Cupping Therapy: Deep Tissue Massage in the Opposite Direction

Updated: Apr 20

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Table of Contents

The History of Cupping

What does the science say?

How is Cupping Therapy done?

What is Cupping good for?

Are Cupping marks bruises?

Ready to Get Cupped?!


Cupping therapy and massage can push and pull tissue to treat neck/back pain.
Cupping therapy and massage can push and pull tissue to treat neck/back pain.

What is cupping? Imagine if an octopus tried to give you a massage, kneading and lifting tight muscles. As your body relaxes, circulation is restored, and you can feel space and movement where you once felt tight, stuck, and stiff.


There are many types of Cupping therapy, but all of them create a vacuum to lift and decompress the body. This is why Cupping is called “Deep Tissue massage in the opposite direction.”


When a massage therapist uses Cupping, they are able to both push and pull on your muscles, effectively doubling the treatment.


Just like massage, Cupping should feel good and the pressure is adjustable from very light to very intense to suit the client’s preference.


But there's a lot more to cupping than just that... Let's review the research, learn how Cupping is done and what it's good for, and examine those bizarre and inconsistent marks it can leave.



The History of Cupping


Cupping (hijama) is an ancient and world wide tradition for health and wellness.

Most people think of Cupping as part of Traditional Chinese Medicine, where there’s the famous saying: “Acupuncture and cupping, more than half of the ills cured.” But the practice is much larger than China. Eastern Europe, the Middle East, and Latin America have practiced Cupping throughout history.


The oldest written reference to Cupping comes from 1550 BC, in the Egyptian medical textbook Papyrus Ebers.


The Greeks practiced fire Cupping with clay pots, Hippocrates and Galen both being advocates.


The Prophet Muhammed said “Hijama (Cupping) is the most helpful procedure for human beings to cure themselves” (Sahih al-Bukhari º5357).


Older practices often used Cupping as a spiritual or religious practice for purification, as well as treatment for disease, organs, and muscle pain. Various peoples used fire, acupuncture needles, and even blood letting in combination with the cups. Wow!


In the U.S., Cupping has only recently gained popularity, from physical therapists and chiropractors who found the myofascial decompression to be a great tool for treating soft tissues like muscles and fascia.

Cupping is world wide: Cupping therapy with hollow buffalo horns on the streets of Indonesia.
Cupping therapy with hollow buffalo horns on the streets of Indonesia.

Cupping entered public consciousness when celebrity athletes like Michael Phelps appeared with infamous circular marks at the 2016 Olympics.


Because of this long worldwide history, there are many different styles of Cupping, and many old and new ideas about cupping does.


This article would become way too long if I tried to address every type of cupping, so I’ll be limiting the discussion to the modern Western approach, which has been re-invented to focus solely on soft tissue decompression.



What does the science say?


Small interlude: I always want to be as honest and sconce-based as possible, and that means admitting what we don’t know. Unfortunately, there’s just a lot about Cupping that has yet to be explained.


There’s a couple reasons for this. For one, it’s just difficult to study any soft tissue treatment, given the number of variables between participants and providers and the subjectivity of things like "pain" and "tightness." The research on massage lags behind for this same reason. Plus, there’s not a lot of money to be made from studying Cupping. Big pharma would rather push pills.


The most difficult aspect of Cupping research is the possibility of a placebo effect. Double blind trials are the gold standard of research: some participants get meds, some get sugar pills, and the data is assembled and studied without bias. But that doesn’t work with Cupping. You can’t have some participants receive Cupping, and some only think they’re receiving Cupping.


So, most studies end up comparing Cupping versus no treatment at all. Cupping almost always demonstrates good outcomes, but the value of that data is diminished because of the possibility of bias.


Cupping therapy MRI by Christopher Daprato and Kenneth Leung (UCSF Department of Physical Therapy).
MRI by Christopher Daprato and Kenneth Leung (UCSF Department of Physical Therapy).

A 2018 review of existing research summed it up like this: “Cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups. … No explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary for conclusive judgment on the efficacy and safety of cupping in athletes.” (Source)


There are many vague and bold claims of how Cupping removes toxins, cures respiratory illness, speeds up the metabolism, improves fertility, relieves eczema, and more. Places will advertise cupping for weight loss or cupping to get rid of cellulite. These benefits remain unproven.


Given the widespread use of Cupping around the world, and my personal experience and the transformations I’ve seen in my clients, I feel confident that Cupping is beneficial for myofascial health. At minimum, we can agree cups create a local tissue stretch, which will cause muscles to release, just like massage.



How is Cupping therapy done?


Your experience will be different if you receive cupping from a Traditional Chinese Medicine (TCM) practitioner or someone using a Western approach.


The most dramatic and flashy form of cupping is Fire Cupping. A flaming cotton ball is used to heat the air inside the cup, which is then quickly applied to the skin. As the air inside cools, it contracts, and a vacuum is created. Fire Cupping is favored by TCM. It’s known for feeling intense and leaving dark marks.


Fire cupping uses glass cups and fire to create a vacuum.
Fire cupping uses glass cups and fire to create a vacuum.

Nowadays we also have plastic cups that use a handheld pump to create suction, or squeezable silicone cups. My preference is silicone cups, because they can conform to the curves of the human body (unlike the unchanging rim of a glass or plastic cup). This means we can stick cups anywhere, and glide them over the skin to massage with negative pressure.


Plastic cups use a handheld pump to create a vacuum.
Plastic cups use a handheld pump to create a vacuum.

The longer a cup is one spot, the more likely it is to create a mark, so gliding techniques are the least likely to leave marks.


The pressure can be gentle and light, or it can be satisfyingly and intensely deep.


It’s important to note that Cupping should never be painful. Alert your practitioner if it’s too intense and they will reduce the pressure for you.



What is Cupping good for?


Any condition that can be helped by massage can also be helped with Cupping, with some added benefits to Cupping.


  • Back and neck pain

  • Stiff muscles

  • Headaches and migraines

  • Carpal Tunnel Syndrome / Thoracic Outlet Syndrome

  • Sciatica

  • TMJ Disorder

  • Rheumatism

  • Inflammation

  • Anxiety

  • Digestion

  • Menstrual cramps / endometriosis

  • Relaxation and well-being


A great example of Cupping’s strengths is treating Piriformis Syndrome (often misdiagnosed as Sciatica). The Sciatic nerve runs through the Piriformis muscle, and when that muscle is tight, it squeezes the nerve and causes sharp, shooting pain down the hip and leg.


Massage will try to reduce Sciatic pain by pressing on the Piriformis muscle, which, of course, agitates the Sciatic nerve further. Instead, try cupping! By stretching Piriformis with negative pressure, it both releases the muscle and creates space around the nerve to restore neural flow. Compression disorders such as Sciatica and Carpal Tunnel Syndrome are just some of the conditions that Cupping excels at treating.


The cups trap and stretch tissue to loosen muscles and connective tissue. The decompressive force separates tissue layers and invites blood flow to the area. This is particularly good for Trigger Points, those pesky stubborn knots that often send aches far and wide in the body. Trigger Points are the result of a circulation problem: a knot so tight it’s tourniqueted itself off from circulation. Cupping teases apart the knot, and brings in fresh circulation.


Cupping can also be used on tissues that we can’t grab hold of with our hands, such as the diaphragm (which runs deep, front to back through the torso).


When used in a massage, Cupping allows multi-tasking and a more productive session: for example, cups can be used passively open up the hips while the massage therapist’s hands work on the low back, for effective low back pain relief.


You can even give a gentle and relaxing face massage with cups, using gliding techniques that won’t leave any marks. This is a popular beauty treatment in Korea. The light suction moves lymph to reduce bags under the eyes and wrinkles, and it brings fresh circulation to the skin to help with acne. It’s great for jaw tension/TMJD and headaches. Plus, facial cupping feels amazing!


(Learn more about lymphatic massage and how this unique treatment can help with puffiness, wrinkles, and energy levels.)



Are Cupping marks bruises? Are Cupping marks dangerous?


Well, no discussion would be complete without addressing the most infamous aspect of Cupping: the marks.


Cupping marks on a woman's upper back indicate cupping therapy was done for upper back pain relief.
Light/medium cupping marks on a woman's upper back.

OK, I’ll admit it. Cupping is like a hickey. Practitioners won’t say that to avoid sexualizing soft tissue therapy... but it’s the simplest way to understand what Cupping marks are.


They aren’t a bruise, because the marks aren’t tender or painful like a bruise. The most accurate term is “hematoma.”


Marks develop when cups are left on for longer periods of time at intense levels. Stationary Fire Cupping will probably leave marks; gliding silicone Cupping will leave lighter marks or no marks.


Cupping marks are not permanent. They usually fade in 5 days or so.


Traditional Chinese Medicine explains the marks as a sign of stagnant Qi (Chi). The theory is toxins have been brought to the surface and removed from the body, and therefore the goal is create as many dark marks as possible. The truth is no one can fully explain the marks yet, and until we understand what’s happening to the body, it may be inadvisable to purposefully create dark marks .


Traditional Chinese Medicine interprets cupping marks to learn about stagnant Qi.
Traditional Chinese Medicine interprets cupping marks as a sign of stagnant Qi and toxins.

A mark sometimes develops “petechiae,” tiny little red dots. Petechiae is the result of micro-hemorrhage of the blood vessels. What’s interesting is that with repeated cupping, marks and petechiae will no longer appear. The theory is that this minor tearing of blood vessels allows for the vessels to heal again stronger, in the same way that exercise works: you lift weights, tear muscle fibers, and they heal back stronger than before. Whether this is true or not has yet to be proven.


In my practice, I do not see marks as dangerous nor as an ideal outcome. I only leave cups on for short periods of time to minimize the development of marks.


You can get Cupping without any marks: let your practitioner know you don’t want marks, and they can adjust the treatment for you.



Ready to get Cupped?


Cupping and massage are a great combo for relaxation, muscle health, and pain relief.


As you’ve learned by now, not all cupping is created equal, so put some consideration into who you book an appointment with. TCM Practitioners, Physical Therapists, Chiropractors, and Massage Therapists are some of the health care practitioners who perform cupping therapy. Ask your practitioner about their training and experience before receiving treatment, and listen to the language they use around marks.


Please note that Cupping is not suitable for everyone. If you have a condition that affects cardiovascular system such as Diabetes, deep vein thrombosis, or low blood pressure, or if you have skin fragility or lesions, Cupping is not recommended for you. Cupping is safe during pregnancy with certain precautions, same as massage. Always disclose your full health history and the medications you’re currently taking to your practitioner.


Looking for excellent Cupping therapy in Seattle?


In our Deep Heat Flow massage treatment, we combine Cupping, Cannabis Massage, and Hot Stones for a tension-melting sensory experience. Book online today.

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