Some of this info may challenge what you have learned previously. We base all of our content on the research that is available and sometimes that conflicts with what other instructors may have taught previously. This info comes straight from Health Canada, the CDC and the MSDS info from different products.
Cups generally fall under the category Semi-critical Medical Equipment/Device or Noncritical Medical Equipment/Device. Reprocessing then, should be for semi-critical medical equipment/devices as it is the higher of the two standards, and we are not testing them before putting them through a reprocessing process. The standard for semi-critical medical equipment/devices is High Level Disinfection (HLD).
While this sounds difficult, it is really easy as part of your reprocessing process. Reprocessing is the word used for using an item on a client and then processing it for safe use on another client. The process is wash, rinse, dry, disinfect, rinse and dry. Simple!
Wash – Washing cups and IASTM tools is the first step in reprocessing. Washing should be done in soap and water, with some sort of mechanical force. The aim is to remove all visible organic matter. This can be massage oil, sweat, hair, or whatever you can see on the cup.
Rinse – This just removes the soap off the cups/tool so that the disinfectant is not impeded in any way.
Dry – At this stage in our process, we just need to shake off the majority of the rinse water, so that the disinfectant is not diluted.
Disinfect – We recommend that you use 7.5% hydrogen peroxide (H2O2). This is the most environmentally friendly of the chemical disinfectants, though it is still harsh. Make sure that you are wearing gloves and if you tend to splash, eye protection. The cups and tools need to sit in the H2O2 for 30 minutes. This is called contact time, and if you are using another high level disinfectant, please refer to the label for the appropriate contact time.
Rinse – This is done to make sure the disinfectant is totally rinsed off the cup or tool. This is to protect your client’s skin (and your own!)
Dry – The cups or tools are left to air dry as part of the HLD process. Then they can be restocked to your room and cycled into your treatments.
A note about hydrogen peroxide. The bottle you get from the manufacturer will probably be at a much higher concentration that you need, likely 15-35%. You will need to dilute it down with distilled water. The math for this is quite easy. You need to know how much of the higher concentration H2O2 you need to make up a measured quantity of 7.5% peroxide. So, let’s show you the math with an example. Change the numbers to suit your situation.
You purchase some 34% H2O2 from the hydroponic or pool supply store. You need to end up with 7.5%. And, you want to end up with 4 litres of it (nearly a gallon). Four litres is 4000 millilitres (ml). So, how much 34% do you need? To get the answer, multiply 4000 x 7.5 and then divide the answer by 34. You should end up with 883 ml of the 34%. I have found, the easiest way to measure this is to use a 1000 millilitre measuring cup. Measure out the 883 ml of H2O2, then top the litre up with distilled water. Then add 3 more 1000 ml measuring cups full of distilled water. And you are done. Your total volume will be 4 L and and the concentration will be 7.5%. You want to use distilled water as most municipal water is treated with chlorine or fluoride and this does not mix well with hydrogen peroxide.
Even though cupping is done on intact skin there is still a chance blood or body fluids can come in contact with cups. It has happened to many health care practitioners (we ask in our courses!) Examples of this from my practice have been a patient with a bug bite that wasn't visible or mentioned that bled while cups were in place. Another patient had shaved that morning and had knicked her leg. There was no cut visible nor was this mentioned. Another patient had a hair cut in the morning and also had a razor knick that wasn't visible. A very small amount of blood was on the skin and touching the cups after the cupping treatment with each of these cases. The problem most people fail to see is that if the cup has not been disinfected from use on the patient before, there is a chance of cross contamination to this client. As well, in this case, after the treatment the cups need to be sterlized, a bump up the disinfection tree. There is always a chance this can happen which is why cups should always be treated to HLD. With hydrogen peroxide, sterilization can be achieved with a contact time of 6 hours.
So what about the other methods we have heard that are not recommended? Let's take a look.
Alcohol - The FDA has not cleared any liquid chemical sterilant or high-level disinfectant with alcohol as the main active ingredient. Alcohols are not recommended for sterilizing medical and surgical materials principally because they lack sporicidal action and they cannot penetrate protein-rich materials. Two studies demonstrated the effectiveness of 70% isopropyl alcohol to disinfect reusable transducer heads in a controlled environment. In contrast, three bloodstream infection outbreaks have been described when alcohol was used to disinfect transducer heads in an intensive-care setting. The documented shortcomings of alcohols on equipment are that they damage the shellac mountings of lensed instruments, tend to swell and harden rubber and certain plastic tubing after prolonged and repeated use, and bleach rubber and plastic tiles.
Barbicide - is a quaternary ammonium product that Health Canada categorizes as a low-level disinfectant. Barbicides active ingredient is Benzalkonium chloride which is classed as a Category III antiseptic active ingredient by the United States Food and Drug Administration. Ingredients are categorised as Category III when "available data are insufficient to classify as safe and effective, and further testing is required” Health-care–associated infections have been reported from contaminated quaternary ammonium compounds used to disinfect patient-care supplies or equipment,
Cavicide - is an intermediate-level surface disinfectant. It is not appropriate for uses where skin is exposed to it.
Bleach - sodium hypochlorite is not effective in the disinfection of bacterial spores and prions.
Seventh Generation - main ingredient Sodium lauryl sulfate (SLS) is a skin irritant. It can cause damage to the outer layer of skin by disrupting the function of skin proteins and causing itchy, cracked, and dry skin. Journal of the American College of Toxicology (1983, Vol. 2, No. 7) researchers noted, “The longer these ingredients stay in contact with the skin, the greater the likelihood of irritation, which may or may not be evident to the user.” The study authors go on to note that sodium lauryl sulfate causes “severe epidermal changes” to the area of the skin where it was applied. Since the primary side-effect of SLS, namely skin irritation, is dependent on the level and duration of exposure, consumer product formulators design products to avoid or minimize this effect during consumer use.
If and ONLY if you are 100% certain no blood or body fluids have touched the cup can an intermediate disinfectant be used and ONLY if the cup is being use on the same patient. The cups must remain in contact with the disinfectant for a minimum of the time given on the product label (This is called contact time, and every disinfectant has one). However many of these chemicals have not been tested and used on all types of cups to see if they will damage cups. Many chemicals cause the cups to break down and cloud up. Why would you want to risk damaging your cups or more importantly spreading disease?
As newer disinfectants become available, persons or committees responsible for selecting disinfectants and sterilization processes should be guided by products cleared by the FDA and the EPA as well as information in the scientific literature.
Happy and Safe Cupping!
page 32 and Appendix B (p 71) and G (p 91)
There are people in the industry that deny to some degree or another, that cupping marks are bruises. This argument is based normally on two points.
The first is based on the definition of a bruise in some dictionaries:
"An injury appearing as an area of discoloured skin on the body, caused by a blow or impact rupturing underlying blood vessels." -Google Search 'definition:bruise' and similar at dictionary.com and the Cambridge English Dictionary.
There are a couple of problems with this argument. Firstly, not all dictionaries use the words, "...caused by a blow or impact..." In fact, in the Merriam-Webster dictionary this part is left out, and also the dictionary of medicinenet.com. Interestingly, Wikipedia uses the language, "...is a type of hematoma of the tissue, the most common cause being capillaries damaged by trauma..." Trauma could refer to the pressure gradient of cupping.
This means that we are essentially arguing over semantics based on the mechanism of injury, ignoring the fact that the result is the same. The definitions all agree that the colour of a 'mark' is caused by the blood coming out of the ruptured blood vessels.
Additionally, the medical definitions of a hematoma tend to omit the mechanism of injury and just speak about the colour and that there has been a rupture in the underlying capillaries...and this is how we, as western medical practitioners, should be referring to the marks anyway. The problem here is that we shouldn't expect our patients to know the medical terminology, so we tend to use a synonym...and generally the synonym we use is "bruise."
The other argument is that cupping marks are not a bruise because there is no pain to the touch. This is an interesting argument as pain is totally subjective and as such can be bent to the argument at hand.
If a patient says that the cupping mark hurts, the practitioner is typically told that they have over treated the patient. Interestingly, my own cupping marks almost always are tender to the touch, regardless of the length or amount of treatment. Pain or tenderness is subjective to the individual and should be addressed on a case by case basis - pain or tenderness itself does not have anything to do with the definition of a bruise.
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Cupping Canada offers THREE different hardness levels for Silicone Cups - 55A, 60A and 65A.
The 55A Silicone Cups are perfect for Dynamic Cupping where you require lighter suction and more glide.
The 60A Silicone Cups are perfect for applications where you require more suction with slight glide.
The 65A Silicone Cups, while also good for suction, are better for stationary work.
Hardness Levels
Durometer is one of several measures of the hardness of a material such as silicone. Higher numbers indicate harder materials; lower numbers indicate softer materials. When dealing with silicone products, hardness is defined as a material's resistance to indentation. The durometer scale was defined by Albert Ferdinand Shore, who developed a device to measure hardness in the 1920s.
The application that a product can be used for is determined based upon a number of factors, durometer being one of them. Measuring the durometer of any elastomer, using silicone as an example, can be a tricky task to a non-professional. It is important for the end-user to have an understanding of what a durometer is and what numbers like Silicone 55A mean. A better educated client is one that will make better choices and be a more satisfied client because they have a better understanding of the product they are purchasing.
When it comes to off the shelf silicone sheet rubber products, the following silicone hardness are available: silicone 40A, silicone 50A, silicone 60A, and silicone 70A. These are listed from a soft silicone sheet (40A), to a hard silicone sheet (70A).
Made to order products such as Silicone Cups will have variances in between each of the hardness levels outlined above. It is important to know your silicone and ask the questions of your supplier so you are getting what you want and expect out of your product!
Food Grade vs Medical Grade Silicone
Food grade silicone is a type of silicone that is safe for use with foods. The silicone is used frequently in making molds to use for food that begin as liquids and solidify. It is nontoxic; does not stain food, dishes or cookware; is easily removed from cast objects; and is safe for use on various plastic objects.
Medical grade silicone is tested for bio-compatibility and is appropriate to be used for medical applications and must meet certain high standards of manufacture, bio-compatibility and safety, e.g. EU Regulation 2017/745 (MDR) or ISO 10993.
How do you tell the difference between Food Grade and Medical Grade Silicone? Look at the transparency...we placed a quarter underneath 3 different silicone cups to help demonstrate the difference.
When ordering your silicone products, be sure to ask the supplier what hardness level their cups are...if they don't know, don't order!! It's always better to ask and KNOW what you are getting than to receive your cups and be disappointed with the quality.
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As more and more people discover the benefits of Cupping Therapy for themselves as well as their patients, a lot of questions come up as to when you can - and more importantly can NOT - treat with either Silicone or Vacuum Cups. Please see the following guidelines for when NOT to cup!
Just say no when:
Proceed with caution when treating a patient with the following - these are not absolute contraindications, but must be reviewed carefully before proceeding:
If you have any questions about a condition or situation and are unsure as to whether it is safe to proceed with Cupping Therapy, please feel free to email us at info@cuppingcanada.com and we would be happy to help!
]]>We see a lot of posts on social media from people asking why their cups won't stick to a specific area. Loss of suction is mainly related to the adhesiveness between the cup and skin. If the adhesiveness is good then the suction will usually hold for an extended period of time. But if the adhesiveness is poor, then the suction becomes weak and loosens in short time.
This can be cause by a number of things such as:
If you have an issue with a cup not 'sticking' to a certain area, first make sure there isn't a bony prominence causing the problem. Then apply a small amount of massage oil to the area on the patient and around the rim of the cup. This will allow for a tighter seal, especially for areas with a high density of hair.
Next, apply 1-3 minutes of Flash Cupping to the area. This will bring blood flow into the region.
Finally, apply the cup again to the area being treated and check that the adhesiveness with the skin is adequate.
If these steps don't fix the problem, it may be time to consider a new set of cups that are better quality or suited for the type of treatment being applied.
]]>A regular question that comes from practitioners is...how should I clean my cups?
Semicritical Medical equipment/devices are those that comes in contact with nonintact skin or mucous membranes but ordinarily does not penetrate them (e.g., respiratory therapy equipment, transrectal probes, specula). Reprocessing semicritical equipment/devices involves meticulous cleaning followed by, at a minimum, high-level disinfection.
“Failure to use disinfection products or processes appropriately has repeatedly been associated with the transmission of healthcare associated infections.”
Public Health Agency of Canada/Health Canada
In all situations, regardless of the kind of cup that you are using, the health standards should be followed when cleaning your cups. Health Canada outlines that the following methods are not acceptable for achieving proper disinfection/sterilization:
Best Practice for Cleaning Your Cups:
Sort and Soak: Unless they can be cleaned immediately, your cups should be sorted and then submerged in water and detergent to prevent the organic matter from drying on them. For vacuum cups, complete disassembly of each item is necessary to allow effective cleaning. Heavy or nonimmersible items should be wrapped in, or covered with, a wet towel.
Remove Organic Material: Use a detergent or enzymatic cleaner to ensure your cups are clean and all visible material on the cup has been removed. Detergent is used to reduce surface tension and suspend the soil in water.
Rinse: A thorough rinsing is necessary to remove all the soil and cleaning agent from the items, to avoid spotting and to ensure thorough cleanliness. Depending upon the quality of the available water supply, the final rinse may require distilled or de-ionized water. Cleaning agents (i.e., detergents) may also make surfaces slippery or leave residuals that impair equipment integrity and function. Ensure that residuals of the cleaning agent are removed to prevent neutralization of the disinfectant.
Drying: Ensure that the majority of excess water is allowed to drain off the cups. Drying prevents microbial growth so ensure that all of your cups and corresponding equipment are completely dry before disinfecting for storing or re-using on the next client.
High Level Disinfection: High-level disinfectants include 2% glutaraldehyde, 7.5% hydrogen peroxide, 0.2% peracetic acid, 2-7% enhanced action formulation hydrogen peroxide and 0.55% ortho-phthalaldehyde (OPA). Pasteurization also achieves high-level disinfection.
Of these, 7.5% hydrogen peroxide is a cheap and environmentally friendly option. Cups must be left to soak for 30 minutes to achieve high level disinfection. (If you leave them 6 hours, they will be considered sterile!)
After soaking, rinse and let the cups dry before using them on your next client.
Tip: If cupping therapy is a regular technique used in your treatments, ensure you have more than one set available in order that you can follow the above best practices to ensure safety for your clients.
References-
Canadian Standards Association. Decontamination of Reusable Medical Devices. CAN/CSA-Z314.8-08. 2008.
Canadian Standards Association. CAN/CSA-Z314.0-13 Medical Device Reprosessing - General requirements. 2013.
Food and Drugs Act. Medical Devices Regulations, SOR/98-282. 1998
As a professional manual therapist providing wellness and care, you always run the risk of facing a medical malpractice lawsuit. There is always a chance that a claim puts your practice at risk, sets you back by thousands of dollars that can bankrupt you; and worst of all, destroys your credibility as a care provider. To protect yourself from such possible situations, it is advisable that along with the necessary membership from the jurisdiction where you are practicing and proper training from a qualified instructor, you also ensure you have proper professional liability insurance.
Why You Need Liability Insurance
Many jurisdictions have made it mandatory for therapists to maintain liability insurance to get their license for practicing in that state or province. Depending on the jurisdictional requirements, you may not even be allowed to provide Cupping Therapy. Cupping may fall under the “use of tools” that is restricted by some organizations or regulatory bodies. If Cupping Therapy is not in your scope of practice, you would need to provide Cupping Therapy treatments without your professional 'hat' on...in which case you NEED to have insurance!
Remember, most insurance companies do not cover illegal activities. This is very important if Cupping, "use of tools" or the “movement of cups” is not under your jurisdiction's scope of practice.
There are many coverage providers out there and when choosing a company, find one that is experienced, understanding, and knows the profession well. In case you face a claim, they should be able to help you resolve the issue as smoothly as possible. Try checking with your colleagues and other cupping therapists who have coverage and trust their judgment when choosing the provider that can not only prioritize your best interests but is also economical.
Cupping Canada has entered into an exclusive arrangement with BFL Canada and Trisura Insurance to make available Cupping Therapy Insurance in the event that you are not able to obtain it from your professional association or regulatory body. To submit your application, please download the PDF file below, complete all required information and email to kgaetano@bflcanada.com.
Cupping Insurance Application PDF
References–
1. https://www.abmp.co m/massage-liability-insurance
2. https://www.lmtsuccessgrou p.com/blog/?p=113
1. The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature published in September 2016
The aim of this review is to present an overview of the available literature on the physical and physiological effects of vacuum massage on epidermal and dermal skin structures in order to find the underlying working mechanisms that could benefit the healing of burns and scars.
2. Cupping therapy: A prudent remedy for a plethora of medical ailments published in February 2015
Cupping therapy, one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of “Qi". Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy.
3. An Updated Review of the Efficacy of Cupping Therapy published in February 2012
On the basis of a study of six databases all through 2010, researchers have concluded that cupping therapy has been proved to be highly effective in treating medical problems like cervical spondylosis, acne, facial paralysis or Bell’s palsy, herpes zoster, lumbar disc herniation, and cough and dyspnea.
4. Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial published in March 2011
A study was conducted on a group of 32 participants suffering from lower back pain, of which 21 were given wet cupping treatment combined with acupuncture at two specific points on the back for two weeks. All the participants were also prescribed exercise and acetaminophen. It was found that the group given the cupping sessions showed significant improvement in the pain as compared to the other group.
5. Randomized Controlled Trial of Pulsating Cupping (Pneumatic Pulsation Therapy) for Chronic Neck Pain published in 2011
Pulsating Cupping or Pneumatic Pulsation Therapy when combined with massage can give relief to patients suffering from chronic pain in the neck. It can also help improve the quality of life for patients.
6. Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials published in December 2010
A series of 8 Randomized Controlled Trials were conducted on 651 patients. Researchers found that when wet cupping treatments were given to them for herpes zoster along with medications, their symptoms showed a significant improvement and reduced the rate of postherpetic neuralgia.
7. The effect of moving cupping therapy on nonspecific low back pain published in April 2006
A study was conducted on the effectiveness of moving cupping or gliding cupping for relieving lower back pain. 37 patients were given moving cupping therapy while 33 other patients were treated with the medicine, dexibuprofen, a kind of nonsteroidal anti-inflammatory drug. It was found that the patients taking cupping therapy found it more effective as compared to those taking the drug therapy.
8. Medical and Scientific Bases of Wet Cupping Therapy (Al-hijamah): in Light of Modern Medicine and Prophetic Medicine published in May 2013.
Researchers have found that there are many ailments for which medication like steroids, opioids, and non-steroidal anti-inflammatory drugs need to be prescribed. However, often these medications have to be discontinued when patients cannot tolerate them. Such patients can opt for alternate methods of treatment like cupping therapy for issues like persistent nonspecific low back pain, chronic non-specific neck pain, herpes zoster, lumbar disc herniation, and fibromyalgia, among others.
9. The Efficacy of Wet-Cupping in the Treatment of Tension and Migraine Headache published in 2008
After conducting treatment with wet cupping on 70 patients over a period of 3 months, it was found that their symptoms of severe stress-related headaches and migraines were greatly reduced.
10. Cupping for Treating Pain: A Systematic Review published in April 2007
Randomized clinical trials were conducted on patients with lower back pain, pain from cancer, herpes zoster, and trigeminal neuralgia, among others. The study found that when patients were treated with a combination of wet and dry cupping therapy, those receiving the treatment along with drugs for cancer and analgesics responded with less pain that those that received only the medication.
11. Cupping for Hypertension: A Systematic Review published in 2010.
Keeping the Cochrane criteria in mind, the results of dry cupping therapy for hypertension was studied. The study found that both dry and wet cupping is highly effective in cerebral vascular function. This treatment also improves the ability of the arteries to expand and contract and thus pump blood more effectively.
12. Cupping for stroke rehabilitation: A systematic review published in March 2010
Cupping therapy has been found to show good results in patient that have suffered a stroke. The treatment can help relieve pain in the hemiplegic shoulder and high upper-limb myodynamia.
Content courtesy of https://cuppingresource.com/medical-research-for-cupping-therapy/
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