Cupping

What it is

Cupping is the most physical of the therapies we offer, and one of the few that patients regularly ask for by name. Glass cups are placed on the skin under suction, drawing the tissue gently upward rather than pressing down into it — in mechanical terms, almost the reverse of massage. For shoulders that remain tight despite stretching, a low back that feels locked, or muscles that seem to have settled into a permanent state of tension, it can produce a kind of release that nothing else in the treatment room does quite the same way.

Cupping is usually incorporated within an acupuncture or massage and bodywork treatment, and not booked as a standalone treatment.

How it works

The traditional method, and the one we use most often, is fire cupping. A flame is passed briefly inside a glass cup and immediately withdrawn before the cup is placed on the skin. As the heated air inside cools and contracts, the pressure drops and the skin and underlying tissue are drawn upward into the cup. The flame never comes into contact with you, and because it is inside the cup for only a fraction of a second, the glass itself remains comfortable against the skin.

The cups are usually left in place for ten to fifteen minutes while you rest. At first there is a firm pulling sensation, which generally settles quickly into something closer to a sustained, deep stretch.

The effect of the suction is local and mechanical. It decompresses layers of muscle and fascia that manual therapies ordinarily approach through compression, increases blood flow through the area, and appears to reduce the sensitivity of tight and painful tissue. This is why a shoulder that has resisted days of stretching can sometimes begin to release within minutes under a cup.

The clinical literature on cupping remains relatively thin, with mostly small trials and the strongest research concentrating on neck and low back pain. What is not in question in the treatment room is how consistently people with muscular pain return to it, and that the particular combination of suction, decompression, and sustained stretch produces an effect that manual pressure alone does not.

The variations

• Stationary cupping — cups placed and left in position over specific points or areas of tension. The standard treatment.
• Sliding or moving cupping — oil is applied and a cup is moved slowly across the muscle under suction, which feels like a deep, broad massage stroke. Used over the back and along large muscle groups.
• Flash cupping — cups applied and released repeatedly in quick succession, a stimulating rather than sustained technique.
• Suction and silicone cups — hand-pumped or squeezable cups that produce suction without a flame. Used on areas where a glass cup will not seal well, and where a flame is not appropriate.

The marks

Cupping leaves circular marks, and it is better to know what they are before you encounter them in the mirror.

They are not bruises in the ordinary sense: nothing has struck or compressed the tissue, and the marks themselves are generally not tender. Suction draws a small amount of blood from the capillaries into the surrounding tissue, producing the characteristic circular discoloration beneath each cup. The color may range from a faint pink to deep purple. Traditionally, a darker mark is understood to indicate greater congestion in the area, while tissue that is not holding much tension may barely mark at all.

The marks usually disappear within three days to a week, although occasionally they remain visible for as long as two weeks. They are painless as they fade. If you have a wedding, a beach holiday, a sleeveless dress, or anything else involving photographs and exposed shoulders, plan accordingly — or tell us and we can work somewhere less visible.

Cupping marks became briefly famous during the Olympics, when a number of American swimmers competed with them plainly visible across their shoulders and backs. Cupping has remained closely associated with professional athletic recovery ever since.

What cupping is used for

Cupping is at its best with muscular and soft-tissue complaints, and these are the reasons most people come to us for it.

• Neck, shoulder, and upper back tension — the most common reason people ask for it. Desk-bound shoulders, a stiff neck, upper back tension that has been there for months.
• Low back pain — particularly muscular low back pain and the tightness that follows a strain.
• Sports recovery and muscular soreness — after heavy training, and for the tight quadriceps, hamstrings, calves, and IT bands that come with running and cycling. Sliding cupping over large muscle groups is the usual approach.
• Restricted movement and chronic tightness — old injuries, repetitive strain, and the tissue quality that comes with sitting at a desk for years.
• Tension headaches — where they start in the neck and shoulders, as many do.
• Coughs, colds, and chest congestion — cupping over the upper back is a traditional treatment at the onset of a cold, for chest tightness and a stubborn cough.
• Stress held in the body — the sensation is unexpectedly relaxing, and many people find it leaves them calmer than they arrived.

Afterward

Keep the treated area covered and warm for the remainder of the day; skin that has been cupped is temporarily more sensitive to cold and drafts. Drink water, avoid a hard workout, and leave saunas, steam rooms, hot tubs, and swimming until the following day. A pleasant heaviness or tiredness for a few hours afterward is common and passes on its own.

Mild soreness over the treated area the following day is also normal. Sharp pain, blistering, or broken skin is not — call us if any of these occur.

Safety

Cupping is a low-risk treatment in trained hands. All cups are thoroughly cleaned and disinfected between patients, and the flame used for fire cupping remains away from the skin at all times.

Tell us if you take blood thinners or have a bleeding disorder, if you bruise very easily or have particularly thin or fragile skin, if you have varicose veins, or if you are pregnant — cups are avoided over the abdomen and low back during pregnancy. We do not cup over broken, inflamed, or sunburned skin, over moles or other skin lesions, or directly over a known blood clot or tumor site.

Common questions

Does it hurt?

No, although the sensation can be strong. It feels like a firm, sustained pull, which most people find satisfying rather than painful. Sliding cupping over a very tight muscle can be intense in much the same way as deep-tissue massage. If it is too strong, tell us; the amount of suction is easily adjusted.

How long do the marks last?

Usually three days to a week, occasionally up to two. They fade from purple through green and yellow like a bruise, and they do not hurt.

Are the marks a sign of damage?

No. Nothing has been injured; the suction draws a small amount of blood out of the capillaries into the surrounding tissue. Areas that are not tight tend to mark very little.

Do the cups get hot?

No. The flame is inside the cup for a fraction of a second and never touches you. The cup is warm at most.

Do you do wet cupping?

No. We practice dry cupping only — nothing is incised and no blood is drawn.

Can I have cupping if I take blood thinners?

Tell us. It may still be possible with much lighter suction, or we may advise against it. Have the conversation before treatment rather than after.

Can I go to the gym afterward?

Leave it until the next day, along with saunas, steam rooms, and swimming.