Cupping Therapy: What It Is and What to Expect

Round marks on the back of an athlete or a film star after a session. Cupping has been used in many traditional systems of medicine for centuries, and it's now used by some physiotherapists as one of several hands-on tools for muscle pain and tightness.

What cupping is

Cups made of silicone, plastic or glass are placed on the skin, and suction is created, either with a hand pump or by squeezing a silicone cup. The suction lifts the skin and the tissue underneath, rather than pressing down on it like a massage.

In physiotherapy, cupping usually means dry cupping, which uses suction only. It is different from wet cupping (hijama), which involves small cuts in the skin.

Ways cups are used

• Static cupping: cups are left in place for a few minutes over a tight or sore area
• Moving (sliding) cupping: oil is applied and the cup is glided over the muscle, a bit like a massage in reverse
• Cupping with movement: you gently move the joint or stretch while the cup is on

What it's used for

• Tight, sore muscles in the neck, shoulders and back
• Muscle tension linked to desk work or sport
• Stubborn trigger points
• As a warm-up for stiff tissue before exercise

What the evidence says

Research on cupping is still limited and of mixed quality. Some studies suggest it can reduce neck and back pain in the short term. Like other hands-on techniques, it probably works mainly by calming sensitive tissue and nerves. It's best used as part of a plan that includes exercise, not as a treatment on its own.

About the marks

The round marks are caused by small blood vessels under the skin releasing a little blood when the tissue is lifted. They are usually painless and fade over a few days to around two weeks. They are not a sign of "toxins" being drawn out, and darker marks don't mean the treatment worked better.

What it feels like

Most people feel a tight, pulling sensation that eases after a minute or so. It shouldn't be sharply painful. Tell your physiotherapist if it is, and the suction will be reduced.

Who should avoid it or check first

• People taking blood-thinning medicine or with a bleeding disorder
• Over broken skin, rashes, sunburn, varicose veins or a suspected blood clot
• People with fever or feeling unwell
• During pregnancy, especially over the abdomen and lower back
• People with very fragile skin, such as after long-term steroid use

After a session

• Drink water as normal and stay gently active
• Avoid very hot showers on the area for a few hours
• Mild soreness for a day is normal

Our approach

We use cupping only after an assessment and with your consent, where it suits your problem, and always together with exercise and advice so the benefit lasts.