Can Cupping Help with Muscle Pain?

Image courtesy of Reuters

For about four hours, yes.

Many people saw the big purple bruises on gold-medalist swimmer Michael Phelps during the Summer Olympics, and became curious about cupping. Phelps is such a fan he posted a photo of himself getting cupped on Instagram. You probably saw bruises like that before back in high school, when we called them hickeys.

In the United States, people turn to cupping to relax the muscles and reduce pain, particularly in the neck or back, and some athletes say that it helps with sports-related pain.

The practice goes back to ancient Greece and Egypt and is now most common in China, where it is used for many conditions that might benefit from an increase in blood flow. According to an overview of the research, largely from China, cupping may be helpful to boost acupuncture or medication to treat acne, facial paralysis, shingles, and arthritis in the neck. The best evidence – which isn’t strong – applies to neck pain.

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Here’s how it works. Your therapist will put a flammable substance — alcohol, herbs, or paper — in a cup and set it on fire. Once the fire is dying, she’ll put the cup upside down on your skin, where it sits for up to three minutes. The air inside the cup cools, creating a vacuum. Your blood vessels expand, creating the bruise. You can see a video of a “fire” cupping below:

Another option is to use a rubber pump to create a vacuum. If the therapist uses silicone cups, she can move them from one spot to another on your skin.

In “wet” cupping, the liquid is your blood. The therapist puts the cup on your skin for three minutes, then removes the cup and makes light cuts on your skin with a scalpel. A second suction draws out your blood. Obviously, you’re risking infection, so if you try this, ask the therapist how he ensures cleanliness, and be sure that he applies some antibiotic and a bandage to each bruise afterwards. You can see a “wet” cupping below:

In a “needle cupping,” the therapist puts cups over acupuncture needles inserted into your skin.

Whatever method you opt for, it’s typical for the therapist to use no more than seven cups in a session. The bruises last from three to 10 days.

The recent science about cupping focuses on chronic neck pain, a common problem. A 2012 study compared the effects of cupping and a relaxation exercise on 61 middle-aged volunteers with chronic neck pain. Half of the volunteers received a cupping treatment twice a week for 12 weeks. The others did the relaxation exercise. Both groups reported less pain overall at the end of the trial, but the people who received the cupping reported more of a mood boost and felt less pain when the neck was pressed.

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In a study published in 2014, researchers implanted a microdialysis system on both sides of the trapezius muscle in 12 volunteers, half of whom had chronic neck pain. The system detected levels of lactate, pyruvate, glucose, and glycerin in the muscle. The researchers also measured the pain thresholds for all of the volunteers, either in their feet if they had neck pain, or near the neck in the healthy group. The cuppings occurred on only one side of the neck.

The results: Beginning two hours and forty minutes after a cupping, the muscle experienced chemical changes that usually come from intense physical exercise. Pain thresholds increased in the neck pain patients immediately after the cupping, but the effect was gone by the end of 4.5 hours.

It makes sense that athletes would like a practice that gives them immediate pain relief and then makes a muscle feel exercised.

Some people hope that a series of cuppings will help a chronic pain lessen over time. A study published in 2013 followed volunteers for two years after they had received cupping for neck pain. Overall, they didn’t report less pain, but did have more ability to turn their necks. Sixteen patients out of 82 said that the cupping kept their neck pain below what it had been, for around 9 months on average. But remember that they knew they’d received a treatment, so the placebo effect could explain all that relief.

To be sure the treatment actually did more than a placebo, you would need “blind” study comparing a group receiving a treatment and a group that received a placebo, and no one involved would know which group was which. In this study, the researchers noted that most of the patients didn’t choose to have more cupping therapy.

The study measuring pain thresholds also wasn’t blinded, so, again, the measurement may reflect the placebo effect. Is cupping a dumb thing to do? As long as you’re not spending too much or risking infection, something safe that makes you feel better isn’t necessarily a mistake. Pain is very much about perception, and we all have ways to “psych” ourselves into desired frames of mind.

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