Cupping Therapy

A complementary treatment used alongside physiotherapy and rehabilitation

Cupping therapy is a technique that uses specially designed cups placed on the skin to create suction.

Within a physiotherapy setting, it may be used for selected people experiencing muscular discomfort, stiffness or persistent musculoskeletal symptoms. It is generally used as an additional treatment alongside exercise, strengthening, mobility and activity progression rather than as a standalone approach.

The aim is usually to help manage symptoms and make movement or rehabilitation more comfortable.

What is cupping therapy?

Cupping therapy involves placing cups against the skin and creating negative pressure inside them.

This gently lifts the skin and superficial tissues into the cup.

Depending on the technique, cups may remain in one position or be moved across the skin.

In physiotherapy, dry cupping is generally the more relevant form. This does not involve cutting the skin or drawing blood.

The treatment should be selected according to your symptoms, medical history and rehabilitation goals.

What is dry cupping?

Dry cupping involves applying suction to intact skin without making any cuts or removing blood.

The cup may be:

• Left in one position
• Applied to several areas
• Moved gently across the skin

The amount of suction can usually be adjusted according to your comfort.

Dry cupping should not be confused with wet cupping, which involves breaking the skin and is a different procedure with additional risks and infection-control requirements.

Who may benefit from cupping therapy?

Cupping may be considered for selected people experiencing:

• Muscular discomfort
• Neck or shoulder tension
• Back discomfort
• Localised muscular tenderness
• Stiffness
• Some persistent musculoskeletal pain
• Exercise-related muscle soreness

Whether it is appropriate depends on the cause of the symptoms.

Not every painful or tight area needs cupping.

What happens during your first appointment?

Before treatment, the physiotherapist will usually assess the problem.

You may be asked about:

• Where symptoms occur
• How long they have been present
• What makes them better or worse
• Previous injuries
• Previous surgery
• Medical conditions
• Medication
• Skin conditions
• Current exercise
• Work
• Sport
• Previous treatments
• Your rehabilitation goals

A physical assessment may also look at:

• Movement
• Strength
• Joint mobility
• Muscle tenderness
• Functional activities

This helps determine whether cupping is appropriate or whether another treatment should be prioritised.

What happens during cupping treatment?

The treatment area is exposed and the skin is checked before the cups are applied.

The clinician then creates suction within the cup.

Depending on the technique, cups may remain in place for several minutes or be moved across the treatment area.

You may feel:

• Pulling
• Tightness
• Pressure
• Warmth

The amount of suction can usually be adjusted.

Treatment should not feel intolerably painful.

What does cupping feel like?

Most people describe cupping as a pulling or stretching sensation.

Some areas may feel more sensitive than others.

You may notice:

• Firm suction
• Pressure
• Warmth
• Temporary tenderness

If the suction feels excessive, tell the clinician.

Stronger suction does not necessarily mean better treatment.

Why does cupping leave marks?

Cupping commonly produces circular marks where the cups were placed.

These occur because suction changes blood flow and causes small blood vessels near the skin to respond.

The marks may appear:

• Red
• Purple
• Darker than the surrounding skin

They are not necessarily the same as bruising caused by direct trauma.

However, they can look similar and may remain visible for several days.

How long do cupping marks last?

The marks usually fade gradually.

For many people they settle within several days, although darker marks may take longer.

The exact duration depends on:

• Suction strength
• Treatment duration
• Skin sensitivity
• Individual tendency to mark or bruise

You should consider this before treatment if the area will be visible for work, events or sport.

Are darker marks a sign of more toxins?

No.

The colour of a cupping mark should not be used to diagnose “toxins”, poor circulation or another medical problem.

Darker marks can simply reflect the response of the skin and superficial blood vessels to suction.

Treatment should be based on clinical assessment rather than the colour of the marks.

Cupping for muscular pain

Cupping may sometimes be used where muscle discomfort or tenderness forms part of a musculoskeletal condition.

Treatment may be directed towards areas such as the:

• Upper back
• Shoulders
• Lower back
• Thighs
• Calves

Any temporary symptom relief should be used to support movement and rehabilitation.

If weakness or reduced physical capacity is contributing, strengthening may still be required.

Cupping for neck and shoulder discomfort

Neck and shoulder symptoms can be influenced by:

• Prolonged activity
• Work demands
• Training
• Reduced movement
• Muscular sensitivity

Cupping may occasionally be used as an additional treatment.

Rehabilitation may also include:

• Neck movement
• Shoulder strengthening
• Upper-back strengthening
• Exercise
• Workplace advice

The wider causes of symptoms should still be considered.

Cupping for back discomfort

Back pain can have many contributing factors.

Cupping may sometimes be used for temporary symptom management, particularly where there is local muscular discomfort.

However, long-term rehabilitation may also need to address:

• Movement
• Strength
• Lifting tolerance
• General activity
• Exercise

The aim should be to improve function rather than rely continually on passive treatment.

Cupping for sports recovery

Some athletes use cupping as part of recovery after demanding training or competition.

It may be used for areas experiencing:

• Muscular soreness
• General tightness
• Post-training discomfort

However, cupping does not replace:

• Sleep
• Nutrition
• Appropriate training load
• Strength
• Recovery time

It should be considered an optional complementary technique rather than an essential recovery method.

Cupping after exercise

Cupping may sometimes be used after training when muscles feel sore or tight.

The treatment may temporarily change how the area feels.

However, normal post-exercise soreness often settles naturally.

Cupping is not required after every hard training session.

Recovery planning should consider the overall training programme.

Cupping and delayed-onset muscle soreness

Delayed-onset muscle soreness can occur after:

• New exercises
• Heavy strength training
• High-volume activity
• Returning after a break

Cupping may sometimes be used for comfort.

However, soreness itself is usually temporary and does not necessarily indicate damage.

Gentle movement and appropriate recovery may also be useful.

Cupping alongside physiotherapy

Cupping may form one part of a physiotherapy programme.

Treatment may also include:

• Strengthening
• Mobility
• Manual therapy
• Exercise
• Movement rehabilitation
• Activity modification

Not everyone requires every treatment.

The clinician should use cupping only when there is a clear reason for including it.

Why exercise still matters

Cupping does not directly restore:

• Muscle strength
• Power
• Balance
• Endurance
• Running capacity

These physical qualities need to be developed through active rehabilitation.

For example, reducing calf soreness does not automatically restore the strength required for running.

Cupping should therefore support exercise rather than replace it.

Cupping and manual therapy

Cupping may sometimes be combined with:

• Soft-tissue treatment
• Joint mobilisation
• Exercise

The combination should depend on the condition.

Using several passive treatments together does not automatically produce a better outcome.

The rehabilitation plan should remain focused on function.

Static cupping

Static cupping involves placing cups over selected areas and leaving them in position for a short period.

The suction remains relatively constant during treatment.

This may be used over larger muscle areas.

The intensity and duration should be adjusted according to the individual.

Moving or gliding cupping

Moving cupping involves applying suction and then gently moving the cup across the skin.

A lubricant may be used so the cup can move more easily.

This creates a different sensation from static cupping.

It may not be appropriate if the skin is:

• Irritated
• Fragile
• Damaged
• Highly sensitive

Cupping and fascia

Cupping is sometimes described as a treatment that “releases fascia”.

This description can be overly simplistic.

The suction affects the skin and underlying superficial tissues, and some people report changes in:

• Comfort
• Movement
• Tissue sensation

However, treatment should not be presented as physically breaking apart or permanently releasing tissue.

Cupping and circulation

Suction causes temporary local changes in blood flow within the skin and superficial tissues.

This contributes to the redness or circular marks commonly seen after treatment.

Claims that cupping permanently improves circulation throughout the body should be treated cautiously.

Its use in physiotherapy is better considered in relation to local symptoms and comfort.

Does cupping remove toxins?

There is no need to describe cupping as a way of pulling toxins from muscles or the body.

The body's normal systems, including the liver and kidneys, are responsible for processing and removing waste products.

Cupping should be presented as a physical treatment technique rather than a detoxification procedure.

Evidence and realistic expectations

Research into cupping for musculoskeletal pain has produced mixed results.

Some people report temporary improvement in pain or muscle discomfort, but the overall evidence is not strong enough to suggest that cupping is necessary for most musculoskeletal conditions.

For this reason, it is best viewed as an optional complementary treatment.

The most important question is whether it helps you progress with:

• Movement
• Exercise
• Function
• Rehabilitation

Cupping is not a cure

Cupping should not be presented as a cure for:

• Back pain
• Neck pain
• Sports injuries
• Arthritis
• Tendon problems

These conditions may require more comprehensive assessment and rehabilitation.

Cupping may sometimes help manage symptoms, but it does not replace treatment of the underlying physical limitations.

What happens after treatment?

After cupping, you may notice:

• Circular skin marks
• Mild tenderness
• Warmth
• A feeling of heaviness
• Temporary soreness

Some people notice little reaction.

Most mild effects should settle naturally.

Can I exercise after cupping?

Usually yes.

Normal movement and rehabilitation exercises can often continue.

If the treated area feels particularly sore, very demanding activity may occasionally need to be modified temporarily.

Any exercise restriction should generally be based on the underlying condition rather than the cupping itself.

Can I train after cupping?

Many people can continue normal training.

However, if you have significant skin sensitivity or soreness, it may be sensible to reduce heavy contact or friction over the treated area temporarily.

Athletes involved in contact sport should also be aware that visible cupping marks may remain for several days.

Can I shower after cupping?

Normal washing is usually possible.

However, the skin may be more sensitive immediately after treatment.

It may be sensible to avoid:

• Very hot water
• Aggressive scrubbing
• Irritating skin products

until the area feels comfortable.

Skin sensitivity

Cupping directly affects the skin.

Tell the clinician if you have:

• Sensitive skin
• Eczema
• Psoriasis
• Frequent skin reactions
• Easy bruising

Cupping may worsen some skin conditions and may not be appropriate over affected areas.

Cupping and bruising

Circular marks are common after treatment.

Some people may also develop more typical bruising, particularly when:

• Strong suction is used
• Treatment is prolonged
• They bruise easily

The clinician should use the minimum intensity needed to achieve the treatment goal.

Skin irritation

Temporary redness is common.

Less commonly, people may develop:

• Irritation
• Itching
• Small blisters

Tell the clinician if your skin feels excessively painful or irritated.

Treatment should be stopped if the skin is not tolerating the suction.

Burns

Some traditional forms of cupping use heat to create suction.

In a clinical physiotherapy setting, mechanical or pump-based suction may be preferred because it avoids the use of flame.

Heat-based cupping carries a risk of burns if not performed correctly.

Infection risk

Dry cupping on intact skin generally carries a low infection risk when appropriate hygiene is followed.

Cups should be:

• Properly cleaned
• Disinfected or sterilised as required
• Used according to infection-control procedures

Cupping should not be performed over infected or broken skin.

Who should provide cupping therapy?

Cupping should be performed by a practitioner who has appropriate training in:

• Anatomy
• Skin assessment
• Treatment precautions
• Infection control
• Safe equipment use

The clinician should also understand when cupping is unlikely to be appropriate.

Consent

Before cupping, the clinician should explain:

• What treatment involves
• Why it is being considered
• Likely skin marks
• Possible side effects
• Alternative treatment options

You should have an opportunity to ask questions.

Treatment should only proceed with your consent.

When cupping may not be suitable

Cupping may need to be avoided or modified in people with:

• Open wounds
• Active skin infections
• Fragile skin
• Significant skin conditions in the area
• Significant bleeding problems
• Certain vascular conditions
• Recent significant trauma
• Reduced sensation in the treatment area

Your medical history should be reviewed before treatment.

Medication and bleeding risk

Tell the clinician if you take medication that affects bleeding or clotting.

This may include:

• Anticoagulants
• Antiplatelet medication

These medicines may increase the chance of bruising or bleeding-related complications.

Do not stop prescribed medication without medical advice.

Reduced sensation

Cupping may not be appropriate over an area with significantly reduced sensation.

If you cannot accurately feel:

• Pressure
• Pain
• Skin irritation

you may not be able to recognise excessive suction.

Tell the clinician if the treatment area feels numb or less sensitive than normal.

Pregnancy

If you are pregnant or think you may be pregnant, tell the clinician before treatment.

The suitability of cupping may depend on:

• Treatment area
• Symptoms
• Stage of pregnancy

Alternative physiotherapy approaches can be used where appropriate.

Cupping over varicose veins

Strong suction should generally not be applied directly over prominent varicose veins or areas with significant vascular problems.

If you have circulation concerns, tell the clinician before treatment.

Cupping around recent surgery

Cupping should not be applied directly over:

• Recent wounds
• Unhealed incisions
• Areas with post-operative complications

Once healing is complete, treatment may only be considered if clinically appropriate.

Post-operative rehabilitation should continue to follow surgical guidance.

Cupping after injury

A new injury should first be assessed.

Pain, swelling or bruising following trauma should not automatically be treated with cupping.

Early management may require:

• Appropriate loading
• Movement
• Protection where needed
• Medical investigation

Cupping is generally more relevant to selected muscular symptoms than acute serious injury.

When further assessment may be required

Further clinical or medical assessment may be appropriate if you experience:

• Severe or rapidly worsening pain
• Significant unexplained swelling
• New weakness
• Persistent numbness
• Fever or signs of infection
• Significant skin changes
• Severe pain following trauma
• Unexplained loss of function

These symptoms should be assessed rather than managed routinely with cupping.

Cupping for returning to the gym

If muscle discomfort has interrupted gym training, cupping may occasionally be used as an additional treatment.

Rehabilitation may still need to restore:

• Squatting
• Lifting
• Pulling
• Pressing
• Carrying

Progressive strength training is usually more important for long-term physical capacity.

Cupping for runners

Runners experiencing repeated muscle tightness may need assessment of:

• Training volume
• Running speed
• Strength
• Previous injuries
• Recovery

Cupping may help some people feel temporarily more comfortable.

However, recurring symptoms should not be managed only by repeatedly treating the same muscle.

Cupping and return to sport

Returning to sport requires appropriate:

• Strength
• Power
• Running
• Jumping
• Change of direction
• Conditioning

Cupping cannot assess or restore these qualities by itself.

It may only play a supportive role within a wider rehabilitation programme.

How many sessions will I need?

There is no fixed number of cupping treatments.

Some people may use it occasionally as part of physiotherapy.

Others may find that it offers little benefit.

Treatment should be reviewed based on whether it produces a meaningful improvement in:

• Symptoms
• Movement
• Exercise tolerance
• Function

There is usually little value in continuing indefinitely if it is not helping.