In an article about the importance of Hyaluronic Acid for therapists WHY THERAPISTS NEED TO KNOW ABOUT HYALURONIC ACID. PART II, we discussed ways to decompress superficial and deep fascia. In one of the videos, we showed the application of Mobile Cupping with a Vertical Lift.
Our colleague, Boris Prilutsky, LMT, asked for clarification on adding a vertical lift to mobile cupping. Boris is an exceptional therapist and educator. He is also an expert in the clinical application of cupping and shares his expertise with other therapists. Bris introduced us to the silicone jars, so we felt obligated to participate in a professional discussion.
Let’s start with Fig. 1, which presents the basic arrangement of soft tissues in the anterior arm.
A – Skin
B – Subcutaneous tissues
C – Superficial Fascia with fibrotic bridges
D – Biceps Brachii Muscle
E – Deep Fascia with fibrotic bridges
F – Brachialis Muscle
G – Fibrotic bridges between Brachialis Muscle and Periosteum of humerus
H – Periosteum of humerus
I – Humerus
As readers may see, each layer of soft tissue is separated by a line of fibrotic bridges, which give the soft tissue stability and elasticity. Normal elasticity allows the layers of the soft tissue to slide against each other during our activities. This is the foundation of full ROM.
Lost elasticity in fibrotic bridges is the first step in developing complex somatic abnormalities, which end up with soft tissue adhesions. Let’s look at the video below, considering that it presents a soft tissue arrangement on the upper shoulder. You may see skin with subcutaneous tissue; fibrotic bridges originated from the superficial fascia, which covers the trapezius muscle and, finally, the trapezius muscle itself.
At the beginning of the video, the healthy superficial fascia allows normal sliding between the skeletal muscles and the skin with the subcutaneous tissue. Next is a shortening of the bridges, and gradually, adhesions form in the area where fibrotic bridges become shorter. Eventually, fully formed adhesions glue layers of soft tissues against each other. Medical Massage allows restoring normal mobility between soft tissue layers by gradually stretching fibrotic bridges using various techniques, including Cupping. This part is illustrated in the final part of the video.
Thus, maintaining the elasticity of fibrotic bridges is a key component of successful somatic rehabilitation. Since fibrotic bridges originate in the superficial and deep fascia, restoring the health and elasticity of the fascia is a critical part of a correctly formulated medical massage session.
Generally speaking, therapists have a limited set of clinical tools, which is why every detail matters, and optimizing performance is a critical factor in stable clinical outcomes.
Mobile cupping without vertical lift is a valuable clinical tool. However, its primal target is the skin. Secondarily, it decompresses superficial fascia, stretching the fibrotic bridges but only in the horizontal direction. Yes, in a way, it is a lateral shift. However, the vertical lift added to the mobile cupping makes decompression of superficial fascia more efficient and clinical benefits more sustainable.
Fig. 3a illustrates the normal soft tissue arrangement in the posterior shoulder: skin, subcutaneous tissue, superficial fascia with fibrotic bridges, and finally, the superficial muscle (trapezius).
Fig. 3b illustrates the silicone jar’s application in a mobile regime with vertical lift. As readers may see, vertical lift, added to the cupping, allows vertical stretching of the fibrotic bridges (vertical black arrow) while horizontal stretching is still applied (two horizontal black arrows). Such a combination more efficiently separates the skin and subcutaneous tissues from the trapezius muscle, fully decompressing superficial fascia by stretching fibrotic bridges also vertically.
Furthermore, there is a critical consideration. The vacuum generated during the cupping must be very moderate to avoid bleeding between fibrotic bridges. If that happens, bleeding will harden fibrotic bridges, ruining the therapy’s effect.
Silicone jars have an ideal shape for mobile cupping with vertical lift, and they give therapists perfect control over the intensity of the vacuum they intend to generate within the jar. For example, fire used during cupping doesn’t give the therapist complete control of the vacuum needed to decompress superficially located soft tissues.
Thus, adding vertical lift to mobile cupping gives extra clinical benefits in the decompression of superficial fascia, which is, in turn, the first step in treating muscles’ hypertonicity.
ABOUT THE AUTHOR
Dr. Ross Turchaninov
For Dr. R. Turchaninov’s bio, please click here: Who is Dr. Ross Turchaninov?
Category: Medical Massage
Tags: JMS 2024 Issue #1
