If you watched the Olympics last year, you may have noticed some athletes with round purple bruises, like Michael Phelps.

michael phelps cupping marksImage from: menshealth.com/health/what-is-cupping-therapy

These are the telltale signs of cupping therapy. Unfortunately, when the story was reported, I don’t think they did a particularly good job of explaining cupping and how it works.


What is cupping?

Cupping is one of the therapies of Chinese medicine, alongside acupuncture. (It was also used in ancient Egypt and Greece, among other civilisations). It involves creating a vacuum inside a container, in order to pull the skin and underlying tissues up away from the body. The vacuum can be created the traditional way using a flame (fire cupping), or using a pump with cups that have integrated valves.

fire cupping


What is cupping used for?

Cupping is primarily used to treat painful musculoskeletal problems, but is increasingly being used to help enhance performance for athletes. In traditional Chinese medicine it is also used for treating other internal conditions.


How does cupping work?

Cupping is a bit like ‘reverse massage’. While most physical therapy interventions like massage and foam rolling work by compressing the tissues, cupping pulls the tissues up, away from the body. This has two main effects:

1. Decompression and creation of space

By creating suction, the layers of the soft tissues are able to separate slightly. This allows blood and tissue fluids to get into and out of the area more easily, promoting healing.

The image below is from a lecture by Christopher Daprato and Kenneth Leung (UCSF Department of Physical Therapy) which you can watch here (the relevant section starts at 1:02:00). The image shows MRI scans of the trapezius taken before, during and after cupping. Notice how much more space there is in the tissues during and after the treatment.

MRI scan before, during and after cupping

2. Breaking up adhesions

The connective tissues (fascia) form in layers that surround every part of the body, providing surfaces that can move freely across each other. They also form fibres that link together structures that need to be held together. When parts of the body don’t move enough, more and more fibres can form between layers, creating stiffness and restricted movement. These kinds of adhesions can also happen as a result of trauma.

With cupping, we pull on parts of the connective tissue, which can begin to loosen up binding in the fascia layers. When combined with movement – either by sliding the cup or by moving the body – there is also a sideways shearing force between these layers. This can further break up adhesions and allow for freer movement. In turn, this can increase range of motion, especially in tissues that were previously tight or restricted. For a swimmer like Michael Phelps this will increase the length of their stroke and improve their performance.

3. Movement away from the body

Cupping creates a drawing sensation away from the centre of the body to the outside. In classical Chinese medicine, we are particularly interested in the directions of sensation we create in the body. The idea is that when you create a direction of force on the body, things start moving in that direction.

What things are actually moving will depend on the type of movement, location in the body and so on. The Chinese refer to this as ‘Qi’. Usually translated as ‘energy’, ‘Qi’ can refer to different things in different contexts.

In this case, it refers to both the sensation of movement that you may feel in your body, as well as whatever physiological components are moving inside the body. That might be blood, tissue fluids, lymph, nerve impulses or anything else. By creating a sensation that moves from the centre of the body to the outside, we can draw deep stagnation or toxins up to the surface where they can be more easily cleared.

4. Other effects

Because cupping causes minor, controlled injury to an area of the body, it is thought that this creates an inflammatory response, encouraging the body to repair that area. This theory is also used to explain some of the effects of acupuncture in pain relief and injury recovery.


Is cupping safe?

Cupping is generally very safe, but there are circumstances where it is contraindicated. For example, it is not suitable for those taking blood thinning medications, or over the abdomen or low back of a pregnant woman.

I would recommend seeking out a fully qualified traditional acupuncturist (for example, a member of the British Acupuncture Council in the UK). Some other manual therapists may have training in cupping techniques as well, but this is not common so you should ask about their training before going ahead with the treatment.