A simplistic explanation brings us back into physiology. After cupping (MFD technique), there are neurophysiologic responses that the body manifests. While the cup is still exerting negative pressure on the tissues, it goes through a brief ischemia or “paleness” followed by immediate flushing or hyperemia as the blood re-enters the area. As a result, it produces endogenous (internal) opioids and endorphins that affect the limbic system and the brainstem to help alleviate the pain. In some respect, myofascial decompression (MFD) therapy which we call cupping relieves pain by acting as a counterirritant. It seems to follow Melzak and Wall’s gate control theory of pain management similar to the concept of TENS unit except decompression offers more morphological change in the myofascial system to increase hydration in the ground substance.
The technique is gentle despite its alarming after marks. Since the myofascia cannot be forced to release by yanking or attempting at compressive manipulations, a sustained low pressure lift is more beneficial for what we are trying to achieve. In relation to myofascial release, creep is the distortion of tissues as function of pressure overtime. With myofascial release (MFR), 90-120 seconds is the time for the first barrier to generally release and push into a new range of extensibility. Often times, the patient expresses a feeling of heat, release or pulsation in certain areas which we call therapeutic pulse possibly during hysteresis. Hysteresis is the exchange of heat and energy as tissues are distorted leading to permanent deformation.
There is also a gentle microtrauma that occurs in muscle tissues in order to slowly reeducate the muscles, fascia or tendon to reshape itself to perform better function and extensibility. If you ever experienced stretching your hamstring for the first time in years after sitting in front of the desk, you realized that there were some changes that occurred in the fascia and tendons that allowed you to finally stretch the hamstring in full length. A gentle microtrauma has occurred in order to allow for the reshaping of that hamstring. The same is true when one is exercising to increase the bulk of the muscle which we refer to as hypertrophy.
While tendon hysteresis takes 5-10 minutes (Kubo 2001), therapists have a better chance at working with myofascia which has a larger and more extensive role in supporting the muscles and tendons. The myofascia simply put, has a big role in supporting our muscles and bones. It therefore demands its own attention. As we have more myofascia than skin, the once thought of as the largest tissue in the body, therapists have begun paying attention to this universal ally if we can ever get it to function well.
The recent book published by Dr. Guimberteau on the architecture of the human living fascia has brought a never before seen clarity on the view of the extracellular matrix and the life the fascia manifest itself in all our muscles, tendons, bones and viscera. Unlike the dried out human cadaver fascia we learned in physical therapy and medical school, these structures look alive and beautifully hydrated when viewed in highly magnified endoscopy.
Certainly, I have embraced the use of cupping for purposes of myofascial decompression with which many patients have verbalized good results. While not everyone will ever like the same form of treatment, Ambient Physical Therapy approaches a patient individually and designs a careplan that may call for a multi-modal approach, or singular modality depending on the need of the patient. In other words, even with cupping therapy as narrowly focused as an MFD approach, a thorough evaluation is tantamount to success. It is important to understand the underlying problem that caused the movement syndrome and the resultant pain. Nothing can replace a good evaluation. As the saying goes, a correct diagnosis is half the cure.
So, while the media sensationalized the circles residual after the treatment, the true correction of movement syndromes that caused pain are not just the correction of myofascia but also neuromuscular timing, strength, proper use of body mechanics as well as postural and lifestyle change. The physical therapist with a trained eye to detecting movement syndromes coupled with skilled manual therapy and holistic approach may very well be the answer to some of your unresolved pain issues.
About the author:
Desiree Gibbs, PT, MHA, ABDA
Ambient Physical Therapy is an experienced private practice