Cupping (part III)

What Does Cupping Do?

As you can imagine there can be quite a variety of answers to this depending on the source, influenced by culture, beliefs, education, and experience.  The short answer would be that cupping instigates a change in the body.  In the past it was used it to draw unwanted substances from the body such as pus or poison from a wound site, and in some cases even evil spirits.  More modern explanations of what cupping does include hyperemia (increasing blood flow to an area), and relaxing local soft tissues.  It can also help to break up adipose (fat) deposits, edema/swelling, and help to soften up scar tissue so it’s more flexible. Traditional Chinese medicine practitioners often use cupping in conjunction with acupuncture to open energy channels and meridians. 

I like what my good friend and colleague, Sue Falsone of Structure & Function has to say about it all.  “There is no Eastern versus Western physiology – it’s all the same!”  So from here I’ll talk about the physiology from my scientific and Western influence.  As I mentioned earlier, I describe to my patients that cupping decompresses the hypodermis, which I’ll explain further below.  Understanding how cupping works its “magic” on so many issues necessitates an understanding of what structures it impacts.

The “Lasagna Slice” is one of my favorites for understanding the anatomy and physiology of the connective tissue layers. Cupping impacts all of these layers, as well as multiple body functions. Source unknown.

From the top down, this layered formation is loaded with important stuff:

  • Epidermis – the outermost layer of skin, which happens to be the most prevalent and highly innervated tissue in our body (see research slide below).
  • Dermis – just below the epidermis. This layer holds the hair cells that participate in thermoregulation as well as fight/flight response. It also houses the sweat and oil glands, which have autonomic (involuntary) nerves dedicated to them regulating their function.
  • Hypodermis – the name for the area below the dermis and above the deep fascia. It includes multiple structures that can be impacted with cupping:
    • Adipose tissue – (the yellow filler in the above image) serves as energy storage as well as insulation.
    • Superficial fascia – the wispy, membranous layer that divides the hypodermis in half. It serves as an important barrier between what we perceive in the outside environment and what’s going on inside the internal environment of our bodies.
    • Vertical ligaments – (the upright and leaning columns in the above image). These connect the skin to the superficial fascia as well as the superficial fascia to the deep.  With time these can become overstretched, owing to some of our sags and wrinkles.
    • Multiple tiny nerves – (not pictured above, but located throughout the hypodermis) provide sensation to the skin, and also regulate function of the sweat and oil glands as well as the lymphatic and blood vessels. The majority of these nerves have an autonomic component, which means they communicate with the part of the nervous system that controls the involuntary functions of the body. More on this below.
    • Multiple tiny blood vessels – (depicted in the above image as the red and blue lines) bring nutrition to the surface and carry waste products away.  Fun fact: the majority of them work primarily to control thermoregulation. 
    • Lymph nodes and vessels – (not pictured above, but found just below the superficial fascia in the hypodermis) aid in the movement of fluid throughout the body.
    • Loose connective tissue containing hyaluronan or hyaluronic acid (not pictured above, but found throughout the hypodermis) serves as a water-loving lubricant to keep things sliding and spaced apart.  Hyaluronan is a key component in many age-defying and wrinkle resistant products. 
Research showing the skin to be the most innervated tissue in the hip region
Layered analysis of the connective tissues of the hip shows the skin and superficial fascia to have the highest quantity of nerves. From Fascia and Soft Tissue Innervation in the Human Hip and their Possible Role in Post-surgical Pain, Fede et al, accessed at

While all these structures are vital in their own way, I want to elaborate on the nerves in the skin and hypodermis. Researchers at the University of Padova, Italy took layered samples of the connective tissues in the hip (very similar to the lasagna slice) and evaluated them in cadavers and living subjects who were undergoing hip surgery. Layer by layer they analyzed both the number of nerves in each layer and the size of the nerves. There was little difference between the cadavers and live subjects in terms of findings. They found the greatest quantity of nerves (the black diamonds in the above chart) to be in the skin! We always think joints or muscles as causing all the pain, but not so. Second highest for number of nerves was still not the joint but the superficial fascia. No surprise that the muscle would have the largest nerves since they need them to contract.

As the nerves course to the surface they serve various functions, based on location, anatomy, and purpose. The autonomic nerves are not a completely separate component, but provide input along their path even to the muscles. However, they dominate at the surface where the majority of neural input to the skin and hypodermis is coming from and going back to the autonomic nervous system (ANS). This makes perfect sense since the skin and superficial tissues are like radar: they are constantly perceiving the surrounding environment in order to make adjustments that support homeostasis (optimal function of an organism). You step outside from a cool office into blistering heat and immediately your superficial blood vessels have to dilate to dissipate heat, or you will become overheated.

Peripheral nerves are mostly autonomic
A wonderful simplification of a complex construct. The autonomic nervous system gives off branches to the muscles as it works its way up to the skin, where cupping can reach it. Used with permission from Dr. Carla Stecco, MD.

Time to circle back to the original topic of what cupping does.  As mentioned earlier, cupping has the effect of decompressing the hypodermis as well as the skin.   These structures can become thickened, stuck, condensed in response to overload – sort of like the deep fascia.  This overload can come from direct trauma, like a fall on a shoulder, a kick in the thigh from a cow, or a surgery on the abdomen.  But it can also become overloaded from environmental stressors such as cold, heat, chemicals (foods, medications, lotions, etc.), or even prolonged stress/anxiety.  These can affect the skin and hypodermis by compromising the space and slide between all the structures coursing through that I listed earlier.  I liken it to an area that should be like a nice chowder, thick and sturdy enough to support the contents yet also permit them freedom to move and function.  In cases of dysfunction it becomes more like peanut butter, making it much harder for these structures to exist in it and function normally.  The vacuum created in cupping helps to break up what gets stuck together, thickened, and dysfunctional in the these areas of the skin and hypodermis.  Whether it’s a small isolated pocket of dysfunction or a broad area, cupping helps to “unstuck” these areas freeing up the nerves, glands, vessels, and other structures.   

A depiction of some of the systems, functions, organs, and targets impacted by the autonomic nervous system (ANS). Rather impressive, don’t you think? This doesn’t even show them all! Source unknown.

Are you starting to see how powerful this can be for influencing multiple systems and functions throughout the body?  I’ve mentioned adipose, lymphatics, circulatory, sweat, oil, nerves – and they’re all talking to the autonomic nervous system (ANS) and participating in our immune, thermoregulation, and metabolic systems.  It’s amazing!  Think about all the medications on the market that target many of these organs and functions. Worthwhile to consider is the powerful impact we can have on these by properly identifying and addressing dysfunction in the skin and hypodermis. I like to say that cupping allows us to impact, massage, rock, kiss, unclog, decompress, and soothe the ANS.  It is also a very powerful tool for changing the proliferation of scar tissue and influencing the formation of collagen fibers. When I’m dealing with a patient who has any form of dysfunction that is regulated by the ANS I like to bring cupping into treatment at some point.  No wonder so many cultures have used it for so many problems for so many centuries!

Watch for more information on cupping in future posts! (This post is a continuation in 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.)

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.

One thought on “Cupping (part III)

  1. Astonishing information (however, too difficult for me to really grasp)!! But so delighted to have you when pain takes over parts of my body….

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