To understand the concept espoused in myofascial decompression, such as what occurs in cupping therapy, it is good to understand the basic idea of myofascia. Once again, our reference to cupping therapy is narrowly focused into the realm of physical therapy and not to be confused with the ancient methods and its variants, which are probably more expansive in their claims of usefulness.
Trauma and residual inflammatory responses can create myofascial restrictions that would ultimately lead to chronic symptoms of pain and disease. The myofascial system tends to dehydrate after trauma or inflammation causing the ground substance to turn to a thickened, glue-like substance. It is believed that this piezo-electic system (pressure electricity) called fascia exerts approximately 2,000 pounds per square inch in pressure,resulting in episodes of headaches, muscle tightness, spasm and nerve irritation.
As this pressure crushes the nerves, blood vessels and tendinous or bony structures, not only do you feel pain, but you probably also begin the process of compensation so as not to aggravate the symptom. Some of these compensatory motions and postures further compromise sensitive structures such as discs between the vertebrae and the nerves that supply the muscles causing easy fatigue, neck and back pains. The train wreck can start from the top of the head to the tip of your toe as the fascia really envelops the body like a stocking of some sort. It covers the body and envelops every group of muscles, tendons and bones continuously without break. So, any snag in the shoulder or neck can manifest pain far away into the hip, the lower back, the rib cage or the foot. In essence, the compressive myofascial tightness can manifest anywhere and possibly in sling patterns, depending on the activity or the position that the previous trauma occurred. For instance, someone who had a vehicular accident may have a different manifestation than the rower, the golfer, the gardener, or the football player who happened to jam his shoulder as he ran into another player during the game.
This is why I complement my physical therapy evaluation and treatment with gentle and light touch myofascial release, trigger point therapy, static magnetic therapy as well as myofascial decompression (MFD) Cupping Therapy. The in-depth whole body assessment for possible movement syndrome is important in my practice as this often guides me to see possible patterns of neuromuscular deficiency, as well as myofascial restrictions.
Cupping Therapy as it applies to physical therapy forms treatment targets to promote mechanical tissue change, trigger point release, release restriction in myofascial lines, softening scar adhesion and also releasing hyper-tonic or stiff muscle groups which can be restrictive or outright painful as you go about your daily tasks. While I often begin with the gentlest approach of myofascial release, soft tissue mobilization, craniosacral therapy and neuromuscular reeducation, there are times when myofascial decompression is warranted.
Our body’s fascial system has five components. First, there are the fibroblasts, which make and secrete all fibers of areolar connective tissues. Areolar connective tissue is found surrounding blood vessels, nerve bundles, muscles and organs. It also fills the spaces between organs and connects your skin to the underlying muscles.
Then there are the collagen fibers, which are the strongest and have the most abundant cross-linking of fibers causing immense tensile strength. It is a type of protein fiber found abundantly throughout the body more specifically in various connective tissues such as cartilage, tendons, bones and ligaments. Collagen fibers allow for athletes and dancers to do movements often beyond normal range without snapping or breaking the bones.
We also have elastic fibers which are rubber-like proteins which allow tissues to return to its original shape. These elastic fibers or yellow fibers which are made up of elastin proteins are found in the extracellular matrix of connective tissues. These fibers are believed to stretch up to 1.5 times their original length and snap back to their original relaxed length. The contractile characteristic of these fibrils serves well to keep our skin, muscles and blood vessels to stretch along as needed when our daily activities and movements necessitates reaching, bending or lengthening.
Our fascia is also composed of reticular fibers which serve to connect vessels and nerves and even have more “give” than collagen. The reticular fibers or reticulin is a type of fiber in connective tissue composed of type 111 collagen secreted by reticular cells. It forms many crosslinks and randomly oriented collagenous fibrils to form a meshwork supporting the tissues. It is lying in an amorphous matrix substance. This extracellular matrix that holds interstitial fluid via sugar-protein molecule is called ground substance. In connective tissue, the ground substance is the amorphous gel like substance surrounding the cell. It is a transparent, colorless fluid like gelatinous material which fills the spaces between fibers and cells. It consists of large molecules called glycosoamynoglycans (GAGs). Suffice to say that these fluid gelatinous beds that lie at the bottom of the connective tissue fibers have a huge function on its own as far as myofascia is concerned. It needs to be hydrated to effectually support the connective fibers. The process of decompression in cupping therapy provides that avenue to increase the space between the myofascial layers so, hydration and glide can occur.
The originator and long-time practitioner of myofascial release, John Barnes PT in one of his article contends that trauma and inflammation tend to dehydrate the ground substance causing residual pain and tightness and reduction of flexibility or pliability of myofascial tissues. The recent endoscopic work of a French surgeon Guimberteau have shown some dramatic live video and pictures of how beautifully alive and hydrated the myofascia are, in his book The Architecture of Human Fascia.
While regular myofascial release requires a very light touch, almost to the point of mere intent, the cupping technique, while it works to decompress myofascia in the process, also seems to align more towards soft tissue mobilization. It is effective in superficial fascia as well as fascia around deep muscles and viscera where longitudinal or lateral directional force is not enough due to the depth or form of the muscles. The myofascial decompression technique is another tool in a physical therapist tool box for those who believe in holistic practice. At Ambient Physical Therapy, if my patients are happy, I am happy.
About the author:
Desiree Gibbs, PT, MHA, ABDA
Ambient Physical Therapy is an experienced private practice