At its core, cupping therapy hasn’t changed all that much since its earliest recorded practices, which date back to 1550 B.C. Egypt. Just like thousands of years ago, small cups are still applied to the skin and used to create a vacuum of negative pressure that draws the tissue up into the cup. (Perhaps our ancient predecessors even looked at the bubbles of skin and resulting polka-dot bruises with the same kind of morbid fascination that we do today.) But what has shifted and evolved is the accessibility of cupping and cupping materials.
Historically, cupping therapy has been administered by trained practitioners—physicians, surgeons, bathhouse attendants, and even barbers—to treat maladies ranging from headaches and narcolepsy to digestive issues and lung disease. Now, much like electrical nerve stimulation devices, kinesiology tape, foam rollers, and compression boots, it’s part of the everyday athlete’s recovery kit.
Nowadays, most people use cupping to alleviate sore or tight muscles, treat injuries, and address mobility issues. And, anyone with a credit card can order a set of cups to apply in the privacy of their own home.
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But should you actually try at-home cupping? In general, treating your own ailments without the guidance of a professional comes with risks. In addition to potentially wasting time and money, you may miss underlying medical issues or exacerbate existing conditions and create new problems. So, to get a sense of whether or not athletes should attempt cupping on themselves, we spoke with a few experts on the topic. Here’s what you need to know.
How does cupping work?
Whether you use traditional bamboo cups, glass cups heated with fire, plastic cups and an attachable pump, or silicone cups with built-in plungers, cupping generates suction that pulls up on the skin. Ethan Kreiswirth, Ph.D., ATC, a physiotherapist who works with the USA indoor sprint cycling team, explains that a few things happen from there.
“When you start pulling up on the skin, you also pull up on something called fascia,” he says. Fascia is the thin, multilayered, fibrous connective tissue that encases and supports every part of the body, including the muscles, bones, joints, tendons, and ligaments. According to Kreiswirth, when there’s adequate space between fascial layers, the body’s tissues easily “slide and glide” against each other.
“When you don’t have space between tissues and all of these fascial layers are affixed or kind of stuck together like two pieces of Velcro, they don’t move, then you don’t get really good tissue gliding,” Kreiswirth says. “And when you don’t get good tissue gliding, it may result in poor range of motion.”
By pulling up on the skin and fascia with a cup, you effectively create space, allowing fluids to flow between the layers and hydrate the tissues, and muscles and joints can then move more freely.
Grayson Wickham, doctor of physical therapy and founder of Movement Vault, a rehab, stretching, and mobility app, suggests that the benefits some patients experience from cupping, like relief from pain and tightness, are likely a nervous system response.
He states that, just like with other manual therapies, including foam rolling and muscle fascia release techniques, there’s no clear evidence that spells out exactly what’s happening in the body. But the generally accepted theory is that these manual therapies, including cupping “sends an input to our central nervous system, and our central nervous system receives that input, interprets it, and if it’s done correctly, then it sends an output to that muscle to relax the tension in the muscle,” Wickham explains.
Increased blood flow is also a potential benefit of cupping. “Because there’s suction involved, there is some level of bringing blood flow to the area that the cup is on,” Wickham says. “Any time you bring blood flow to an area, you’re going to bring nutrients with that blood. That’s essentially how tissue is getting its nutrition.” Theoretically, using cupping to increase blood flow to an injured area of the body, like a mild tear in a tendon, could help expedite the healing process, he says.
Is cupping effective?
Both Kreiswirth and Wickham note that the quality of most of the research on cupping is subpar and, therefore, there’s not a lot of solid evidence that proves the therapy to be effective. “You find many what I call one-off studies or small sample studies with one measured outcome, and then there’s no follow-up,” Kreiswirth says, noting that, within studies on cupping, there’s also no control for other variables, like age or injury type.
For this reason, Wickham says many of his peers reject cupping altogether. “When it comes to my realm, as a doctor of physical therapy, my colleagues and I are very evidence-based. So, if the research isn’t extremely strong, we’re basically going to discount it,” he says.
However, both have used cupping in their own practices to varying levels of success. Wickham is clear that it’s not one of his “go-to” strategies. “I feel like there are better techniques when it comes to manual therapy,” he says. But, if he’s not achieving the desired outcome with other tactics, or a patient really likes cupping, he may incorporate the practice into his overall treatment plan with good results.
Kreiswirth, too, can point to instances in which he used cupping to help athletes deal with training-related aches, pains, and stiffness. But the physiological effects of cupping, he suggests, may only be part of why cupping, or any form of sports medicine for that matter, “works.”
“The bio side is the ‘sliding and gliding,’ but psychosocially, being treated by someone is a huge outcome,” he says. Research shows that factors like treatment setting and positive patient-therapist interactions may influence clinical outcomes. “I don’t [always] even need to touch the person. We could just talk about body awareness and breathing and maybe calm the whole system down,” Kreiswirth says.
So, there may be a bit of a placebo effect at play when it comes to cupping. But if athletes feel better, the treatment is ultimately effective.
Should you try at-home cupping?
Ideally, cupping therapy would be administered by a qualified professional. Mark A. Slabaugh, M.D., an orthopedic sports medicine surgeon with Sports Medicine at Mercy Medical Center in Baltimore, Maryland, has seen athletes benefit from cupping, but only when under the care of practitioners who are trained in its use and can monitor the individual’s response.
“I am very hesitant to recommend home use since cupping can be done for too long or done with too much pressure, which can negatively affect the skin and cause skin irritation and possibly even necrosis,” or tissue death, he says. “I would recommend athletes try cupping under the guidance of a professional athletic trainer or physical therapist, trying it only on one area first to determine if it helps their body to respond positively to an intense training session. If it does work, then more areas can be cupped at an appropriate negative pressure.”
Both Kreiswirth and Wickham would also prefer that athletes work directly with a professional, especially if they’re dealing with an injury, numbness, tingling, or pain, which can often be the sign of a less-obvious medical condition.
That being said, at-home kits are affordable and widely available, and there are countless tutorials on YouTube, Instagram, and TikTok. Athletes who want to try cupping on their own will do so, and clinicians, including Kreiswirth and Wickham, know this.
What are the best ways to perform at-home cupping?
If you do decide to purchase a cupping system to use at home (you can find them on sites like Amazon, but brands like Theragun also have their own take), here’s what to keep in mind, from the experts:
1. When choosing your cups, take note of the material. “Make sure you’re not allergic to whatever properties they’re using to make the cups,” Kreiswirth says. So, for example, if you’re allergic to silicone, you may want to go with plastic cups.
2. Opt for a kit with cups of multiple sizes. For most large areas, Wickham uses cups with a diameter of 2.5 to 3 inches, but he finds that 1-inch cups are better suited to small areas, like the back of the neck.
3. Wickham notes that, while there aren’t a lot of contraindications for cupping, you should never apply cups to an open wound, a scab, or your eye area. Kreiswirth also recommends avoiding body parts that are swollen or postoperative, as well as your head and the front of your neck, due to the amount of blood vessels in those areas.
4. There’s no standardized treatment time for cupping, but Kreiswirth believes that keeping the cups on for anywhere between 90 seconds and five minutes is adequate. And, if you find cupping helpful and don’t experience any soreness or bruising, it’s fine to use cups on a daily basis.
5. It can be helpful to move the body part you’re treating while cupping. “Remember, the mechanical portion of this is you're trying to increase the sliding and gliding of tissue that may be stuck together, Kreiswirth says. “So we have two pieces of Velcro, they’re stuck together, we cup one side of it, it picks up a little bit, and now you’re able to slide and glide a little bit more.”
6. While cupping is often associated with bruising, it’s not necessary or a sign of the effectiveness of the treatment. Therefore, if cupping does result in marks or soreness, Kreiswirth does not recommend re-treating the affected area.
