The Use of Cupping in Musculoskeletal Medicine

The Use of Cupping in Musculoskeletal Medicine

Cupping is a technique where a vacuum is created in a cup, drawing the skin up into the cup decompressing the layers of the epidermis and subcutaneous superficial fascia. Cupping has been practiced in most cultures in one form or another throughout history but the true origin of cupping therapy remains uncertain (Qureshi et al 2017). 

Cupping massage is a modern version of a traditional therapy, newer plastic materials allow flexible and softer cups without compromising the efficacy of the modality. Today, cupping is frequently carried out using plastic cups and a manual hand-pump to create the vacuum. The vacuum “draws” the soft tissue perpendicular to the skin, providing a tensile force, which can be left in one site for a prolonged period or moved along the tissue. The practitioner can control the intensity of the desired suction from 80 mmHg to 250 mmHg. The most common sites of application are the back, chest, abdomen and buttock. The cups are typically left in place for 5-15 minutes depending on the client’s reaction and sensitivity. To cover a wider area, lubricants can also be used to move the cup around once placed on the skin. Cupping massage uses varying amounts of suction along with a glide, stroke, torque, pull, vibration, all in a multi-planar nature.

Physiological Effects of Cupping

The biological mechanism and clinical effects of cupping are still not well researched, the skin, subcutaneous tissue and fascia are all embedded with mechanosensitive nerve fibers, so it is likely that cupping invokes a number of neurophysiological responses (Chen et al. 2017).  

Is Cupping Safe?

Cupping is generally considered a safe therapy with minor side effects such as erythema, edema, and ecchymosis in a characteristic circular arrangement. The longer a cup is left on the skin and the higher tensile stress inside of the cup, the more of a circular mark is created this is due to capillary dilation. Cupping encourages blood flow to the cupped region (hyperemia), often the patient may feel warmer and/or hotter as a result of vasodilatation taking place, slight sweating may occur.


Cupping is a technique where a vacuum is created in a cup, drawing the skin and subcutaneous superficial fascia up into the cup. The use of cupping originated as early as 3000 B.C.E in a pre-scientific era and much of the reasoning once used to explain the effects do not make sense in the light of what we know today. Anecdotally cupping is used to alleviate pain, whether cupping works via a placebo effect, counter irritation or mechanotransduction are all up for discussion.

More to Explore

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Qureshi, N.A., Ali, G.I., Abushanab, T.S., El-Olemy, A.T., Alqaed, M.S., El-Subai, I.S., Al-Bedah, A.M.N. (2017). History of cupping (Hijama): a narrative review of literature. J Integr Med.

Rozenfeld, E., & Kalichman, L. (2016). New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of Bodywork and Movement Therapies.