).

If that’s not enough to convince you this can be dangerous in the wrong hands, well, you are likely one of those people that scare me. Yes, driving is statistically the safest mode of transportation, however, avoidable accidents happen every day; most often because people: A) are not paying attention, B) do not ever think it could possibly happen to them so they fail to practice basic safety precautions, or C) a combination of both A and B. If someone is not capable of acknowledging the dangers of cupping, they are in no position to proclaim its benefits. And if everyone starts pushing this like it’s the best new ice cream flavor in town, we are in big trouble.

Physiology 101

Claim: A cupping mark is not a bruise.
- Truth: Indeed it is. I agree, “cupping mark” sounds much more endearing than bruise and Sweet n’ Low sounds cuter than aspartame, but under a microscope it is the same thing. Tocopheryl acetate= Vitamin E. Every research paper ever published iterates the marks are circular ecchymosis (you know what that means). Broken capillaries are exactly that: broken/disrupted capillaries. This is not to negate that cupping induced ecchymosis may have therapeutic value, but rather any such value has not been clearly defined under the existing paradigm of cupping. Also, the bruising may very well be entirely unnecessary in order to achieve results. Imagine that. It is both a cupping mark and a bruise and to deny that is to deny climate change. “But in Chinese medicine it is not a bruise, it is caused by stagnation”, you say? “It is sha“, you say? As far as I recall, actual stagnation leads to necrosis and if we aren’t referencing the same medical dictionary, this discussion will go nowhere. Call it sha or whatever you want, a bruise by any other name is still a bruise.
Claim: Cupping does not cause damage.
- Truth: If that is what you believe, kindly put the cups down, walk away slowly, and never use them on anyone ever again. Please. If cupping causes capillary damage, that is by definition damage. The extent of the damage is another story, but a blanket statement of ignorance regarding the potential dangers is reason to worry. If I went for a cupping treatment and the therapist did not acknowledge this, I would not allow them to perform the treatment on me. Period. Surgeons acknowledge all the risks of a procedure before performing it. Cupping is not above a surgical procedure. We’ve already discussed the serious damages that can occur.
Claim: Cupping does not hurt.
- Truth: Say whut? More accurately, cupping should not hurt. But it sure can! It’s hurt me on occasion. If someone says it hurts them, please believe them and pop that thing off. Remember do no harm? Yeah. THAT.
Claim: Cupping removes toxins.
- Truth: LOL. I could leave it at lol, but that’s not productive. First of all, define the “toxins”. I’ll wait… mercury? arsenic? lead? cholera? some kind of bacteria? a skin-eating amoeba? According to the laws of the universe, there are only 2 ways actual toxins leave the human body; either poo-poo or pee-pee. That’s it. If they are able to be leeched out of someone’s skin with vacuum cups, your client is an alien species and not human. Or a frog. Maybe they’re a frog. Don’t take my word for it, read this.
Claim: Cupping improves circulation and lymphatic function.
- Truth: Whoa, I’m confused. If cupping creates a bruise, sorry, I mean “cupping mark”, which is a disruption in local circulation- technically sucking blood out of the circulatory system- how is this an improvement? When I bump into a table and bruise my thigh (which happens more often than I’d like because I’m a clutz), I don’t think “Look at the improved circulation!” I understand it is minor internal bleeding, which is hardly an improvement. And as for lymphatic function, HOW? Yes, I read the explanation “suction pulls plasma and red blood cells into the tissues and up through the layers and the lymphatic system towards the surface” and I don’t understand. Blood doesn’t get sucked through the lymphatic system. I looked for evidence for this mechanism online (because this would be easily testable in a lab) and there is zero to affirm it. ZERO. Therefore, it is a false claim. I could also claim cupping helps my hair grow faster by suctioning my follicles (even though my hair grows anyway). Makes just as much sense.

magician-25490_640 If we want to give someone an accurate, ethical explanation about cupping and how it may help them, the information in this link is pretty much the only wording that does the justice. To that you may add, “let’s try and see if it helps” and proceed with care and humility. As MTs, we have to do better than just repeating inaccuracies. It is our responsibility to be clear. We can help people without making up stories and we should give our clients more credit than that. Cupping is not magic, unless of course you somehow manage to pull rabbits out of cups after a treatment, TA-DA! Then it’s magic 😉

The positives and the hope

Cupping also stimulates the mechanosensitive Aβ fibers which reduce nociceptive input. More intense stimulation activates the C and Aδ fibers in the affected areas, thereby raising the inhibitory receptive fields of cortically projecting and provoking diffuse noxious inhibitory controls. In addition, cupping probably strongly impacts relaxation and may serve as a social, comforting interaction. Further investigations of these mechanisms of action are necessary.” -Rozenfeld 2016

smilie-678967_640 Now, this is a potential positive effect of cupping worth exploring! Skin deformation is something cupping has in common with many other effective modalites such as Graston technique (the Western version of GuaSha) and manual therapy. The nerve receptors which register mechanical pressure (in this case, created by the cups pulling the skin up-and-in via the vacuum effect) are stimulated in a way that inhibits nociceptive signals the brain may interpret as pain or dysfunction. Hmmmm…. see where this is going? Don’t the potential effects of cupping on the nervous system which regulates all other systems, make so much more sense than promoting unfounded claims? Could that be why people feel better afterwards? Do clients really need to be bruised for cupping to be effective?

I will leave it at that hypothesis and I do not have the answers to any of those last questions, but it is food for thought. To give credit where credit is due, I stumbled upon this better notion by reading something written by Jason Erickson (I will update this with a link whenever I find it again, but for now the reference is lost in cyberspace).

Conclusion

I like cupping! Many people do for their own reasons and there are so many skilled practitioners. What I do not like are false claims or clients being misinformed. Perform cupping with care, know its limits and potential dangers, and remember it’s ok to say “We don’t know exactly how or when this works, but if you want to try it out I will do my best. Let me know how you feel”. Is that so bad after all?

The Awkward Shift in Manual Therapy

April 24, 2016 by Tania 11 Comments

[Written while listening to this and then this. Comments are welcome below.]

This week I had the opportunity to take an awesome continuing education class (led by Rolfers® Rey Allen and Michael Polon). It is based on the groundbreaking work of Diane Jacobs, PT. It was one I’ve had my eye on for a couple of years, then the timing was finally PERFECT. A great CE class is food for the soul of a MT 🙂 And after 20+ years of doing this, I’ve become VERY picky.

In last week’s post, we “chatted” about one reason this site was born and this week we’ll piggy-back on that topic a little more. Let’s begin with the great divide that is happening in our profession and then *spoiler alert* we will close with the inevitable shift that is on the horizon. And by horizon, I mean it’s still 10-20 years away from being accepted as an undeniable truth, but we’ve gotta start somewhere.

Two words. Pain Science.

I won’t begin to open that can of dendritic worms here- at least not in ONE blog post, because it is a giant can with waaay too many worms. But Google has a lot to say about it, so you can start there and we’ll continue to whittle away at different angles of the topic for as long as this site is up and running. Which will be a long time.

As a teaser, let’s just say that discoveries in pain science over the last (I’ll generalize) 10-15 years are about to shake the foundation of everything we thought we knew about the body, particularly from a structural perspective. Massage therapists, I hope you’re all sitting down. Surgeons, chiropractors, orthopedists… I suggest ya’ll hold on to each other tightly and don’t let go. Let’s take each other by the hand because this may be uncomfortable until everyone gets used to it. The same denial and awkwardness awaits us as did when people began to realize the sun did not revolve around the earth. And that the earth was round and not flat. And that simple hand washing could save lives. Rest assured, things get REALLY exciting after the fledgling awkwardness. Just like your first 8th grade slow-dance.

The Great Divide

On one side we have science. And we all like to high-5 science when it goes along with exactly what we assume, think, or thought we thunk. On the other side we have what we were taught and/or what we believe is true. Remember: beliefs are not facts a.k.a. unicorns are not horses.

But who doesn’t love unicorns?! Unicorns are awesome! Yes, they are but we all know they don’t exist. Put it this way: the unicorns of manual therapy are being outed. However, where the horses will lead us is in an even more magical and wondrous direction. You can believe that. (This effects other disciplines too, like surgery, orthopedics, etc., but we’re a MT site so that’s what we relate it to.)

So, guess what happened when science told stubborn-me so much of what I thought I knew for 15+ years had been proven wrong? That’s right, I threw an internal hissy fit. It looked something like me scrambling online like a mad woman for nearly a year to try and reverse-prove the science wrong. (Yeah, that didn’t go so well.) The good news is the hissy fit subsided after I realized how cool the facts were because they solidify what we as MTs have known all along about the inseparable body-brain-mind connection. (Don’t worry, we’ll discuss this more in the future). It is almost EVERYTHING. Almost.

The great divide boils down to basic stubbornness and I’m admitting to have been very guilty of it. I mention this to let you know, in advance, I understand any initial backlash. Been there, done that. And so, I trust any hissy fits will subside as mine did. We all now know and accept the earth revolves around the sun.

Where will you stand in the divide?

Easy answer. One of three things will happen.

Maybe it’s a little uncomfortable at first, but you accept the facts and refine your work to produce better results based upon the most current information we have available. You accept the earth is round and are not afraid to travel across the ocean to new and exiting places.
You insist on holding on to past theories, even though they’ve been squashed. But as more and more people start to realize there is more (or less) to it, you slowly start to let out-dated thinking go and then gleefully join the gospel choir in singing “it is the earth that revolves around the sun, and not the other way around”.
In spite of all the evidence and shifts in understanding, you outright refuse to let those beliefs be replaced by actual facts. The world will have to pry those beliefs out of your cold dead hands. You, like, seriously, really believe in unicorns. Hell, you’d saw 14 inches off the end of a broom and duct-tape it to a horse’s forehead to prove to everyone unicorns DO exist! Then you’ll point to a rhino and say “Oh yeah! Well, that has a horn so that’s a unicorn!”

Wherever you stand, it’s cool. I get it. Just don’t be the guy in #3 because that’s just mega-cray-cray bonkers. I’ll leave you with that. See you next week!

Hasta la pasta, rasta.

Introducing the 1st Blog Post!

April 19, 2016 by Tania Leave a Comment

[Written while listening to this. Comments are welcome below.]

Yessss! I’m very excited to present Pinpoint Bodywork’s very first blog post. It’s been a little under a week since soft-launching the site on Facebook on April 13, 2016. Since then I’ve been sifting through ideas of how to kick off this posting extravaganza. It finally dawned on me a good starting point would be to explore one very important reason why this site was born in the first place.

Here we go

I’ll spare you the nitty-gritty details of my background (if you want to know more, you can go here). Long story short: I’ve been an LMT since 1994. At that time, there was limited information about the actual effects of massage on the body (there were many fair guesses though) and there was ZERO information on what the real world would be like after I was done with school. I was basically thrust into the world clueless and hungry at a time when the internet was just becoming a thing no one ever dreamed you’d be able to watch TV shows on. So, I’ve really had to dig deep for much of what I’ve learned. And I’m still digging.

You’d think having access to lightning fast internet connections would make digging for information easier for everyone, but it doesn’t. It’s become more challenging and the proof of that is in the puddin’. In this case, the puddin’ is the true state of the profession of massage therapy (particularly in the United States). We have TOO MUCH information, and unfortunately much of it is bogus.

Where are we going?

We were doing well for a while with being considered sorta-kinda-maybe healthcare professionals, but then something slowly began changing. Credibility began slipping through the fingers of our progress (some may disagree with this statement, and that is o.k. but like it or not, there are plenty of sentiments to back it up). Up until the 90s, massage was widely covered by insurance companies and now the ability for MTs to earn a living by receiving reimbursement is dwindling and losing ground as we speak. Do you wonder why that is? No no no, big pharma is not to blame. We are the ones who have been holding ourselves back.

Before moving on, it is important to know a brief history of modern massage therapy. It puts our place in the world into perspective and it will make you proud. You can read a fantastic summary of it here (article by Patricia J. Benjamin, Ph.D., L.M.T., and AMTA National Historian).

Now, I’m not sure what happened between the birth of modern massage and where we are today, but massage therapy has yet to realize its full capability. This may be a $12.1 billion industry, but we still have a very long way to go in walking side by side with other healthcare professionals. I won’t get into all of the reasons why right now, because this blog post would turn into a 1,000 page report and ain’t nobody got time for that. But for starters, the profession of massage therapy is stuck in the middle of a huge identity crisis. And it can only move forward if everyone does their part in helping to sort out its identity. The big kick in the pants is much of this sorting out process entails permanently discarding outdated beliefs and myths and stepping onto the concrete evidence available to us as of 2016. This is what I like to call “the separation of church and state” in massage therapy. However, accomplishing this has been a lot more challenging than one may imagine. You’ll see what I mean 😉

Where do YOU want US to go?

“Science is a method for deciding whether what we choose to believe has a basis in the laws of nature or not.” -Marcia McNutt, geophysicist

There is a divide in the profession of those that want to move it forward (even if it means simplifying the definition of the service we provide, which is actually a good thing) and those who are settled in the ways of false claims. There are those who remain ever curious and those who never question what they’ve been told to believe. I used to be one to buy into anything that sounded cool, mystical, or mysterious. But as I began digging (initially looking for evidence to support the claims of the cool special things I thought I knew about), I began discovering there was a lot wrong with what I learned- or if not entirely wrong, what I learned was highly inaccurate. And to make matters worse, there was no evidence to support it, or if there was it had since been refuted. My world of knowledge collapsed and it was the best thing that could have ever happened to the way I approached my work as a MT. The truth will set you free, but may hurt just a little at first 😉

To be fair, some of the stuff I was taught was based on the best information available at the time. But today there is better data and new discoveries are being made as I write this. Now it is time for massage therapy to catch up with itself and realize its true purpose so more people may benefit from it, both within and outside of the profession.

I will end this post with a link to this article titled When Will Massage Therapy Believe In Itself? by Dr. Christopher Moyer.

Dr. Moyer is a behavioral scientist and massage researcher whose work has opened my eyes on many levels. He is also co-author of the textbook Massage Therapy: Integrating Research and Practice. His article sums up perfectly one of the most important reasons behind creating this site: separating the facts from the fluff. It also addresses a truth that is hard for some to swallow. We can believe whatever we like, but as healthcare professionals we cannot present personal beliefs as facts and make medical claims based upon them. Doing so is hurting the credibility of our profession.

Let’s get to work.

Leave a comment below or you are welcome to start a discussion in the Pinpoint Bodywork Facebook Forum!

Later alligators!