What Is Cupping Therapy? Benefits and Applications

Have you ever noticed a famous athlete or Hollywood celebrity sporting large circle-shaped marks on their bodies and wondered, “What is that?” Those discoloration marks are from an ancient therapy known as cupping, in which a suction process moves blood through the body to remove toxins.

Egyptian, Chinese and Middle Eastern cultures have practiced cupping physical therapy for thousands of years, but it has only gained popularity and notoriety in the United States over the past 20 years, thanks to celebrities and athletes showing off their cupping marks.¹

Documented in one of the world’s oldest medical textbooks (from 1550 B.C.), cupping physical therapy is now taught in some Doctor of Physical Therapy (DPT) programs and used by physical therapists, massage therapists, acupuncturists, physicians and chiropractors.² It is believed to treat conditions that cause pain as well as other ailments.

The practice of suction cup therapy is not without controversy, as a lack of conclusive evidence has led some to claim that it only offers a placebo effect.³ Learn more about cupping therapy, including tips on who it is and isn’t recommended for and where you’ll likely find cupping offered.

Cupping Therapy Explained

Cupping is a therapeutic process using a glass, ceramic, bamboo or plastic cup to create suction on the skin. Typically, the practitioner applies a flame to the inside of the cup to remove oxygen before placing the cup on the skin, creating negative pressure that draws the skin into the cup.⁴

Some cups feature a suction device, so heating the cup is not necessary.⁴  Cupping increases blood circulation in target areas where the cups are placed, relieving muscle tension and promoting cell repair.

History of Cupping

It turns out that cupping has been a staple of traditional Chinese medicine and is popular in ancient Egypt, Greece and Islamic culture.² Records show that ancient Egyptians practiced cupping physical therapy as early as 1500 B.C. to treat menstrual imbalances, vertigo and fever.

The Chinese attribute cupping to Ge Hong, a famous alchemist during the Jin dynasty.⁵ Ancient Greek doctors prescribed cupping physical therapy for headaches, lack of appetite, maldigestion, fainting, abscess evacuation, narcolepsy and other ailments.⁶

Types of Cupping Therapy

There are two main types of cupping physical therapy: wet and dry. The practice of wet cupping involves lightly piercing the skin with a needle, allowing blood to flow into the cup. Dry cupping does not incorporate the skin piercings; thus, the skin remains dry.⁷

Beyond these two main methods, there are a variety of cupping practices to explore, including:⁸

• Needle cupping: In this combination of acupuncture and cupping, acupuncture needles are applied, then cups are placed over each needle.
• Massage cupping: After creating suction, the therapist moves the cups across the skin.
• Facial cupping: Small silicone cups are placed on the face to assist with rejuvenating and detoxifying the skin.
• Water cupping: One-third of each cup is filled with warm water and then inverted onto the skin for suction.

How Does Cupping Work?

The driving theory for the effectiveness of cupping physical therapy is that suction encourages improved circulation, promotes healing and reduces pain. One acupuncturist at Cedars-Sinai Integrative Health in Los Angeles noted that her patients feel immediate benefits. “I often hear them say their pain went from an 8 to a 3 on a scale of 10,” she said.²

During Treatment

Your suction cup therapy session will vary slightly based on your selected treatment. The practitioner will ask you to lie face down or face up on a table, depending on the area they are working on.

In a dry cupping process known as fire cupping therapy, the practitioner uses a flammable substance—such as herbs, alcohol or paper—that they place in the cup and then light on fire.⁹

Once the fire extinguishes itself, the practitioner quickly places the cup upside down on the area needing treatment. This creates a vacuum as the air inside the cup cools and raises the skin within the cup opening.

A therapist can achieve the same suction effect with modern cups featuring air pumps that allow the practitioner to control the amount of air removed from within.⁴

Some therapists leave the dry cups in place for approximately three minutes and then remove them, while others opt to massage or stretch the area by briefly moving the cup.⁹

In wet cupping or hijama, the practitioner places the cups on the skin before making any needle piercings or cuts. After several minutes of suction, they remove the cup and administer small cuts to the raised skin to release blood and toxins.⁹

Suction cup therapy is typically not painful, creating only mild discomfort. One journalist wrote about his experience with fire cupping and reported, “I couldn’t see the flame with my head buried in the massage board, but I could feel the heat. I winced and tensed. I needn’t have bothered; it was painless.”¹⁰

What Does Cupping Do?

Following cupping therapy treatment, the notorious circular marks caused by the bursting of capillaries may appear on your skin. These bruise-like discolorations do not hurt and typically heal on their own within 7 to 10 days.²

Infrequent side effects may include skin infection, burns, scar formation, nausea, anemia, headaches and dizziness. Many of these potential risks are preventable, and researchers generally consider cupping therapy to be a safe practice.¹¹

What Are the Benefits of Cupping?

Proponents of cupping claim a broad scope of cupping therapy benefits. Mostly, it’s believed to promote healing and muscle recovery.

It also treats: ^4,12

• Neck, shoulder, back and knee pain
• Skin issues such as acne and hives
• High blood pressure
• Fibromyalgia
• Migraines
• Arthritis
• Gastrointestinal disorders

Scientists have researched cupping therapy benefits over the years from several angles. A 2018 study found that wet cupping may help remove excess heavy metals from the blood, having an excretory effect on the kidneys.¹³ Evidence suggests that it can be an effective treatment for those suffering from neck pain, a health condition that is the second most significant cause of chronic disability worldwide​​.¹⁴

Cupping Therapy for Athletes

As evidenced by the repeated appearance of cupping marks at both the 2016 and 2021 Olympic Games, many high-performing athletes endorse cupping.^15,16 Athletic trainers and sports clinical specialists, physical therapists trained to treat amateur and elite athletes, often use suction cup therapy to help athletes’ muscles recover following intense and repetitive physical activity.

Olympic swimming star Michael Phelps is one of the most renowned athletes to wear cupping marks in competition, sparking worldwide interest at the 2016 Games in Rio. His record-breaking swims made him the winningest Olympian, with 23 gold medals.¹⁷ His trainer told ESPN in 2016 that he had been using the treatment on Phelps since 2014.¹⁸

Cupping was still visible at the 2021 Olympic Games in Tokyo, even though Phelps did not compete. Swimmers Adam Peaty of Great Britain, Akira Namba of Japan and Kyle Chalmers of Australia were all seen sporting recognizable circles during the competition.^{19, 20}

Over the years, professional basketball and baseball athletes  have also incorporated cupping into their treatment modalities. Athletic trainers for the NBA’s Oklahoma City Thunder and MLB’s Washington Nationals have used cupping physical therapy with their players.^{21, 22}

However, research on cupping therapy benefits and effectiveness for athletes has so far delivered inconclusive results.²³

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Who Should Avoid Cupping Therapy?

Although cupping is generally considered safe, it’s not recommended for everyone. People with certain medical conditions should avoid cupping, specifically those with the following conditions:⁴

• Epilepsy
• Hemophilia
• History of strokes
• Eczema
• Psoriasis

Other factors to consider are:²⁴

• Age: Cupping should either be avoided or very closely monitored on seniors and children due to the fragility of their skin.
• Pregnancy: Avoid cupping in the abdomen and lower back areas.
• Medications: If you take blood thinners, do not try cupping.

Research Behind Cupping

Research on cupping has often delivered inconclusive results. Consequentially, some medical professionals are vocal about their skepticism of cupping. One UCLA exercise physiologist called it “pseudoscience” in a piece about the Michael Phelps cupping phenomenon.²⁵ Their perspective is based on multiple research sources that cite statistically weak data.

For example:

• A 2019 report could not identify a unified theory to explain the effects of suction cup therapy and argues for large clinical trials for future data substantiation.³
• A 2017 study on cupping used to treat knee osteoarthritis states, “Only weak evidence can support the hypothesis that cupping therapy can effectively improve the treatment efficacy and physical function in patients.”²⁶
• Research from 2011 acknowledged that cupping may help reduce pain, then stated, “…even for this indication doubts remain.”²⁷

Where Can I Get Cupping Therapy?

You can find trained cupping health and wellness practitioners—from masseusesand acupuncturists to physical therapists, doctors and chiropractors. The type of cupping expert you need may depend on the treatment you want.⁴

Cupping in Physical Therapy

Studies have shown that cupping is a viable treatment option among physical therapy modalities. It can positively impact a patient’s flexibility, pain threshold and range of motion.²⁸

Physical therapist Rob Stanborough, PT, DPT, MHSc, MTC, CMTPT, FAAOMPT, has incorporated cupping into his treatments for years to manipulate his patients’ soft tissue.

He notes, “We use our hands and elbows but can also use instrument-assisted soft tissue manipulation, dry needling where permitted, cupping, and other methods, all to get those tissues moving. Our goal is to increase mobility, promote healing, and restore function.”

Average Cost of Cupping Therapy

The cost of suction cup therapy most likely will be impacted by your geographic location, but $30–$100 is the average range for a treatment.²⁹ Around the world, the price is typically considered affordable compared to other treatment modalities, such as acupuncture.³⁰

Overall, questions still linger about the benefits of cupping physical therapy. We need more research into the modern-day efficacy of this ancient treatment method.

The largest PT school in the United States,* the University of St. Augustine for Health Sciences (USAHS) offers a hands-on Doctor of Physical Therapy (DPT) degree. Join a collaborative cohort of peers who learn under the mentorship of expert faculty-practitioners. Practice with mock and real patients in our state-of-the-art simulation centers and learn anatomy with our high-tech tools. Prepare for clinical practice with a wide range of patients, as well as for advanced roles in research, practice leadership, and policymaking. Residential (blended didactic courses + in-person labs on weekdays) and Flex (online coursework + in-person labs on weekends) formats are available.

*Based on total DPT degrees conferred as reported by the Integrated Postsecondary Education Data System (IPEDS). Data is captured by IPEDS through interrelated surveys conducted annually by the Department of Education’s National Center for Educational Statistics (NCES). https://nces.ed.gov/ipeds/

Sources

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