Working as an Acupuncturist in Hospice

by | Feb 23, 2019 | Hospice Acupuncture

Available Now

Hospice and Home Health Acupuncture

Online Continuing Education Trainings for Acupuncturists

6 NCCAOM PDAs including Safety and Ethics

Gain clarity and confidence for working with patients at the end of life and home visits. Whether you work in hospice or simply want to have tools to provide comfort care for loved ones, patients, and their families.

In the Hospice and Home Health Acupuncture training you will learn:

  • Practical skills for safely treating medically fragile patients, which may require a different approach than treating patients in a clinical setting.
  • Strategies to connect compassionately with patients at the end of life.
  • Ways to navigate home healthcare, including travel, general safety, and interactions with family and other caregivers.
  • About the role of acupuncture in hospice care, both as a unique medical service and integrating within the hospice system and hospice team.
  • About the stages of dying from the Eastern and Western perspective.
GET THE TRAINING

Hospice work is a calling. To care for people with a terminal diagnosis and less than six months to live requires a different approach to medicine and healing. Whether we are a nurse, doctor, social worker or acupuncturist, we want to help the patient feel comfortable, whole, and human.

I worked for several years as an acupuncturist in hospice. I visited patients in their homes or care facilities, using acupuncture and gentle touch to help with symptom management. I collaborated with hospice administration to craft policies and procedures, and worked to educate the medical and care team about acupuncture services. Most of this post is based on my personal experience, with the goal of helping other acupuncturists connect with this kind of work.

Every Hospice is Different

Every hospice organization is different. In size, location, philosophy, direction, management, funding, culture, etc.

A hospice may be small and local, part of a large hospital system, or a nationwide company. The hospice may provide extensive training and support for providers, or hardly any.

Some hospices have acupuncturists attend the weekly Interdisciplinary Group (IDG) meetings, and others do not. Pay rate can vary quite a bit. Charting and data collection is different from place to place.

How Acupuncture is Funded in Hospice

Most hospice patients use Medicare* to cover hospice services. This allows patients to receive medical care including nursing, occupational therapy, medications and home medical supplies.

In the meantime, for a hospice to include acupuncture services it may be paid through alternative means such as a grant or special fund from donations. The existence of these grants and funds are due to dedicated efforts from medical directors, grant writers, private donors, and other advocates.

Volunteering

Volunteering is always a great way to gain experience, network, and serve the community.

While it is possible that volunteer positions can lead to, or turn into, paid positions, it is not a guarantee. I once had a mentor caution me against volunteering as an acupuncturist in hospice because it could perpetuate an unpaid track in the system. I have seen this to an extent with massage therapy in hospice and oncology, where there is an established track of massage volunteer positions and a lack of paid ones in some hospice organizations and hospitals. I don’t know if this is causation or correlation but it’s worth noting.

On the other hand, I have heard of at least one case of a volunteer acupuncturist being offered a full-time paid position in hospice. So it can happen if the administration is willing to set aside funding and prioritize acupuncture services.

In the Hospital Handbook Project, acupuncturist Megan Gale suggests volunteering in a hospital (can also apply to hospice) in a non-acupuncturist role. She said that it allows you to become familiar with hospital protocols and culture, while meeting people and helping out, but not giving away your acupuncture services for free on a regular basis.

In either case, it is important to be advocating for reimbursement for our expertise, training, and services, just like any other healthcare provider.

Private Practice

It is possible to have a private practice working with hospice patients. Here are some tips for hospice private practice:

  • Most hospice patients are in their homes or care facilities, you will be going to them rather than them coming to your clinic.
  • Keep in mind that these patients will have to pay out of pocket since Medicare does not cover acupuncture.*
  • It may be possible to bill a patient’s private insurance, but find out if it covers home visits.
  • If there is no insurance coverage, find a price point you feel comfortable with, that will be accessible to patients and also cover your costs.
  • Reach out to cardiologists, oncologists, pulmonologists, and dialysis clinics with information about how acupuncture can help terminally ill patients with symptom management. You can also connect with retirement homes and senior centers and offer services there.
  • Look up “home health bag technique” and tips for home health nursing online so that you can maintain clean technique in the home environment.

A Job in Hospice, Gaining Experience

I worked with two different hospice organizations as a contracter. Even though these positions are not full-time employment, I gained valuable experience in this field including working with patients directly, navigating different hospice organizations, and learning how to advocate and promote acupuncture as a service.

If you can take a contract position, shadow with another acupuncturist, see patients in private practice, or volunteer, it can open doors such as:

  • Meeting other providers in hospice who can become part of your professional network as mentors, colleagues, and references.
  • Building a good reputation in your community as the “hospice acupuncturist” and gaining multiple referral sources.
  • If you are contracting with a hospice organization, advocating for a raise in your contract rate, or for full-time employment.
  • If you are volunteering, advocating for a paid position.
  • Having relevant experience on your resume that can lead to employment at another hospice or hospital.
  • Working in a challenging and rewarding field that opens up opportunities you may not yet know of.

My advice is to take advantages of opportunities to treat patients and learn about the hospice field. At the same time advocating to turn contract, part-time, or underpaid work into full-time, well-paid positions.

Some Things I’ve Done to Work in Hospice

Here is some of what I’ve done over the years to be involved in hospice:

  • Volunteered in hospice providing massage therapy for the nursing staff and patients.
  • Worked in hospice as a nurse assistant.
  • Researched acupuncture in hospice and palliative care while in the masters program at acupuncture school.
  • Asked around constantly if anyone knew anyone who did acupuncture in hospice, and eventually connected with an acupuncturist working in hospice who became my mentor.
  • Joined the Washington State Hospice and Palliative Care Organization (WSHPCO).
  • Cold-called and cold-emailed every hospice I could find in the area, asking if they had acupuncture positions or were interested in learning about the benefits of acupuncture.
  • Connected with the Hospital Handbook Project.
  • Connected with the medical director of a hospice and palliative care organization who was interested in starting an acupuncture pilot program. I helped create policies and procedures for acupuncture, educate the healthcare team about acupuncture, bring another acupuncturist on the team, and find ways to gather outcome data. After 6 months the pilot program was considered successful and the medical director has asked all departments to refer patients to acupuncture.
  • Connected with a local hospice that already had a grant-funded program in place for integrative therapies, but no acupuncturist. They just needed an acupuncturist to help create policies and procedures for acupuncture, particularly for home visits. I work with some excellent people and have learned a lot about hospice.
  • Wrote an article for Acupuncture Today interviewing the founder and director of the NAHPCA. This was a chance to spread the word about this organization and also learn more from someone who has worked in this field for many years.
  • Shadowed with an acupuncturist who has a full time job in hospice to learn more about what she does.
  • Presented about acupuncture in hospice for the WSHPCO, and the Washington Acupuncture and Eastern Medicine Association.

If you feel called to do this work, then start to network, reach out to people and organizations that you think could benefit from acupuncture services. Write grants to start a pilot program. Talk to practitioners that work in the hospice field and ask if they know of any opportunities for mentorship, shadowing, or otherwise getting involved.

 

*As of 2020 acupuncture for low back pain is covered by Medicare. There is momentum toward advocating for acupuncturists to be Medicare providers, but how all of this will play out in general, or in hospice in particular, remains to be seen. More information on Medicare and acupuncture here. 

About Gua sha Tools

by | Jan 30, 2019 | Gua Sha

Gua sha is a versatile technique for relieving pain and resolving restrictions in the myofascia. Gua sha has its roots in ancient medicine and is still used today by acupuncturists to treat pain, inflammation, and disease.

In modern usage gua sha is also called scraping therapy, Graston, or instrument assisted soft tissue mobilization (IASTM), and is used to treat pain and myofascial restriction rather than disease or illness. There are many different kinds of tools out there for scraping therapy. Some are generic and marketed simply as gua sha tools, some are marketed to distinguish themselves from gua sha and have their own training systems to accompany the tools.

I am a practitioner and instructor of gua sha, with training both in Western and Chinese medical perspectives, and I have found that sometimes practitioners get stuck with inferior tools that limit the potential effectiveness of their treatment, or think they must purchase several very expensive tools in order to practice gua sha at all. In this article I hope to demystify gua sha tools and help you understand the advantages and disadvantages of the most common tools you will come across.

 

Material

The material determines the durability, porousness, strength, resonance, conductivity, and the cost of your tool. Almost anything can be made into a scraping tool, from traditional animal bone to modern polycarbonates.

 

Metal

Stainless steel, copper, silver, and titanium. In general, metal is the most durable, least porous, strongest, and most conductive and resonant in terms of being able to transmit information from the tissues being worked to the hands of the practitioner. Many of the quality stainless steel tools available now are highly polished, allowing a the treatment to go more directly to the fascial layers and bypassing some of the overstimulation that can cause the body to generate sha*.

Metal does not break, chip, fray, or easily melt and can easily last the lifetime of your practice. Copper and silver tarnish and may be mildly reactive with some people’s skin, or their skincare products. Stainless steel and titanium are fairly non-reactive although some people have metal allergies so be sure to check first before using a metal tool on a patient.

Copper and silver have healing properties and are very conductive to temperature and vibration which can be clinically useful. Metal tools in general will cost more than other types of tools. I am not a fan of aluminum scraping tools and do not use them.

A traditional form of gua sha called “coining” uses a coin to scrape the back, so technically a coin could be used in practice as long as it is completely disinfected.

In my experience the quality copper tool or small stainless steel tools are the best. I like how the resonance of the metal allows me to get palpatory information through the tool and feel connected to the patient while I’m treating. I find that well-made metal tools are easy to grip and have a nice weight and substance, and are overall excellent for clinical use.

 

Ceramic

The ceramic soup spoon is a traditional tool for gua sha. These tools are very affordable and work fairly well. I used the ceramic soup spoon for years in my practice before I found the metal tools that I like.

Even though the spoon feels smooth it is not highly polished as some of the metal tools and may cause a micro-abrasion to the skin. This may overstimulate the superficial blood vessels and generate sha without necessarily directly addressing the fascial layers. The spoons can break or chip so be aware to check the edge before use to make sure there are no sharp edges that could damage the skin. Some ceramic spoons have a metallic line painted around the edge, do not use this type of spoon on patients as the paint has the possibility of rubbing off.

 

Animal Bone or Horn

Bone, horn, usually from cattle. A tool made of animal bone or horn will be porous, more insulated, and more brittle or weak that other materials. The main problem with these for clinical practice is their porousness and tendency to fray or crack making proper disinfection of the tools unlikely, and the lifetime of the tool shorter.

 

Stone

Jade, rose quartz, bian stone. The semi-precious stones are often very smooth and can sometimes be difficult to get a good grip, but can be good for gentle work on the face and for more massage oriented techniques such as trigger point work. The stone tools are lower resonance than metal, and these tools can be disinfected.

The bian stone on the other hand can sometimes be slightly rough and cause micro abrasions to the skin so be aware of that. Stone is strong but can still break if dropped.

 

Plastic

Polycarbonate resin, other hard plastic. These tools are often inventive in terms of shape because of the relative ease of manufacturing a new design in plastic. They are more insulated than many other types of tools, they do not break, and and their ability to be disinfected is good, overall making them workhorses for clinical practice.

There are lots of tools like this on the market in many different shapes and sizes and varying degrees of quality. In my personal experience even the higher quality polycarbonate tools feel awkward and large in my hand, while the cheaper plastic tools feel flimsy and ineffectual.

 

Wood

Wooden gua sha tools can be difficult to disinfect properly and very likely to break down with continued use. They are nice and lightweight but probably best for home use.

 

Jar Lids

It may sound strange but jar lids, specifically metal Plastisol lined caps are the preferred gua sha tool of Dr. Arya Nielson, author of a book and many research studies on gua sha. The lids can be disposed of after a single use, which Dr. Nielson finds useful for her hospital practice. I have not personally used lids but this option can be handy for working in a hospital or other high volume setting where a single-use tool is necessary.

 

Infra-red “Gua sha” Tool

This is not a gua sha tool

I include this as a warning to avoid using or receiving treatment from this so-called gua sha tool. There is nothing about gua sha in traditional or modern practice that requires it to be plugged in or for the tool to generate heat of any kind. I came across this unfortunately because a patient came to me who had received this treatment elsewhere and had severe burns that resulted in scarring, and ultimately a lawsuit against the practitioner.

 

Other Factors to Consider

Shape and Size

Gua sha tools come in all shapes and sizes. Larger tools are designed specifically for large areas of the body such as the illiotibial band, while smaller tools or tools with very small corners are meant for getting around small joints such as the vertebral facets.

A large tool is not always necessary even on a larger body part. If you can warm up an area before applying gua sha then the treatment area will be more focused and a smaller tool suffices. Also it is possible to get into small joint areas including the wrist, metacarpals, and vertebrae without a particularly small tool or small edge.

That said, I do try to match the size of tool or part of the tool with the structure that I am working on, and work within the patient’s comfort level so that it does not feel to pointed or sharp. For larger areas of the body I make sure the area is warmed up first so I’m not trying to break through a large swath of locked-up fascia with just a large tool.

Edge

A rounder edged tool will be more difficult to use for the scraping technique of gua sha and may be more effective as a massage tool. I find this to be true of many of the jade and rose quartz gua sha tools. A sharper edge will be more effective for scraping and generating sha but can also be less comfortable for the patient. The high quality metal tools will have a good scraping edge that is not too sharp, and some of the tools have one edge that is sharper and one that is more round.

Disinfection

If you are doing gua sha in a professional setting you must disinfect your tools, either with chemical disinfectant, heat such as an autoclave, or ultraviolet light. Be aware of how your disinfection method may compromise the integrity of your tool. Chemicals, heat, or moisture may break down or otherwise react with bone, horn, wood, certain plastics, and certain metals.

Safety

Materials that can break or get chipped such as ceramic, stone, plastic, or wood must be inspected before application to make sure there is no sharp edge that could break the skin.

Application and Preference

You should be able to hold the tool comfortably without it slipping or being the wrong size or shape for your hands. You should be able to use the tool without stressing your own shoulders, wrists, or thumbs. You should be able to generate enough pressure that sha can arise naturally, but not have to press so hard that there is bruising. You may prefer different tools depending on what you are doing or who you are working on.

As long as a tool is safe for professional use you should use whatever tool you prefer. Find a tool that fits in your hand, works with your body and the needs of your patients, and that you enjoy using.

 

*Sha is a Chinese term that roughly translates to “sand” or “silt”, indicating the granulated texture of tissues that are compromised by pain and lack of circulation. Sha is also the term for the discoloration that arises when the tissues relate the stagnant blood, fluids, and metabolic waste into the superficial vessels. Sha can also be translated to indicate disease, and in the Chinese medicine tradition gua sha can be used to treat disease, and the qualities and quantity of sha that arises helps with diagnosis and prognosis.

Scar Therapy with Acupuncture and Eastern Medicine

by | Dec 22, 2018 | Eastern Medicine

What is a Scar?

A scar is fibrous connective tissue that patches up an area of skin or muscle that has been injured in some way either from a burn, cut, infection, or other damage. Scar tissue is the body’s way of healing after a trauma but it does not function quite as well as skin or muscle. However, scars do not have to be permanent. Connective tissue can be softened, broken down, changed, integrated, and healed.

Types of Scars

A keloid scar. This would be considered a yang scar in Chinese medicine.

From a Chinese medicine perspective scars can be yin or yang. Yin and yang are always relative, but in general a yin scar will be pale, sunken, and soft. A yang scar will be darker, raised, and more rigid. Some scars are a combination.

In Western physiology scars are categorized as keloid, hypertrophic, and contracture, and also acne scars. Keloid scars are raised above the skin and usually darker or redder than the skin tone. Hypertrophic scars are similar to keloids but not raised above the surface of the skin. Contracture scars can occur with burns and cause the skin and fascia to tighten which can affect muscles, nerves, and even organs. Acne scars are also common and appear as small pits in the skin.

Why Treat Scars?

Scars come in all shapes and sizes from small and barely noticeable to life-altering scar tissue that covers the body. If a scar is causing discomfort, pain, or dysfunction it is important to get scar therapies.

Any scar is on some level restricting the free flow of movement and function in the body (aka qi). Most of the time this will not impact quality of life, but larger, deeper, older scars can be a source of localized or radiating pain, restricted movement, and depending on the location and depth, interference with proper organ function.

Although often scars will fade with time, they also have a tendency to harden over time and continue to restrict the surrounding fascia without treatment.

The Goal of Scar Therapy

The goal of scar therapy is to return the scar to as much normalcy as possible in terms of appearance, movement, sensation, and function. It depends on the size, depth, and age of the scar, and the general health of the skin and the body. But therapeutic interventions can resolve pain and numbness in the area, help bring back movement in a joint, reduce the appearance of the scar, and make the scar itself more integrated and functional with the surrounding tissues.

Methods

Acupuncture

A yin scar from multiple surgeries on the lateral left leg. Acupuncture needles are surrounding the scar bringing about increased blood circulation and gently breaking up the scar tissue.

One acupuncture technique for scars is “surrounding the dragon” where needles are inserted all around the perimeter of the scar with the goal of bringing qi and blood circulation to the areas. This also serves to loosen the surrounding fascia and relieve radiating pain and tension.

A more assertive technique to to actually insert acupuncture needles underneath the scar to further break down the scar tissue.

Massage

Massage will help soften scars and also free the restricted fascia surrounding the scar tissue. with consistent treatments. Touch itself is very important for healing the emotional trauma around scars. Part of the goal of scar therapy is to integrate the scar tissue with the surrounding area, the same goes for integrating the experience that caused the scar into our life to be able to move on..

Cupping

Cupping can be used directly on the scar or around it to loosen the fascial layers and encourage circulation.

Gua sha

Gua sha may be used around or on the scar. My preferred method is to use a Japanese tool called a chokishin made of silver and do a spreading or gliding stroke over the scar to gently encourage circulation without aggressively trying to break up the scar. But it depends on the scar and what is needed.

Topicals

Vitamin E oil, or grapeseed oil which is high in vitamin E, are both helpful for scars. Castor oil softens hardened areas and masses and is useful for scars. Zheng Gu Shui is an herbal liniment formulated to help heal bones and tendons, but it is helpful for scars by increasing blood circulation and reducing pain.

Conclusion

Scars can heal and it is worth it to seek out simple therapies that can treat your scars and improve your quality of health and life.

The Lungs in Chinese Medicine

by | Nov 3, 2018 | Eastern Medicine

In the teachings of traditional Chinese medicine the Lung is much more than a physical apparatus. It is a system of functionality within the body that includes breathing, the strength and quality of the voice, functioning of the the nasal passageways, sinuses, throat, lungs, and skin. The Lung regulates and distributes water in the body, and when it is malfunctioning it produces pathological phlegm, or mucus, that can obstruct the nose, throat, voice, lymph pathways, skin, and chest.

Note: in this post, when referring to the entire system of influence from a traditional Chinese medicine perspective the name of the organ will be capitalized: the Lung, the Heart etc. When referring to to the biomedical model of the discrete organ it will be lower-case: the lungs.

Lung and Large Intestine are the organs of the metal element, or better called the metal phase. Metal is about the functions in nature related to purification and boundaries- that is letting in and letting go- and the emotion of grief around the process of letting go. On a basic physical level as we breath in we are connecting to the outside world, we are literally bringing in the air of the world into our bodies and into our blood. When we exhale we are letting go of metabolic waste products that if kept in our bodies would be very harmful.

The Lung also houses a particular aspect of the spirit, called the po, the corporeal spirit. The Lung plays the role of minister within the body, advising and protecting the Heart, the emperor.

Thyroid: the Gland of the Lung

Even though Chinese medicine did not acknowledge the thyroid gland as a discrete gland, it is still considered part of the Lung function.

The fascial planes that separate the different layers, sections, tissues, and organs in the body run along specific pathways to organize the body. There is evidence that the fascial planes correspond closely to the channels in Chinese medicine theory, one of the best physiological explanations for the connection between limbs and organs.

In the case of the thyroid and Lung channel there is a specific fascial plan, the precervical fascia, that connects the thyroid gland to a key point on the Lung channel located on the outer chest. Functionally the thyroid hormone regulates cellar respiration, as well as breathing and heart rate. Embryologically the lungs and the thyroid both grow from the primitive pharynx.

Physiologically the only actual connection the lungs have to the rest of the body is the larynx, the voice box, so the “quality of the voice” as diagnostic for the Lung has a clear physiological reason.

Lung and Blood

In the biomedical model the shape of the lungs are very similar to a tree, where the “trunk of this tree is our windpipe, the branches are the main bronchi, the twigs are the bronchioles and finally the leaves are the alveoli. (Keown)”

The blood is “wafted” from the heart into smaller and smaller waterways until it is a single blood cell that can interchange carbon dioxide and oxygen with the alveoli. The space between the alveoli serves the same function as the space between the leaves on a tree- for sunlight, or in the case of the Lungs, spirit, to circulate.

Lung and Heart

The Heart and Lung are both located in the uppermost part of the thorax, or upper jiao, and both have roles on governing or overseeing the other organs. In Chinese medicine the Heart is called the emperor and the seat of the spirit, the shen which is translated literally as heart-mind. The Lung is the minister and regulates and filters what reaches the emperor. Therefore breathing exercises to strengthen and purify the lungs, used in many systems of spiritual practice such as meditation and yoga, are important to relax and calm the heart-mind, the spirit.

Breath and Spirit

Breath is linked to spirit in almost all cultural traditions. Air is the most rarified element and the closest to the invisible source of life. When we breath we take in this invisible force that grants us life at each moment. Most spiritual exercises such as meditation, qigong, yoga etc. involve an awareness of the breath to attune more to the spiritual aspect. The Lung is called the “delicate organ” in Chinese medicine and is easily damaged by outside pathogens. Yet this same delicacy allows the most subtle and spiritual element to enter into our bodies and transform into our life force.

Pathologies of the Lung

Allergies, asthma, shortness of breath, phlegm or mucus in the nose, sinuses, throat, or chest, nosebleeds, disliking of speaking, sore throat, sinusitis, rhinitis, emphysema, cough, common cold, unresolved grief, low immunity. The Lung “system” encompasses all of these types of pathologies, which are caused by a deficiency of qi, or proper movement and functionality of the lungs, the thyroid, cellular respiration, blood nutrient exchange, and state of the heart-mind. These physical organs and glands are connected by the conductive fascial planes that travel down the anterior chest and arm, and therefore stimulating a point on the arm can treat these pathologies.

 

 

Reference
Daniel Keown, The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine 

Styles of Cupping

by | Oct 31, 2018 | Eastern Medicine

Cupping as Medicine

Cupping is a healing modality with ancient roots that is still widely practiced today. Traditionally cupping was used to treat disease by pulling pathogenic factors such as excess cold, heat, wind, or stagnant blood and fluids to the surface of the skin to clear out through the pores.

In Chinese medicine cupping is used to treat disease, including arthritis, chronic pain, colds, flus, and liver disorders. Cupping is also practiced as manual therapy to resolve pain and tension, decompress restricted fascia, and increase circulation.

Mechanism of Action

Cupping uses a negative pressure created by a pump, suction, or vacuum. Cupping draws stagnant blood and fluid to the superficial vessels, thereby increasing circulation and lymph flow within the layers of the fascia.

The Discoloration/ Cupping Marks/ Sha

Cupping draws blood and fluids to the superficial vessels, temporarily filling them and creating a mark that looks like a bruise or rash. This discoloration is temporary and usually fades in a couple of days to a week. Unlike a bruise, the treated area feels immediate pain relief and resolution of tension.

Even if the discoloration does not appear there are still beneficial changes in the texture, temperature, and appearance of the skin and myofascia.

Styles of Cupping

All cups have a way to create a negative pressure. The most common styles of cups we see today are fire cups, external pump cups, silicone cups, and facial cups.

Fire Cupping

How Fire Cupping Works

Fire cupping uses simple cups made of non-flammable material, usually glass but sometimes bamboo or ceramic. A vacuum is created by removing the oxygen in the cup with a controlled flame, such as a lit cotton ball soaked in rubbing alcohol or a small charcoal on a metal handle. The flame is inserted into the cup and quickly removed and the cup placed on the skin. The vacuum created inside the cup causes the muscle tissues to be pulled up inside.

Fire Cupping and Traditional Chinese Medicine

Fire cups are necessary in order to use several techniques of traditional Chinese medicine including bleeding cupping, herbal medicinal cupping, and combined moxibustion or needling with cupping. Fire cups are the most traditional form and that style has a special place in the heart of many practitioners.

Practical Considerations

Tthe glass cups can get very warm and can create a very strong suction, arguably the strongest potential suction of all the types of cups. The glass cups are easy to clean and disinfect, but can break when dropped, or the rim can become chipped..

Fire cupping is somewhat difficult to learn at first and requires some practice, and there is a danger of burning when not done properly, mostly from the possibility of the cup getting too hot.

Glass cups can glide on the back but do not glide very well on other parts other body, and they are difficult to control the suction level. Overall fire cups are best used by acupuncturists using traditional techniques.

Fire Cupping and Massage Therapy

While cupping is in the scope of practice for massage therapists in most states, fire cupping in particular is not covered by many of the professional massage liability insurance carriers. To find out if this applies to you check with your state massage board and professional liability insurance carrier.

 

External Pump Cups

This style of cups usually come in a set of multiple size cups made of either plastic or polycarbonate, with an external pump. Suction is created by using the pump to draw the muscle tissues inside the attached cup. The most common type is the hand pump or pump gun, but there also exists a machine pump.

How External Pump Cups Work

The cups pop right into the pump and suction is created by squeezing the pump or setting the machine. With the pump it is possible to control the suction easily, and without taking the cup off the body. External pump cups can be used for self-care even on the back and shoulders. They attach easily to areas around joints such as elbows, wrists, the lateral and posterior neck, knees, and ankles.

These cups are somewhat difficult to clean and properly disinfect because of the valve in the cups and the possibility of body fluids entering the pump. The cheaper plastic cups are breakable, the polycarbonate cups are much more sturdy. With their thin rim and domed shape these cups are difficult to do gliding techniques.

The biggest cups in the sets still tend to be smaller than the large fire cups or silicone cups. However in the machine pump sets there are very large cups.

 

Silicone Cups

Silicone cups are made of medical-grade silicone and are self-suctioning. The common types are the mushroom shaped cups and the dome shaped cups.

The technique of squeezing and applying the cup to the body can be mastered in minutes. These cups contour to the body and glide easily. They can be easily cleaned and disinfected, and do not break down, fray, or lose shape over time.

Amplifying the Suction

Even though silicone cups have limited suction compared to other styles, it is possible to amplify the suction by placing multiple cups in one area, or by pulling up on the cup when gliding. The mushroom shaped cups are easier to glide and provide greater suction than the dome shaped cups.

The quality varies somewhat, which is true of all the styles of cups. Be wary of silicone cups that have a visible center seam, which shows a cheap manufacturing process and compromises the smoothness of the cup.

The mushroom shaped silicone cups are better to use in clinical practice because they get strong suction than the dome shaped cups and are easier to grip for gliding. The silicone cups are easy to clean and disinfect, they never break when dropped, and are not destroyed by oil like equipment made from vinyl.

Facial and Jaw Cupping

Facial cupping requires specialized cups with very limited suction. Facial cups are either very small cylindrical glass cups with a small rubber bulb, or small conical silicon cups. The technique can be a gentle pumping suction to mimic the lymphatic system or gliding along the face. Facial cupping is meant to improve circulation of blood and fluid and is generally for cosmetic purposes.

Jaw cupping uses a slightly larger cup, usually the largest in the glass facial cupping set and is applies to the muscles of the jaw for therapeutic decompression. This technique is more likely to leave discoloration on the face but is very effective for TMD, facial tension, neck pain, and headaches.