Provider/Financial Disclaimer FMT Rock Pods · Cupping therapy, also known as hijama therapy in some Arabic cultures, is a fascinating alternative form of medicine that has received

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FMT Cupping Therapy Practitioner Certification

FMT Rock Pods

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RockTape and the presenter for this seminar have financial associations with the manufacturer of

commercial products used in this seminar.

You are not required to purchase the supplies or products used in this course.

Provider/Financial Disclaimer

Instructor

Brad Norris Director of Clinical Education / Events – Team Promotion - ROCKTAPE Canada

M.Ed.( Biomechanics ), NKT, Clinical Exercise Physiologist / KinesiologistPoliquin Strength Coach – Level 3, Performance Acupuncture, FST,

Soft Tissue Release

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- Someone important

We are a movement company that dabbles in tape.

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FMT RockPods - OutlineHistory of Cupping

Decompression Effect

Research

Treatment Considerations

Graded Exposure

Cupping Techniques

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Movement Pyramid

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Movement Matters

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Multi Modal Approach

TouchTeach Move

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What is Cupping Therapy?“Cupping therapy” is an ancient form of alternative medicine in which a therapist puts special cups on your skin for a few minutes to create suction. People get it for many purposes, including to help with pain, inflammation, blood flow, relaxation and well-being, and as a type of deep-tissue massage.

Negative PressureTargeted Therapy

Neurosensory StimulationPlacebo?

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Cupping Therapy History

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History

Cupping therapy, also known as hijama therapy in some Arabic cultures, is a fascinating alternative form of medicine that has received mention in historical accounts dating from possibly 5,000 years ago 12

Evil Spirits

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Healing Through Suction

In the East, the Chinese have been practicing the art of cupping for at least three thousand years

An old Chinese medical maxim state “Where there's stagnation, there will be pain. Remove the stagnation, and you remove the pain.”

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Today

Micheal Phelps - 2016 Olympic Games

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Negative Pressure Cup Styles

Fire Bulbs

Vacuum Device16

Traditional Types of Cupping1. Flash Cupping - cups are applied and removed in quick succession

in order to create an effect on pain without a reactive effect on the skin

2. Dry (Static/Fixed) Cupping - is probably the method most often employed.

3. Wet Cupping - is also called Hijama. After using dry cupping for up to 5 minutes, the therapist will make small incisions in the area. The cup is prepared once again and applied to the affected area. Blood will be drawn out of the body in the vacuum.

4. Massage Cupping (also known as glide cupping) - involves moving the cup over the affected area, such as the back, to combine both massage and cupping, this effectively causes a myofascial release.

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Mechanisms

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Under the Cup Analysis

www.cuppingtherapy.org

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Many Variations/Meanings

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Injury or Healing?

1. Mechanical Effects

2. Fluid Dynamic Theory

3. Neuro-Chemical Effects

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Mechanical Effect - Creating Space

Separating Layers

Decompression

22Beneath the Skin - MSK Ultrasound (Mind Ray DP 30)

Negative Pressure - Mechanical

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Fluid Effect - External Pump

ProteoglycansGlycosaminoglycans (GAG)

Hyaluronic Acid24

What’s its Relevance?

Petros C. Benias, Rebecca G. Wells, Bridget Sackey-Aboagye, Heather Klavan, Jason Reidy, Darren Buonocore, Markus Miranda, Susan Kornacki, Michael Wayne, David L. Carr-Locke & Neil D. Theise. Structure and Distribution of an Unrecognized Interstitium in Hu

Not just dense connective tissue Lattice work of fluid channelsCommunicating network

Shock Absorber

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Neuro-Chemical Effect / Response

Neural Response Chemical (Enzyme) Response

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Talk to the Brain

Neural Response

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Neuro-Cognitive ApproachFact: Sensory representation is disrupted and tactile

acuity is reduced in people with back pain.

Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci

Lett. 1997;224:5-8.

Luomajoki H, Moseley GL. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med.

2011;45:437-440.

Solution: Training sensory representations requires

the delivery of stimuli to the body part of interest. Stimulation alone is seldom sufficient to modify

sensory representations. Instead, the combination of

the stimulus and its salience or functional contextappears to be important

Jenkins WM, Merzenich MM, Ochs MT, Allard T, GuicRobles E. Functional reorganization of primary somatosensory cortex in adult owl

monkeys after behaviorally controlled tactile stimulation. J Neurophysiol. 1990;63:82-104.28

Precision Training

Improve Sensory Map Change Body Awareness

Decrease PainImprove Motor Control

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Haptic (Touch) & Visual Cueing

Haptic Cueing is the mechanism by which signals are detected by our skin and the sense of touch is used to provide spatial orientation and situational awareness in motion detection.

A Visual Cue is a signal and reminder of something; aiming to be self–explanatory and preattentive, it brings to mind knowledge from previous experiences providing a framework for its own interpretation

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Haptic Learning - Nerve Growth Factor

Studies have shown that just the feeling of touch promotes the release of NGF in the brain. The release of NGF in a learning environment will facilitate nerve net growth in response to the learned task in both the central and peripheral nervous system, resulting in improved proprioceptive feedback and motor patterning.

Tortora, Gerard J. and Nicholas P. Anagnostakos. Principles Of Anatomy And Physiology. Sixth Edition. NY Harper, 1990. pp 336

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Enzymatic Effects of Cupping Therapy

Chemical Response

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Enzymatic Effects of Cupping Therapy

Heme

Heme Oxygenase

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Skin Strain CascadeSkin Strain

Hemoproteins

Heme

Enhanced Tissue Injury

Wound Contraction and Fibrosis

Excessive Scar Formation

Oxidative Stress&

Inflammation

H0-1/H0-2

COBiliverdinBilirubin

Fe/Ferritin

H0 - Heme Oxygenas 34

Cupping Response Summary

Bruising - Good/Bad? NeitherGraded Exposure ConceptPerson Attached to Tissue

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Minimum Effective Dose

The smallest dose that will produce a desired outcome.

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Research

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ResearchLimitations: most studies don’t include proper control groups and thus cannot rule out a placebo effect

Reality: The therapeutic effects of cupping remain controversial

Bottom Line: Generally considered safe, lest the possible bruising, if applied by trained professional

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Systematic Review

Conclusions:

Results of our systematic review provide some suggestive evidence for the effectiveness of cupping in the management of pain conditions

Limitations:

RCTs included in the analysis and the methodological quality were too low to draw firm conclusions

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Acute/Chronic Pain - SR Study

Review of 16 Trials concluded that…..

“at least moderate evidence that cupping is more

efficacious than no treatment or other treatments

(such as heat therapy, usual care, and conventional

medications) in reducing pain over the short term.” 40

Chronic Neck Pain

Conclusion.

A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP

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Lower Back Pain

Conclusions:

Chinese cupping may be a low-risk, therapeutic treatment for the prompt reduction of symptoms associated with subacute and chronic low back pain. Cupping may allow patients to progress to functional movement training in a timely mannerby promptly reducing pain and muscle tenderness and improving range of motion.

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Immune Response to Cupping Therapy

Histamine

Heme-Oxygenase

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Cupping Therapy - Critical Review

Demonstrating the local and global

response to cupping (negative pressure) including the release Heme Oxygenase - 1

and it’s role in healing and pain

management.

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Heme Oxygenase (H0-1) and Repair

Accumulating data demonstrate that the HO enzymes

execute anti-inflammatory, anti- apoptotic, and anti-proliferative functions through the effector molecules

generated by heme catabolism

Upon injury, free heme is released from hemoproteins,

causing accelerated oxidative stress of local proteins, further damaging cells and tissues. Heme also has pro-inflammatory

properties

Increased heme levels have also been associated with

fibrosis formation

It is thus of importance to control the levels of free heme at

sites of injury.

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Neck and Shoulder Pain

Heating 46

Skin Response - Post Cupping

Cooling with Red Marks

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What are the Red Marks?Possible Histamine ResponseMany people believe that the red marks that are often seen after receiving cupping are bruises. This is actually not the case. When suction is applied, some people have what is called a histamine response, where a redness appears on the tissue. It is part of the natural healing response of the body. The coloration disappears within minutes to hours of receiving cupping. Some people have a stronger histamine response than others, depending of their skin type.

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Cupping Response Summary

Bruising - Good/Bad? NeitherGraded Exposure ConceptPerson Attached to Tissue

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The Cups

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Silicon Cups - Benefits

• Easy to Clean/Disinfect • Each to Apply - Plunger• Moldable to Various Body Parts• Various Decompression Levels• Different Sizes/Colors• Carrying Case for Portability

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RockPods - 2 Sizes

LargeSmall52

Cleaning Cups Silicone has low toxicity and low chemical reactivity with lotions and creams. Silicone is non-porous so it will not support bacterial growth. In addition, silicone cups are odorless, non-shattering, watertight and hygienic as they are easy to clean.

Generally speaking, if cupping is performed on intact skin only, cups can be treated as noncritical reusable medical devices that need to be cleaned and then disinfected with an appropriate low-level disinfectant.

Alcohol Cavicide

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Skin Prep - Optimal Suction Effect

Increased tissue temperature

Emollient

Hair length

Mold to Body Contour54

Non Negotiable

COMFORTSAFETY

PRACTICAL

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Remember, you are working on a person attached the tissues

Graded Exposure

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Pre-Plunge Method

Pre-Plunge Prior to Application

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Plunge Method

Plunging Technique

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Inversion Method

Greatest Vacuum Effect

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Inverted Method Application

Apply convex surface to target area - press down on edge create vacuum.60

Treatment Considerations

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Indications• Decreased pain• Promotion of healing• Improved bloodflow• Improved range of motion• Manipulate dermal/subdermal connective tissue• Neurosensory stimulation (Novel Stimulus)

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Contraindications• Over areas of broken skin (open wounds) or rashes severe

edema (swelling), or otherwise fragile skin • Areas where there are large blood vessels • High fever with convulsions. • Bleeding disorders• Pregnant women should never have cupping on the

abdominal and sacral area. • Varicose Veins• Dermatitis and Eczema • Hernia• Severe health issues (CHF, Renal Failure)• Areas near large veins such as groin region• Infections• Systemic inflammatory conditions (RA)• Over the scalp

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Check your work

Screen/Re-Screen

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Screen/Re-Screen Model• Pain Perception

• Range of Motion

• 2 Point Discrimination (Mapping)

• Function - Balance, Reaction Time, Motor Control, etc

• Tissue Glide/Pliability - MSK Ultrasound

65What we want to take advantage of

Possible Mechanisms

1. Mechanical Decompression - space acquisition

2. Neuro-Chemical Effects - cascade of neuro-chemical responses to mechanical stimulation

3. Neurosensory Effects - improved body awareness, decreased smudging, improved tactile acuity, perception and control

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Remember, you are working on a person attached the tissues

Graded Exposure

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Position Progression

Relaxed

Lengthened

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Treatment Methods

External Glide• Optimal Treatment Vectors (linear, torque, etc)

• Position Progressions (relaxed, lengthened, loaded, meaningful)

Internal Glide• Open and Closed Chain (weight bearing)

• Functional Patterns (tri-planar)

1. Longitudinal 2. Shearing 3. Unloading 4. Rotational Shearing (Door Knob)

5. Flattening

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External Glide Vectors

Identify the Optimal (Preferential) Vector 72

External Glide - Horizontal Glide

Medial/Lateral Linear Glide

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External Glide - Vertical Glide

Superior/Inferior Alternating Vertical Glide 74

External Glide - Torque

Door Handle Method

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External Glide Case Study

Note: Directional Preference + Communication 76

Internal Glide Examples

• Cup + Movement - creating internal shearing effect• Reinforces the safety/comfort with once painful pattern

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Treatment Considerations (Graded Exposure)

1. Comfortable - 3 Levels of Vacuum2. External Glide - Mobilization Vectors/Grades3. Internal Glide - Meaningful Patterns 4. Patient Position - Progressions/Regressions5. Dosage - 3-90 secs6. Education/Encourage - Psycho/Social

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Strategies

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RockPod Strategies

1. Flash Cupping Therapy - cups are applied and removed in quick succession in order to create an effect on pain without a reactive effect on the skin

2. Dry (Static/Fixed) Cupping Therapy - is probably the method most often employed.

3. Sensori-Motor Retraining

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Order - Less is More Approach

1. Flash Cupping Therapy - 5 seconds per site in series

2. Static Cupping Therapy - 30-90 seconds per site

3. Massage Cupping Therapy:

• External Glide - Multi-Directional/Vector

• Internal Glide

• Local + “Ripple” Applications

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7Flash Cupping Strategy

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Flash Cupping

Quickly apply and removecups to and from the body region experiencing pain.

Vacuum Dosage: 3-5 Seconds

Note: NO lasting skin reaction should be observed

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Technique #1: On/Off Rapidly

Apply Vacuum (over target area)

Remove (within 3-5 secs)

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Technique #2: Precision Mapping

Smudged Tactile (Haptic) + Visual Cueing

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85T arge ting co rtica l rep resen ta tions in the trea tm ent o f ch ron ic pa in : a rev iew . M ose ley G L1, F lo r H . N euro rehab il N eura l R epa ir. 2012 Ju l-A ug ;26(6 ):646-52 . E pub 2012 F eb 13 .

Harnessing Brain Plasticity

…“Pain emerges according to the apparent danger to body

tissues and the need for concerted action, not according to the true danger or damage at a tissue level, means that anything

that is detectable or accessible to the brain and relevant to the

evaluation of danger to body tissue has the capacity to modulate

pain.” Reduce HelplessnessEstablish a sense of control

Show Positive ChangeBuild Confidence

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8Dry Cupping With Movement

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Dry Cupping

Apply cups over target area andneighboring regions (ripple) to aid in pain mitigation and mobilityenhancement.

Vacuum Dosage: 30-90 Seconds

Note: Some skin/tissue response may be observed (non tender bruising) 88

Low Back App

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External Glide Techniques

Treatment Vector

Mobilization Grade

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Position Progressions

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Internal Glide - Sagittal Plane

Functional/Meaningful Movements - Internal Glide

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Internal Glide - Frontal Plane

Make it Meaningful

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Internal Glide - Transverse Plane

Make itMeaningful

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Low Back App - Therapy Assisted

External Glide - Optimal VectorPatient Position - Meaningful?

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Cervical App with Movement

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Shoulder App with Movement

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Therapist Assisted Mobilization

Augmented External Glide (therapist)Regressed Patient Position - Neutral Decreased Smudging - Gamifaction 98

Lateral Elbow App

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Therapist Assisted Manipulation

External Glide(therapist and/or patient)

Patient Control 100

Hand/Wrist App

Small Cups

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Therapist Assisted Manipulation

Door Knob Technique102

Ant Thigh App with Movement

Closed Chain

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Lateral Thigh App with Movement

Open Chain Movement

Target Pod

Distal Ripple Pods

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Post Thigh App with Movement

Target Pod

Distal Ripple Pods

Closed Chain Movement

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9Sensori-Motor Retraining with Cups

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Internal vs. External Cueing• Internal cue: The individual focuses on his/her body parts

and how they move.

• External cue: The individual focuses on affecting something in his/her environment. He/she focuses on the outcome of his/her movement.

Example:

• Jumping Movement

• Internal Cue - Explode through hips

• External Cue - Touch the Sky

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Scapular Depression/Retraction

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Latissimus Stretch

Cup Target TissueStretch Protocol• Static, C/R, etc

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11Nerve Entrapment Cupping

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Mechanism

Decompression Effect

Pain Mitigation

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Sciatic Nerve Mobilization

Clinical Relevance: Weakness, Numbness, Shooting Leg/Back Pain, Tingling112

Sciatic Nerve - Therapy Assisted

Optimal External Glide Internal Glide Movement

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Medial/Lateral Skin Screen

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Med/Lat Mobilization

Alternating Vectors

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Thank you

Jeanine [email protected]

Instructor NameInstructor email

www.postureanalysis.com

www.webexercises.com

www.pesi.com