Note: Unlike the peptide articles in this series, cupping therapy is an established clinical technique offered by licensed physical therapists and other healthcare providers. This article is educational but reflects real therapeutic practice.
Introduction
When Olympic swimmers arrived in Rio de Janeiro in 2016, the circular purple marks on their shoulders instantly went global. What millions of viewers saw for the first time was cupping therapy — and the centuries-old practice suddenly became one of the most Googled health topics on the planet.
But cupping didn’t start at the Olympics. It is one of the oldest recorded medical practices in history, documented in ancient Chinese, Egyptian, and Middle Eastern medicine going back thousands of years. Today it has been integrated into modern physical therapy, sports medicine, and pain management, where it is used in ways that would be recognizable to those ancient practitioners while being understood through contemporary physiological frameworks.
What Is Cupping Therapy?
Cupping therapy involves placing cups — traditionally made of bamboo, glass, or ceramic, and now also silicone — on the skin and creating a negative pressure (suction) environment within each cup. This suction pulls the superficial layers of skin, subcutaneous tissue, and fascia upward into the cup, producing the characteristic circular marks that made headlines at the Olympics.
There are several variations in contemporary practice:
- Dry cupping: Suction only — no heat, no bleeding. Most common in physical therapy settings.
- Wet cupping (hijama): Involves superficial skin incisions before or after cupping to draw small amounts of blood. Not typically used in Western physical therapy settings.
- Fire cupping: Traditional technique using flame to create suction in glass cups. Effective but being replaced in clinical settings by vacuum pumps and silicone cups.
- Moving cupping (gliding cupping): Oil is applied to the skin and the cup is moved in strokes across the target area — producing an effect somewhat similar to deep tissue massage.
- Flash cupping: Rapid application and removal of cups across an area to stimulate local circulation without the sustained suction that produces marks.
What Happens Physiologically?
The physiological mechanisms through which cupping produces its effects are an active area of research and discussion. Current understanding points to several plausible mechanisms:
Increased Local Blood Flow
The suction created by cupping draws blood into the superficial capillaries of the treated area. This local hyperemia (increased blood flow) is thought to deliver oxygen and nutrients to the tissue while facilitating the removal of metabolic waste products.
Fascial Release and Decompression
Conventional massage and soft tissue techniques apply compressive force to tissues. Cupping is notable for applying tensile (pulling) force, which may decompress layers of tissue — including fascia, connective tissue, and muscle — in ways that compressive techniques cannot. This decompressive effect may help release adhesions, improve tissue mobility, and reduce the mechanical restriction that contributes to pain and stiffness.
Pain Gate and Neurological Effects
Cutaneous stimulation from cupping may activate mechanoreceptors in the skin that modulate pain signal transmission through the gate control mechanism — the same general principle underlying TENS (transcutaneous electrical nerve stimulation) and massage.
Inflammatory Response Modulation
The circular marks left by cupping — called petechiae or ecchymosis — represent extravasation of blood into the superficial tissue from ruptured capillaries. This is not harmful, but it does trigger a local inflammatory healing response. Some researchers theorize that this controlled micro-inflammatory response may initiate or accelerate a healing cascade in underlying tissue, similar in principle to how dry needling works.
What Does the Evidence Show?
Cupping has a growing body of research behind it, though the quality of evidence varies and large randomized controlled trials are still relatively limited:
- A systematic review published in PLOS ONE found evidence supporting cupping for neck pain, lower back pain, and shoulder pain compared to waiting list controls, though noted methodological limitations in available studies
- Research on cupping for myofascial pain syndrome and trigger point treatment has shown promising results, particularly when combined with other physical therapy interventions
- Athletic performance and recovery studies have shown trends toward reduced delayed onset muscle soreness (DOMS) and improved range of motion, though sample sizes remain small
- A Cochrane review noted that while cupping shows beneficial effects for some conditions, the evidence quality is generally moderate and more rigorous trials are needed
The evidence for cupping is more developed than many purely alternative techniques, while still not reaching the level of the strongest physical therapy interventions. Most physical therapists use it as a complement to, not replacement for, evidence-based rehabilitation.
What Conditions Is Cupping Used For in Physical Therapy?
In the physical therapy context, cupping is most commonly applied for:
- Myofascial pain syndrome and trigger point release
- Neck pain and cervical dysfunction
- Lower back pain and thoracic stiffness
- Shoulder pain, including rotator cuff conditions
- IT band syndrome and lateral hip pain
- Post-surgical scar tissue management
- General muscle soreness and athletic recovery
What Do the Marks Mean? Are They Bruises?
The circular discolorations left by cupping are one of the most common questions patients ask. They are not bruises in the conventional sense. A bruise results from trauma that causes blood to leak from damaged vessels. The cupping marks result from suction drawing blood into the superficial capillaries, some of which rupture due to the negative pressure — but without the traumatic tissue damage associated with a bruise.
The marks typically resolve within 3–10 days and are generally painless to touch. Their color and intensity can reflect the condition of the underlying tissue — darker marks in areas with more congestion, stagnation, or dysfunction. Whether this interpretation has physiological validity or is more metaphorical is debated in the literature.
What to Expect During a Cupping Session
In a physical therapy or clinical setting, cupping is typically:
- Preceded by a thorough assessment to confirm it is appropriate for your specific condition
- Applied to a specific target area based on clinical findings — not randomly placed
- Combined with other physical therapy techniques such as soft tissue mobilization, exercise, or dry needling
- Explained clearly before application — you will know exactly what is happening and why
Sessions typically take 5–15 minutes for the cupping component, within the broader context of a physical therapy appointment. You may feel warmth, pulling, and pressure during treatment — it should not be acutely painful, though mild discomfort in tight areas is common.
The Bottom Line
Cupping therapy is a well-established clinical technique with a growing evidence base, a clear physiological rationale, and a long clinical history. It is not a cure-all, and its benefits are best realized when integrated intelligently into a broader, individualized physical therapy plan.
If you are curious whether cupping might be appropriate for your specific condition, the best starting point is a consultation with a licensed physical therapist who can assess your situation and explain how cupping would fit within your treatment plan.
