Cupping and Scraping (Gua Sha)

Here, we have a female patient in her mid to late 20’s that complained of chronic tension and pain in the upper back and shoulders.  She had tried scraping previously with great results.

Scraping or ‘Gua Sha’ is a technique of using some object such as a piece of wood, bamboo, bone, stone or metal in the shape of a dull blade to scrape the integument (skin) and rise stagnant blood to the surface.  Once the stagnant blood rises to the surface it will be cleaned and carried away by the normal processes of healing over the next few days.

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The circle marks are from immediate cupping that was done.  Notice there really is not much in the way of discoloration one would expect.  This is likely because she is very active and does plenty of yoga and other streatching which keeps the skin and underlying tissues well hydrated and the fluids move freely.  She was indeed in excellent shape working out at least 3 times a week.  The other ‘bruising’ or purple mottling outside the cupping circles is from the Guasha.  I used what I call ‘the fish’ (top of the photo) for this with a light warming oil.imag0270

This technique is also great for chest congestion and was first used on me in about 1988 when I was quite ill in college.  It worked great I might add and spurred me on to eventually become a healer…

After the patient above had treatment we did perform a great chiropractic manipulation (mobilization) to open all the joints of the upper back and ribs.  This opened very easy as the muscles were much more relaxed.  She reported significant improvement that visit.

I will let you know what happened next…

 

 

Therapeutic Cupping, part 2

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Application and practice of Cupping Therapy

Determine the goals of cupping. Make sure you and the person receiving the cupping understand the time it may take to get the desired result.  Try to become clear on the desired result and ascertain if it is attainable.  Then look up the points where cupping would be most useful.  Generally, the most painful areas are a good start.  You can get very complex with cupping and have the body look like a pepperoni pizza and get no real benefit.

Place the cups, then hold them in place with one hand.  Using the other hand, hold the pump gun, and place the end on the tip of the cup valve.  Without pushing or pulling the cup, and maintaining a good seal from skin to cup, pump two times to get the skin to rise.  (This of course depends on the style of cupping you are doing.)  You can then change the suction with the cup by changing the valve to release the vacuum and then reapplying the pump to ‘fine’ tune.

Check in one minute or so to see if there is any skin color change.  If not, consider more pumps.  You can pump a lot; I like to consider the comfort of the person receiving cupping.  Allow the cups to remain:

About 5 minutes for children

About 10 minutes for youth/adolescents and young adults.

About 5 minutes for women that are pregnant or menstruating (check precaution)

Use longer depending on what your goals are.  Severe pain requires more.

Generally you should do less in the summer months, as the skin sweats and can better clean itself. Less stagnation occurs, if the patient gets out and gets movement and sweats.

 

In the winter the skin is contracted and can take longer to get a good result.  It may take more visits.

 

After the treatment is complete, pull up the tab releasing the vacuum.  Remove the cup and clean immediately.  If there is difficulty removing the cup, use a finger to press the skin next to the cup to release the suction, letting the cup become free of the skin.

 

If there is bleeding in the cup:   Make sure you have alcohol and tissues to clean.  Surround the cup with some tissues before you remove it as the blood may flow.  Consider the flow pattern.  Make sure to not get any of the blood on you.  Use rubber gloves and consider it a toxic spill.  Be careful!  Discard that blood by flushing down the toilet.  Make sure and soak the cups involved in alcohol and soapy water, wash them well and dry well before putting back in the case.

 

 

 

 

 

Removing the cups:

With the vacuum cups, simply pull the tab at the top while holding the cup in place.  Sometimes if you do not hold the cup in place it will be uncomfortable.  Pulling the orange tab will release the negative pressure vacuum inside the cup and allow it to easily be removed from the skin. (See Diagram).

 

 

 

 

 

 

 

 

 

 

 

 

 

If the cup still is stuck, gently tilt the cup to the side and press with the other hand toward the cup on the skin next to the cup (See Diagram).  It will pop loose.  Notice there will be a whole new pattern you will see.  There is the bulge that will remain for a few minutes to an hour.  This is where the cup pulled the skin.  Then around that there will be a purplish ring, or gully. (See Diagram) This also will disappear in a few minutes to an hour.   The gully is not too significant therapeutically, so ignore it for now.

 

 

 

 

 

 

 

 

 

Finally around all of that will be the red flash, if any.  This was the histamine response from the skin, due to the pulling of the skin around the cup lip.  If any of these last more than an hour it is likely that the patient is dehydrated and/or has severe stagnation.

 

 

 

 

 

Treatment times and plans:

In general the time for one single treatment really need only be about 5 minutes.  That is about as long as it takes to really see the result of the cupping.  I do three pumps for the first visit, and after five minutes can add a pump or two if no results comes up.  Once you have added a pump or two wait another five minutes.

 

With cupping and massage, you can use moving cupping to start and then use some good oil to get more of the fluids going by doing some effleurage and light petrissage.  After doing a few minutes of massage go back to stationary cupping to bring up deeper fluids.

 

How often can you treat?

You can treat daily but not on the same spots.  With each moderately stagnant spot wait until it has changed to at least the yellow or brownish color before cupping there again.   This generally takes about 4 days.  If you are looking to treat a very large area, use the moving cupping to achieve this.

 

With any treatment there is a duration of care.  If you are receiving no result after three or so treatments go on to another modality.  Try scraping or try heating the body well before the cupping.  Some people are not suited for cupping.  This depends on their personal preference, age, their constitution and disease processes they are experiencing.    There are many reasons for this which we will discuss in the workshop itself.

 

Cupping and water blisters, what it means

In the process of cupping one can show up with water filled blisters.  Sometimes almost immediately and sometimes after more than ten minutes of treatment.  (the picutre here is after 10 minutes with 4 pumps on 2″ pneumatic cups.

In looking up some research I found this article: https://www.researchgate.net/publication/264132955_The_Study_of_Blister_Caused_by_Cupping_Therapy

Other sites had different descriptions, but this is what it is, physiologically and practically.  The blisters of course can occur if one were to use hot or flame cupping with the glass cups and alcohol as the fuel for the suction.  This is a very common practice, but I do not use it because I dislike having rubbing alcohol and flame near things like me.  ( I used to have quite long hair and was concerned that a mishap would set me alight!)

Generally when blisters occur on the skin under the cup there is little or no other color change.  The color change indicates the amount of stagnation that you would see.  Darker would mean that that tissue had not moved in a while and was ‘congested’.  The blisters show a ‘damp heat’ in the area and may be an indication of what is called “wet Xie-qi” There is a report from the patient that there is a heavy feeling during the cupping which does not occur with other spots (colors).  Once the cups have been removed there is a cold feeling at the blistered area (even if the blisters have not been popped) and a more energized and “fresh” feel on the area.   The blisters are considered to have toxic wetness or dampness in them.  The picture here is of a woman suffering from a congestive chest flu.  She reported feeling much better almoste immediately after her treatment. img_20170104_135749img_20170104_135730

After the cups are removed I generally use a paper towel and press the blisters, they will pop and the fluid will release.  I will also put a little salve on it and possibly cover them.  It is very important to have the patient keep the area covered and warm as these ‘holes’ are massive conduits to release heat energy and the patient may get chills.

There is logically some risk of infection for the open blisters but this would depend on the patient’s general constitution and health status.

With this sign (blisters) we recheck in a couple days to make sure there is the healing we desire and may continue cupping in other areas.  As a practice we wait to have the blisters and ‘raw’ skin completely heal before doing it again on that spot.

Here is another post from a different blog on the subject.  http://www.magnolianaturalmedicine.com.au/cupping

 

 

Cupping Therapy, Part 1

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For the past couple years I have been hosting and teaching therapeutic cupping to other practicioners.  Here is some of the information we learn in the class.

History of Cupping Therapy.

Cupping is mentioned in the West as far back as Herodotus around 400BC, in Egypt around 1550 BC in the Papyrus Ebers, and in China, it has roots that go back thousands of years.  Of course, there are many techniques of cupping, but one can safely assume that the original techniques were used to release pus and other poisons for either injuries, illnesses, bites or the like.  In the West, it became a common practice to remove poisons or ‘morbid humors’ and this usually necessitated cuts to release one of the humors, for example, blood.   This is most like the more modern ‘Wet’ cupping or ‘Hijamma’, (Hijamat  Bilashurt) which we will not practice in this workshop.  Prior to our modern western medicine as we know it were many odd theories and techniques. Only some have stood up to real scrutiny and the tests of time and scientific study.

  1. The theory of four humors (fluids) in the body. The four humors are blood, pus, bile and black bile… Humors:
    1. Blood: in vessels, heart, arteries, veins, capillaries as well as reservoirs of liver, spleen, pancreas and uterus.
    2. Phlegm: lymph nodes, stomach, lung, respiratory tract, bronchi, brain, vertebral column, sinuses, and spleen.
    3. Yellow bile: gall bladder, liver, spleen, stomach, small intestine (all parts) and some capillaries.
    4. Black Bile: Spleen, veins of the liver, stomach, large intestine, joints, bones, peripheral nerves, hypochondriac region.

Once a humor is aggravated or disturbed or gets too excessive it builds up in a receptacle, (spleen, liver, uterus etc.) then it will overflow and can spread and overcome other functions causing disease.  This is considered archaic and has little basis in physiology.    The humors are considered in relation to quality and quantity.  Some are thickened and some are thinned with disease processes.  Some are sticky or too slippery, or hot or cold etc…

Of course we do not hear about these any more from medical doctors, for good reason.  They are not accurate.

 

Chiropractic adjustment causes stroke, really?

According to the recently published Medline Plus article, August 7, 2014, Could Chiropractic Manipulation of Your Neck Trigger A Stroke?, Dr. Jose Biller, chair of neurology at Loyola University Chicago Stritch School of Medicine, stated, We strongly believe that patients should be informed of this association before undergoing neck manipulation.”

OK, So I have been a chiropractor for almost 20 years, I know about 50 chiropractors personally.  Have worked with a half dozen or so.  I have done thousands of neck adjustments and I taught and evaluated technique at a major Chiropractic College so I feel I know a thing or two about adjustments.   So if you figure in all those adjustments I figure that HAS to be way over 1,000,000 adjustments to the neck, and yet I have never heard of one incident.*

Every month or so someone will come to me and tell me that their friend’s father’s neighbor’s uncle had a stroke from a chiropractor.  Seriously??.  This happens at least once a month.  Never is it the person I have spoken to or someone they directly KNOW.  It got me to thinking, so I looked up everything I could about strokes, CVAs, dissections, etc on the web.  Lots of passionate info on the ‘evil’ chiropractic adjustment.  Not one MRI, CT, Coroner’s report, or other documentation.  It seems that with that kind of problem there would at least be something… NOPE.

So, if you are reading this and HAVE info, please send it to me.  I would be a great supporter of change to chiropractic and neck manipulations… But keep this in mind.

Even if they do happen (I believe they can and do occur, but not at a ‘significant’ rate to muster an outcry).  I do also believe.  Now (* see above)  an ‘incident’ would be something serious.  The stroke, Cerebro-vascular accident, carotid or vertebral artery dissection, even a hematoma would be significant.   However, sometimes people do suffer pain, stiffness, achy-ness, dizziness, lightheaded-ness after an adjustment.  That, in my experience,  is also rather rare.

Let’s look at this another way.  An anesthesiologist’s mal-practice insurance is almost as much as I can make in a year.  (around $60,000, go ahead, look it up.)  and like car insurance, the rates go up with more risk.  Ever insure a kid?   A General Practitioner’s (your average family care MD) insurance is about $8,000.00 a year.  Now get this… for me, my insurance is about as much as you would pay for liability on a 1998 Nissan minivan.  Yup, just over $1,000.00  THAT is a YEAR.  for the same limits as the GP (MD).  So do the math.  The insurance company does not love chiropractic more or less than any other profession, nor do they give any discounts to make it lower than the insurance for an MD.   It’s all about that math…

OK, so our insurance is low, really low.  That should be an indicator of risk.  I can find no police reports, coroner’s reports, mal-practice claims that discuss stroke either.  (SEND ME ONE IF YOU HAVE IT) Seems those that are up in arms about this would have some hard documentation. Although there is what seems to be a valid case from Canada, but that was years ago.   ( If it is true, it still is a very tragic and terrible thing to have happened…)

In summary, I think I am a good person, vigilant about my art and science of chiropractic, I love and care for people and would NEVER do anything that I would think could harm my fellows.  I would tend to believe I am a rather average personality in chiropractic and not over cautious or over zealous, neither are any of the 50+ I know and have worked with.

I would imagine that if anyone had a stroke it would be all over the news, right?  It is such a rare event I would think it would get a lot of press.   Nothing… Try looking it up.

Let me know if you know something I don’t.  Send me the documentation.  I really want to know.  Of course we would need to change some protocols if it is a fact that CHIROPRACTORS giving CHIROPRACTIC adjustments are doing this.  We can change, we definitely would change.  We love our patients and have not only taken an oath to help but also sincerely care for our patients.

I would take out cases done by Osteopaths, Massage Therapists, Friends, That ‘guy’ at the gym, Trainers, Hair stylists, MMA fighters, any one that is drunk, Martial Arts teachers, Acupuncturists, Physical Therapists and the whole shebang that THINK they can do a chiropractic adjustment.   Not the same technique nor the same forces involved in the same vectors etc.  (I can go over that another time.)

So here is my stand.  Yes they (strokes) can happen from a chiropractic adjustment.  Yes, that is tragic, an accident, largely unforeseeable.  Preventable?  Mostly.  There is ALWAYS an exception to the rule,  unfortunately.   From negligence?  mostly no. Does there have to be legislation?  no, go after something big first, something that is really causing problems with the public in real significant numbers like prescription anti-depressants or pain killers and suicides.

Am I going to change how I work?  no.  I am tedious in checking patients, I  treat each one gently.  My technique is solid and I am confident not harmful.   Should there be studies?  Yes, you betcha.  However you might find out they are more helpful than you feared, tread lightly, and do good scientific study.

 

Nuff said.

Dr. Sean

 

 

 

 

 

A remedy for General Anxiety Disorder with Acupuncture and Meditation

Meditation training and acupuncture for anxiety, panic attacks, stress, and worry…

Acupuncture treatments are well known to facilitate relaxation and whole body harmony.  Meditation can enhance the effectiveness of that effect as well as train you to see anxiety rising in your body and give you effective and realistic tools to stop it in its tracks.  We find that worry, stress, and anxiety are common in today’s world.  We also have discovered that if you practice being upset, worried, or stressed you will automatically ‘go there’ when something occurs that is either out of your control or not what you wanted at the time.  Meditation PRACTICE allows us and trains us to see and be in the world in this present moment and to become aware of the changes in our minds and bodies.  With this powerful practice we can better control and guide our minds to live the life we want and deserve.  Not to become a slave to our ‘gut’.

Acupuncture has a very specific set of points that can change person to person for stress, anxiety, depression, worry, and panic disorders.  Once we have determined the pattern you are in, this therapy does not help you identify the cause but instead realize and acknowledge the process and stop it before it ramps up to a full blown episode.  With a few treatments you can start to feel calm much more of the time, feel balanced, centered and in control.  Therapy will give you the why’s we work on HOW you are going to manage and get through it, effectively.

The trend I am seeing in my practice is a large number of people diagnosed with GAD or some other similar syndrome.  They tell their medical doctor and promptly get a prescription that can last as long as eight months, just to start.  Few are going to a therapist.  I find therapy is helpful to some, but many times it is like archaeology, it digs deep into your past and re-lives and re-ponders the old problems rather than develop a strategy to cope and control the effects.  Stress happens to everyone, EVERYONE.  It is the response that can get out of control. This is why some people have panic attacks and others do not.  It is a ‘timing’ problem, not a coping problem.  The body gets into a pattern and every time the initial stimulus starts we begin a cascade of stress and release of hormones.  The Vagus nerve then reads that as a major problem which releases more stress hormones and the event begins.  If you let it go, you have a full blown panic attack.  If you can catch it in its earliest stages, you can stop it or at least buffer it.

The course of treatment lasts four months (about half the time of a medication regime).  Twice a week meditation and acupuncture in a safe, calm relaxing environment with an anchoring essential oil formula you can take with you.  The meditation practice will start with tuning into your body while in an acupuncture treatment session, appreciating and really understanding what it IS to BE relaxed.  Guided meditation, specific to YOU is offered along with techniques to use at home and work to enhance the benefit of being HERE NOW…  Total cost for the four months is $1000.00  as a discounted package, to go through the entire program is essential, as it is a practice of the mind and body,  would cost about $2,000.00.  ($60 per acupuncture treatment with personalized essential oil for grounding ($15), then guided meditations while you are getting treatment ($49) each)  The schedule is a minimum of twice a week for up to an hour each session, with the gradual decrease in frequency after the second month to no less than once a week. After the fourth month, maintenance is highly recommended on a once a month basis. (billed separately)

Post Surgical Chiropractic Treatment?

Most of my practice as a chiropractor over the past 17 years has been to keep people from getting surgery.  I have to say, I have been pretty successful with that.   I have had only three patients that had low back pain so bad that conservative care did not help.   All three worked very hard at educating themselves, sticking to their protocols and schedules and really attempted to beat the odds of having the operation.  Although I did not feel like a failure for ‘letting’ them get the operations, I did feel responsible for their well being and helped them research different options to find the right surgical procedure for them.

This of course consisted of advice on which questions to ask the surgeon and whether they should have a neurologist or an orthopedist do the job.  In my opinion, I would always have them go for the neurologist surgeon.  They are far more ‘dainty’ in their work and are interested in the details of the operation.

Now that the ‘Silver Tsunami’ has begun, I find many patients come to me with back pain, forget they had surgery 35 years ago and want treatment.  When they are on the table, I see scar tissue on their lower back and, well, the whole plan changes.   Not that I turn them away, but a whole new list of questions begins, reviews of x-rays, detailed history and real detailed functional capacity evaluations begin.  I want to know if I could even help them at all.  I can improve range of motion with training, adjustments to the spine and extremities where there was no surgical changes.  I can teach them stretches and modifications of their work stations/situations that help etc…

What I cannot do is change the surgical area.

What can be done to a post surgical patient depends on the type, extent, and age of the surgery, the scar tissue that has inevitably built up, the current level of flexibility and general health of the patient and more…

There are a couple scenarios I have come across in my practice that deserve review and explanation to get the point across.

1. Let’s call him ‘John Q’.  John had surgery for lumbar scoliosis in his early 20s, a Harrington rod on each side of his spine was surgically bolted to the vertebrae in his lumbar and thoracic spines and a keloid  scar went from between his shoulder blades to his sacrum.  His spine was as straight as an arrow!  (better have been).  He had good range of motion and could almost touch the ground with forward bending but rotation and side bending were reduced.  His complaint was upper back pain, ache in his thoracic and lumbar areas as well as pain in the rump on the right.  After sending him for his full physical and new x-rays to see if the rods had broken (yes, it happens…) we got to work.  Hmmmm… Cannot adjust where the rods are… but can work on the Sacrum, Ilium, neck and upper thoracic spine.  OK, ok, wait a minute… why the neck?  Let’s leave that for a whole other time, but the quick and dirty is that the whole body wants to and has to work together to get you easily through space and time.  The neck will try to loosen to make up for differences elsewhere etc…

So what did we do?

This is what worked…

1. Massage to the muscles of the whole spine, including trigger point work and work on the keloid scar on his back with Arnica extract oil.

2. Chiropractic adjustments to the Sacro-iliac joints with S.O.T. blocking and Full-Spine style hands on adjustments.

3. Chiropractic adjustments and therapies to the neck to improve (His unique) alignment, and reduce muscle tension.

4. Stretches and exercises to improve over all flexibility, strength and stability.

This took only a couple weeks to see real subjective improvement.  His neck regained stability and motion, his scar softened and did not hurt, his back no longer ached.

There is no possibility of ‘correcting’ the curve of  someone that has had this type of surgery, and trying to go for that ‘text book’ range of motion and alignment would only make John much worse.  He was released from any ‘active care’ and was taught that when his own ‘tricks’ and exercises do not give relief, he should seek massage and chiropractic care.  It works for him quite well.  His quality of life is maintained and stress is reduced, his whole outlook got better because there WAS HOPE and someone to LOOK and figure out what could work.  He was told his life would be painful and that he should just accept it.   Nahhhhh… c’mon.  We did it…

The next case example…

Sue, we’ll call her.  A 50 something exec, lots of travel for work.  History of laminectomy one year prior.  Scars almost invisible (great arthroscopic work!)  Pain comes and goes, very tight quads, back muscles as well as rump muscles.  Good range of motion overall.  Pain gets so bad she must frequently get up from sitting, lying down, has to take muscle relaxants and pain pills to get through the day.  Other providers were more than happy to supply her with great drugs, and tell her ‘that’s the way it’s going to be, so take your meds.  Imagine how bad it would have been without the surgery?!’  (Her pain levels and patterns were very close to those from before surgery*)

OK, this one was easy, we had no hardware to deal with and adjusting her lower spine was easy in the prone position, pain was usually relieved immediately.  We gave her stretches for her hips, back, knees, and helped her learn to lift again with her back care in mind.  She required visits after or before most trips and occasional care here and there to keep her pain free and mobile.

SO, what did we do with both of these people?

We did not use special machines, lasers, muscle stim, ultrasound, gizmos, gadgets, elixirs, potions, medications or anything like that… we used TLC, hands on care, and Education.

There are simple stretches for the low back that have worked in 10 of 11 cases when done, there are simple and easy

*Failed Back Surgery (see more) http://www.ncbi.nlm.nih.gov/pubmed/21463472