Cupping therapy is a complementary treatment that uses suction cups placed on the skin to create negative pressure, drawing blood toward the surface and increasing circulation to the treated area. The suction lifts the skin and underlying soft tissue away from the deeper muscle layers, producing a decompression effect that releases tension, reduces pain, and promotes the body’s natural healing response. Cupping therapy originated approximately 1500 B.C. in ancient Egyptian, Chinese, and Middle Eastern cultures, making it one of the oldest recorded treatment methods still in clinical use today. A 2025 systematic review and meta-analysis published in the Journal of Traditional Chinese Medicine examined 72 randomised controlled trials involving 5,720 participants and found that cupping therapy reduced pain intensity across multiple conditions. This article explains how cupping works, what types exist, what it treats, how it compares to massage, what to expect during a session, and how to care for yourself before and after treatment.

What Is Cupping Therapy and How Does It Work?

Cupping therapy is a form of myofascial decompression that uses suction cups to create a vacuum against the skin, lifting the superficial tissue layers away from the deeper muscles and fascia to increase blood flow, release adhesions, and reduce muscular tension. The term “myofascial decompression” describes the mechanism precisely: while massage therapy compresses tissue downward to release tension, cupping therapy decompresses tissue upward, producing a fundamentally different physiological response.

The suction force inside each cup pulls the skin and subcutaneous tissue (the layer of connective tissue directly beneath the skin) upward into the cup. The negative pressure created by this pull expands and ruptures tiny blood vessels called capillaries within the treated area. Capillary rupture triggers a localised inflammatory response where the body sends fresh blood, oxygen, nutrients, and immune cells to the site. The Cleveland Clinic confirms that this mechanism stimulates the body’s natural healing response at a cellular level, replenishing the cupped area with healthier blood flow.

The decompression effect also separates layers of fascia and muscle that have become adhered together through tension, overuse, or injury. Fascial adhesions restrict normal muscle glide and compress nerves and blood vessels within the tissue. Cupping lifts those adhesions apart from below rather than breaking them down from above, which is why many patients report a different quality of relief from cupping compared to traditional deep tissue work. A 2023 systematic review published in the Journal of Back and Musculoskeletal Rehabilitation found cupping therapy beneficial in musculoskeletal and sports rehabilitation, supporting its role as a clinical treatment rather than a purely traditional practice.

What Are the Types of Cupping Therapy?

The types of cupping therapy include dry cupping, wet cupping, running (sliding) cupping, and fire cupping, each using a different method to create suction and achieve a specific therapeutic effect. Dry cupping is the most commonly practised type in Canadian rehabilitation and massage therapy clinics. Wet cupping involves a small skin incision and is less common in North American clinical practice.

Type	How Suction Is Created	Duration on Skin	Movement	Best For
Dry Cupping	Pump or silicone squeeze removes air from the cup	5-15 minutes	Stationary	Localised muscle tension, trigger points, pain relief
Running (Sliding) Cupping	Same as dry; oil applied to skin first	Continuous movement for 5-10 minutes	Gliding across the skin	Broad muscle groups (back, thighs), fascial release
Wet Cupping	Pump or heat; small skin incision made after initial suction	3-5 minutes per round	Stationary	Traditional practice; less common in Canadian clinics
Fire Cupping	Flame inside glass cup consumes oxygen, creating vacuum	5-15 minutes	Stationary	Traditional Chinese medicine practice; glass cups only

Sources: Cleveland Clinic; Banner Health; National Centre for Complementary and Integrative Health (NCCIH); StatPearls (National Library of Medicine)

Dry cupping uses a hand pump or flexible silicone cup to remove air from inside the cup after it is placed on the skin. The vacuum pulls the tissue upward without breaking the skin. Silicone cups offer adjustable pressure because the practitioner controls suction intensity by how much they compress the cup before placement. Running cupping applies oil or lotion to the skin before placing the cups, allowing the practitioner to glide the cup across a broader area. Running cupping covers more surface area than stationary dry cupping and produces a sensation similar to a deep, pulling massage stroke.

Fire cupping is the traditional method where an alcohol-soaked cotton ball is briefly ignited inside a glass cup. The flame consumes the oxygen inside the cup, and the practitioner quickly places the cup on the skin before the air pressure equalises. The resulting vacuum creates strong suction. Fire cupping requires glass cups and specialised training, and it carries a slightly higher burn risk than pump-based methods. At our clinic, our registered massage therapists use dry and running cupping techniques as part of a broader registered massage therapy treatment plan.

What Does Cupping Therapy Treat?

Cupping therapy treats muscle tension, chronic pain, back pain, neck pain, shoulder stiffness, headaches, sports recovery soreness, and soft tissue adhesions that restrict normal movement. The Cleveland Clinic reports that cupping may ease symptoms of arthritis, carpal tunnel syndrome, headaches and migraines, and gastrointestinal disorders. The conditions that respond best to cupping share a common feature: restricted blood flow and fascial tension in the affected tissue.

Chronic low back pain is one of the most studied applications of cupping therapy. A 2022 meta-analysis published in the journal Medicine analysed 10 randomised controlled trials involving 690 patients with low back pain. Wet cupping produced a statistically significant reduction in pain intensity (P < .01), and both dry and wet cupping groups showed significant disability score reductions compared to control groups. Chiropractic care combined with cupping therapy often addresses low back pain from two directions simultaneously: spinal joint mobilisation restores segmental motion, while cupping releases the surrounding soft tissue tension that contributes to stiffness and restricted movement.

Neck and shoulder tension from prolonged desk work responds well to cupping because the upper trapezius and levator scapulae muscles develop chronic fascial adhesions from sustained static postures. Cupping decompresses those adhesions while increasing local circulation to muscles that receive reduced blood flow during long periods of seated work. Athletes use cupping for post-training recovery because the increased blood flow accelerates the removal of metabolic waste products from fatigued muscles. A 2024 randomised controlled trial confirmed that cupping yielded positive results for fibromyalgia treatment, expanding its evidence base beyond musculoskeletal pain alone.

Does Cupping Actually Release Knots?

Yes, cupping releases muscle knots by lifting and separating the compressed layers of fascia and muscle tissue that form the knot, increasing blood flow to the area and allowing the muscle fibres to return to their normal resting length. A muscle knot, clinically called a myofascial trigger point, is a hyperirritable spot within a taut band of muscle where the fibres have contracted and cannot release on their own. Traditional massage compresses the knot from above to force the fibres apart. Cupping decompresses the tissue from below, pulling the overlying fascia away from the trigger point and creating space for blood and oxygen to reach the contracted fibres. The combination of decompression and improved circulation allows the trigger point to deactivate. Many practitioners combine cupping with direct trigger point pressure within the same session, using both decompression and compression to address the knot from two directions.

Is Cupping Better Than Massage?

Cupping is not better or worse than massage; it is a different mechanism that complements massage rather than replacing it. Massage therapy applies direct compression to muscle tissue using the therapist’s hands, forearms, and elbows. Cupping therapy applies decompression through suction, lifting the tissue upward. Compression pushes adhesions apart from above; decompression pulls adhesions apart from below. The two mechanisms target the same problem through opposite physical forces.

A patient with chronic upper back tension may respond better to cupping in areas where the fascia has become densely adhered and resistant to direct pressure. The same patient may respond better to deep tissue massage in areas where specific trigger points require sustained compression to deactivate. Physiotherapy assessments help determine which technique, or which combination, is most appropriate for each patient’s presentation.

In practice, many registered massage therapists integrate cupping into a massage session rather than performing it as a standalone treatment. A session might begin with running cupping across the upper back to lift the fascial layers and increase circulation, followed by targeted deep tissue work on the specific trigger points that cupping exposed. The cupping prepares the tissue for deeper manual work, and the manual work addresses the focal adhesions that cupping alone cannot fully resolve. This integrated approach often produces stronger results than either technique used in isolation.

Does Cupping Therapy Really Work?

Yes, cupping therapy shows promising evidence for pain relief, with multiple systematic reviews confirming its effectiveness for musculoskeletal pain conditions, though the quality of available research is still improving. The 2025 meta-analysis by Wang Yiying et al. reviewed 72 randomised controlled trials involving 5,720 participants and found that cupping reduced pain intensity across multiple conditions. The majority of included trials reported cupping improved cure rates (average risk ratio greater than 1.15) and reduced Visual Analogue Scale (VAS) pain scores (average mean difference reduction of 0.16 to 7.0 cm).

A separate 2025 meta-analysis published in BMJ Open concluded that cupping therapy may be effective in reducing pain intensity for chronic musculoskeletal pain with immediate effects. An evidence-mapping study published in Frontiers in Neurology in 2023 confirmed “good support for the clinical use of cupping therapy” for pain outcomes. The National Centre for Complementary and Integrative Health (NCCIH) recognises cupping as a complementary health approach and notes that research is ongoing.

The evidence has limitations. Many existing trials carry high risk of bias due to difficulty blinding participants (patients can feel whether cups are applied with suction or not), small sample sizes, and inconsistent cupping protocols across studies. The honest assessment is that cupping shows consistent positive signals for pain relief across a large body of trials, but the field needs more high-quality, well-blinded studies to confirm the magnitude of the effect. In clinical practice, the low risk profile of cupping combined with the consistent patient-reported benefits makes it a reasonable complementary tool within a broader rehabilitation plan. Acupuncture is another evidence-supported complementary modality that shares historical roots with cupping and is often used alongside it in clinical settings.

Does Cupping Reduce Cortisol?

Cupping may reduce cortisol by activating the parasympathetic nervous system through sustained skin stimulation and pressure receptor activation, though the direct evidence for cortisol reduction specifically from cupping is limited. The mechanism is plausible: sustained contact with the skin activates pressure receptors that stimulate the vagus nerve, which increases parasympathetic activity and lowers cortisol (the body’s primary stress hormone). Research on massage therapy has documented this cortisol-reduction pathway extensively, and cupping produces a similar sustained pressure stimulus through suction rather than compression. Patients frequently report feeling deeply relaxed during and after cupping sessions, which is consistent with parasympathetic activation.

What to Expect During a Cupping Session

What you can expect during a cupping session is a structured treatment that begins with a brief assessment, proceeds through cup placement with adjustable suction, and concludes with aftercare instructions. At our Markham clinic, cupping is delivered as part of a registered massage therapy appointment, meaning your RMT assesses your condition, applies cupping where it is clinically indicated, and combines it with other manual techniques within the same session.

1. Assessment and preparation. Your RMT asks about your symptoms, treatment goals, and any contraindications before beginning. The treatment area is exposed and cleaned. Oil or lotion may be applied to the skin, especially for running cupping.
2. Cup placement. Your therapist places 3 to 5 cups (up to 7 in some cases) on the treatment area. Silicone cups are compressed and released to create suction; pump cups are attached and pumped to the desired intensity. You feel a pulling, tightening sensation as the skin lifts into the cup.
3. Suction hold. Cups remain in place for 5 to 15 minutes depending on the treatment goal and your tissue response. Your therapist monitors the tissue colour beneath each cup and adjusts or removes cups based on the response. Communication throughout the session keeps the intensity within your comfort level.
4. Running cupping (if used). With oil applied, the therapist glides the cup across the skin in slow, deliberate strokes. Running cupping covers larger areas like the full back or thighs and produces a deep pulling sensation.
5. Cup removal and post-treatment. Cups are removed by breaking the seal. The treatment area shows round, reddish marks where the cups were placed. Your therapist explains the marks, provides aftercare instructions, and may follow the cupping with targeted manual therapeutic massage work on specific areas of tension.

Is It Painful to Do Cupping?

No, cupping is not painful. The sensation during cupping is a firm pulling or tightening of the skin, which most patients describe as unusual but comfortable. The Cleveland Clinic confirms that cupping should not cause pain, though you may feel mild skin tightness during the procedure and slight soreness afterward. The suction intensity is adjustable; your therapist increases or decreases the vacuum based on your verbal feedback throughout the session. Areas with significant tension or adhesion may feel more intense than areas with healthy tissue. If the sensation becomes uncomfortable at any point, tell your therapist immediately so they can reduce the suction or reposition the cup.

What Do Cupping Marks Mean?

Cupping marks are round, reddish or purplish discolourations caused by broken capillaries beneath the skin, and they are not true bruises. True bruises result from blunt force trauma that damages muscle fibres. Cupping marks result from controlled suction that ruptures superficial capillaries without damaging the underlying muscle. The Cleveland Clinic specifically distinguishes cupping marks from bruises, noting that the marks should fade within one to two weeks.

The colour and intensity of cupping marks carry diagnostic value for experienced practitioners. Darker marks (deep purple or crimson) indicate greater tissue congestion, meaning the area had poor circulation and significant stagnation before treatment. Lighter marks (pale pink or light red) indicate healthier circulation with less underlying congestion. Areas of chronic tension and restricted blood flow typically produce darker marks than areas with normal tissue health. Marks from subsequent sessions on the same area often become progressively lighter as the tissue health improves, which provides visual confirmation that the treatment is producing cumulative benefit. Laser therapy applied to cupping-treated areas can accelerate the resolution of the marks by stimulating cellular repair and reducing residual inflammation.

What Should You Do Before and After Cupping?

Before cupping, you should hydrate well, eat a light meal, and communicate your symptoms and health history to your practitioner. After cupping, you should continue hydrating, avoid hot showers for 4 to 6 hours, and allow the treated area to rest.

• Before: Hydrate. Drink water in the hours leading up to your appointment. Well-hydrated tissue responds more comfortably to suction and recovers faster after treatment.
• Before: Eat a light meal. Avoid arriving on an empty stomach, as cupping can cause lightheadedness in some patients. A light meal 1 to 2 hours before the session provides stable blood sugar without diverting blood flow to heavy digestion.
• Before: Communicate. Tell your therapist about any medications (especially blood thinners), skin conditions, recent surgeries, or areas of sensitivity. Full disclosure allows the therapist to adjust technique and avoid contraindicated areas.
• After: Hydrate. Drink 2 to 3 extra glasses of water beyond your normal intake in the 24 hours following treatment. Hydration supports the lymphatic system in processing the metabolic waste released during cupping.
• After: Avoid hot showers and baths for 4 to 6 hours. The treated skin is more sensitive and the pores are open after cupping. Hot water can irritate the skin and increase post-treatment soreness.
• After: Avoid intense exercise for 24 hours. Allow the treated muscles to recover and the localised inflammatory response to complete its healing cycle before adding training stress.
• After: Keep the treated area warm. Cover the cupped areas with clothing and avoid direct exposure to cold or wind for several hours. Traditional cupping practice and modern clinical guidelines both recommend protecting the treated skin from environmental exposure immediately after treatment.

Why No Shower After Cupping?

You should avoid showering immediately after cupping because the treated skin is sensitised from the suction, the pores are open, and hot water can increase inflammation and soreness in the cupped areas. Waiting 4 to 6 hours allows the skin to recover from the suction stimulus and the superficial capillary rupture to begin its natural clotting and repair process. Wet cupping carries additional infection risk from the small skin incisions, making the no-shower guideline even more important for that method. Lukewarm water is acceptable after the waiting period; avoid very hot water for the rest of the day.

How Many Days Should I Rest After Cupping?

You do not need to rest for multiple days after cupping. Most patients return to normal daily activities immediately after the session. The recommendation is to avoid intense physical exercise for 24 hours to allow the localised inflammatory response to complete its healing cycle. Light walking, gentle stretching, and normal work activities are all appropriate on the day of treatment. Exercise rehabilitation sessions can resume the day after cupping, and many athletes schedule cupping on rest days specifically to align the recovery window with their training schedule.

How Long Do Cupping Results Last?

Cupping results last from several days to several weeks for acute pain relief, with cumulative benefits building over a series of treatments. A single cupping session may produce immediate relief from muscle tension and stiffness that persists for 3 to 7 days. The relief tends to diminish as the underlying tension patterns re-establish themselves through the same activities (desk work, training, repetitive movement) that caused the tension initially. Repeated cupping sessions produce longer-lasting results because each treatment further improves circulation, reduces fascial adhesions, and retrains the tissue’s baseline state of tension.

How Often Should You Get Cupping?

How often you should get cupping depends on your condition, but most patients benefit from weekly sessions during active treatment and monthly sessions for ongoing maintenance. Acute muscle tension or pain may respond well to 1 to 2 sessions per week for the first 2 to 3 weeks, then taper to biweekly or monthly as symptoms improve. Athletes managing training-related soreness often maintain a biweekly cupping schedule during heavy training blocks. Your registered massage therapist adjusts the frequency based on how your tissue responds between sessions and how quickly the cupping marks fade, which reflects improving tissue health.

Who Should Not Get Cupping Therapy?

People who should not get cupping therapy without medical clearance include those with bleeding disorders (haemophilia), those taking blood-thinning medications, people with active skin conditions (eczema, psoriasis, open wounds), individuals with a pacemaker, and pregnant individuals (particularly on the abdomen and lower back). The Cleveland Clinic lists anaemia, cardiovascular disease, deep vein thrombosis (DVT), a history of stroke, and epilepsy as additional contraindications. Cupping should never be applied directly over bones, the spine, the eyes, or areas with active infection or open wounds.

The contraindication list exists because cupping ruptures capillaries and increases local blood flow. Patients with bleeding disorders or those on anticoagulant medications face elevated bruising and bleeding risk under the suction. Skin conditions like eczema and psoriasis can flare or worsen with the skin irritation caused by suction. Pregnant individuals should avoid abdominal and lower back cupping because of the potential effect on blood flow and tissue tension in those areas. The safest approach is to disclose your full medical history to your practitioner before the first session so they can determine whether cupping is appropriate for your situation.

Does Cupping Pull Out Toxins?

Cupping does not pull out toxins in the way popular claims suggest. The Cleveland Clinic notes that some people believe cupping releases toxins, but the mechanism is more accurately described as improved lymphatic drainage and enhanced removal of metabolic waste products from the treated area. The suction increases local blood flow, which helps the body’s natural waste-clearance systems (the lymphatic system and venous return) process byproducts like lactic acid more efficiently. The darker colour of cupping marks in congested areas reflects poor pre-existing circulation, not “toxins” being drawn to the surface. Cupping supports the body’s own cleaning systems rather than extracting specific toxic substances.

Frequently Asked Questions

How Long Do Cupping Marks Last?

Cupping marks typically last 7 to 14 days and fade gradually from dark red or purple to light pink before disappearing entirely. The duration depends on your skin type, the intensity of suction used, and the level of tissue congestion in the treated area. Areas with significant pre-existing tension and poor circulation produce marks that last closer to two weeks. Healthy tissue with good circulation produces lighter marks that fade within a few days.

Can You Exercise After Cupping?

You should avoid intense exercise for 24 hours after cupping to allow the localised inflammatory response to complete its healing cycle. Light activity like walking and gentle stretching is appropriate on the day of treatment. Full training intensity can resume the following day. Many athletes schedule cupping sessions on rest days or recovery days to avoid overlap with high-intensity training.

Is Cupping Safe During Pregnancy?

Cupping during pregnancy requires caution. The Cleveland Clinic advises against cupping therapy during pregnancy due to limited research on its effects. Banner Health recommends avoiding cupping on the abdomen and lower back during pregnancy specifically. Consult your healthcare provider before receiving cupping therapy during pregnancy. Lighter prenatal massage techniques are generally considered safe alternatives during pregnancy.

What Is the Difference Between Dry and Wet Cupping?

Dry cupping uses suction alone to lift the skin and underlying tissue into the cup. Wet cupping adds a small skin incision before or after suction to draw a small amount of blood. Dry cupping is the most commonly practised method in Canadian massage therapy and rehabilitation clinics. Wet cupping is more common in traditional Middle Eastern and Chinese medicine practices. Dry cupping carries lower infection risk because the skin is not broken.

Does Cupping Help With Headaches?

Cupping may help with tension headaches by releasing muscle tightness in the upper trapezius, suboccipital, and cervical spine muscles that contribute to headache patterns. Research published in the Journal of Traditional Chinese Medicine reported that cupping improved symptoms related to pain conditions including headaches and migraines. Cupping applied to the upper back and neck reduces the muscular tension that compresses nerves and restricts blood flow to the head.

Can Cupping Help With Anxiety?

Cupping may reduce anxiety symptoms through parasympathetic nervous system activation. The sustained skin contact and pressure receptor stimulation during cupping promote a relaxation response similar to the one documented in massage therapy research. Patients frequently report feeling calm and deeply relaxed after cupping sessions. While cupping is not a primary treatment for anxiety, it contributes to overall stress reduction as part of a broader wellness and rehabilitation approach.

Putting It All Together

Cupping therapy is a clinically supported complementary treatment that uses negative pressure to decompress soft tissue, increase blood flow, and reduce pain. The evidence from 72 randomised controlled trials and multiple systematic reviews confirms that cupping provides measurable pain relief for musculoskeletal conditions, with a low risk profile that makes it appropriate as part of a broader rehabilitation plan. Whether you are managing chronic back pain, recovering from athletic training, or dealing with stubborn muscle knots that resist traditional manual therapy, cupping offers a different mechanism of relief that complements the techniques you may already be receiving.

At KC Rehab, our registered massage therapists integrate cupping into your treatment session based on your assessment findings, combining it with deep tissue work, trigger point therapy, and other manual techniques to address your specific needs. If you are curious about whether cupping could help your condition, a conversation with our team is a good place to start. Booking is easy through the contact page.