The Real Science & Application of Cupping Therapy

By Dr. Mario Novo

cupping therapy

Stronger, Leaner, Healtier, FOREVER

Introducing Functional Strength Training: 
The Monthly Membership Training Solution For People Who Want To Look, Feel And Function Their Very Best, Forever.

Join FST NOw

Stronger, Leaner, Healtier, FOREVER

Introducing Functional Strength Training: 
The Monthly Membership Training Solution For People Who Want To Look, Feel And Function Their Very Best, Forever.

Join FST NOw

After the polarizing red circles on Michael Phelps shoulders surfaced last week at the 2016 Rio Olympic Games, many questions arose pertaining to the science, application and efficacy of the myofascial decompression technique also known as cupping.

As claims and debate started to rip through the world of sports performance and physical therapy, and now even into mainstream worldwide media over the past two weeks on this therapeutic topic, many questions were left unanswered. But now, it’s time to take an unbiased, scientific look at the research and application of the technique known as cupping.

Here is the science behind why Gold Medalist Olympic athletes are choosing to be treated with cupping, and a complete review of the current scientific literature behind this technique from Dr. Mario Novo.

The Emergence of Cupping In Elite Sports Performance

cupping michael phelps

At the top of the sport performance food chain, are the Olympians. These almost god like beings have chiseled away at their human form, with countless hours of practice to become the very best at their sport. In the pursuit of greatness, one is required to take risks with pushing their bodies to the limit. When it is down to the hundredth of a second between winning the gold, or silver for your country, you learn to become comfortable with stress. Although these Olympians break themselves in the training room day in and day out to adapt to stress, the secret is truly in their ability to recovery.

Let’s take a dive into cupping as a form of recovery and how best we can apply the body of known studies to create a frame work worth looking into.

Cupping therapy is defined as a complementary and alternative medicine (CAM) within the world of holistic medicine, and traditional Chinese medicine (TCM). Cupping like many other CAM based treatments are provided as a conservative and alternative method towards improving human health through the reduction of pain when present, and tissue healing.

With nearly 80% of all general doctor’s visits involving pain, as well the rise in American based chronic or recurrent pain costing an estimated $200 billion annually and the rise of prescription based addiction and accidental death; implementing pain science, and holistic approaches towards pain management is as we should view it, a fundamental right towards health and independence of drugs. Here is where cupping plays a role alongside other CAM’s, and advanced medical provider forms of therapy can make the largest difference in how individuals consume healthcare, towards improving quality of life.

The Various Methods of Cupping

cupping fire

Depending on where you look, there can be nearly 7 to 10 different methods for applying cupping. All methods involve the application of a cup or dome to promote localized negative pressure to an area of the body for alleviating pain, and improving tissue recovery.

Dry cupping is by far the most commonly applied methods, which uses either a heat element or pneumatic device, to create the suction required to raise the soft tissue into the cup or dome. Either method produces a gentle and painless, bruise on the skin, which has now become the hallmark of our 2016 Summer Olympic games.

Cupping is applied to various regions of the body, which are individually unique to the athlete/clients/patient needs. The most common areas of application are the back, chest, abdomen, and buttock. The cups are typically left in place 5–10 minutes with the after effects of erythema, edema, and ecchymosis subsiding within a few weeks.

An interesting way of viewing cupping when compared to massage is that massage or external applied force into soft tissue, is noted by a positive pressure change in the surrounding soft tissue structures. The novel stimulus of negative pressure is also used like massage to alter sensory and or pain perception but it also influences the microcirculation of specific body area, which has been demonstrated to change local tissue circulation.

The Mechanism of Effect of Cupping


Specific mechanisms of acute metabolic tissue change and pressure pain thresholds have been studied with dry cupping. Such studies have demonstrated that while participants received dry cupping, observed increases in blood flow (hyperemia) occurred. This increased blood flow or vasodilatation does appear to also influence tissue temperature but more importantly, appears to increase capillary endothelial cell repair, accelerated tissue granulation, and angiogenesis (formation of new blood vessels) within the regional treated tissue.

Emerich et al found that following cupping participants demonstrated a rise in the lactate/pyruvate ratios which indicated an increase in the anaerobic metabolism of the surrounding tissue.

What this can mean to a patient or athlete, is the potential for a rise of key ischemic (low oxygen) chemical mediators that are involved with promoting cellular/metabolic adaptation, and tissue recovery.

When cupping was compared to wait-list groups, heat modalities, and certain conventional pain medications, cupping showed better effectiveness for pain reduction. It’s no guess that when compared to exercise cupping demonstrated no change, but for many individuals that are unable to train secondary to pain, or over-reaching; cupping appears to be another powerful tool such as dry needling, IASTM, taping, and neuromuscular/musculoskeletal manual therapy based modalities, which all uniquely play a role in the modulation of pain perception, improved muscle recruitment and tissue recovery.

Because, we should all be able to agree that pain plays an inverse role with the ability for an individual to recruit muscle and process useful sensory feedback (proprioception, kinesthetic awareness) via inhibitory feedback systems; the promotion of improved musculoskeletal function should be promoted through the restoration of sensory input via various methods of pain modulation.

Cupping within the context of sport performance can be viewed as a practical method to pre/post activity sensory modulation, which also plays a role with soft tissue health. For Olympic athletes, who have gone the distance, one can imagine they will set no limits to their performance while at the games. Hence, administering cupping can be viewed as a quick treatment session (5-10 min) where they can restore sensory awareness, and already begin increasing the local chemical signaling pathways that influence tissue recovery. For our non-Olympians in the room, I included; pain should be a respected symptom, which often plays a role in teaching us about harm. Hence, we should not be applying cupping at such high frequencies as these athletes, due to the potential for adverse effects as well the potential for increased tissue injury secondary to altering our pain perception.

Because pain plays a role with learning, we can also learn to be in pain. This is apparent with individuals who express chronic pain that lack acute tissue damage. Hence, there is more to pain than chemical irritants and trauma. In regards to chronic pain, cupping may play a role for some individuals seeking a novel approach towards improved function as a complimentary program leading towards the progressions of an exercise prescription.

Relative Safety and Precautions

cupping bleeding

While cupping therapy offer benefits, it goes without mentioning that adverse effects do exist. As with any modality, there are inherent risks that a skilled therapist should be aware of. With cupping, there appears to be an associated risk with the types of application, and frequency that can lead to injury.

Cupping is not advised to be used over excoriated, oozing, or infected areas, as this may promote enhanced D-dimmer (a fibrin protein found in tissue inflammation). As mentioned earlier, cupping will result in the reddening of skin with a the presence of a bruise (ecchymosis) which is regarded as a normal reaction after cupping that should resolve in a manner of 2-5 days. There are adverse effects of swelling, and or burns in some cases, with rare occurrences of an increased pain at the site of supping, and very rare occurrences of reported muscle soreness or tingling in the original site of treatment.

About The Author

Screen Shot 2015-09-09 at 8.15.30 AM

Dr. Mario Novo is a results driven sports orthopedic physical therapist who specializes in strength and conditioning. Known well by his clients/patients as a mentor and educator, Mario’s passion is to unify the highest levels of rehab science with successful mind and body strength coaching. With Mario’s research having focused on new advancements in muscle hypertrophy periodization and joint health, his goals are to share his knowledge and improve on the human condition through personalized cutting edge program design. Mario currently resides in middle Tennessee where he plans on integrating his skills and knowledge in resistance exercise and rehab to empower and inspire those individuals ready to make a change in their lives through health and fitness. He is also the owner of, an integrated platform of strength training and physical therapy.


  1. Christopoulou-Aletra, N. Papavramidou Cupping: an alternative surgical procedure used by hippocratic physicians J Altern Complement Med, 14 (2008), pp. 899–902
  2. Huber, M. Emerich, M. Braeunig Cupping – is it reproducible? Experiments about factors determining the vacuum Complement Ther Med, 19 (2011), pp. 78–83
  3. Farhadi, D. Schwebel, M. Saeb, M. Choubsaz, R. Mohammadi, A. Ahmadi The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial Complement Ther Med, 17 (2009), pp. 9–15
  4. Michalsen, S. Bock, R. Ludtke, et al. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial J Pain, 10 (2009), pp. 601–608
  5. Moetaz El-Domyati, F. Saleh, M. Barakat, N. Mohamed Evaluation of cupping therapy in some dermatoses Egyptian Dermatol Online J, 9 (2013), pp. 1–15
  6. Anjum, S. Jamil, A. Hannan, J. Akhtar, B. Ahmad Clinical efficacy of Hijamat (Cupping) in Waja-ul-Mafasil (Arthritis) Indian J Tradit Knowl, 4 (2005), pp. 412–415
  7. Chirali Cupping Therapy: Traditional Chinese Medicine (1st ed.)Elsevier Health Sciences, London (1999)
  8. Teut, S. Kaiser, M. Ortiz, et al. Pulsatile dry cupping in patients with osteoarthritis of the knee–a randomized controlled exploratory trial BMC Complement Altern Med, 12 (2012), pp. 1–9
  9. Ullah, A. Younis, M. Wali An investigation into the effect of cupping therapy as a treatment for anterior knee pain and its potential role in health promotion Internet J Altern Med, 4 (2007), p. 1
  10. Lauche, S. Materdey, H. Cramer, et al. Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain- A randomized controlled trial PLOS ONE, 8 (2013), pp. 1–9
  11. Cui, J. Cui Progress of researches on the mechanism of cupping therapy Zhen Ci Yan Jiu, 37 (2012), pp. 506–510
  12. Iqbal, A. Ansari Al-Hijamah (Cupping): the natural holistic healing art–a review Int J Adv Ayurveda, Yoga, Unani, Siddha, Homeopathy, 2 (2013), pp. 23–30
  13. Emerich, M. Braeunig, H. Clement, R. Ludtke, R. Huber Mode of action of cupping-local metabolism and pain thresholds in neck pain patients and healthy subjects Complement Ther Med, 22 (2014), pp. 148–158
  14. Hanan, S. Eman Cupping Therapy (Al-Hijama): it’s impact on persistent non-specific lower back pain and client disability Life Sci J, 10 (2013), pp. 631–642
  15. McCabe Complementary therapies in nursing and midwifery, from vision to practice (1st ed.)Ausmed Publications, Australia (2001)
  16. S.S. Yoo, F. Tausk Cupping: east meets west Int J Dermatol, 42 (2004), pp. 664–665
  17. Shekarforoush, M. Foadoddini, A. Noroozzadeh, H. Akbarinia, A. Khoshbaten Cardiac effects of cupping: myocardial infarction, arrhythmias, heart rate and mean arterial blood pressure in the rat heart Chin J Physiol, 55 (2012), pp. 253–258
  18. Schumann, R. Lauche, C. Hohmann, T. Zirbes, G. Dobos, F. Saha Development of lipoma following a single cupping massage-a case report Forsch Komplementmed, 19 (2012), pp. 202–205
  19. Ma, J. Cui, M. Huang, K. Meng, Y. Zhao Effects of Duhuojisheng Tang and combined therapies on prolapse of lumbar intervertebral disc: a systematic review of randomized control trails J Tradit Chin Med, 33 (2013), pp. 145–155
  20. Samadi, M. Kave, S. Mirghanizadeh Study of cupping and its role on the immune system J Relig Health, 1 (2013), pp. 59–65
  21. Jiang, L. Liang Samples for therapeutic errors in cupping therapy Zhongguo Zhen Jiu, 25 (2005), pp. 671–672
  22. Hon, D. Luk, K. Leong, A. Leung Cupping therapy may be harmful for eczema: a Pub Med Search Case Rep Pediatr, 2013 (2013), pp. 1–3
  23. Wei-hua, W. Jia-hong, Y. Bing-xiang Clinical practice Cupping therapy-induced elevated D-dimer Chinese Med J-Peking, 125 (2012), pp. 3593–3594
  24. Lee, S. Ahn, S. Lee Factitial panniculitis induced by cupping and acupuncture Cutis, 55 (1995), pp. 217–218

Related Posts


  1. Christian Wagenpfeil August 16, 2016 at 10:32 am - Reply

    great article!

    • John Rusin August 16, 2016 at 4:39 pm - Reply

      Thank you so much!! Appreciate it. Dr. Novo did a great job!

  2. Philip Fabrizio August 16, 2016 at 11:10 am - Reply

    Thank you for this well written, well researched, unbiased, piece on cupping! I found cupping to be very effective for pain relief. I’d rather reach for cupping than advil.

    • John Rusin August 16, 2016 at 4:40 pm - Reply

      You are welcome! Thanks to Dr. Mario Novo for writing this article!

  3. Paul September 26, 2016 at 9:21 am - Reply

    You reference studies comparing the effectiveness of cupping to wait-list controls, heat packs, and conventional pain medications. In fairness these controls do not mimic the psychological effect of of treatments such as soft tissue manipulation, dry needling, and other manual therapies. It would seem that we cannot rule out that at least a portion of the observed effect was placebo. While cupping clearly has potential to help, is there any evidence of how its effectiveness for various neuromuscuoskeletal conditions compares to other common treatments in the orthopedic PT world?

  4. lure cups March 29, 2019 at 6:02 pm - Reply

    What’s up colleagues, how is all, and what you wish for to say concerning
    this post, in my view its genuinely amazing designed for me.

Leave A Comment