The skinny on cupping: What does the science say?

Cupping therapy has been used for a very long time, but has now become part of mainstream conversation.
Cupping therapy has been used for a very long time, but has now become part of mainstream conversation.
Getty Images/Krisanapong Detraphiphat
  • Cupping therapy has been used for thousands of years.
  • It is believed to encourage blood flow and promote healing in many ways.
  • However, existing research has mostly delivered inconclusive results, and more high-quality trials are needed.

It is an ancient therapy that dates back to thousands of years - in fact, it has been documented in one of the world’s oldest medical textbooks (from 1550 BC), notes Cedars Sinai. But cupping quickly became part of the mainstream conversation in 2016, after Olympic athlete Michael Phelps was spotted with multiple circular marks on his skin. Phelps later said he uses cupping as part of his recovery programme. 

The practice, which pulls blood to a certain area of the body to improve circulation, flushes out toxins and loosens up muscles and joints, has also drawn the attention of some celebrities. Jennifer Aniston, Gywneth Paltrow, Victoria Beckham and Justin Bieber have previously been spotted with "cupping" marks on their bodies.

So, how does it work, is it safe and what does science say about its supposed benefits?

Dry and wet cupping

Cupping involves using a suction cup to suck in air (oxygen) around the skin. In doing so, it creates a partial "vacuum" at certain trigger points to encourage blood flow, which may then promote healing and decrease pain.

Dr Robert Shmerling, senior faculty editor for Harvard Health Publishing explains that "dry cupping" involves a suction cup applied to the skin for several minutes, and is sometimes combined with massage, acupuncture or other alternative therapies. "Wet cupping", on the other hand, is similar except that blood is removed by making small cuts in the skin so that toxins can exit the body via the small wounds.

READ MORE | What is cupping and how does it work?

"Cupping has been popular in Egyptian, Chinese and Middle Eastern cultures going back thousands of years, but increasing numbers of people worldwide have been adopting it. Celebrities and athletes have popularised it in the US in recent years," says Shmerling.

Advocates of the therapy also claim that it helps with back and neck pain, skin diseases like acne, lowering cholesterol, knee arthritis, migraines, and improves immune function.

The process is typically done by a trained professional, such as an acupuncturist, massage therapist or chiropractor. 

What does the evidence say?

Researchers over the years have tried to answer the question on whether cupping truly does have healing properties.

A 2015 review looking at 75 studies concluded that cupping might provide some relief for chronic neck or back pain, and no serious adverse effects were found. However, the quality of the evidence was too limited to draw firm conclusions, notes Harvard Health.

Researchers of a study looking at cupping to treat knee osteoarthritis wrote that, unfortunately, “Only weak evidence can support the hypothesis that cupping therapy can effectively improve the treatment efficacy and physical function in patients.”

A 2017 study suggested that the mechanical effect of cupping increases local blood flow and stretches underlying tissue.

A 2019 study concluded that there was no single theory to explain the whole effects of cupping, but that there were some theories. However, larger clinical trials were needed to confirm the benefits of cupping, said the authors.

The bottom line

While there have been some studies suggesting that cupping may reduce pain and promote healing, most of them are of low quality which cannot conclusively tell us whether cupping is effective.

In a blog post, a Mayo Clinic physician noted: "While some of the available studies do suggest a possible role for cupping in treating fibromyalgia, the definitive answer to its actual role will have to wait for larger and more rigorous studies to be completed."

Edzard Ernst, emeritus professor of complementary medicine, University of Exeter, wrote in the Conversation that back then, cupping was used mainly for musculoskeletal problems, such as back pain, neck pain or shoulder pain. His impression was that it helped ease the pain of most of his patients. "However, there weren’t any proper clinical trials to tell us more back then," he wrote.

Shmerling adds that, considering the evidence, the data does not seem to convincingly answer whether cupping does what it's proponents claim it does.

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He explains why it’s tough to perform high-quality studies on cupping: "The best studies are 'blinded placebo-controlled trials' in which neither the patient nor the researcher knows which treatment (real or placebo) has been given to a study subject. 

"When medications are studied, coming up with a placebo pill is not difficult, it can be much more difficult to create a convincing placebo comparator for cupping. In addition, pain can be a difficult thing to measure and the placebo effect - improvement related to an expectation of benefit - can be quite powerful."

But there have been studies comparing actual acupuncture with convincing but fake acupuncture, and so, similar studies of cupping could be possible, says Shmerling. 

Is it safe?

Studies so far have found cupping to be generally safe. The primary side effects are minor bruising and discolouration marks, which fade over a number of days or weeks. According to the National Health Institute (NHI), the practice may worsen eczema or psoriasis. It is also not recommended for people with epilepsy, haemophilia, or a history of stroke.

In very rare cases, there have been reports of bleeding inside the skull (after cupping was done on the scalp) and anaemia from blood loss (after repeated wet cupping).

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Sterilisation of equipment between patients is also crucial as the equipment can become contaminated with blood - intentionally in wet cupping or inadvertently in dry cupping - and may spread bloodborne diseases such as hepatitis B and C, notes the NHI.

Like all therapies, it's important to see a professional who has been trained appropriately to do cupping. If you are interested in this therapy, you should first consult with your doctor. 

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