What’s the Scoop on Cupping?

My first exposure to cupping was seeing the perfectly circular bruises on Michel Phelp’s during the 2016 Summer Olympics. Since then, I have come across it many times in the University of Delaware athletic training room seeing athletes performing exercises with cups suctioned to their back. I have even tried it myself a couple of times to see what the hype was about and if I felt a difference using this type of recovery method. 

Figure 1. Michael Phelps swimming with visible cupping markers (bruises) on his shoulders. 

Now if you haven’t heard about cupping you may be wondering: what is cupping? Cupping is the application of plastic, glass, bamboo, or ceramics cups [1] to the skin via suction. The suction can either be created naturally by heating up the inside of the cup using a flame and allowing it to cool on the skin creating negative pressure and lifting/stretching the skin up. The other way to get this pressure is to use a suction device.[1] There are also two types of cupping, similar to needling; there are both wet and dry methods. Dry cupping is exactly the procedure I described above while wet cupping is when small cuts are made on the skin before the cup is applied and blood is drawn out. [1] The original idea behind this technique was that it was regulating Qi in the body. More recently, people claim that it promotes blood flow and therefore has a positive effect on the healing process, reducing soreness and pain. There are still many who find cupping bizarre and disgusting due to the often dark bruising and the odd look of the skin suctioned into cups. In particular, a Forbes article by Steven Salzberg goes as describes it as “someone giving you a massive hickey, and then doing another dozen or so all over your back, or legs, or wherever ” [2]. So by now, you should have a pretty clear image that while there are many advocates and cupping has been gaining interest (especially if professional athletes on the world stage have used it), there are still many skeptics and people who say it is harmful. Let’s see exactly what the research says about cupping. Is it beneficial? Harmful?


An article published in The Journal of Alternative and Complementary Medicine by a group of Australian and German researchers performed a systematic meta-analysis of clinical trials evaluating the effects of cupping on athletes. [3] They found 11 valid (according to their criteria) trials with a combined total of 498 participants from China, the United States, Greece, Iran, and the United Arab Emirates. Participants received cupping 1 to 20 times in daily or weekly intervals either alone or in combination with another procedure, like acupuncture.[3] The study found no conclusive results however. Even though there were improvements to the participant’s perception of pain, an increased range of motion, and lower levels of creatine kinase, there were large variations between symptom intensity and recovery measures, and other metrics.[3] There are also some limitations to this study. One of the main concerns is the reliability of the data. The researchers report an unclear or high risk of bias in many of the trials and they also mention that none of the trials reported safety. 


Another study published in 2016 in the Journal of Novel Physiotherapies evaluated the effects of various soft tissue mobilization techniques, including cupping, on active myofascial trigger-points in 20 amateur soccer players.[4] Athletes received cupping once a week for three weeks. They found that all techniques used, including cupping, improved pain pressure threshold and pain sensitivity significantly. [4] The researchers concluded that more research must be done to fully be able to draw a conclusion. Some limitations of the study were the small sample size (n = 20) and that the study was limited to only amateur soccer players. Other studies, including the previously mentioned study viewed multiple different sports instead of one. This also provided a much larger sample size compared to this study.  


Overall, there appears to be no definite answer, at least at this time, on if cupping helps promote healing and reduce pain and muscle soreness. For some, it appears to be beneficial in relieving pain but due to a limited number of studies and the questionable accuracy of others, there is no conclusive data for or against cupping. As the first-mentioned study by Bridgett et. al stated, “ No explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary for conclusive judgment on the efficacy and safety of cupping in athletes.” [3].




[1] NCCIH. “Cupping.” November 2018. Retrieved from: https://www.nccih.nih.gov/health/cupping

[2] Steven Salzberg. “ The Ridiculous and Possibly Harmful Practice of Cupping”.  May 2019. Retrieved from: https://www.forbes.com/sites/stevensalzberg/2019/05/13/the-ridiculous-and-possibly-harmful-practice-of-cupping/#57ce2d2331f3

[3] Rhianna Bridgett, Petra Klose, Rob Duffield, Suni Mydock, and Romy Lauche.The Journal of Alternative and Complementary Medicine.Mar 2018. 208-219.http://doi.org/10.1089/acm.2017.0191

[4] Fousekis, Konstantinos et al. “The Effectiveness of Instrument-assisted Soft Tissue Mobilization Technique(Ergoné Technique), Cupping and Ischaemic Pressure Techniques in the Treatment of Amateur AthletesàMyofascial Trigger Points.” (2016).


Questions to Consider:

  1. Have you ever gotten cupping done? If yes, what are your thoughts? Did you find it beneficial? If no, was there a reason why?
  2. How do you think studies looking at cupping should compare its effects for the most accurate evaluation? Should they compare across different sports because the benefits should not be sport dependent or within one sport to get a better comparison?

A Closer Look At: Cupping

Among Olympic athletes you may have noticed something different in recent years – spots. Big red spots. Elite athletes from a variety of different sports have been spotted with – well- spots. But where are these markings coming from?

Michael Phelps, Alex Naddour, and Natalie Coughlin are a few of many athletes who have utilized cupping, an ancient therapeutic technique that has given them their spots.

Michael Phelps, male US swimmer, 2016 Rio Olympics

Cupping is a practice used in traditional medicine in which suction is created using a glass, bamboo, plastic, or ceramic cup. Negative pressure is generated within the cup and used to lift the skin and surrounding tissues. There are over ten different types of cupping therapy, each utilized to treat a variety of ailments. Most broadly cupping can be categorized in to wet cupping, where incisions are made on an indiviudal prior to applying negative pressure via cup, and dry cupping, where no incisions are made. However, treatments can be further classified by their power of suction, method of suction, and material inside the cup [1].

Since 3500 BC cupping has been practiced across several cultures. The earliest references to cupping therapy are found in the Ebers Papyrus, one of the oldest and most important medical papyri of ancient Egypt dating back 1550 BC. However, this form of therapy has not just been exclusively used by the Egyptians, rather it has been used across many cultures for thousands of years. In ancient Macedonia, cupping therapy was used to treat diseases and health disorders. Ancient Arab practitioners utilized cupping therapy to treat hypertension, polycythemia, headache and migraine, and drug intoxication. Hippocrates advocated cupping therapy as a treatment for many ailments in his treatise Guide to Clinical Treatment. Greek and Roman practitioners regularly used wet and dry cupping to treat a variety of diseases. To this day, Cupping therapy acts as one of the cornerstones of traditional Chinese medicine [2].

Today, athletes utilize cupping to decrease recovery time between training sessions, improve range of motion, alleviate inflammation, and reduce pain [3,4,5].

Research suggests that cupping may alleviate pain in individuals. A 2012 pilot study was conducted to assess the effects of a single wet cupping session on pain. Fifty individuals suffering from non-specific chronic neck pain were selected to receive a single wet cupping therapy session. Relative pain levels were measured through participant questioners and mechanical sensory and pain threshold values. Measures taken directly before therapy sessions and three days after treatment and were compared to assess changes in pain levels. Participants reported a statistically significant reduction in pain three days after treatment; however, because measures in reduction of pain are directly correlated with patient reporting, findings may be based on placebo effect or patient bias making it difficult to draw significant conclusions from this study [6].

Several systematic reviews (SR) assessing the impact of cupping on pain relief suggest there may be a positive correlation between the treatment and pain reduction. Several published randomized clinical trials including cupping interventions have been associated with a reduction in pain; however, these studies are limited by size and potential bias, and share a poor study design. Many studies are limited in longevity, participant sample size, and lack of a sufficient placebo for cupping therapy making it difficult to draw significant conclusions regarding the impact of cupping on pain relief [7,8,9,10].

Little is known about the mechanism of action of cupping. Several theories look to explain the pain relief experienced by individuals, including the following two:

  • The Pain Gate Theory: Chronic pain is influenced by altering pain signaling at the nociceptor level. Through stimulating pain via cupping, the frequency of nociceptor impulses will be increased, leading to the closure of pain gates and inevitably pain reduction.
  • Diffuse Noxious Inhibitory Controls: “Cupping therapy may produce an analgesic effect via nerves that are sensitive to mechanical stimulation. This mechanism is similar to acupuncture in that it activates A∂ and C nerve fibers which are linked to the DNICs system, a pain modulation pathway which has been described as ‘pain inhibits pain’ phenomenon”[9]

The potential mechanisms by which cupping may alleviate pain are not well understood, and certainly require validation by scientific studies. However, in addition to participant pain relief, reported effects of cupping also include increased blood flow to the skin [11] and a reduction in inflammation [12]. These physiological impacts may also influence pain relief experienced in clinical trial participants; however, further research is required to draw any conclusions about the mechanisms by which cupping works to potentially reduce pain.

Although it is difficult to draw significant conclusions relating cupping therapy with pain relief, research study participants, athletes, and thousands of other people claim cupping has helped reduce their pain. Cupping has been practiced for over 5000 years across a number of cultures and has alleviated the pain of many. It’s long history of helping indiviudals enduring pain and illness gives it promise as an effective treatment method. Bottom line- whether it directly facilitates pain relief or acts as a placebo – cupping has helped alleviate pain for thousands of years and can be beneficial.

Questions to consider

  • Cupping therapy – placebo or effective? Does it matter?
  • Measures of patient pain have been qualitative in many clinical trials, is an effective way to evaluate the impact of treatment? Are there any other ways to measure pain that may be more effective?
  • Recently cupping has become more commonly seen in popular culture – featured in films such as The Karate Kid and The Gua Sha Treatment and publicly displaced on the bodies of Olympic athletes: what impact does the integration of this traditional treatment in popular culture have on public perception?


[1] Aboushanab, T.S., AlSanad, S. (2018). Cupping Therapy: An Overview from a Modern Medicine Perspective. Journal of Acupuncture and Meridian Studies, 11(3), 83-87.

[2] Qureshi, N. A., Ali, G. I., Abushanab, T. S., El-Olemy, A. T., Alqaed, M. S., El-Subai, I. S., & Al-Bedah, A. M. (2017). History of cupping ( Hijama ): A narrative review of literature. Journal of Integrative Medicine,15(3), 172-181. doi:10.1016/s2095-4964(17)60339-x

[3]How Cupping Therapy Benefits Athletes. (2018, August 31). Retrieved from https://www.communityacupuncture.org/2018/05/01/how-cupping-therapy-benefits-athletes

[4] Is cupping therapy effective among athletes?. (2018, January 13). Retrieved from https://medicalxpress.com/news/2018-02-cupping-therapy-effective-athletes.html

[5] What is Cupping Therapy? (Or Why Do Athletes Have Red Spots?). (2019, January 29). Retrieved from https://wellnessmama.com/129773/cupping-therapy/

[6] Lauche, R., Cramer, H.,Hohmann, C., Choi, K.E., Rampp, T., Saha, F.J, Musial, F., Langhorst, J., Dobos, G. (2011). The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study. Evidence-Based Complementary and Alternative Medicine, 2012. doi:10.1155/2012/429718

[7] Kim, J.I., Lee, M.S., Lee, D.H., Boddy, K, Ernst, E. (2011) Cupping for Treating Pain: A Systematic Review. Evidence-Based Complementary and Alternative Medicine, 2012.

[8] Kwon, Y.D., Cho, H.J. (2007). Systematic Review of Cupping Including Bloodclotting Therapy for Musculoskeletal Diseases in Korea. Korean Journal of Oriental Physiology and Pathology, 21(3), 789-793.

[9]Al-Bedah, A.M.N., Ibrahim, S.E., Qureshi, N.A., Aboushanab, T.A., Ali, G.I.M., El-Olemy, A.T., Khalil, A.A.H, Khalil, M.K.M., Alqaed, M.S. (2018). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complement Medicine, 1-8.

[10] Mehta, P., Dhapte, V. (2015) Cupping therapy: A prudent remedy for a plethora of medical ailments. Journal of Traditional and Complementary Medicine, 5(3), 127-134. 

[11] Liu, W., Piao, S.A., Meng, X.W., Wei, L.H. (2013). Effects of cupping on blood flow under skin of back in healthy human. World Journal of Acupuncture, 23(3), 50-52.

[12] Lin, M.L., Lin, C.W., Hsieh, Y.A., Wu, H.C.,Shih, Y.S., Su, C.T., Chiu, I.T., Wu, J.H. (2014). Evaluating the effectiveness of low level laser and cupping on low back pain by checking the plasma cortisol level. 2014 IEEE International Symposium on Bioelectronics and Bioinformatics.