It is exciting to see so many therapists using cups to perform vacuum therapies for clients. Many styles of cupping are now being taught and it is understandable that this allied approach to bodywork has integrated so well with other valuable massage therapy modalities.
We receive many emails with questions about seemingly peculiar reactions clients have had during and after treatments, including blistering, hives, strange discolorations, swelling, nausea, headaches and more. While some may consider this an adverse reaction, it can also be viewed as valuable information on the actual condition of the client.
Blistering
We have received multiple questions regarding blistering and each time we respond first with questions for the therapist, such as:
• Does the client have an inflammatory issue and is it a general condition or is it localized to the area that blistered?
• Did the blisters appear while the cup was in place or sometime after it was removed?
• Is the client on any oral or topical (cream or patch) medications?
• How long was the cup left in place?
Knowing the actions of the techniques, such as creating a counter-irritant response, will help to understand why the client may have had this reaction. A very large part of the assessment is the duration that the cups were left in place.
ACE techniques specify that the cups can be left in place for up to three to five minutes and then removed. They can always be replaced in the area if more treatment is required. Our reasoning is that the techniques are so powerful that the “less-is-better” approach is very effective for most clients and does not create more severe reactions.
If the blisters appear under the cup after a few minutes, it suggests that the inflammation is more superficial, while a deeper inflammation often surfaces a bit later (since it would logically take more time travelling via the dilated blood vessels to the skin surface). If the cups are left in place longer than three to five minutes, the deeper inflammation could come up while the cup is still adhered.
When treating a client for the first time, I have found it is easier for the body to tolerate and to respond positively to vacuum therapy when the cups are used with massage movements. I often begin with pumping movements to acclimate the client’s body to the effects of the work. A thorough client intake and consultation is also imperative to understand what I am working with.
If hives have appeared during or after a treatment, educator Martha Graham has this input: “A localized histamine reaction can be a normal response to cupping, and it typically lasts for a few minutes to an hour longer … The histamine reaction could be from a harbored chemical in the body or simply the reactivation of the inflammation cycle.
The lymphatic system will remain stimulated with the lymphatic terminals open for approximately 24 hours after treatment. In theory the reaction could last for 24 hours, however, but that is not a typical response. Of course, if the hives persist, are systemic or become severe it would be pertinent for the client to seek medical attention.”
Discolorations
Strange discolorations often appear when the vacuum pressure is high, or the cup is left in place for a long while. They can also appear with very little pressure or duration at old injury sites or surgical sites. These “decorations” are unique to each client and offer so much information. These are not bruises, but bruising can occur with aggressive cupping techniques. If the mark can be erased a day or so later it indicates that it is not a bruise, so that is one easy way to determine which one has occurred.
Paying attention to discolorations can be fascinating and truly informative. A client with severe scoliosis ended up with dark purple and black discolorations that indicated a serious head, neck and back injury in her early history. Her mother reported that she had fallen down cement stairs on her head as a three-year-old child.
That knowledge allowed me to trace the damage back through the compensatory patterns her body adopted as she grew up and release them so she could maximize her range of motion with the Harrington Bars, plates and cables that had been installed.
We saw one student in class turn a yellow color all over and when she questioned her mother, it turned out she had been seriously jaundiced as a child. Many women I work on who have had breast surgeries or C-sections do end up with discolorations around the incisions; the blood can get trapped and stay lodged in the tissues. The black to brownish-red colors will indicate how long ago the surgery or injury took place. When I see a mixture of these colors, it often indicates repetitive movement patterns or numerous injuries to the same area that are frequently found in athletes.
Swelling
It does not seem to happen regularly, but there can be swelling in an area hours after treatment. If there is no inflammation, this leads us to consider any restrictions to lymphatic flow that may have been overlooked in the treatment.
If the area is hot, this could indicate latent inflammation and the body has reacted with fluids gathering in the area. Another potential cause could be an autoimmune issue such as fibromyalgia. It is so beneficial to do a lighter treatment for the first one to two appointments, including a lot of pumping with centripetal movements.
Additional Reactions
Nausea and headaches are very rare, but both lead to a review of any medications or supplements the client listed in their intake and to find any they may have forgotten. It is also so helpful to review surgical history that included anesthesia, or any exposure during their life to heavy-duty chemicals.
Another consideration is vagus nerve dysfunction, which can lead to nausea, lack of appetite, dizziness, IBS and more. There are no listed causes for vagus nerve dysfunction but working the lateral and posterior neck with vacuum therapy can greatly affect the nerve and cause an increase or decrease in symptoms for the client.
Headaches frequently indicate dehydration, and vacuum therapy often stimulates a healthy thirst that leads the client to drink a good amount of water afterward, and the headache will disappear quickly. If the headache persists, it is necessary to investigate if it is caused by medications, incomplete soft tissue release, an impinged nerve or blood vessel, or other potential causes.
See into the Body
This is the joy of sleuthing via the cups! The treatments are so effective, and we are also given valuable clues through each client’s unique response to the treatment. Be sure to use your cup as a magnifying glass to see into that body on the table, and continually update your assessments to develop a truly effective custom treatment protocol that produces real results.
About the Author:
Anita Shannon, LMT, is licensed in massage therapy and cosmetology since 1983, and an educator since 1990. She presents workshops on ACE Massage Cupping and MediCupping since developing these methods in 2002. She is also a MASSAGE Magazine All-Star, one of a group of innovative therapists and teachers who are educating the magazine’s community of massage therapists in our print magazine, on our social media channels.
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