Everything you must know about Suction Cupping Therapy
Cupping has been around in much of the Eastern world for thousands of years.
Its rise to prominence over the last 5 years has been largely in part thanks to Michael Phelps and other Olympians during the 2016 Olympic Games in London.
Cupping has been used widely for just about every ailment you can imagine and comes in as many as seven different flavors.
Due to the nature of cupping and the many different variants, as well as the widely inconsistent methods of use, it is very difficult to accurately measure and test its true effectiveness.
We still don’t fully understand how cupping (works) may help or how it should be best used in some instances.
While it’s been studied for decades, very little research has shown it’s more useful at helping athletes recover than other modalities such as massage.
Most research regarding effectiveness on athletes has been fairly pedestrian. In some instances, even a bit dangerous.
Until a standard of practice is reached, and licensed practitioners can be certified, the use of cupping should be used cautiously.
For now, unless you just want to spend the money or don big bruises, or have no other options, we recommend against cupping and using other forms of recovery tools at your disposal.
What’s Inside
Side Effects of Cupping Therapy
Karate Study and Inflammatory Markers
Ultrasound Elastography Results
Vacuum Myofascial Therapy vs Cupping Therapy
I think we can thank Michael Phelps for bringing cupping therapy (CT or “cupping”) to the forefront of the western world -- for better or worse, we’ll find out.
Phelps claims he began cupping in 2014. But it wasn’t until the 2016 Olympic Games in London where fans may have first taken notice of some odd, perfectly circular discolorations on the back and shoulders of the future’s most prolific Olympian of all time.
Many may have taken more notice given he was on the TV nearly every other race, setting a new world record and racking up gold medals for the US. It wasn’t just him either. By this Olympic cycle, many swimmers and gymnasts were now suddenly donning new spherical tribal tattoos.
Michael Phelps first donning the distinctive cupping bruises along his shoulders
But they weren’t tattoos at all. Had they been, it would likely have been cult-like behavior worthy of more attention. Instead, the Americas were formerly being introduced to “cupping”. It is by no means a new concept. CT has been a practice of cultures around the world for millennia. In fact, its uses are pretty heavily rooted in ancient Egypt, China, and Greece, though it has been practiced for some time in countries like Japan, India, and Pakistan (more traditionally called Hijama) [1,4].
Now, on top of athletes all over the globe sporting crop circle bruises all over their bodies, you have celebrities like Dwayne Johnson, Gwenyth Paltrow (who actually sported the spots all the way back in 2004), Jennifer Aniston, Justin Bieber, and Kim Kardashian proudly showing off their new obsession on Instagram. But what the f*&! is it, and should you hop on the bandwagon?
What is Cupping Therapy?
The process and theory behind cupping are fairly simple. A practitioner uses rigid cups -- usually made of plastics and other polymers, bamboo, or glass -- and suction to create a vacuum and draw fluid into the area [4].
If you ever caught a glimpse of the “Karate Kid” remake with Jackie Chan, you might remember a scene in which Jackie uses a flame and glass bulbs to create suction on Jaden Smith’s arm. This is the traditional method of Chinese cupping.
There are two distinct subcategories of cupping -- dry and wet. Dry refers to using only suction and does not draw blood. Wet, is simply blood-letting with suction. That is, creating small incisions or punctures on the surface of the skin before applying the cup to allow for blood to be drawn out during suction [2].
The Chinese actually have seven different types of cupping that fall into these two categories: retained cupping, bleeding cupping, moving cupping, empty cupping, needle cupping, medicinal (herbal) cupping, and water cupping. Each type of cupping therapy has a specific use case and will be used to treat each ailment a little differently [6].
It has been used to help treat everything from lung disease, ear and back problems, extracting poison, cholera, epilepsy, lack of appetite, headaches, or even gynecological ailments. Much like Scrofula Syrup was used many years ago to treat -- well -- everything. Many things were a catch-all for cancer to headaches and ulcers or insomnia.
Classic example of “snake oil” cure-all. Scrofula Syrup was used to treat just about everything under the sun in its hayday.
As humans, we tend to latch on to anything that’s “ancient” or “natural” and can often fall prey to unruly characters who pitch us products whose claims are superior to any known science. We’ve all heard the stories of those who chose to try and cure their cancer using CBD, green teas, and essential oils rather than modern methods of treatment. Before you get too up-in-arms, there are some of these that can help but a majority of them overshadow the few that actually work. Many resort to these modern-day “snake oils” because it is cheaper in most cases, or they get duped into believing the more natural the solution, the more likely they are to cure their ailments.
Is cupping just another snake oil or are there modern uses with some validity? Today our aim is to get a better understanding of this traditional medicinal practice and find the line between hokum and fact. We want to approach this from an athletics standpoint only, so we’ll try our best to reduce cupping’s effect on most treatments outside the realm of sports. For example, I don’t care if cupping works to clear your acne or migraine, as it does not pertain to our purposes in this forum.
What The Science Tells Us
We don’t know exactly what mechanism cupping can deliver therapeutic relief, but some proposed benefits may help explain it.
Some believe that by placing cups directly over specific acupressure points, where energy is said to be amplified and more readily manipulated, you can increase blood pooling in the tissue (hyperemia) or stop blood flow (hemostasis) which can result in a therapeutic effect [2]. Think of this as putting a suction cup over a precise acupuncture point.
Cupping can physically grab and lift the fascia below the skin which may have a positive effect on lymphatic drainage, nutrient exchange through increased skin blood flow, and raise temperatures of the fascia through friction with the cup that can make the fascia less viscous (more fluid) [9].
Others believe that wet cupping, in particular, may mimic functions of the kidney and act as an external artificial one [1]. A kidney specializes in removing waste, toxins, and excess fluid. Cupping might do much of the same but on a more localized level. To get a little more “science-y”, the pressure from the suction of the cups causes an increase in blood at the site which causes the rate of filtration of the blood through the capillaries to increase. When this occurs, all of the filtered blood that has pooled will be sucked up into the cup, and “Bob’s your uncle.”
The authors mentioned that scratches or cuts on the skin during wet cupping increase immunity by “stimulating inflammatory cell migration and endogenous opioid release. This action leads to improved blood flow, removal of toxins, restored neuroendocrine balance, improved oxygen supply, and tissue perfusion.”
In relation to athletics, cupping proponents allege that it is a great tool for sore muscles, neck, and back pain (not sure if that’s supposed to be a general or specific treatment of a cause of neck and back pain), and arthritis of the knees [4].
Is Cupping Useful?
Cao et al, (2010)[5] performed a deep analysis of a combined 550 studies published on cupping from 1954 through 2008. We focused on the results more suited to our purposes. These were in regard to pain, lateral femoral cutaneous neuritis, cervical spondylosis, lumbar sprains, scapulohumeral periarthritis, facial paralysis, soft tissue injuries, arthritis, sciatica, and myofasciitis.
Percentage of cupping therapy types used throughout analysis of 550 studies published between 1954 and 2008.
They finalized:
“This review suggests that there is insufficient high-quality evidence to support the use of cupping therapy on relevant diseases. Although quite a number of clinical studies reported that cupping therapy may have effect on pain conditions, herpes zoster, symptoms of cough and asthma, acne, common cold, or other common diseases. The current evidence is not sufficient to allow recommendation for clinical use of cupping therapy for the treatment of above diseases of any etiology in people of any age group.”
Cao et al., (2012)[6] followed up their original study with an updated one. In their research, they concluded that the majority of the studies showed that cupping was at least of some promise in treating some pain conditions, shingles, cough, and shortness of breath. They also reviewed many randomized controlled trials (RCTs), though they admitted were still of poor standard based on the Cochrane risk of bias tool, that showed the effectiveness of CT on its own and in conjunction with western medicine.
What they found was that cupping therapy combined with other treatments like medicine or acupuncture demonstrated a notable benefit over either of the treatments on their own in achieving a remedy for things like shingles, Bell palsy, and cervical spondylosis. In short, neither was particularly useful as a standalone, but when augmented by another treatment did seem to help more.
Again, The Athlete’s Forge isn’t interested in treating shingles, or coughs, but Bell palsy, and cervical spondylosis are at least more in our physiological wheelhouse.
He et al., (2020)[7] set out to determine the effect of three different cup sizes (35, 40, and 45 mm in diameter) on skin blood flow (SBF). They used Laser Doppler flowmetry (LDF) to measure SBF on the triceps muscle of 12 participants. None of the participants knew of the differing cup sizes and the pressure was held at a constant -300 mmHg for 5 minutes each.
As one may logically expect, the larger the cup, the more localized blood flow after the suction is removed. This isn’t to say more blood was pooled there, that one is pretty obvious, but that the amount of blood that actually diffuses out of the capillaries and into the tissue and then returns is much higher. This is a good thing generally, as it means an increase in oxygen supply, and higher rates of diffusion of nutrients like glucose and amino acids into the dermis to help nourish it. As a matter of fact, higher rates of circulation are often sought after in beauty treatments for this very reason.
This is certainly good to know and maybe of some use for more skin-related issues, but I’m not so sure it is much more useful to the purposes of athletics -- a sentiment held by many other researchers it would seem. The denser blood flow could be quite beneficial in tissue recovery from a logical standpoint, but the evidence is sparse that it is. Or at the very least, it’s not significant enough to be demonstrable.
That study’s results were mirrored by Wang et al., (2020)[8]. They stated their belief that CT’s likely benefits, where seen, are due to the increase in local blood and lymphatic flow once the pressure is removed. Specifically with soft tissue healing and myofascial pain relief. Unlike the study above, Wang’s team spent more time-varying the pressures and came to the conclusion that SBF was significantly increased after cupping therapy at pressures between −225 mmHg and −300 mmHg for 5 min. They were quick to note that several studies they had seen suggested not going beyond pressures of -375 mmHg for risk of harming the soft tissue within the cup, and anything below -225 mmHg might be too small to show SBF benefit. More on this in our section below on the inherent risks of cupping therapy.
In this study, the team found that the higher negative pressures were more effective at increasing SBF than the lower values and that the shorter duration of 5 minutes (as opposed to 10 minutes) caused a larger peak SBF.
Skin blood flow responses before and after cupping therapy in four protocols: (A) −225 mmHg × 5 min, (B) −225 mmHg × 10 min, (C) −300 mmHg × 5 min, and (D) −300 mmHg × 10 min.
As one might assume, ruptured capillaries occur most often when an increase in blood flow takes place within a short period of time, usually a few seconds. If it helps to liken this to something more common, imagine a hickey. The bruising we see after a CT session is a consequence of this observation. What we see with longer durations though, is vasodilation in the soft tissue gradually dissipates. Therefore, five minutes of CT may be more effective in increasing SBF than ten minutes.
Now we’re starting to perhaps get a more precise prescription method to adhere to which may help in giving more predictable results.
More to our purposes still, Warren et al., (2020)[9] investigated CT versus self-myofascial release (SMR) such as foam rolling or self-massage. The study was centered around hamstring injuries in 17 mixed-gendered collegiate athletes participating in football, track, basketball, softball, and baseball. Each had symptoms ranging from tightness and pain to decreased strength and flexibility of the hamstrings.
The athletes were randomly assigned to either the CT or SMR group. The CT group received three minutes of static cupping treatment using six cups on the hamstrings and was asked to perform 10 repetitions of active knee flexion and another 10 repetitions of passive straight leg raises with the cups still on. The SMR group received 10 minutes of heat treatment on the hamstrings before 60 seconds of general foam rolling over the hamstring and then 90 seconds of foam rolling directly on the hamstring where it felt the tightest.
The paper concluded that both groups saw positive changes in hamstring length after treatment, though there was a heavier favorability toward the CT treatment. This could be due to the fact that the athletes were asked to use active mobility in conjunction with the cupping. This also was more of a test of flexibility, than anything else, but we continue to piece together some potentially useful information. Neither result is too surprising given the way in which fascia and other soft tissue manipulation work.
An interesting point you see when reading this study, or anything in regards to the fascia for that matter, is how collagen fibers are more resistant to reorientation when stretched along a longitudinal path. Over time, that constant longitudinal stretch will realign collagen fibers in the correct orientation but multiplanar manipulation is actually more effective. What they point out is having round cups along the hamstring and spaced out multi-linearly, likely plays an important role in CT effectiveness in at least this use case.
Note, they too had no method of sham prevention (no control group) and were at risk of high placebo effect involvement.
Further studies have shown that dry cupping can be effective at reducing chronic neck pain and non-specific low back pain in patients [10] but the quality of evidence was fairly low even with the combined 1000+ patients over 21 randomized controlled trials reviewed. Woods et al. stated that more evidence, research, and time were needed to truly sniff out the efficacy of such treatment and long-term effects.
Cupping Research Bias
Cupping is actually a highly researched topic. Meaning it’s quite easy to locate thousands of studies over the last several decades, but there haven’t been many high-quality studies. Quantity doesn’t necessarily mean quality. What I mean by that is most of the studies you will find come out of China which introduces heavy biases, and more importantly, most of the studies do not have control groups or a good way of measuring effectiveness.
So what you end up having are studies you can’t really trust or ones that offer no conclusive evidence the damn thing works. Without control groups, you run into a high likelihood of placebo-dominant returns -- anyone and everyone will conclude on their own that the treatment worked better than nothing.
We also have absolutely no governing body or quality controls on what prescription is most effective for any specific use case. Therefore, the numerous variables are out of control and fundamentally a guessing game. In science, in order to control the intended result, we prefer to have enough evidence to prescribe a solution before it’s utilized in mass. If everyone were using the same cup material, type of cupping methodology, suction pressure, time under that particular pressure, and for the same symptom, then that would be ideal. Instead, you have practitioners all over the world using cups of all sizes for time frames ranging from a few seconds to 20+ minutes, and for symptoms from muscle soreness to breast cancer and, more recently, Covid-19 [17].
If you went to your doctor today with a bruise on your thigh and he gave you the same treatment procedure you would get for an amputated leg, you’d probably find yourself a new doctor and report him for “uber quackery”. Sure, this is hyperbolic, but you get my point.
Almost every single study I reviewed was sure to point out two things in particular: 1. No one to this day understands the mechanism for which cupping actually works and 2. There’s rarely ever a sham intervention or control group to ensure unbiased results.
While this is true, one problem is that it’s quite difficult to come up with a reliable and convincing treatment method comparable to cupping. It’s easy with pill treatments where you get two different pills -- a placebo and the test drug. As mentioned by one Harvard study [4], “pain can be a difficult thing to measure and the placebo effect — improvement related to an expectation of benefit — can be quite powerful.”
Lust for a 'quick fix'
As with most therapies, there’s usually logical reasoning behind the premise that gives it some sort of efficacy. It’s that base logic, that hint of believability, that is used to ultimately market the hell out of just about anything.
Athletics, much like the electronics and technology sector, is a breeding ground for the latest and greatest “thing” to squeeze out an edge. Most of it is absolute garbage or so small a change its value is only realized by the pockets of the brilliant advertiser that feigned its usefulness. We’ll throw money at it all day in hopes it can drive our productivity -- *cough* Apple *cough*. In our endless pursuit to “Keep up with the Jones” (maybe Kardashians?), we will find anything that MIGHT give us an advantage over another, or even death itself.
How many of you athletes have sports rituals? Something you have to do because you think if you don’t, your team will lose. Or if you don’t do it, you won’t perform optimally during your next competition.
Superstition in the health sciences is another word for placebo. If you believe it’ll work, there’s a CHANCE it may. You’re administering your own low-dose medicine to help alleviate a particular symptom. Has there ever been a conclusive study performed that showed putting your right shoe on before your left shoe and then lighting a black candle on gameday led to your team’s victory?
Can we finally agree that you can’t spot reduce fat, that you can’t get 6-pack abs in a week, that machines are not just as effective as free-weights, that cardio is not the way to lose all your weight, or being flexible enough to sit on your own head is not how you become a better athlete?
Side Effects of Cupping Therapy
Those keen to defend CT as a harmless therapy regardless of its effectiveness may also want to slow their roll for a bit. While it isn’t necessarily a life-threatening treatment by any means, it does pose some potential risks.
Most of the associated risks are skin-related, but there are other side effects reported.
While skin complications can be an unwanted nuisance, or even a more severe medical condition in relation to dry cupping, wet cupping presents more far-reaching concerns.
Effects ranging from the standard bruising and burns to psoriasis and anemia [2], and in more extreme cases, near-death incidents due to negligence.
Concerns have arisen over the years of unhygienic treatments being carried out in garages, room rentals at local community centers, and the use of unsanitary tools such as animal horns and being wielded. The use of such tools can contribute to disease and other ailments.
The blood-letting can also increase the risk of bloodborne pathogens in the form of HIV, hepatitis b or c. The same things we are required by the Occupational Safety and Health Administration (OSHA) to train for, here in the U.S., to protect those in the workplace from infectious diseases.
Example of bloodletting or “wet” cupping
The very same reason we tell our kids not to pick up random needles on the street, and we should reasonably expect safety from such things when in a professional therapeutic environment.
Therein lies perhaps the largest of all problems -- the lack of a governing body or certifying board to ensure that each practitioner adheres to rigorous training involving the treatment, health screenings, safety protocols, and more. Without some sort of licensure, you don’t know what you’re getting. Without standards, the ability of the therapy to do, or not do, what it is you need is a guessing game and you’ll experience different results each time you visit someone new.
I bet you would screen your general practitioner more in-depth because you take your bigger health problem quite seriously. You should do the same for other forms of medical treatment.
If your only sources of information and validation for a health provider are Yelp!, Craigslist, or your free-spirited friend, you may wish to be very wary of what you are looking to gain and if it’s a form of treatment you wish to pursue.
The Head of Blood Borne viruses for Public Health England, Dr. Fortune Ncube said, "At present, in the absence of national best practice guidance, we advocate that anyone performing wet-cupping must do so in a clean and hygienic environment, following standard infection control procedures, and must be appropriately trained in order to prevent the risk of causing infection or harm to both practitioners and clients."
He also cited some extreme examples of negligence from unlicensed practitioners in regard to CT.
"A female patient with breast cancer came to see me. She was in the advanced stages of cancer because she had not been for her chemotherapy. She said she had been Hijama and that the practitioner had told her it would cure her.
"Also, a man with heart problems had a heart attack whilst he was having the treatment carried out and the person treating him didn't realize." [3]
Baseball Study
In Chiu et al., (2020), they took a look at eighteen baseball players from the same team -- nine diagnosed with trapezius myofascial pain syndrome, and nine healthy players as a control group -- and put them through a four-week cupping therapy program.
Myofascial pain syndrome is where there are very localized points of pain within tense bands of muscle. Because of the difficulty involved in precisely locating the issue and why it specifically occurs, treating such an ailment is not well understood. Cupping has been utilized as a method of possibly promoting blood circulation within the arterioles and smaller capillary beds and shows promise in assisting recovery from muscle fatigue and aid in muscle function.
In this program, athletes received dry cupping with a negative pressure of 400 mmHg for 15 minutes, twice a week, at least two days apart. They built a six-cup system (5.5cm inner diameter each) with pressure sensors and tissue elevation markers to help collect more data.
The pressure gradually decreased over the process, with the control group displaying a much more significant loss of pressure than the myofascial treatment group. The pressure loss seemed to be more defined in the last week of treatment than in the first, but over the four-week timeframe, there was no significant change in either the soft tissue lifting or compliance.
Image of hardware used (a) a pressure sensor, (b) drawing of the field of view of the distance sensor, (c) suggested solution for the distance sensor cover, (d) photograph of the main device with the cover removed, and (e) a screen capture of the software graphical user interface.[11]
There was a clear increase in the lift in the myofascial pain group with no change in soft tissue compliance in the group. That’s to say that the skin gave way and lifted in the cup higher and the underlying soft tissue was more compliant for the normal group than that of the myofascial group, over a 15-minute cupping session.
However, they found that after four weeks of treatment, the myofascial group’s upward compliance trend was just as high as the normal group’s, although it was still statistically insignificant.
As for pain, each participant was asked to fill out a questionnaire to evaluate whether or not the pain had subsided, worsened, or saw no change. After the four weeks of therapy, myofascial trigger points (MTrPs) could no longer be identified in eight of the nine athletes with myofascial pain syndrome.
So what does it all mean? The study concluded that the monitoring system they built was feasibly beneficial for healthy or debilitated athletes. Both groups experienced an increase in both soft tissue compliance and self-assessed feeling better over the training period. This supports other data from similar studies comparing dry cupping therapy range of motion and flexibility results to that of passive stretching amongst healthy individuals. Which begs the question, why not just do some focused stretching or massage?
Karate Study and Inflammatory Markers
In this study [12], twenty-one male karate athletes were split up into three groups: a group who vigorously exercised, one that received cupping therapy, and another that did both.
Each athlete in each group had panels done to assess specific inflammatory markers before, directly after, and 30 minutes and 24 hours after the session. Specifically, they observed interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α).
Researchers routinely monitor these inflammatory markers as they show up with inflammation in the body (hence the name) and are known to play a key role in regulating your immune response to inflammation.
TNF-α causes localized inflammation and helps control infection. When white blood cells detect infection, they release TNF-α which signals other immune cells to come in and do work to stave off and clean up. IL-6, on the other hand, not only incites the inflammatory response, but it helps to mediate it.
Depending on how much IL-6 is released, it can either increase inflammation or reduce inflammation and your immune response as needed. So, particularly strenuous exercise can cause elevated levels of inflammation for obvious reasons and the subsequent release of both of these cytokines (protein messengers that communicate with other immune system cells to execute specific tasks). Hence, the study looks into CT’s effectiveness on hard-working athletes.
What was found in the study was that after cupping therapy alone, there was a significant decrease in observable IL-6 and TNF-α immediately when compared to baseline. This same suppressed result was observed at 30 minutes and up to 24 hours after therapy compared to the other two groups which were significantly higher than baseline.
The vigorous exercise with the CT group demonstrated fewer IL-6 and TNF-α values than the vigorous exercise group alone, throughout the entire range up to 24 hours. This led researchers to believe that CT does show promise in helping facilitate inflammation in the body -- post-exercise or otherwise.
This promise demonstrates a need for larger studies to validate findings, as the researchers stated, and ones with a sham group.
There are a few theories as to why cupping may help mediate these inflammatory responses, but the science is not definitive. In fact, no one yet understands fully how it works, though the “nitric oxide theory” and “blood detoxification” were cited in the study as possible explanations. Again, going back to microcirculation and more.
Ultrasound Elastography Results
Ultrasound elastography is a form of ultrasound that has been used for a few decades now to map and display different tissue stiffnesses. By running the ultrasound capture box over a certain area of the skin and applying a bit of pressure or using sound waves to deform the tissue, you can actually see a colored representation of the different regions beneath the skin that are more or less resistant to stress.
The image shows the region of interest using B-mode ultrasonography in breast tissue while the image on the right uses elastography, with blue indicating harder tissue and red indicating a softer tissue.
This tool and technique were used in a study by Jan et al. (2020) to help measure the changes in muscle stiffness, specifically the triceps after CT had been performed. The goal was to try and understand CTs effect on managing fatigue and if particular cup sizes played a role in reducing muscle stiffness.
Twelve healthy participants were used to test the efficacy of the therapy using cup sizes with an internal diameter of 35mm, 40mm, and 45mm. Muscle stiffness was measured with a pressure of -300 mmHg for five minutes both before and after the therapy.
What was found was that triceps stiffness did indeed lessen after CT with 40mm and 45mm cups but was not significant at all in the 35mm cup compared to the baseline measurements.
They noted that the superficial layer was not really affected, but the deep layer stiffness was significantly reduced in those same two cups.
This shows that there’s at least some benefit to the reduction of deep-layer tissue stiffness after CT, specifically with cups 40-45mm wide, meaning there’s more information we can use to push for more studies and a better understanding of the bigger picture.
Vacuum Myofascial Therapy vs Cupping Therapy
Rodríguez-Huguet et al. (2020) set out to determine how vacuum myofascial therapy devices (VT) might help improve range of motion, neck pain-related disabilities, non-specific neck pain, etc. While VT isn’t exactly cupping, it allows for precise digital control of suction and, as these researchers found out, demonstrates similar results to CT.
Thirty-eight participants with non-specific neck pain were split into groups and administered either VT or a physical therapy treatment using massages which included ultrasound, and transcutaneous electric nerve stimulation (TENS).
Each was given five treatment sessions over the course of two weeks.
They concluded that both groups had experienced improvements in pain, neck disability, range of motion, and pressure pain according to self-diagnosing scales (NPRS, SF-12), NDI, PPTs). It was apparent that the VT group showed larger improvements when compared to the physical therapy group, though. In fact, the VT group held those improvements relatively well at a one-month follow-up as well.
Problems with Cupping
As discussed earlier, one of the most prominent and concerning issues with cupping therapy is its inadequate training and usage design. There’s no real standard for who delivers treatment (ie, no certification process), not enough communication between patients and therapists about medical history or potential concerns, poor knowledge of basic clinical sterilization procedures, no clearly defined treatment guidelines, etc.
A practitioner who decides to dole out treatment, may not be aware of acute issues that could give rise to much more severe problems or in rare and extreme cases, even death.
One case from a medical examiner [15] points to such concerns.
In this instance, a 31-year-old man was referred to his clinic due to complaints he had regarding circular purple lesions on his shoulder. He had a pre-existing episode of a pustular skin rash (later diagnosed as herpes zoster) on his neck and shoulder and had it taken care of with treatment with valacyclovir.
The man still suffered from shoulder pain and decided to undergo a few sessions of CT. A few days after one CT session and before being referred to the medical examiner’s clinic, blood-filled blisters appeared. They were able to treat it with a corticosteroid ointment.
So, misdiagnoses can cause more harm than intended.
There have been many reports of ulcer formations, panniculitis, localized infections, koebnerization, hyperpigmentation, and more. Reasoning dictates that this likely occurs more often due to prolonged suction which causes the epidermal and dermal layers of skin to eventually start to separate.
There are even rare cases of serious side effects, such as bleeding inside the skull after cupping on the scalp and anemia from blood loss after wet cupping.
Another issue is that cupping actually breaks capillaries, which is what leads to the bruising, and if CT is continually performed in the same spots, can lead to the death of the skin [16].
Third-degree burns likely formed from repeated use of CT over the same spots and the patient admittedly having his wife remove blisters after sessions. Burns also became infected.
Conclusions
Cupping therapy is a very old medicinal practice that dates back thousands of years and while its use is not new, we’re only just beginning to research and attempt to understand its relevance and effectiveness as a therapy.
It is quite easy for me to mark this up as pseudoscience, and where current research stands, it should be seen as such.
There’s been quite a bit of research over the last several years on cupping, but most of it is low quality and in need of better design. Sham interventions are non-existent and control groups are scant and often difficult to employ. Most of the studies also come directly from one source -- China. If you remember, China is also where cupping likely originated and is still practiced.
Evidence that cupping may help reduce pain is present, but the evidence is generally weak, though there's some promising evidence in other areas of effectiveness.
Really, there’s just not enough solid indication across the board that it is any more beneficial than other forms of treatment that don’t leave your body maimed or in danger of more damaging effects, especially when administered by non-certified practitioners.
This brings us to perhaps the largest point of contention for most and that is the lack of any consistent or well-formed protocol or a certifying board. Each time you receive CT you could be getting wildly varied procedures, improper or inefficient therapy, or risk making preexisting conditions worse.
Most CT practitioners don’t perform any medical history screenings to help form a solid basis of attack and keep you from potential harm, making it up to you to do your own research or talk to a medical professional to determine if it’s safe prior to doing it.
CT happens to show a much higher success or potency rate in treating skin-related issues such as psoriasis, neurodermatitis and chronic idiopathic urticaria, and shingles.
As we have discussed, there are significant benefits that have been demonstrated when CT is combined with other therapies such as acupuncture and modern medicines when treating specific ailments like Bell palsy and cervical spondylosis as compared to any of the aforementioned treatments as a standalone.
This is something that may be of some benefit to a few of you but does not affect athletes looking to recover any quicker.
Aside from all the aforementioned, we still don’t understand how cupping works to aid patients in most instances, unlike other alternative medicines or therapies. CT in and of itself, might not necessarily even be dissimilar to other forms of vacuum suction, but we are unsure by what mechanism it benefits your health.
We discussed earlier how these types of therapies tend to be used sometimes as convenient cure-alls. Well, there have been many reports, overseas in particular, of practitioners utilizing cupping therapy as a form of treating COVID-19 [17].
However, we urge you to speak to a licensed physician before undergoing any radical treatments for anything more than basic complementary healthcare needs.
If you choose to get CT done, ensure you do your research and choose a provider you can trust and who has experience in more than alternative medicines. Make sure that they do their own research into your medical history and be open to asking them questions about how they practice CT. Also, from all our research, don’t let them keep any cupping instruments in suction on your person for more than 5-10 minutes if you want to see the best results.
Interested in working together?
References
Furhad, S., & Bokhari, A. A. (2020). Cupping Therapy. In StatPearls. StatPearls Publishing.
https://sciencebasedmedicine.org/cupping-olympic-pseudoscience/
https://www.bbc.com/news/health-32653971
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