What combines the ancient traditions of Asian medicine and key fascia-releasing techniques? Cupping massage. In fact, this modern take on an ancient therapy brings together the best of both worlds.
A Field of Contradictions
I received 14 months of well-rounded and comprehensive massage school training to begin my career. After graduating in 1995, I realized that I really didn’t know much of anything. A lot of my accumulated knowledge contradicted itself. For instance, if I have a client who suffers from headaches, should I spend a bunch of time doing neuromuscular therapy trying to extinguish trigger points that might be activating the pain process, or should I look at the structural components that might be creating a head-forward, rounded-shoulder posture? Perhaps the headache comes from some sort of vertebral misalignment or subtle craniosacral imbalance? Maybe an inactive muscle in the neck is creating instability, or could it be a faulty eye pattern? What if nothing physically has changed with my client, and the headaches are a result of an increased stress level?
Given all those questions about just the subject of headaches, I knew I couldn’t build a big enough toolbox of techniques to relieve every person’s symptoms every time. But let’s look at a few other questions I had as a new therapist. Should I follow the path of most resistance or least resistance when doing myofascial release? Should I try to massage and soften the tight side or stimulate the tissues that seem nonactive? Do I deliver deep myofascial alignment work (that might be painful) versus work that I know will feel good and settle the client into a parasympathetic state?
After many years of practice and research, I’ve come to the conclusion that we can accomplish both goals by using what I call Soma Cupping. Through this technique, we can move into and against the fascial grain, while at the same time introducing rotational and decompressive forces. Through Soma Cupping, tissues that are hypertonic can be softened, and flaccid tissues can be stimulated. By closely monitoring the level of negative pressure employed, we can utilize this work to keep our clients in a parasympathetic state.
The Science on Fascia
One of the people in our field doing rigorous science on therapeutic touch is Robert Schleip, PhD. Schleip, a former trainer at the Rolf Institute and a department chair at Ulm University, writes, “In myofascial manipulation, an immediate tissue release is often felt under the working hand. This amazing feature has traditionally been attributed to mechanical properties of the connective tissue. Yet, studies have shown that either much stronger forces or longer durations would be required for a permanent viscoelastic deformation of fascia.”1 In other words, the ideas I was taught about fascia “melting” or it being “restructured” were incorrect. We can’t press hard enough or hold the release long enough to melt the fascia.
One way to think about fascia and its tensile strength is to think of fresh seaweed. It’s tough and strong. We can’t generate enough force to change its structure (without actually tearing the fibers). It is, however, also pliable. We can move it in the direction we feel it should go, if the seaweed is hydrated instead of dried out.
The science is clear—we can’t reorient fascial fibers. Why, then, are deep myofascial disciplines such as Rolfing and Active Release Technique often so effective? Perhaps it’s because the act of manipulating the fascial system bombards the central nervous system (CNS) with huge amounts of information. The CNS forms a better holographic image of itself, for lack of a better phrase, because of the increased proprioceptive feedback. The result is a better internal map. Muscles that may have become dormant have a chance to revive thanks to improved nervous system conduction, while improved muscle activation can hold the fascial system in better alignment and improve posture.
“Fascia, nevertheless, is densely innervated by mechanoreceptors that are responsive to manual pressure,” Schleip continues. “Stimulation of these sensory receptors has been shown to lead to a lowering of sympathetic tonus, as well as a change in local tissue viscosity. Fascia and the autonomic nervous system appear to be intimately connected.”2
Embedded within the fascia are untold numbers of proprioceptors that feed information to the CNS. Dating back to 1957, researchers found there are 10 times more sensory nerve endings in fascia than in muscles.3 Mechanoreceptors, nociceptors, chemoreceptors, thermoreceptors, and baroreceptors all give the CNS vital information about our moment-to-moment status. These proprioceptors create an internal map that dictates (among many other things) whether we should be in a sympathetic or parasympathetic state. The better the map, the more likely we are to move our clients into pain-free movement and enhance regulation of their nervous systems.
There is a key phrase in Schleip’s statement that should be further examined: “... a change in local tissue viscosity.”
Manual therapies improve the levels of interstitial fluids. What, then, is the most efficient way to improve viscosity between sliding tissues? Dynamic movement is certainly the number-one way. Our lymphatic systems don’t work well unless we move. What happens, though, if there is an injury and our clients can’t move freely? Or if we are working on someone who sits in the same position for 8–12 hours a day?
We can press down on the tissues, flex them, stretch them, slap them like bongos (kidding, but …). All of these things help increase fluid movement in the interstitial tissues. There is another way, though. We can apply suction.
The Benefits of Soma Cupping
By using Soma Cupping, we can lift and separate tissues off of each other. This movement bathes the fascial structures in fluids; as a result, the matrix gets rehydrated and made more pliable. Think of a sponge when it’s in a dry, contracted state versus a sponge with water in it. The dried-out sponge is rigid, but the physical bonds that make up the structure of the sponge don’t change. If fluid is reintroduced, it becomes supple again.
There are several advantages to using Soma Cupping, including application directly to the spine to affect the intraspinal muscles that are too small and too deep to be massaged directly, and utilization of rotational forces applied to the fascial web—something hands-on therapy can’t duplicate. (Note: you can use any brand of cups while employing these techniques, but I have found that clear silicone cups are easiest to work with.) Soma Cupping is also an effective tool for relieving trigger points, as trigger points are ischemic in nature. Simply place a cup on the area of tenderness for 20–40 seconds. The area will turn pink as blood and lymphatic fluids are drawn into the area under the cup. Recheck for tenderness after the cup is released.
Soma Cupping is also an exceptional treatment for dealing with scars. Scars bind and restrict the fascial web. Scar tissue may also interfere with CNS conduction. While Soma Cupping can’t erase scar tissue, it can loosen the adhesions and stimulate proprioceptive feedback.
For the therapist, cupping massage is also a hand-saver. Over the last 20 years, I have had several hand, wrist, and forearm issues. I now spend 20–60 percent of my bodywork sessions employing Soma Cupping. Letting the cups do the work has been a boon, and I don’t feel like I am shortchanging my clients. In fact, I feel like I am giving them state-of-the-art work.
Application
Let’s look at a practical demonstration of how Soma Cupping can be used for structural balancing:
1. With the client standing, place your thumbs on top of both crests of the ilium (Image 1). Measure for an imbalance across the horizontal plane (i.e., is one side higher than the other?).
2. Repeat the test with the client in a seated position (Note: the seated surface should be as flat and firm as possible so as to not alter the test). Measure for differences in hip height (Image 2).
3. Compare the results.
• If the hip imbalance is worse while seated, then the high hip is being pulled up.
• If the hip imbalance is worse while standing, then the low hip is being pulled down.
• If one hip is high when both seated and standing, use the treatment for whichever test has a greater discrepancy.4
Two corrections
1. If the ilium is being pulled up:
Place a large cup on top of the quadratus lumborum-vertebral border. Apply several firm tugs upward toward the feet. Release the suction and move directly adjacent to the spot that was just mobilized. Apply the cup again and move it in a downward manner. Repeat until the entire upper border of the ilium and quadratus lumborum are treated.
2. If the ilium is being pulled down:
Place a large cup on the gluteus medius-sacroiliac border. Apply several firm tugs down toward the head. Release the suction and move directly adjacent to the spot that was just mobilized. Apply the cup again and move it in an upward motion. Repeat until the entire lower border of the ilium and gluteus medius are treated.
Note that no oil or lotion should be used for either technique. The intent is to have a firm grip on the tissues, rather than sliding.
Now, reassess. If the correction is done with enough force, the hips will likely be level upon retesting.
Cuppng therapy is not only a valuable addition to your therapeutic toolbox, it can also prolong the career of the massage therapist’s hands by letting the cups do the hard work. This effective technique is gaining not only in popularity, but also in research-based affirmation.
Notes
1. Robert Schleip, “Fascial Plasticity—A New Neurobiological Explanation, Parts 1 and 2,” Journal of Bodywork and Movement Therapies 7, no. 1, and 7, no. 2 (January 2003 and April 2003).
2. Ibid.
3. Donald L. Stillwell, “Regional Variations in the Innervation of Deep Fasciae and Aponeuroses,” The Anatomical Record 127, no. 4 (April 1957): 635–53.
4. When standing, there is an equal pull from the upper and lower body. While seated, the legs are taken out of the gravitational field so the forces to sit up are concentrated on the torso rather than the lower body. It sometimes happens that one hip is higher than the other in both standing and sitting to the same side. While nothing is impossible, I have yet to see one hip being high while standing and the opposite hip elevated while seated.
Gregory Gorey, LMT, graduated from the Academy of Somatic Healing Arts in 1995. He developed Soma Cupping therapy, and, in 2012, he started posting instructional massage videos on YouTube. As of June 1, 2016, his free online tutorials have been viewed more than 50 million times. For more information, visit www.somacupping.com.