This post is part of a series on cupping. To facilitate a better understanding of cupping, I would suggest you first review an introduction to the connective tissues and their layered formation by reading Fascia Facts.

I love cupping!  My only regret with using it is that I did not begin sooner.  I stumbled upon it in 2016 or so.  I, along with the rest of the viewing world, saw Michael Phelps, the Olympic swimmer with circular bruises all over his shoulders (and other places).  Prior to this I had heard of cupping but had no exposure to it.  Fast forward to now, 2021 as I write this:  I use cupping on practically every person I treat!  It’s not the answer to every problem, and it’s not the only intervention I utilize.  But when it is the right technique to use and it is applied in the right location with proper dosing it can impart incredible influence on the body.  I remember using it once on a young woman who had pain in her anterior (front of the body) lower rib region following a surgery in the area years prior.  Nothing seemed to help her pain, and she was truly suffering.  I cupped her throughout the area and not only did it alleviate her pain, but also her constipation which had been present since childhood.  Magic?  Sort of, but not if you understand the anatomy and physiology of our amazing bodies. 

Cupping bruises on Michael Phelps 2016 Olympics
Michael Phelps in the 2016 Olympics in Rio de Janeiro brought cupping to the attention of the world with his circular bruises. I have heard such bruises referred to as the “Badge of Honor,” although I try to avoid leaving such evidence of cupping. Photo from Vanderbilt University My Southern Health.

What is Cupping?

Cupping basically involves the use of suction or a vacuum force applied to the surface of the skin.  I guess you could use the hose of a vacuum cleaner, I never thought about it until now.  Kind of hard to control the intensity of the suction at least with my central vac, so let’s not.  More commonly cups are used, although some cultures used animal horns, pottery, or metal containers and still may (see the history section).  The vacuum effect was often created by the practitioner placing the pointed end of the horn in their mouth and sucking.  Fortunately we now have some alternatives on the market!  Modern day cups are typically glass, hard plastic, or soft silicone depending on the technique used as well as the preference of the practitioner and patient.  A vacuum or negative pressure is created in the cup, causing it to suction the skin and tissue below where applied.  I explain to patients that it decompresses the hypodermis, which I’ll elaborate more in the physiology section.  When using the soft silicone cups the vacuum is created by simply pressing the cup onto the skin, making them very simple to apply especially for self or home treatment.  This simplicity comes at the cost of versatility, specifically in terms of the amount of suction available (all or none).  The hard plastic cups often have a valve at the top and come with a pump that creates the negative pressure (this is the type I use in practice).   Glass cups are preferred by some, especially when heat is being used to create the vacuum effect. 

An example of the silicone cups and their application.  These are the simplest of all the options in cups, making them popular for home or self-treatment.  Negative pressure is created by simply compressing the top of the cup, causing it to affix to the skin.  Images from Amazon. 
Here I am using the hard plastic version of cupping that uses a pump to create negative pressure. I like the versatility and control I have with this version of cupping. I can vary the amount of suction used according to the person’s tolerance and their dysfunction. I also like the options it gives with using static cupping (leaving the cups in place) as well as dynamic cupping – gliding the cup as I am doing in the photo on the far right. Dynamic cupping is my go-to for several reasons, and I tend to use it the most. This kit comes with a variety of cup sizes which suit various parts of the anatomy. The tube pictured in the middle photo also allows for self-treatment of hard-to-reach places such as the back. Most people are surprised to learn how inexpensive these kits are (as of this writing this kit is $36.99) through Walmart. I have used this kit for years and it has held up well. I often recommend to my patients that they purchase a kit for home use as part of their self-management/maintenance strategy – another post another day! Photos by Colleen Whiteford, center photo from Walmart website.
Heated glass cupping
This depicts cupping with glass cups and using heat to create the vacuum. The flame consumes the oxygen inside the cup, allowing for the suction component. The heat also generates a nice sense of warmth without burning. From

Some sources recognize as many as 10 different types of cupping methods, which could vary according to how you classify them:  weak/light cupping, medium cupping, strong cupping, moving cupping, needle cupping, moxa/hot needle cupping, empty/flash cupping, full/bleeding cupping (see image below), herbal cupping, and water cupping.  It’s not my intent or desire to address all of these, and some are self-explanatory.  To my way of thinking moving or dynamic cupping could have more than one interpretation.  First, the practitioner is gliding the cup on the patient as I’m doing on the leg in the earlier picture.  This requires some type of lubricant, and may even necessitate repeat application of the lubricating agent depending on the dryness of the skin and the length of the session.  I tend to use generic lotion, but others may use essential oils or something else.  This is my favorite method for several reasons:  it minimizes bruising as compared to static cupping; it can cover a broad area of dysfunctional tissue; the gliding of the cups mimics massage in a way, but with a decompression element as opposed to a compressive force such as our hands impart; it helps to highlight areas of greatest dysfunction in the tissue, as they will typically be more sore. 

A second interpretation of moving/dynamic cupping could be to having the patient actively move the body part that has the cups on it.  So if the thigh was being cupped, the patient would bend and straighten the knee, or walk around with the cups on.  The challenge with this is keeping the cups on, as movement tends to dislodge them especially if there is lubricant on the skin.  Glass cups certainly would not be a good idea in this case!  For me the decision to use light, medium, or strong cupping depends on the person and the issue being addressed.  Dysfunctional tissue can be very sensitive, so I tend to respect the patient’s pain report and vary the intensity of suction according to their tolerance and response.   Sometimes I’ll also use a combination of static and dynamic cupping simultaneously.  If there is a particularly stubborn and painful area within a larger area that I am treating, then I may place a cup over the worst spot and leave it still for maybe 1- 5 minutes while I do dynamic cupping around it.  I have also placed cups over stubborn and painful fascial densifications that are resisting resolution with manual shearing (for more information on this see my section on Fascial Manipulation).  Sources vary as to how long to leave cups in place, and I have read anywhere from 10-30 minutes. 

Depiction of wet cupping from a centuries-old German bible. Wet cupping differs from standard cupping in that prior to the cup being applied a tiny incision is made to the skin, then the cup applied with suction over the site. The result is that there will be some blood suctioned into the cup. While some clinicians today still utilize this form of cupping, I have no experience or training with it and currently have no plans to pursue it! I will refer you to a study that did show it to be beneficial for removing heavy metal toxins from the body . Image source: Otto von Passau: Die 24 Alten (Bruchstücke).

Watch for more information on cupping in future posts!

Wishing you health and joy,



Published by Colleen Murphy Whiteford

I am a physiotherapist, graduate of Saint Louis University Class of 1984. I married my best friend and business partner, Bill, who is also a physiotherapist, in 1988. We have worked together all these years - an example of God's grace! Together we started Appalachian Physical Therapy which continues to thrive. I am a big believer in the power of touch, the manual therapies, and treating holistically. There are many alternatives to medications, surgeries, and testing, but people are often uninformed. My perspective emphasizes the role of the connective tissues including the fascia. Lack of attention to this structure is the source of many physical ailments - our bodies are truly fearfully and wonderfully made (Psalm 139)! I am passionate about helping people of all ages and diagnoses maximize their health, and empowering them to understand their role in management and prevention of problems.

3 thoughts on “Cupping

  1. Wonderful information to have! Thank you for sharing your knowledge in such an easy to understand approach!

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