Cupping (Part IV)

How Can You Know if the Skin and Hypodermis are Dysfunctional?

Certainly in some cases the problem is clearly visible, such as with skin disorders like rashes, acne, varicose veins, excessive sweating or dry skin.  But the skin doesn’t always manifest as problematic and point us in the right direction, even when there are underlying problems.  Another visible manifestation of underlying issues can be the storage of excess adipose – the sophisticated word for fat.  For some it is general and widespread throughout the body.  Many others, even relatively thin folks, can harbor frustrating love handles and a muffin-top belly that can be very resistant to elimination, especially after childbirth.  Lymphedema, the name for the abnormal accumulation of fluid typically in a limb, is often managed with compression garments and fluid reducing medications.  All of these visible issues are often very stubborn, unresponsive to treatment, and at best managed but not resolved.  Lab work and X-rays often reveal no problem and provide no clue as to where the source of a problem lurks.  Some soft tissue issues may be visible on MRI depending on the method used and the person reading it.  It’s also possible to view the soft tissues with diagnostic ultrasound.  But such diagnostic tools are not always available, and can be costly to utilize (we don’t have them in our clinic). 

Autonomic dysfunction manifesting in the skin, belly fat, and lymphedema.
Examples of autonomic nervous system struggles that are manifesting visibly at the surface. All of these often have components that can be helped with cupping. Middle image from Other images from internet, sources unknown.

Fortunately our best diagnostic tool is always “on hand” through palpation.  The Fascial Manipulation Association logo highlights that “A Knowledgeable Hand is Potent,” and this holds true for palpating the superficial structures.  When performed by a competent clinician, visual inspection and palpation can be very accurate for identify dysfunction of the skin and hypodermis. Palpation of the hypodermis is a skill that was not emphasized in my physical therapy training, but I have acquired with time, practice, and intention.  It necessitates a lighter touch, which makes sense considering the superficial nature of the structures as compared to the deep fascia and muscles.  It also requires an appreciation of the layered formation of the tissues – different structures will be found at different depths.  This can be done as follows:

  • Open hand – palpating for several characteristics:  moisture/dryness of the skin; thickness of the underlying tissues – dysfunction will often feel dense, lumpy; and sensitivity, even to a light touch. 
  • Pincer – grasping or pinching the tissues from the skin down to the deep fascia between the thumb and fingers.  Dysfunctional areas will typically be painful as the nerves are sensitized by the surrounding dysfunction.     
Flat hand and pincer palpation techniques
Here I am demonstrating on my own leg the two palpation techniques I typically utilize for assessing the skin and hypodermis – flat and pincer palpation. . Photo by Colleen Whiteford.

What Conditions Can be Helped with Cupping?

By now I hope you can see the tremendous potential for impacting a multitude of issues by accessing the autonomic nervous system (ANS) through the skin and hypodermis.  Most conditions have medications and interventions specifically for the symptoms they generate.   But when you consider the fact that many of the pharmaceuticals available for such conditions are modifying the function of the ANS, it’s no wonder the list of potential side effects can be daunting.  Without a multi-faceted approach that targets the underlying cause of the disorder, logic dictates that it will not resolve and the symptom alleviator will be needed ongoing.  Many of these disorders can involve both the deep fascia as well as the superficial tissues. For deep fascial involvement my go-to is the Fascial Manipulation model, and when it involves internal dysfunction, I follow the model of Fascial Manipulation for Internal Dysfunction.  When the skin and hypodermis are involved, I will generally pull out my lovely cups.  Here are some of the problems and conditions I treat with cupping (along with other interventions):

  • Adipose – cupping can help to break up adipose trapped in thick, dysfunctional parts of the hypodermis
  • Circulation – cupping can free vessels struggling in a thick, dysfunctional environment in the hypodermis and superficial fascia.
  • Digestion – yep.  A host of digestive disorders (IBS, constipation, colitis) can have an element of dysfunction arising from the autonomic nerves trapped in the hypodermis of the trunk, especially the abdomen. 
  • Lymphedema – Cupping can serve to free up the lymph nodes and vessels that are unable to function in thickened areas of the hypodermis.
  • Pain – remember, the skin is the most highly innervated tissue in our body.  Pain attributed to deep structures (muscle, tendon, discs, large nerves, even organs) may be arising from the small superficial nerves as they course their way to the skin.  Cupping can help to break up thickened tissue aggravating these nerves.
  • Scars – cupping can help to reorganize the lay-down of collagen in the vicinity of a scar so it can heal as neatly as possible.  Cupping can also free up nerve endings that may be trapped in the scar causing pain and sensitivity. 
  • Skin – can be very responsive to proper intervention targeting the superficial and deep tissues.  This is one reason I LOVE skin issues!   It’s like the body is drawing a roadmap of dysfunction and pleading for help in these places. Cupping can help to free up nerves, hair follicles, blood vessels, oil / sweat glands that are stuck in muck and can’t work properly. 
Cupping legs for swelling, cramping, fatigue
Cupping the lower leg can be wonderful for helping with swollen legs that get tired and crampy. Photo by Colleen Whiteford.

Who Uses Cupping?

One refreshing fact about cupping is that no one (that I know of) claims it as their sole right and scope of practice, arguing that other practitioners cannot use it.  Hooray for that!  Turf battles exist in all walks of life, and health care is no exception.  There are some acupuncturists who passionately argue that they are the only ones who should yield a solid filament needle.  Some chiropractors insist that they are the only ones who should do manipulation.  Years ago when my husband was the president of the Virginia Physical Therapy Association we fought a brutal battle with chiropractors who attempted to prohibit us ever moving the spine – be it joint mobilization, manipulation, or even traction.  Some physical therapists get very upset with the prospect of athletic trainers treating a non-athletic population.  To me these sorts of wars are costly and distract us all from focusing on what we should be all about:  helping people. 

Cupping can be used by acupuncturists, athletic trainers, chiropractors, doctors, massage therapists, midwives, neuromuscular therapists, nurses, occupational therapists, physical therapists, and anyone else I left off the list here.  There is no requirement of training or licensure board associated with it.  Cupping can even be used by you. Matter of fact, I’ll make that the topic of the next and (probably) final post on cupping.

This post is a continuation in a series on cupping. To facilitate a better understanding of cupping, I would suggest you first review an introduction to the connective tissues and their layered formation by reading Fascia Facts.

Wishing you health and Joy!


Published by Colleen Murphy Whiteford

I am a physiotherapist, graduate of Saint Louis University Class of 1984. I married my best friend and business partner, Bill, who is also a physiotherapist, in 1988. We have worked together all these years - an example of God's grace! Together we started Appalachian Physical Therapy which continues to thrive. I am a big believer in the power of touch, the manual therapies, and treating holistically. There are many alternatives to medications, surgeries, and testing, but people are often uninformed. My perspective emphasizes the role of the connective tissues including the fascia. Lack of attention to this structure is the source of many physical ailments - our bodies are truly fearfully and wonderfully made (Psalm 139)! I am passionate about helping people of all ages and diagnoses maximize their health, and empowering them to understand their role in management and prevention of problems.

One thought on “Cupping (Part IV)

Leave a Reply

%d bloggers like this: