Cupping

Athletes do it. Practitioners recommend it. It’s been around for over 2,000 years. So, what is the deal with “cupping”? Does it truly work? What does the science say? Well, in this article, we will understand what cupping is, its effectiveness, and understand the physiology to give us an evidenced based view of the topic.

What is Cupping?

Cupping is a technique used by many that requires cup-like tools that are suctioned to skin. This technique is thought to help with relaxation and, chiefly, aid in pain, soreness relief [1][2]. Some even use it to relieve congestion or asthma-like symptoms [1]. More extreme views even claim that cupping releases qi (life force) and purges toxins from the body [1]. You may liken it to a specialized type of massage/acupuncture technique using cups.

To be clear, there are several types of cupping, but they generally work similarly.

Is Cupping effective?

There are a number of proposed benefits, so we will need to break this down appropriately. The first, and most studied, claim is its pain relief abilities.

Pain Relief

Like I said, this is the most studied, but the research is a bit equivocal. On one hand, most of the research points to the conclusion that cupping does positively impact pain; as in, it reduces acute and chronic pain, be that in the lower back, neck, wherever [3][4][5]. So, at first glance, one might conclude similarly, but I feel this may be a hasty mistake.

While it is entirely possible various forms of cupping may have a positive outcome on pain measures, the studies that tested this used a variety of measures, but the commonality between measures was the fact that they were, for the most part, questionnaires (subjective measures) [3][5][12]. Now, while I understand that randomized controlled trials are the gold standard for research, they have some laughable issues as most of these “controlled” trials randomize people between a cupping group and a no-cupping/treatment group. This is, often, a great way of determining if there is an effect, and may work if the researchers take biomedical markers that are objective of results, but if the measure is a questionnaire on perceived pain, it seems pretty silly to assume that people who are abundantly aware they underwent treatment will not be significantly biased in their answers.

If I tell one person I will do something to them to relieve them of pain and I tell someone else I will do nothing for them, and I then ask them if they feel any better – which do you think is more likely to answer affirmatively? Obviously, the person who received treatment, even if, objectively, their pain receptors are still firing just as frequently as before. Why? Because, they perceive I have done something to help them, or, worst case, they may just want to make me happy (so nice of them!) and will answer in a way they feel will make me satisfied (this is called “response bias”, or, for fun, we can call it the “grandma effect”, because everyone’s grandma will side with their grandchild, right?).

That isn’t to say cupping isn’t effective, but it does heavily question the research substantiating its effectiveness. Other studies are largely case studies, which certainly should not be used to determine anything beyond setting the road for further study through methodologically sound work [5]. One factor that I must bring up that is a slightly more objective measure of effectiveness is the number of pain relief pills used between the cupping group and the untreated (control) group – the cupping group used less over the counter pain pills than the control group [6]. This might indicate some level of effectiveness, but was this due to a placebo effect or not? We do not know.

Congestion & Asthma

This is especially difficult to assess, because there is almost no literature on the topic. However, among the few case studies that have used cupping to treat asthma or some level of airway obstruction, there have been no conclusions in cupping’s favor [7].

Qi & Detoxing

Surprisingly, I did manage to find a study that mentions the role of Qi and detoxing through cupping, but beyond explaining the concept in more detail, they did not discuss any data or measures for either, so there is no credible scientific evidence for cupping’s impact on Qi or detoxing – although, admittedly, I am no expert in Qi [8].

Skin Conditions

Frankly, as much as I would love to review the literature on this topic, the literature is almost exclusively in Chinese (aka, not one of the languages I know). However, according to two reviews, skin conditions like acne and herpes zoster benefit substantially from cupping [9][10]. That said, considering the lack of sound study design in previous areas, it would be prudent to be extremely skeptical, especially since claims of cupping being superior to pharmaceutical interventions have been made.

Sports Performance

There is no applicable evidence that shows cupping has any positive impact on sports performance. One review which cited many of the issue saturated studies discussed earlier in this study seems to try and make an argument, but taking into consideration the lack of applicable research and the serious problems in research surrounding the topic, the likelihood is low that cupping has any real world impact [11]. However, if research emerges, this conclusion may change.

Safety?

While more studies need to be done on this topic, it seems that cupping may have a few adverse effects, although unlikely to be life threatening. In most cases, bruising is common and not dangerous in healthy populations [13]. Some people may experience more pain at the original site of treatment than originally, some may feel tingling or soreness, and some may experience hematomas (swelling from clotted blood at the site of microtrauma to the vessels)[13]. After cupping, it is also possible to suffer from infection, but this is unlikely in sterile environments [2]. The degree of discomfort, damage, and potential benefit are also largely dependent on the professional doing the cupping.

So, cupping is generally considered safe, based on loads of anecdote and several studies, for generally healthy individuals [2][13].

Understanding the Physiology

Honestly, since the research is not convincing that cupping even has any positive impact, it is difficult to explain the physiology. However, we can discuss the proposed mechanism by which people claim it acts on the body – it is rather simple.

The primary mechanism by which cupping acts on the body is by pulsing on the skin, the blood vessels located through the dermis and hypodermis (parts of the skin, fat) dilate and may even break, leading to bruising in the region, as well as blood pooling outside of the vessels. This may be a positive (if the vessel does not break) by promoting further blood flow through a region. Not only that, it may decrease soreness by promoting blood flow through superficial (surface) regions of the body. These positives are assuming cupping proves to be beneficial (so far, unlikely). However, I do not know how deeply cupping impacts the body, and if its impact is only the skin, then it will likely have a negligible impact on muscle tissue, which is deeper than the dermis and hypodermis, and may be especially useless in overweight or obese individuals with a larger hypodermis.

However, assuming that it does reach the muscle and supply stimulus for greater blood flow, there are several questions we must ask ourselves:

1. How long does this effect last? The bruising is not indicative of effectiveness, simply pooling of blood in the skin and just below the skin.

2. Why not massage? One would be surer of possible tissue perfusion (blood entry) benefits with a deep tissue massage. This, then, brings about the question of - even if cupping is effective, is it more effective than a deep tissue massage?

As we can see, there is more than sufficient doubt to be highly skeptical until further, more sound evidence emerges.

SUMMARY

All in all, while there is plenty of research indicating many potential benefits from cupping, this research has gaping holes in its methodology, causing sureness in effectiveness to drop substantially. Based on the current research, there is no conclusive evidence that shows cupping is, in any way, helpful to the body beyond psychological trickery, placebo effect; this may change as more appropriate research presents itself in the future. Cupping, while coming with some undesired side effects, is likely safe for healthy individuals.

Writer: Nicolas Verhoeven
References

[1] Rushall, K. (n.d.). The Many Benefits of Chinese Cupping | Pacific College. Retrieved from http://www.pacificcollege.edu/news/blog/2014/09/20/many-benefits-chinese-cupping

[2] Cupping | NCCIH. (2016, August 19). Retrieved from https://nccih.nih.gov/news/cupping

[3] Chi, L., Lin, L., Chen, C., Wang, S., Lai, H., & Peng, T. (2016). The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial. Evidence-Based Complementary and Alternative Medicine, 2016, 1-7. doi:10.1155/2016/7358918

[4] Cao, H., Li, X., & Liu, J. (2012). An Updated Review of the Efficacy of Cupping Therapy. PLoS ONE, 7(2), e31793. doi:10.1371/journal.pone.0031793

[5] Huang C, Choong M, Li T. Effectiveness of cupping therapy for low back pain: a systematic review
Acupuncture in Medicine Published Online First: 25 July 2013. doi: 10.1136/acupmed-2013-010385


[6] Kim, J., Kim, T., Lee, M. S., Kang, J. W., Kim, K. H., Choi, J., … Choi, S. (2011). Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial. Trials, 12(1). doi:10.1186/1745-6215-12-146

[7] Alternative Therapy: Cupping For Asthma. Goodwin J, McIvor R. Chest. 2011;139(2):475-476.
doi:10.1378/chest.10-2220.

[8] Mehta, P., & Dhapte, V. (2015). Cupping therapy: A prudent remedy for a plethora of medical ailments. Journal of Traditional and Complementary Medicine, 5(3), 127-134. doi:10.1016/j.jtcme.2014.11.036

[9] Cao, H. (2011). Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials. Alternative Therapy Health Medicine, 16(6), 48-54. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151529/

[10] Cao, H., Yang, G., Wang, Y., & Liu, J. (2013). Acupoint Stimulation for Acne: A Systematic Review of Randomized Controlled Trials. Medical Acupuncture, 25(3), 173-194. doi:10.1089/acu.2012.0906

[11] Musumeci, G. (2016). Could Cupping Therapy Be Used to Improve Sports Performance? Journal of Functional Morphology and Kinesiology, 1(4), 373-377. doi:10.3390/jfmk1040373

[12] Farhadi, K., Schwebel, D. C., Saeb, M., Choubsaz, M., Mohammadi, R., & Ahmadi, A. (2009). The effectiveness of wet-cupping for nonspecific low back pain in Iran: A randomized controlled trial. Complementary Therapies in Medicine, 17(1), 9-15. doi:10.1016/j.ctim.2008.05.003

[13] Cao, H., Li, X., Yan, X., Wang, N. S., Bensoussan, A., & Liu, J. (2014). Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials. Journal of Traditional Chinese Medical Sciences, 1(1), 49-61. doi:10.1016/j.jtcms.2014.11.003

"CLICK" for Most Recent