Does Cupping Work? Examining the Science

The Ancient Practice of Cupping

Man at cupping therapy session
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With massage, pressure is applied to the soft tissue overlying muscle and bone to relieve pain. Cupping is like the opposite of massage. Practitioners use suction cups to draw soft tissue from the surface of the body. Although the exact mechanism of cupping is unclear, its result is evident: Blood engorges the cupped area (hyperemia and hemostasis), forming a large hickey. 

Some people swear by the relief elicited by cupping, and it's used to treat a variety of conditions, including chronic pain and respiratory ailments.

To date, the scientific study of cupping has been limited to few lower-power randomized control trials burdened with bias.

What Is Cupping?

Cupping is an ancient therapy used in China and the Middle East for 2,000 years. Dry cupping is a noninvasive procedure that is often coupled with acupuncture , another form of traditional Chinese medicine.

Cups used in cupping were historically made of bamboo or clay. Nowadays, plastic and glass are often used. The physical mechanism of cupping involves suction. This suction is created either using a flame or suction valve. (Don't worry, the flame isn't applied to your skin. The air inside the cup is burned off using the flame, and the cup is then immediately applied to the surface of the body.) Various cups have been created that can be applied to not only smooth parts of your body but also contoured surfaces.

Two main types of cupping exist- dry cupping and wet cupping (AKA hijama).

Dry cupping is completely noninvasive and uses suction to professedly increase blood circulation, loosen tissue, and relax the nervous system (which is why cupping is used to treat hypertension). Wet cupping is like dry cupping but takes the whole process a step further: Small incisions are made to the cupped area in order to bleed it.

  Wet cupping should be performed in a sterile environment with sterile instruments.

In the hands of a skilled practitioner, cups can be used in various ways. Here are some iterations of cupping therapy:

  • cupping with retention (keeping the cups on for an extra-long 10 to 15 minutes)
  • quick cupping (removing the cups quickly once the skin is sucked into the cup)
  • shaking cupping (gently lifting the retained cups over acupuncture or other skin areas)
  • moving cupping (sliding lubricated cups over the skin or acupuncture points)
  • balance cupping (a mix of the above cupping subtypes)

How Does Cupping Work?

There are various explanations for why cupping works. In my estimation, each explanation is merely a conjecture unproven by science and limited in scope. For example, one theory explains that the negative pressure created by cups stretches muscle and nerve fibers thus increasing blood circulation. However, this explanation doesn't cover why cupping is perceived useful in treating cellulitis and migraines.

Another theory has it that injury caused by cupping trips pain inhibitors in dorsal horn cells at the level of the spinal cord. However, this explanation doesn't explain why cupping is useful in conditions that are usually painless like hypertension.

A third theory ties the therapeutic effect of cupping to acupoints or acupuncture points. (Cupping can be applied either to acupuncture points or localized areas of injury.) Finally, some theorize that wet cupping works by facilitating excretion of tainted blood and tissue fluids.

Does Cupping Pass the Scientific Smell Test?

In recent years, there have been some systematic reviews which scour the literature for evidence that cupping works and whether it poses a risk for adverse effects. As mentioned above, however, randomized control trials (gold-standard experiments) are few and limited by power (low sample size or number of participants) and bias.

In an oft-cited 2013 systematic review published in PLoS ONE, Chinese and Australian researchers found that despite limitations in research design, cupping may help with various diseases or conditions including herpes zoster, acne, facial paralysis (Bell's palsy), and cervical spondylosis. Moreover, a meta-analysis performed by researchers suggested that cupping worked best when combined with other modalities including acupuncture and Western medications. Of particular note, researchers found that both wet and dry cupping were safe with no risk of adverse effects other than painless bruising which typically resolves in about a week.

Another 2013 review article published in the journal Acupuncture Medicine, examined cupping as therapy for lower back pain. Researchers found that cupping may be useful in providing pain control and improved quality of life.

What Does Cupping Mean to You?

From a scientific perspective, we still know little about cupping. It's a consensus opinion among many experts and researchers that even though cupping looks promising as a means of medical therapy, more research needs to be done. Nevertheless, countless people from today and eons past claim relief from cupping, and such anecdotal accounts can't be dismissed. 

Should you decide to partake of cupping, make sure that your practitioner provides therapy in a sterile environment. Practitioners should wear gloves, use sterile cups and other sterile instruments especially when wet cupping.   

On a more personal note, please remember that it's your right to demand that your health care provider wears sterile gloves. Whatever the medical situation (including cupping), you should never feel embarrassed or ashamed to ask the person providing treatment to wear gloves especially if she wasn't planning to. 

Sources:

Cao H, et al. An Updated Review of the Efficacy of Cupping Therapy. PLoS ONE. 2012.

El Sayed SM, et al. Medical Scientific Bases of Wet Cupping Therapy (Al-hijamahl): in Light of Modern Medicine and Prophetic Medicine. Alternative and Integrative Medicine. 2013.  

Huang C et al. Effectiveness of Cupping Therapy for Low Back Pain: A Systematic Review. Acupuncture Medicine. 2013. 

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