Q: Doctor what is cupping therapy and is it beneficial?

A: Cupping therapy, recognized as one of the most ancient and efficient methods for eliminating toxins from body tissues and organs, is also known by various names such as vacuum cupping, hijama cupping, and horn treatment. This practice involves the placement of special cups on the skin to create suction, leading to the drawing up and swelling of the underlying tissue. This process enhances blood flow to the affected area, causing impurities and toxins to be drawn away from nearby tissues and organs towards the surface for elimination.

The techniques employed in cupping therapy include Dry Cupping, where the air inside a plastic or glass cup is suctioned out; Wet Cupping or Hijama, which involves creating a mild suction followed by making small cuts on the skin to draw out a small amount of blood; Oil Cupping or Sliding Cupping, a technique using massage oils; and Flash Cupping or Empty Cupping, characterized by quick, repeated application of cups with minimal retention.

Various types of cups, such as Horn/Suction Cup, Glass/Fire Glass Cups, Plastic/Hijama Cups, Bamboo/Wooden Cups, Silicone/Facial Cups, and Nabhi Pump, are utilized in cupping therapy. Indications for cupping therapy include anti-aging treatment, rejuvenation purposes for healthy patients, as well as relief for localized ailments like headaches, lower back pain, neck pain, and knee pain. It has also shown benefits in treating systemic illnesses such as hypertension, rheumatoid arthritis, diabetes mellitus, mental disorders, heart disease, and infections.

However, certain contraindications must be considered, including excessive dry or cracked skin, open wounds, fractured bones, dislocated joints, bleeding disorders, severe anemia, muscle dystrophy, fear of blood, empty stomach, age below 7 years (for wet cupping), age below 2 years (for dry cupping), abscess, excessive swelling, and the presence of a pacemaker.

Cupping therapy provides several benefits, including the reduction of pain and inflammation, improvement of blood flow, relaxation, well-being, deep tissue massage, and rejuvenation of body organs. It is considered a safe, non-invasive, and cost-effective treatment that facilitates the healing process, strengthens the immune system, and addresses various conditions such as blood disorders, rheumatic diseases, gynecological disorders, skin problems, high blood pressure, migraines, anxiety, depression, and varicose veins.

The effects of cupping extend to different bodily systems, including improved metabolism in skin tissue, better functioning of sebaceous and sweat glands, improved healing, improved skin resistance, stimulation of blood flow and lymphatic drainage in muscles, increased blood flow and secretion of synovial fluid in joints, increased peristalsis and secretion of digestive fluids in the digestive system, improved blood circulation and functioning of red and white blood cells in the blood, and stimulation of sensory nerves in the skin, improving the autonomic nervous system.

While cupping therapy is generally low-risk, some side effects may occur during or immediately after treatment, such as lightheadedness, dizziness, sweating, nausea, skin irritation, marks in a circular pattern, risk of infection, burns from heated cups, blisters, fatigue, headaches, muscle tension or soreness, and itching or scarring. It is crucial for practitioners to follow proper methods for cleaning the skin and controlling infection before and after sessions to minimize these risks.

A physiotherapist typically employs a rubber pump to create a vacuum, causing the skin to rise and blood vessels to expand, simulating a massage effect. Cupping sites are chosen based on the treated ailment, commonly on areas with abundant muscles such as the back, chest, abdomen, buttocks, and legs. Research studies recommend keeping cups on the skin for no more than 5-10 minutes, with residual marks disappearing within 1-10 days. Cupping therapy increases blood flow to sore muscle areas, provides necessary nutrients for healing, and promotes pain relief by exciting small nerves to release pain-killing chemicals. Overall, cupping therapy offers relaxation, helps reduce muscular restrictions, scars, and adhesions, decreases swelling, and increases range of motion.

Q: Doctor my son is 3 months old and has been diagnosed with torticollis. What is the physical therapy treatment?

A: Congenital torticollis (CMT) is a condition in infants commonly diagnosed at or soon after birth. This condition is also known as twisted neck or wry neck.

CMT occurs when there is reduced length and increased tone of sternocleidomastoid (SCM) on one side. Infants present with same side bending and opposite rotation. Treatment approaches for CMT include manual therapy (e.g. therapist-led stretching exercises), repositioning therapy (e.g. tummy time), botulinum toxin (botox) / surgery may be necessary for more severe cases that do not resolve.

A physical therapist first examines the child for passive cervical range of motion with arthrodial goniometer, active range of motion, global assessment, neurological, auditory and visual function assessments to rule out other conditions, Physiotherapy (stretching, strengthening and developmental facilitation) and aggressive repositioning are first-line treatments. Education, guidance and support can reassure and help parents. It is important to educate parents/caregivers on positioning and handling skills to encourage active neck rotation towards the affected side and to discourage side flexion to the affected side. Kinesio taping is an alternative intervention for CMT. It has been suggested that kinesio taping might decrease treatment duration for CMT and that it can have an immediate effect on muscular imbalance in children with CMT. There are certain measures that caregivers can take at home to help their child with CMT, place toys/decorations to encourage infant to turn to other side, position the crib or changing table, so the infant must turn to the other side to see / interact with caregivers. If conservative treatment is not successful, botox or surgical options may be considered. Surgical may be indicated for the following, no improvement after six months of manual stretching, there is a deficit of more than 15 degrees in passive rotation and lateral bending, tight muscular band is present, and there is a tumour in SCM.