Cupping therapy—whether dry, wet (blood), fire, or modern vacuum methods—has regained popularity in manual therapy settings.
It’s important to ground enthusiasm in the evidence base and sensible theories.
Intro
Cupping is often presented as a semi-traditional therapy with purported benefits in pain relief, tissue perfusion, and ‘detoxification’. Many patients ask about it, and my RockPods cupping course has been hugely popular since 2018.
But what does the evidence support?
Mechanisms
The main proposed mechanisms include:
- Changes to blood flow and microcirculation through negative pressure (Lowe, 2017).
- Fascial or connective tissue remodeling, via suction-induced stretch (Teut et al., 2012).
- Neurophysiological modulation (gate control and descending inhibition) (Lowe, 2017).
- “Detoxification” claims, largely unsubstantiated by biomedical evidence (Chi et al., 2016).
These remain theories rather than established mechanisms. For example Lowe’s (2017) publication was a narrative review and not a direct experiment. On my cupping course we take some time to look at the influence of negative pressure on the vascular system. I have written about it here.
What the Evidence Shows
Clinical Outcomes
Meta-analyses suggest cupping may yield modest pain reduction across musculoskeletal conditions:
- A 2021 systematic review found significant short-term pain relief vs. no intervention but low certainty of evidence (Cramer et al., 2021).
- For chronic neck pain, cupping improved pain and disability scores compared with usual care (Kim et al., 2018).
- In low back pain, benefits were small and transient (Cao et al., 2012).
However, most studies have poor methods including lack of credible sham controls. If your wondering how you might offer sham (fake) cupping, then take a look at this study.
Integrating Cupping Into Evidence-Informed Practice
Ø Combine with exercise and education (Teut et al., 2012).
Ø Record pain, function, and satisfaction.
Ø Select appropriate patients. Especially those open to adjunctive options.
Ø Stay updated. Evidence is evolving.
Conclusion
In many clinical contexts, cupping can be effectively integrated into modern manual therapy practice to complement exercise and rehabilitation goals. However, it’s important that cupping is not used in isolation solely for pain relief, and that practitioners apply it safely and effectively—for example, by carefully monitoring suction intensity and limiting the duration of vacuum application to avoid adverse effects.
While much of the literature and expert commentary recommends against using cupping as a stand-alone treatment, this guidance primarily refers to clinical management of specific pathologies, where multimodal care is most appropriate. It does not mean that a dedicated cupping session—used for general therapeutic purposes—lacks value. In fact, a focused cupping session can offer meaningful therapeutic benefits, much like how massage therapy is often delivered as an independent treatment across both clinical and wellness settings.
Find my next UK course here.
References
Cao, H., Li, X. and Liu, J. (2012) ‘An updated review of the efficacy of cupping therapy’, PLoS ONE, 7(2), e31793.
Chi, L. M., Lin, L. M., Chen, C. L. and Wang, S. F. (2016) ‘The effectiveness of cupping therapy on pain and function in chronic neck and shoulder pain: A randomized controlled trial’, Evidence-Based Complementary and Alternative Medicine, 2016, 7358918.
Cramer, H., Lauche, R., Hohmann, C. and Dobos, G. (2021) ‘Cupping therapy for chronic pain: A systematic review and meta-analysis’, Complementary Therapies in Medicine, 56, 102606.
Emerich, M., Braeunig, M., Clement, H. W. and Lüdtke, R. (2014) ‘Mode of action of cupping—local metabolism and pain thresholds in neck pain patients and healthy subjects’, Complementary Therapies in Medicine, 22(1), pp. 148–158.
Kim, T. H., Kang, J. W., Kim, K. H. and Kim, J. I. (2011) ‘Cupping for treating pain: A systematic review’, Evidence-Based Complementary and Alternative Medicine, 2011, 467014.
Kim, J. I., Lee, M. S., Lee, D. H. and Boddy, K. (2018) ‘Cupping for treating neck pain: A systematic review’, Complementary Therapies in Medicine, 41, pp. 9–15.
Lowe, D. T. (2017) ‘Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health’, Complementary Therapies in Clinical Practice, 29, pp. 162–168.
Teut, M., Ullmann, A., Ortiz, M., Rotter, G., Binting, S., and Brinkhaus, B. (2012) ‘Safety and outcomes of cupping: Results of a prospective observational study’, BMC Complementary and
Alternative Medicine, 12, 133.
Tham, L. M., Lee, H. P. and Lu, C. (2006) ‘Cupping: From a biomechanical perspective’, Journal of Biomechanics, 39(12), pp. 2183–2193.