How well do your clients breathe?
That is not something we typically ask upon intake, and it’s most likely not something clients would usually mention to us; however, there is a growing population that struggles with the complex and life-saving function—breathing—that we do about 960 times every hour.
You most likely have clients who have lived with a respiratory condition for some time, unaware that there was anything your massage could do to help ease their symptoms or discomfort.
The American Lung Association states that more than 34 million Americans struggle with such chronic lung conditions as asthma, chronic obstructive pulmonary disease (COPD) and bronchitis. Research by the Cystic Fibrosis Foundation estimates that approximately 40,000 Americans battle cystic fibrosis annually. Symptoms range from tension through the chest and ribs and unproductive coughing to general malaise and fatigue.
Many clients are unaware that their poor posture has led to a dysfunctional breathing pattern. This results in shallow breathing, headaches, anxiety, temporomandibular disorders (TMD), and decreased cervical or thoracic range of motion. Poor function in our respiratory system can be just as troubling as poor posture or weak musculature.
Cupping for respiratory health can help clients breathe better. Here, we will discuss the more common respiratory conditions you may see on your table. By gaining more knowledge about how therapeutic cupping can support clients’ respiratory system, you can significantly impact an increasing population of people who live with respiratory conditions.
Chronic inflammation radically alters the integral function of our lungs. Most commonly, it will decrease airflow, structurally change the airway, create scar tissue, and disrupt the delicate balance of the lungs’ immunological homeostasis, leading to a weakened immune system.
Inflammation can be found in the surrounding muscle tissue from continuous coughing, wheezing or shallow breathing. It can restrict the movement of blood, lymph, oxygen and other vital nutrients.
Many of these conditions affect a crucial immune function called the mucociliary escalator. This collaboration between the cilia and mucous helps trap and remove bacteria, viruses and other pathogens. The sticky, gel-like design of mucus makes it ideal for capturing foreign microbes, harmful particles and other pathogenic passengers as it glides along the cilia1. Healthy cilia rhythmically beat against each other to help push the mucus to the upper respiratory tract to be removed by coughing or swallowing. Many respiratory conditions disrupt this indispensable function.
Decreased Function & Postural Distortions
Functional breathing is more than having healthy lungs; posture also plays a substantial role. As we see more forward-head posture and lower-body cross syndrome, the tensegrity of our structure is disrupted. The ripple effect it has on our ability to breathe is profound.
Forward-head posture is more than musculoskeletal dysfunction. In some instances, the head creeps forward to clear our airway from obstruction; it’s when we add looking down into the posture that we cut off the optimal function of the airway. Shoulders rounding forward compresses the chest, restricting the movement of the ribs and shortening the torso, decreasing the space the lungs and diaphragm have to function and increasing intra-abdominal pressure. Muscles associated with breathing either become adaptively shortened or taut and overstretched.
Think of some muscles that assist in any phase of respiration but also play an important role in our posture: the diaphragm, scalenes, sternocleidomastoid, pectoralis minor, serratus (both anterior and posterior superior and inferior), and quadratus lumborum, to mention a few. If there is a muscular imbalance in these structures, there will be decreased breathing function. The client will likely present with headaches, TMD, restricted cervical or thoracic mobility, back pain and shallow respiration.
Cupping for Respiratory Health
Throughout time, cups have been used for many purposes, including to help remove venom, balance the four humors, and aid physical and mental pain. Acupuncturists and physicians in other cultures have used cups for generations to quell coughs and colds. Today, Westerners are more familiar with cups for their ability to increase range of motion and reduce muscle pain. Recent research has indicated, further, the benefits of cupping for respiratory health
Increasing space is the best place to start when working to increase respiratory function. The negative pressure of cupping is perfect for this. The body naturally responds to the lifting of the muscle from the cup’s vacuum by stimulating the reflexive mechanoreceptors to assist in reducing muscle tension. Thus, restricted accessory muscles in the rib cage will have more freedom in their movement to expand during inspiration.
This lifting and decompressing of tissues will also help release stuck and adhered fascia. This will be valuable for any client with a respiratory condition or kyphotic or forward-head posture.
Cups decompress tissues, which creates vasodilation, increasing the body’s ability to move fluids more freely or enhancing fluid exchange2. Vasodilation is the body’s response to the micro-trauma that cupping can stimulate. This is valuable in the evolution of the inflammation cycle. A study in 20223 showed cupping had a positive effect on inflammation and the integrity of the pulmonary tissues after a lung injury in rats. Researchers confirmed cupping reduced inflammation and edema while reducing cell death, which helped the lungs function from degrading.
Therapeutic cupping also supports hemodynamic movement. A study in 20164 indicated that therapeutic cupping will improve local oxygen intake and increase hemodynamic activity; however, it found that while hemoglobin levels did improve with cupping, that improvement was not significant enough to improve oxygen flow throughout the body.
Cupping can also increase neovascularization2. As time passes and more studies are conducted, it will be interesting to see what further role this could play in assisting lung tissue.
Treating the diaphragm and lungs helps decompress the immediate tissues surrounding them and also releases tension through the regional fascia and possibly to the pleura lining or lungs. (Cups have the ability to reach up to four inches into tissues.) A tight diaphragm can lead to decreased oxygen levels, chest tightness and shortness of breath. If you aren’t familiar with treating the diaphragm or are unsure of your palpation, cupping gives you the indirect-direct treatment to assist the client until you are comfortable treating it directly.
Cupping assists in removing stagnant interstitial fluid, old blood and lymph; as well as metabolic and cellular wastes from the restricted tissue. Wherever your cup goes, body fluids will follow. Have you ever removed a cup, and noticed the client’s tissue looked dense and puffy? That is stagnant debris the vacuum of the cup has now pulled into one space.
It is common for lung conditions to decrease the function of the lymphatic system. Cupping is a great way to address stagnant lymph quickly with profound results. Therapeutic cupping for lymph drainage can help the lymphatic system process environmental toxins, old medications and cellular waste while increasing the movement of white blood cells. This can also be very helpful for clients who often sit, especially with kyphotic postures. When we are in a seated position, we decrease the ability of our lymphatic system to pump lymph centripetally.
Cupping aids cough and congestion by a powerful mechanism of negative pressure. Remember the mucociliary escalator? Leveraging the vacuum of the cup created on the tissues, accompanied by the depth in which cups can penetrate, will help loosen the congested mucus, freeing up the cilia to allow it to move the mucus through the respiratory tract for disposal.
Adding tapotement on top of your cups creates a twofold treatment by generating the same energy wave you make when striking with your hands but coupled with tissue decompression, helping relieve chest congestion.
Cupping also decompresses nerve endings, helping tender tissue become less sensitive. Clients will undoubtedly have muscles that are very tender to touch due to chronic tension. The calming effect cupping has on the nerves allows you to treat as needed while allowing your client to be comfortable during the process.
Cupping therapy should never hurt. If applying a cup to any region of the body results in the client saying it’s painful or uncomfortable, immediately adjust the pressure or use a different cupping technique.
Contraindications in Cupping for Respiratory Health
You know your clients better than anyone; consider their medical history, medications, and active daily living to help formulate the appropriate personalized treatment plan. Remember, if a condition is contraindicated for massage, it’s contraindicated for cupping. If your client has a respiratory condition and you are unsure if therapeutic cupping is right for them, have your client speak to their doctor or arrange for them to speak with you to discuss cupping and its effects.
Also, remember that it is essential to ensure suction pressure and amount of time cups are used in the session are appropriate for the client’s medical history and vitality.
There are a few things to consider when working with clients who suffer from long COVID or were hospitalized with COVID-19. Studies conducted by the American Society for Hematology showed that severe cases of COVID have been linked to an increased risk of thromboembolism5. That risk goes up when coupled with pre-existing comorbidities.
Long COVID can induce hypertension; therefore, even if someone is a long-time client, ask them if they are taking any new medications.
Women have an increased risk of developing postural orthostatic tachycardia syndrome, which can dramatically drop blood pressure, resulting in dizziness and fainting upon standing. Remind the client to take their time when moving after their session. If need be, allow more time at the end of the session.
Your general therapeutic cupping considerations will always apply: if your clients have a clotting disorder: deep vein thrombosis, pulmonary embolism or thromboembolism, cupping is contraindicated.
Bring Cupping to Your Table
Think of all your clients. Do any of them suffer from forward-head posture, rounded shoulders, asthma, COPD, headaches, shallow breathing, cystic fibrosis, chronic bronchitis, chest congestion or Long COVID? If so, you have a client who could benefit from therapeutic cupping.
Cupping’s benefits range from increasing mobility of the muscles associated with respiration, releasing chest congestion, improving inflammatory responses, and increasing blood flow to ischemic tissues. Cupping can lift tightened muscles and fascia, helping create space within formerly closed-off and restricted regions. This can allow the body more room to help perform its most imperative life-saving function: Breathing
Ask clients if they would like cupping in their session, and invite them to try some work to open the chest and ribs. Let them feel the difference, treat one side, have them breathe deeply, and compare the treated and non-treated sides.
When you perform the client intake, ask clients how they feel they breathe. If you are treating a client for chronically tight and restricted tissue due to poor posture or assisting a client who struggles with a lung condition, the benefits of therapeutic cupping for respiratory health can offer great help and relief.
Cupping is a versatile treatment on its own or can easily be added in with other modalities. Therapeutic cupping offers a unique decompression therapy that helps to create space in the body.
About the Author
Lauren Lane, LBMT, is a licensed bodywork and massage therapist in South Carolina and Virginia. Licensed in 2013, she has a growing background in neuromuscular therapy, medical massage, and visceral manipulation. She is a certified Modern Cupping Therapy Practitioner and Educator, Myofascial Release Massage Practitioner, and Manual Lymphatic Drainage Therapist.
1. Fahy JV, Dickey BF. “Airway mucus function and dysfunction.” N Engl J Med. 2010 Dec 2;363(23):2233-47. doi: 10.1056/NEJMra0910061. PMID: 21121836; PMCID: PMC4048736. ncbi.nlm.nih.gov/pmc/articles/PMC4048736. Accessed 06/08/2014
2. Gilmartin S. “The Guide To Modern Cupping Therapy Your Step-by-Step Source for Vacuum Therapy” 2017; 20-21, 25.
3. Ren Y, Qi L, Zhang L, Xu J, Ma J, Lv Y, Zhang Y, Wu R. “Cupping alleviates lung injury through the adenosine/A2BAR pathway.” Heliyon. 2022 Dec 5;8(12):e12141. doi: 10.1016/j.heliyon.2022.e12141. PMID: 36544817; PMCID: PMC9761715. ncbi.nlm.nih.gov/pmc/articles/PMC9761715. Accessed 12/5/2022.
4. Li T, Li Y, Lin Y, Li K. “Signiﬁcant and sustaining elevation of blood oxygen induced by Chinese cupping therapy as assessed by near-infrared spectroscopy.” Biomed Opt Express. 2016 Dec 12;8(1):223-229. doi: 10.1364/BOE.8.000223. PMID: 28101413; PMCID: PMC5231294. ncbi.nlm.nih.gov/pmc/articles/PMC5231294. Accessed 12/12/2016
5. Baumann Kreuziger L MD, Lee A MD, Garcia D MD, DeSancho M MD, Connors J MD. “COVID-19 and VTE/Anticoagulation: Frequently Asked Question” hematology.org/covid-19/covid-19-and-vte-anticoagulation. Accessed 02/12/2022.