What Is Cupping?

By Alaina Curry, DPT

Do you remember the 2016 Rio Olympics? It’s where the legendary swimmer, Michael Phelps, made his final Olympic appearance.

He won five gold medals. But that’s not the only thing people were talking about.

Like everyone else, I was asking, “What are those purple circles on his back?”

They looked like giant polka dots. But even after learning they were the result of a type of traditional Chinese medicine to reduce pain and inflammation, I was still shocked.

“You mean those are BRUISES all over his body?! From suction cups?!”

Shortly after learning that Olympic athletes Michael Phelps and Alex Naddour use “cupping” for recovery and pain relief, I was sitting in physical therapy school learning about it by another name: myofascial decompression (MFD). I learned that it’s safe, noninvasive, and that it can be a great tool in treating pain and musculoskeletal disorders.

In this article, I’ll tell you what “cupping” is, the different types and how they work, and why it can be a valuable therapy for anyone who wants to come back stronger.

What Is Cupping?

In short, cupping is an ancient traditional therapeutic modality. It uses various types of small cups — typically glass, plastic, or silicone — and heat or pumps to create suction.

In the last decade, cupping has gone from virtually unknown in Western culture to being found in most physical therapy clinics. It’s among the most popular treatment modalities in sports and rehabilitative medicine today.

When it comes to treating musculoskeletal issues, cupping can help improve joint range of motion by increasing tissue length and extensibility. It has also successfully reduced pain in many individuals.

The most common method in physical therapy today uses a hand pump vacuum gun that suctions air through a valve on glass or plastic cups, pulling the skin and superficial tissue up.

But there are a few others worth mentioning:

• Silicone cupping: This method uses flexible silicone cups to create a vacuum seal with the skin and then releasing it to create negative pressure, thus suction.

  
  

• Fire cupping: The most traditional method of cupping in Eastern medicine is fire cupping. Yes, fire! Given how I was initially stunned by the general concept of cupping, you can imagine my reaction when I learned this ancient method uses fire.

  
  

  This method involves soaking a cotton swab in alcohol and lighting it on fire, briefly inserting it inside the glass cup and then immediately placing it on the body. Suction is created as the hot air inside the cup cools down.

  
  

  Fire cupping is still around today, believe it or not. It’s commonly used by acupuncturists. And it is believed that this practice balances the energy flow, or Qi, in the body, which is purported to improve circulation and help remove toxins from the body.

  
  

• Wet cupping: Another traditional method used — with or without fire — is wet cupping. It adds a somewhat gruesome twist to standard cupping in that the skin is punctured via a small incision when the suction from the cups kicks in. This draws a small amount of blood.

  
  

  I know, it sounds a bit extreme. But this purportedly helps remove toxins from the body and improve circulation and pain. Another jaw-dropping method in my opinion.

You may be thinking that cupping sounds pretty intense. And while the ancient traditional methods of cupping definitely can be, the suction cupping used today in the Western rehab world is very safe.

It’s considered “dry cupping,” so no blood is drawn. There’s no fire involved. And it’s much easier to control the intensity of suction with plastic or silicone suction cups, which makes it much more comfortable for the patient.

As you can imagine, cupping sometimes gets a bad rap based on the intense traditional methods and a lack of scientific literature supporting some of Eastern medicine’s claims.

However, much more research is coming out that supports benefits for pain relief, improvement in function, and increase in soft tissue length and extensibility. The only downside is that many of these studies are considered poor quality in scientific literature. There is a clear need for more rigorous, high-quality studies to support these claims.

My Experience With Cupping

In my personal experience, cupping has been a vital tool for treating musculoskeletal conditions. I’ve seen firsthand how it can help significantly reduce pain and increase ranges of motion in many of my patients.

I typically perform cupping in addition to myofascial release techniques (MFR), which are well-proven modalities for reducing pain, improving function, and increasing range of motion. MFR targets the same connective tissue as cupping (MFD), but utilizes pressure instead of decompression.

I’ve seen the best results with my patients when using both techniques.

The decompression effect of cupping creates space between the skin, fascia, and muscle. This increases blood flow to the area, which means increased tissue healing.

Yes, cupping causes “microtrauma” to the tissue, which explains the redness and bruising. However, this mild (if any) discomfort is on par with other manual therapy techniques commonly used in physical therapy. Most importantly, it is proven to benefit the tissue in the long run.

I find it even more effective to perform “dynamic cupping,” also known as “massage cupping” or “running cupping” by moving the cups around on the skin with massage oil, lotion, or cream.

I’ve seen this technique improve joint range of motion and flexibility immediately all by itself.

I also like to do another technique that involves actively moving the body under static cupping. In other words, the cups are stationary on the body while the patient actively moves into different positions, therefore more intensely stretching the tissue.

For instance, I may place the cups along the paraspinal back muscles and then have them move into spinal flexion, like Child’s pose, to put the paraspinals on stretch.

This can help target deeper muscle tissue and adhesions, even more so when using plastic cups over silicone. For less intensity, silicone cups can be used as they don’t create as much suction as the plastic cups. Silicone cups are great for people who don’t want any bruising or discomfort.

However, using the suction gun method with plastic cups is more effective on deeper muscles. It’s very easy to manage the degree of suction that is applied to the tissue and skilled therapists can apply the appropriate amount of suction to certain areas of the body to ensure optimal comfort.

My Favorite Cupping Approach

There’s nothing to fear when it comes to cupping. In fact, I have many patients who prefer cupping over other soft tissue work — deep pressure for trigger point release, instrument-assisted soft tissue work, etc.

For instance, deep pressure can more commonly lead to temporary pain and soreness, whereas cupping can sometimes feel more relieving to the body.

I love to combine these manual therapy techniques of pressure and decompression together. It’s the ultimate way to “massage” muscle and connective tissue from all angles.

This approach can work very well for treating tendinitis. For example, I have used cupping to treat clients with tennis elbow and found it to significantly help their symptoms. When it comes to tennis or golfer’s elbow, you will find that tight forearm musculature increases tension on the inflamed tendon(s), causing more pain and inflammation — and sometimes limiting wrist or elbow active range of motion.

Using these cupping techniques directly on the forearm musculature can provide significant relief to those joints and tendons as the soft tissue is lengthened and the joint range of motion improves. This allows for an optimal environment to start rehabbing and strengthening the joints in physical therapy.

You can imagine massaging the muscle like kneading bread dough.

Of course, we can’t fold it over. But imagine if you kept pressing down on the dough. It would eventually flatten out and you would have less and less influence on it with time. If you could pull back up on that dough, it would become softer. Then you’d be able to manipulate it even more.

Well, the more we can do this to muscle tissue, the more space is created for blood flow, and the softer the tissue becomes. Follow this up with some mobility and stretching, and your joints will gain incremental degrees of freedom.

Putting It All Together

Cupping is a great tool for physical therapists like me. Not only because it gives our hands a bit of a break when performing manual therapy, but because of the unique influence it has on myofascial tissue.

It’s the only method that can decompress and relieve pressure from tissue tightness.

A few cups around your shoulder blade can have you go from not being able to lift your arm overhead without pain, to better ranges of pain-free motion almost immediately. It can offer immediate improvement in mobility and function, even if it’s just having an easier time reaching the top cabinet in your kitchen.

Cupping is an incredible tool for physical therapists. And although I’d love to see more research to support its use in evidence-based practices, I have seen firsthand some amazing — and virtually immediate — improvements in patient mobility and subjective pain.

So, if you’re looking for a new level of musculoskeletal pain relief or want to regain some range of motion or mobility, give cupping a try!