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Cupping Therapy - How it Works & Safety

I’ll never forget my first clinical shadow shift as a 1st year Naturopathic Medical student. I walked into a treatment room and saw cupping being done on a patient’s back. I had never seen anything like it and I was so repulsed! In that moment - and remember, I came from a conventional pre-med undergrad education - I seriously questioned the career path that I had chosen.

Fast forward to present day, and here I am, having sought out additional cupping training (two 21 hr workshops) in addition to the my basic curriculum because I absolutely love the therapeutic benefits of cupping and want to keep learning new techniques.

Here’s the issue with cupping - it isn’t regulated. Meaning, various practitioners can offer this as a service with very minimal understanding of tissue response, technique, and lymphatic physiology. This can actually cause bruising and harm to patients so I want to shed light on the safety considerations, in addition to the physiological tissue responses.

Time to get nerdy…

Physiological Responses:

1. Releases myofascial adhesions: Negative pressure created by the suction creates separation and lift of underlying fascia from the muscle to release existing adhesions.

Fascia is connective tissue that surround muscles, but is a separate, independent layer. I think of it like skin on a grape. Normally, muscles should freely move underneath it. When the two layers get stuck together, adhesions can form, which can cause pain and restricted mobility. There are fascial networks in our body that connect over great distances, and sometimes a restriction in one area, creates pain/discomfort in another. When an adhesion forms, it can prevent blood flow from adequately hydrating the tissue, and when soft tissue is dehydrated, it tightens - further affecting contractility and range of motion.

Adhesions can form from: repetitive use of muscles (sport or job), bad posture, sedentary lifestyle, hard pressure (siting on hard chair), and poor hydration.

2. Improves circulation: Cups bring blood and lymph to an area, improving the fluid status of the muscle and fascia. Also, by addressing tight musculature and/or removing myofascial adhesions, peripheral blood flow to the extremities (like hands and feet) can improve.

3. Pain Gate Theory: It’s been proposed that cupping actives pain receptors in the skin (nociceptors) which alters pain response by decreasing signals travelling from the spinal cord to the brain. Cupping also creates micro-trauma via increased pressure on underlying capillaries. Basically, through those two mechanisms, cupping out-competes other pain signals. This can help address ‘central sensitization’ – an over-activation of pain circuitry in the brain in absence of injury, thought to be an underlying mechanism of chronic pain.

Note - the body is responding to cupping via pain signalling mechanisms, but cupping isn't painful. In reality, it feels like a unique massage where you're left with a sensation like more space has been created, as odd as that sounds. My patients know that if it ever feels too tight - they need to let me know ASAP so I can lessen the suction.

4. Release of Humoral/Immune Mediators: Cupping increases nitric oxide release from blood vessels which lowers vascular resistance (decreases blood pressure) and prevents platelet aggregation – so blood is less ‘sticky’. It also affects the immune system by boosting our natural defences (ex. complement proteins like C3) and decreasing inflammatory cytokines (IL-2.)

5. Clears Cellular Waste: This is the basis of a cupping mark. The suction action pulls trapped material to the surface of the skin, which has been trapped in soft tissue and hasn’t been resorbed or cleared by our immune system. These are things like: old red blood cells, cell fragments, lactic acid, and even cigarette smoke!