Cupping

Cupping uses cups placed on the skin to create suction. The cups may be made of glass, plastic, silicone, ceramic or bamboo. The suction is made either by briefly heating the air inside the cup with a flame before it goes on the skin, or with a pump or squeeze bulb once it is in place.

Cupping comes from traditional healing practices in China, the Middle East and other parts of the world. Today it is offered by acupuncturists, some massage therapists and physical therapists, and others.

Dry and wet cupping

• Dry cupping uses suction only. The cups may stay in one place or be slid over oiled skin.
• Wet cupping adds small cuts or pricks in the skin, so a little blood is drawn into the cup. It carries more risk, including infection.

No one knows for sure how cupping might ease pain. The suction lifts and stretches the skin and the tissue under it. This widens small blood vessels and brings more blood to the area.

Researchers think the strong pulling feeling may also change how nerves send pain signals for a while, a bit like rubbing a sore spot.

Traditional systems explain cupping in other ways, such as improving the flow of blood or energy, or drawing out toxins. These ideas have not been confirmed by research.

During a session

You usually lie face down with your back uncovered. The practitioner places several cups on the skin, often over the muscles of the back, neck or shoulders. You feel a strong pulling or tightness under each cup. It should not be sharply painful, so tell the practitioner if it is.

With fire cupping, a flame heats the inside of the cup, but the flame is removed before the cup touches your skin. Cups are usually left on for several minutes. A session often takes about 20 minutes.

After a session

Round red or purple marks where the cups were are expected. They come from tiny blood vessels breaking under the skin, like a bruise. The marks usually fade within a week or two.

Wet cupping leaves small cuts that need to be kept clean and covered while they heal.

Finding a practitioner

Cupping is usually offered by practitioners licensed in another field, such as acupuncture, massage therapy or physical therapy. Rules about who may offer it vary by state. Ask how the cups are cleaned between clients. Reusable cups need thorough disinfection, and equipment for wet cupping must be sterile. The National Institutes of Health has tips on choosing a practitioner (opens in a new tab).

Cupping has been studied less than most other hands-on treatments for back pain. Most studies are small, and many have design problems. The American College of Physicians guideline for low back pain does not include cupping among its recommended treatments. [1] [9]

A review of 18 trials in people with long-lasting pain found cupping eased pain in the short term compared with no treatment. Compared with sham cupping or with other treatments, cupping did not clearly do better. [1]

For neck pain, a review of 18 trials found less pain after cupping, but the quality of the evidence was low. For low back pain, one review found pain relief at the end of a course of treatment, but mainly with wet cupping. Dry cupping did not clearly help. The benefit did not clearly last beyond the course. [2] [11]

Cupping is hard to test fairly. People can feel the suction and see the marks, so they usually know whether they got the real treatment.

Common and expected

• Round marks and bruising where the cups were. These are expected.
• Mild soreness, itching or skin irritation where the cups were.

Less common

• Feeling lightheaded or faint, which has been reported with wet cupping.
• Blisters, or burns from fire cupping.
• Skin discoloration or scars that last longer than expected.
• Infection, mainly with wet cupping or when equipment is not properly cleaned. Poorly cleaned equipment can also spread infections carried in blood.

Rare but serious

• Repeated wet cupping has rarely caused anemia (a low blood count) from blood loss.

Take extra care

Tell your clinician and the practitioner if you take a blood thinner, have a bleeding problem, or have thin or fragile skin. Cupping may worsen skin conditions such as eczema or psoriasis. It should not be done on broken or infected skin.

If you are pregnant, talk with your clinician before trying cupping.

Other downsides

• Cupping is usually not covered by insurance, and any relief tends to be short term.
• The marks can be very visible for a week or more.

Call your clinician for signs of infection, such as spreading redness, warmth, pus or a fever, or for a burn or blister that is large or slow to heal.