Cupping: Ancient Wellness in Contemporary Practice

Massage Therapist demonstrates cupping technique on clientThe art of cupping is an ancient physical health practice that has historical traces on nearly every continent of the world (except Antarctica). Cupping uses a device to create a vacuum that lifts the skin, creating space between muscles, skin, fascia, etc. The cups are commonly made of glass or plastic, but can be made of bamboo, metal, horn, wood, or bone. Cupping has become a standard clinical tool in physical medicine and bodywork settings- used by Physical therapists, Acupuncturists, and Massage Therapists alike.  Much of what is now known about cupping devices is from Chinese Medical services, in the form of glass cupping or plastic cups with a mechanical pump. The suction of these cups are placed over areas of musculoskeletal dysfunction, soreness, pain, or inflammation. “Sliding cups” generally have less of a vacuum, but are applied with oils to glide over bigger muscle groups, gently stretching connective tissue and fascia, accelerating blood flow and lymphatic drainage.

What’s in a mark?

In recent years, images of cupping and the resulting marks have been shared across social media and in the news. With photos of elite athletes and celebrities (think Michael Phelps or Justin Bieber) showing up with circular marks on their back, many questions have popped up about the function of this modality, most commonly – why cupping, and why are there marks? Marks left in cupping can vary in intensity, and also relate to specifics about the injury being treated injury, how long cups are left on, or a person’s individual skin type. A properly trained practitioner can perform a very therapeutic cupping sessions leaving very light or no marks at all. Stronger cupping (with marks), although not essential, can be useful for promoting white blood cell activity and tissue repair in a specific area.

How cupping therapy works

People new to cupping are often perplexed about its function and benefits. A certain mystery surrounds the practice, so I have broken down the theory into 5 principles.

Illustrate of how cupping affects underlying layers
Cupping illustration. Click to enlarge

Cupping as “reverse massage”: if you think about it, most bodywork and massage is pressure pushing down into or across body tissues. Cupping offers a different type of relief below the skin by pulling up and away from the body. This creates space, and a decongesting effect where previously there was adhesion; allowing blood, oxygen, and fluids to circulate more freely. (see image)

Vacuum pressure to draw up:  The vacuum created by the cupping process can increase heat, blood flow and oxygen to an applied area, “drawing” nutrients into chronically dry or dysfunctional muscles. In medical terms, this process is commonly known as erythema (er·y·the·ma). Cupping can pin-point the therapeutic qualities of erythema into the necessary places, where normal massage might have difficulty in reaching in a focused way.

Focused stretching: Cups can provide spot specific stretching to muscles, ligament, and fascia in small areas, helping to increase range of motion, mobility and pain reduction. Small areas can be difficult to stretch with normal mobility techniques. Cups can be very useful to address these heard to reach areas, especially intricate connective tissue along the spine and neck.

Cupping marks and petechia: Marks sometimes left by cupping are often called “bruises” but this is actually not accurate. The marks are not bruises at all, but superficial breakage to capillaries at the outer layer of the skin called “petechia.” Arya Nelson has presented clinical research showing petechia to have localized effects on increased immune proliferation and modulation of inflammation. Leaving marks on certain chronically dysfunctional areas can have lasting effects days after a treatment.

Cupping has systemic effects: Cupping has long been used in Asia for colds/coughs, fatigue, and inflammation systemically. These ancient clinical uses seem to have a noticeable effect on lowering fevers, coughs, colds and general infections. This is standard “grandma medicine” in many East Asian homes. In recent years, cupping has been reviewed for its effects on all types of systemic inflammation with some interesting findings.

These 5 principles are an introduction into our understanding of cupping therapy for localized and systemic therapeutics. This practice spans the ancient and modern, offering consistent results in the relief from chronic and painful musculoskeletal discomfort. Cupping is easily integrated within standard bodywork sessions. Although many styles of cupping exist any well-trained practitioner should be able to tailor a session to each client’s specific needs.


Notes and References:

Arya Nelson “ Science of Gua Sha”

Braun, M., Schwickert, M., Nielsen, A., et al., 2011. Effectiveness of Traditional Chinese ‘Gua Sha’ Therapy in Patients with Chronic Neck Pain; A Randomized Controlled Trial. Pain Med 12 (3), 362–369.

Chan, S., Yuen, J., Gohel, M., et al., 2011. Guasha-induced hepatoprotection in chronic active hepatitis B: A case study. Clin Chim Acta 412 (17–18), 1686–1688.

Kwong KK, Kloetzer L, Wong KK et al. 2009. Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure. J Vis Exp. 30 (August 28):1385.

Lowe DT, “Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health” – particular note: “Macrophages phagocytize the erythrocytes in the extravascular space which stimulates the production of Heme Oxygenase-1 (HO-1) to metabolize the heme. Heme catalysis results in the production of carbon monoxide (CO), biliverdin(BV)/bilirubin(BR) and iron. HO-1, BV, BR, and CO has been shown to have antioxidant, anti-inflammatory, antiproliferative, and neuromodulatory effects in animal and human systems. These substances also stimulate a shift of macrophages to the anti-inflammatory M2 phenotype. There is evidence that the effects are both local and systemic.”



Written by Cristóbal Roberto LMT

Anschutz Health and Wellness Center