Cupping therapy has been around for centuries, but really increased in popularity after Micheal Phelps famously sported his post-treatment markings during the Olympics. Since this time, many elite athletes swear by cupping as a recovery and treatment method.
Cupping, like many other interventions, has a variety of techniques under the same umbrella. This is important to consider in that when you have "had cupping done", it may look different from practitioner to practitioner and from treatment to treatment. This is one of the reasons that it can be difficult to perform quality research in this area.
This being said, we do have a variety of research showing treatment benefit for a variety of conditions. There is a fairly strong "anti-cupping" campaign that exists out there full of people who argue against its use. This community will cite things such a research methodology errors and overdosage leading to the formation of bruises. They bring up valid concerns. However, context is important. Like most treatments, it is only effective with proper dosage, technique, and in the hands of trusted professional.
I tend to fall in the middle on most controversial issues within therapeutic interventions because I believe this is typically where the true answer lies. It is not necessary to be "all for" or "all against" a modality such as cupping. It IS necessary to be aware of the risks and benefits, as comes with any treatment. We can utilize cupping therapy for what it's effective for and not go overboard and pretend it is effective for everything and in every situation.
The proposed theory behind the mechanisms and benefit of cupping can be broken down into 4 main categories: mechanical effects, fluid dynamics, neurochemical effects, and enzymatic effects. We will cover each one individually.
Of all the proposed mechanisms, the mechanical effects are the easiest to see. When the negative pressure (aka suction) of the cup is in effect, you can visually see the lifting of the skin and redness from the increased blood flow. Under the skin, up to 6 millimeters of separation can be seen between layers of tissue on ultrasound studies.
This is useful because during the injury process, particularly chronic longer-lasting injuries, tissues can begin to go through densification and stick together. This decreases the ease of motion in the area and can reduce the range of motion of the adjacent joints over time. This process also tends to lead to pain and increased sensitivity of the tissue due to the associated chemical irritation and stagnation of fluid. Cupping is one technique that I can use to improve the ability of these tissues to glide while improving blood flow to allow healing and improved movement.
The fluid dynamic effects of cupping are helpful for the some of these same reasons. As mentioned, the mechanical disruption and negative pressure caused by the cup leads to a temporary increase in blood flow which can be helpful in bringing quality oxygen and nutrients to the injured area. This can be thought of as one of the primary fluid dynamic effects.
Cupping also tends to lead to a local increase in the temperature of the area being treated. This increase in temperature improves the viscosity (i.e. the ability to "flow" or move) of the fluid. This can be thought of as improving the lubrication of the tissues and around the joint, which allows for improved quality and quantity of motion.
Cupping therapy, along with many other hands-on techniques, creates a chemical cascade in response to the feeling of touch (mechanical stimulus). One substance released is known as nerve growth factor (NGF). NGF acts to strengthen the connection of the nerves in the local area to the spinal cord, brain, and rest of the nervous system. This is relevant because painful conditions, over time, lead to a decreased awareness of the body part compared to the rest of the body or even the same body part on the opposite side of the body. This is known as "cortical smudging", where the brain representation of that body part is less clear and defined, which can contribute to further increases in pain as well as reduced ability to move that body region effectively.
The stimulus of the cup touching the skin and mechanically disrupting tissue also helps to reduce pain levels temporarily in the affected region. Without getting too detailed, you can think of this as the feeling of the cup touching the skin "distracting" the brain from the pain in the area and reducing the intensity of the pain. This is known as the gate theory of pain modulation if you are interested to learn further.
I believe one of the most powerful things that cupping can do in the realm of treatment is to break the cycle of pain. There are times and conditions where pain just seems to come and go in a vicious, seemingly never-ending, cycle. One of the ways cupping can do this is through enzymatic means. The mechanical decompression or disruption caused by the cup leads to the release of heme. Heme is best explained as "blood garbage" that can bunker down in tissues for years and even decades at a time. It is essentially a type of metabolic waste that occurs throughout life and is typically more prevalent is dysfunctional tissues (where injury is also likely to occur). Heme is also one of the byproducts that leads to the bruise-esque markings on the skin after a static cupping session. When heme is released from the tissue during a cupping treatment, a healing cascade begins. Combine this healing cascade with increased blood flow mentioned previously, and you have a powerful start to overcoming a painful and debilitating condition.
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