This time of year, we tend to be looking for health and fitness solutions. The other side of staying in shape, eating right, and losing weight, is muscle fatigue, injury, wear, and other uncomfortable situations. If normal physical therapy or deep tissue massage just isn’t cutting it for you, a more Eastern World approach may be just what you’re seeking.

Cupping is a lesser-known, Chinese muscle therapy that was officially established in the 1950s, but is documented as far back as 300 AD. What is cupping, you may ask? We brought in some local experts to explain.  For more than 30 years, Cioffredi & Associates has been in the business of physical therapy and rehabilitation in the Upper Valley, located on Etna Road in Lebanon.

We caught up with Bill Cioffredi, physical therapist and founder of Cioffredi & Associates, and cupping specialist Marissa Harper Reilly, PT, DPT, ATC, LAT, CSCS, to find out more about this unique style of treatment.

Woodstock Magazine: Tell us about yourself, your involvement with Cioffredi & Associates, and your overall history with physical therapy - how did you get into it, what made you passionate about it?

Bill Cioffredi: Growing up, sports was a large part of my life. I appreciated with the body’s ability to move in the ability to improve human performance. As part of participating in the Shrine Game, the Vermont-New Hampshire All-Star football game that was a benefit for the Shriners Hospital, as players, we had the opportunity to visit children at the Shriners Hospital in Springfield Massachusetts. That was a very positive and powerful experience for me. As I participated in football in college at the University of Pennsylvania, I interfaced with the team athletic trainers who had dual degrees as physical therapists who also worked in the hospitals adjacent to campus. I volunteered working with them in the hospital setting. At that point, I knew this was a professional career that I wanted to pursue.

One of my clinical internships during school was at Mary Hitchcock Memorial Hospital, now the Dartmouth Hitchcock Medical Center. They offered me a job that I was pleased to accept, and worked there for six years where I also met my wife, Ruth, who was working as an Occupational Therapist, specializing in hand therapy.

WM: Tell us about Cioffredi & Associates. How and when was it born? How has it evolved since you first opened? What separates you from the competition?

Cioffredi: I left the hospital in 1985 about the same time that I married Ruth. And set out on my own with a contract at a local nursing home, the home healthcare agency, and opened an outpatient office part-time. I had no grand vision or formal business plan at the time, but only to enjoy working with people one on one in a variety of settings. I had an aptitude for my craft and I worked very hard to develop my skills clinical. My part-time office became full-time, and I developed more service than I can provide by myself.

I gradually added staff but truly wanted to maintain a relatively small office. I had no training and education in business and it did not come naturally to me. There came a time in the insurance industry when there was some talk of the major providers like Blue Cross Blue Shield limiting who they might contract with. Concerns that the small providers may be cut out of the scenario, I decided to “let my business expand”. The company did grow, but it seemed to only consume more of my time and energy along with a level of frustration to administrate the business along with carrying a full caseload, as caring for clients was what I was most passionate about and truly wanted to be doing.

I got to the point where I felt that I needed to either learn and successfully master the operation of a small business or leave the group environment and work with just my wife in treating people with musculoskeletal pain problems. I decided to use my business as a vehicle for personal growth and began a process of training and education as a business executive. Our business has expanded every year. In 2013 we moved into a larger space with a lot of glass exposure to the outdoors and is our current location on 112 Etna Rd. in Lebanon, NH. At this time, I added additional services for our clients including Medically Based Personal Training, massage, health coaching, and nutrition. This has allowed us to treat our clients over a broader spectrum of their health and wellness spectrum. In May 2018 we opened a satellite clinic in Grantham New Hampshire which has outpaced our first-year projections.

At this point, I have a truly exceptional staff who provide the services and a top-shelf executive staff who execute the day-to-day operations. My role is now development, and to provide the environment and support to see each staff member to succeed and grow personally and professionally.

In the last few years, we have participated in a national competition for the best private physical therapy practices in the country sponsored by Advance Magazine. This has included companies with multiple sites and in multiple states. In each of the two years we participated, we received one of the runner-up positions.

WM: We've found that cupping therapy is a relatively popular treatment to receive, today and that Cioffredi offers it. Can you tell us about cupping? What is it, what are its benefits to the patient, and what can a first-timer expect coming in?

Marissa Harper Reilly: “Cupping,” or myofascial decompression as we refer to it in the healthcare realm has become a hot topic treatment intervention in the United States since Michael Phelps debuted the infamous purple cup marks on his back and shoulders in the 2016 Rio Olympic games. In reality, cupping has been around for centuries in Eastern and Chinese medicine as a treatment intervention.

Chinese medicine has traditionally used cupping for treatment of systemic conditions like constipation, infection, anxiety, and headaches with the cups placed along the meridian/chakra systems of the body.  The modern version of cupping used in Western medicine employs more of a focus on restoring movement asymmetries and restrictions which likely contribute to pain.  In the US, we use cupping for treatment of lots of different conditions including but not limited to: plantar fasciitis, knee replacements, low back pain, neck pain, IT band pain, tennis elbow, shoulder pain, muscle strains, etc. We also find it very useful for helping with scar tissue mobility following surgery!

The cups themselves are yet another manual therapy skill, similar to dry needling, massage, and instrument-assisted soft tissue techniques, that we use at Cioffredi & Associates in order to reduce pain, improve range of motion, improve blood flow, and to reduce muscular and soft tissue restrictions. The cups work to create a negative pressure vacuum over the skin and act to decompress the top layers of skin from the underlying layers of connective tissue/fascia, muscles, and tendons. In fact, this is one of the few hands-on treatments that we use in physical therapy that is decompressive in nature. Often times, we find that pain can come from a lack of appropriate sliding and gliding of the connective tissue over the top of muscle or muscle on muscle which causes more shearing which then creates irritation and pain.

In treatment sessions, the silicone or plastic cups are generally placed over one side of the body over areas that your PT finds to be restricted or tight with massage and palpation.  Once the cups are in place and suction is created, we typically take you through, and then have you go through movement to elongate the muscle and soft tissue under the cups in order to stretch out and create more free space underneath the cups. The benefits of cupping occur after the treatment is completed, with most clients reporting less pain and stiffness, improved range of motion, and improved ease of motion.

WM: What made you decide to offer cupping at your facility? What goes into getting your staff trained and certified to administer the treatment?

Harper Reilly: We decided to offer “cupping” as it would continue to broaden the variety of techniques that we use to address soft tissue restrictions. While the technique has existed for years in other parts of the world, it is relatively new as a routine use in this country. Similarly, we began the utilization of Trigger Point Dry Needling (TDN) many years ago. This is the use of the same kind of needles used in acupuncture, but for the purpose of releasing soft tissue restrictions and deactivating muscular trigger points. Regarding restricted, painful movement, all people do not respond to the same techniques. So having a broad variety of techniques provides a better opportunity for success.

Formal training is received through educational courses that are provided by physical therapists who are up on the current research and are trained and experienced in the use of cupping treatment. The technique of applying the cups themselves is not exceptionally sophisticated and does not require certification, but rather, it is the decision-making, the application and in some cases, the manual movement of the cups that demonstrates the expertise of the clinician to resolve the condition.

WM: There are some scary pictures on the internet of the immediate end-result of cupping on the skin. We assume that's only temporary? Why does that happen and what is happening beneath the skin? How will a patient feel after the procedure?

Harper Reilly: A lot of times the bruising and ‘petichaie’ that patients get with the cupping comes from small capillaries/venules bursting due to the negative pressure. Often times, that response is because of the vacuum seal of the cup especially at the edges of the cup where they contact the skin where the pressure in the cup is the highest. Soft tissue that is very sensitive and irritable/restricted sometimes gets that skin coloration more easily than others, and lighter skinned individuals tend to get more discoloration. The color of your skin in response to the cupping does not necessarily indicate extent of tissue trauma. A lot of that comes from the consistency and symmetry of the skin in the cup with the elevated, "Jimmy dean" sausage type appearance where pores are more visible/larger or inconsistencies with colors, markings, or areas where bubble of skin in cup is not uniform and there is indentation/divots/dips/etc.

The amount of suction applied can be modulated. We don't always apply a maximal amount that one might see in some of the web pictures. And, each person's response to the same amount of suction can be different. The color changes that can happen in the skin are always temporary. The amount of time it takes before color changes resolve varies from person to person.