Cupping is a therapy that uses suction cups on the skin to lift and decompress soft tissue, essentially working as the opposite of traditional massage pressure. While a massage therapist pushes down into muscle, cupping pulls tissue upward and apart, increasing blood flow to the area and releasing tension in the fascia (the connective tissue surrounding muscles). It’s commonly integrated into massage sessions to target stubborn knots, back pain, and neck stiffness.
How Cupping Works on Your Body
When a cup is placed on your skin and suction is created, the negative pressure draws skin and underlying tissue upward into the cup. This stretches the fascia, separates layers of tissue that may have become stuck together, and dilates the small blood vessels in the area. Your body releases natural vasodilators, including histamine and nitric oxide, which widen capillaries and flood the treated area with fresh blood.
That increased circulation is the main driver behind cupping’s effects. More blood flow means more oxygen and nutrients reaching tight or damaged tissue, and faster removal of metabolic waste products that accumulate in sore muscles. The suction also stimulates the lymphatic system, helping drain excess fluid from congested areas. Some research in athletes has found that cupping reduces certain markers of systemic inflammation, including decreases in immune cell ratios that track with lower overall inflammatory activity.
The sensation is distinct from any other bodywork. Most people describe it as a firm pulling or tugging, not painful but noticeably intense. Areas with more tension often feel stronger suction, even when the same amount of pressure is applied across multiple cups.
Types of Cupping in Massage
There are several approaches, but two are most common in massage settings:
- Stationary (dry) cupping: Cups are placed on specific points and left in position for 5 to 10 minutes. This creates sustained decompression over a tight area, similar to holding a deep stretch. It’s the classic technique and produces the most noticeable circular marks.
- Sliding (moving) cupping: Oil is applied to the skin first, and the therapist glides the cup across the surface while suction is maintained. This combines the decompression effect with a massage-like stroking motion, covering a broader area. It’s especially popular for the back and shoulders and tends to leave lighter marks than stationary cupping.
A third type, wet cupping, involves making tiny punctures in the skin before applying cups so that a small amount of blood is drawn out. This is a traditional medical practice in some cultures but is not part of standard massage therapy and carries additional risks including infection and scarring.
How Suction Is Created
The original method, fire cupping, uses a flame briefly held inside a glass cup to burn off the oxygen. Once the flame is removed and the cup is placed on the skin, the cooling air contracts and creates a vacuum. Despite how dramatic it sounds, the cup itself isn’t hot when it contacts your skin. The heat is used only to displace air.
Modern alternatives skip the fire entirely. Manual pump cups, usually made of plastic, have a valve on top connected to a small hand pump that lets the therapist dial in precise suction. Silicone cups are the simplest option: you squeeze the flexible cup to push air out, place it on the skin, and release. The cup springs back toward its original shape, creating suction in the process. Electrically powered pumps also exist, though they’re less common in massage rooms.
What the Different Cup Materials Feel Like
Glass cups are the traditional choice and what most clinical practitioners use for fire cupping. They’re thick, durable, and create strong, consistent suction. Many therapists consider glass the best material for deep muscle release, though the intensity can be too much for sensitive areas. Glass sets are also the most expensive and fragile.
Silicone cups have become increasingly popular, especially for sliding cupping and home use. Because they’re squeezable, they don’t require fire or pumps. They conform easily to curved body parts like shoulders and calves, and the therapist can adjust pressure on the fly by squeezing harder or softer. Silicone cups are easy to clean with soap and water, nearly impossible to break, and generally leave lighter marks than glass. They’re the gentler option, making them a good starting point if you’ve never had cupping before. Plastic cups with manual pumps sit somewhere in between, offering adjustable suction without fire and holding up well over time.
What the Research Shows About Pain Relief
Cupping’s strongest evidence is for short-term pain relief. A systematic review and meta-analysis published in The Journal of Pain found a large short-term reduction in pain intensity when cupping was compared to no treatment at all. However, when compared to sham cupping (cups placed without real suction) or other active treatments like conventional massage, the differences were not statistically significant. This suggests that some of the benefit may come from the ritual of treatment itself, the sensation of pressure, or simply lying still for 10 to 15 minutes, rather than from the suction mechanism alone.
That doesn’t mean cupping is useless. Many people experience meaningful relief from muscle tension and soreness, and several biological mechanisms support why it could work: increased local blood flow, tissue decompression, and reduced inflammatory signaling are all plausible pathways. The evidence just hasn’t caught up to the level of certainty that exists for some other manual therapies. For chronic pain conditions like persistent low back or neck pain, cupping is best viewed as one tool among many rather than a standalone solution.
Those Circular Marks
The distinctive round marks left after cupping are not bruises in the traditional sense, though they look similar. They’re caused by superficial capillary rupture: the suction breaks tiny blood vessels just under the skin, allowing small amounts of blood to pool in the surrounding tissue. The marks typically appear as round purplish or reddish discolorations that match the diameter of the cup.
Color varies based on how much stagnation or congestion was present in the tissue. Darker marks generally show up in areas that were tighter or more restricted. Lighter pink marks often appear in healthier tissue. Most marks fade completely within 3 to 10 days, though this depends on your skin tone, how strong the suction was, and how long the cups were left in place. Sliding cupping tends to produce more diffuse, lighter coloring compared to stationary placement.
Side Effects and Who Should Avoid It
The most common side effects are mild: skin redness, tenderness at the treatment sites, and those characteristic marks. These are considered normal responses rather than complications.
More serious but rarer side effects include burns (from fire cupping done incorrectly), persistent skin discoloration that takes weeks to resolve, and in very rare cases, scarring. The National Institutes of Health notes that cupping can worsen skin conditions like eczema and psoriasis, so it should be avoided over active flare-ups. If you’re on blood-thinning medications or have a bleeding disorder, the capillary rupture from cupping could be more extensive than expected. Cupping should also be avoided over sunburned skin, open wounds, or areas with prominent varicose veins.
Equipment hygiene matters, too. Cups that contact one person’s skin can become contaminated with trace amounts of blood, even during dry cupping. Shared equipment without proper sterilization between clients creates a theoretical risk of transmitting bloodborne infections. Any reputable massage therapist will either sterilize cups between clients or use single-use disposable ones.