Cupping therapy: the complete UK guide

Cupping therapy has moved a long way from the glass jars and lit tapers of traditional practice. Today it sits in physiotherapy clinics, sports therapy rooms and home recovery kits, usually in the form of a plastic or silicone cup and a hand pump. It is also one of the most searched-for recovery treatments in the UK, and one of the least well explained.

This guide is the hub for everything we have written about cupping: what it is, what suction does to the body, the different types, what the research does and does not support, what a session feels like, who should avoid it, and how to choose a set. Where a topic deserves more depth, we link to a dedicated article. For the short version, our existing post What is cupping therapy? covers the basics in a few minutes.

What cupping therapy is

Cupping is the practice of placing a cup on the skin and removing some of the air inside it so that the skin and the tissue beneath are drawn up into the cup. The vacuum is created by heat (fire cupping), by a hand pump, or by an electric device. The cups are left in place for a few minutes, or slid across oiled skin, and then released.

It has a long history across Chinese, Middle Eastern, Greek and European medicine. In the UK you will find it offered by acupuncturists, massage therapists, sports therapists, physiotherapists and hijama practitioners, and used at home by people managing muscle tightness or recovering from training.

How suction affects the body: what is known

The honest answer is that the mechanism is only partly understood. What can be said with reasonable confidence comes from a small number of laboratory and imaging studies.

Suction stretches the tissue. A finite-element model of cupping by Tham and colleagues, published in the Journal of Biomechanics in 2006, showed that the stress created by the vacuum stays largely within the area under the cup, that higher vacuum pressures produce higher tissue stress, and that the amount of vacuum is likely to determine how much bruising occurs [1]. In plain terms, the cup pulls the skin, fat and superficial muscle upward, and the harder you pull, the more the tissue is loaded.

Blood flow to the skin rises sharply, then settles. Wang and colleagues measured skin blood flow with laser Doppler before and after cupping on the upper arm of healthy adults. Peak blood flow after a five-minute application rose many times above baseline, and higher suction produced a bigger rise [2]. The authors interpret the pattern as reactive hyperaemia, the surge of blood that follows a period of restricted flow, although this is an interpretation rather than a direct observation.

At higher pressures, small vessels break. Lowe's 2017 review describes how negative pressure stretches the skin, increases local blood flow and, at sufficient force and duration, ruptures capillaries. The blood that leaks into the tissue is cleared by immune cells, a process that involves the enzyme haem oxygenase-1 and produces by-products with anti-inflammatory activity in laboratory studies [3]. This is the most plausible explanation for cupping marks, and it is covered in detail in our article on cupping marks and what the colours mean. A 2024 imaging study in mice found that a lower suction level improved local blood and lymphatic flow without tissue damage, while a higher level caused capillary rupture and swelling [4]. That is animal data, but it supports the idea that more suction is not automatically better.

Several theories, no single answer. A 2019 review grouped the proposed explanations for cupping's effects into six theories, including pain-gate mechanisms (ways in which one stimulus can dampen the perception of another), nitric oxide release, immune activation and the traditional claim of "detoxification" [5]. The authors are clear that none is proven. We would put it more plainly: cupping does not remove toxins from the body.

The types of cupping

Dry (static) cupping

The most common form, and the one our sets are designed for. Cups are applied to intact skin, the air is removed with a pump, and the cups are left in place for a set time, typically five to fifteen minutes. Nothing penetrates the skin.

Wet cupping (hijama)

Wet cupping adds small superficial incisions to the skin before a cup is re-applied, so that a small amount of blood is drawn out. It is an invasive procedure with real infection-control and bleeding considerations, and it should only be carried out by a trained, insured practitioner. In the UK it is most often encountered as hijama, which has a religious and cultural context for many Muslim patients. We compare the two approaches in dry cupping vs wet cupping (hijama).

Flash cupping

Cups are applied and released repeatedly in quick succession over the same area. It is a gentler stimulus that leaves fewer marks and is sometimes used on people who are new to cupping.

Moving or gliding cupping

Oil is applied to the skin, a cup is attached at light to moderate suction, and the cup is slid along the muscle. The effect is closer to a deep massage stroke than to static cupping, and it is popular with sports therapists working on the thighs, calves and back. Our step-by-step guide to using a cupping set covers the gliding technique.

Fire cupping

The traditional method. A flame briefly heats the air in a glass cup, which is placed on the skin as the air cools and contracts. It works, but it carries a burn risk that pump cupping does not. An Australian burns registry review found that cupping-related burns, while rare, were almost all flame burns involving an accelerant such as methylated spirits, with most occurring at home and many requiring surgery [6]. Fire cupping belongs with trained practitioners only.

Electric and vacuum cupping

Electric devices use a motor to create and sometimes pulse the suction, often combined with heat, vibration or a scraping function. They remove the pumping effort and allow more consistent pressure, at the cost of portability and simplicity. The Meifuly electric cupping and scraping machine in our range is an example.

What people use cupping for, and what the evidence says

Cupping has been studied for a surprisingly wide range of conditions, from shingles to acne. For the audience of this site, the relevant questions are about pain and recovery.

Low back pain

A 2018 systematic review and meta-analysis by Moura and colleagues pooled ten trials of cupping for chronic back pain and found a significant reduction in pain intensity compared with control conditions. The authors described cupping as promising, but noted that treatment protocols varied widely [7]. A 2021 "evidence map" of thirteen systematic reviews rated low back pain as the one condition with the most consistent positive findings, while rating the quality of most of the underlying reviews as moderate or low [8].

Context matters here. The NICE guideline on low back pain and sciatica (NG59) does not mention cupping at all. It recommends exercise as the core of treatment, allows manual therapy only as part of a package that includes exercise, and advises against acupuncture [9]. Cupping is not a recommended NHS treatment for back pain, and any benefit is best understood as a short-term aid alongside an exercise programme rather than a replacement for one. We go through this in cupping therapy for back pain and sciatica.

Neck pain

A 2018 meta-analysis in BMJ Open pooled eighteen randomised trials. Compared with no treatment, cupping reduced neck pain and improved function, and it also reduced pain when added to usual care. Against active treatments, the pain benefit remained but the functional benefit did not reach significance. The authors rated the evidence as low to very low quality [10].

Chronic pain overall

The most useful single reference is the 2020 meta-analysis by Cramer and colleagues in The Journal of Pain, which pooled eighteen trials with 1,172 participants. Cupping produced a large short-term reduction in pain compared with no treatment, and a medium reduction in disability. Compared with sham cupping, however, there was no significant difference for either outcome [11]. That last point is important. It suggests that a meaningful part of the benefit people report comes from expectation, attention and the ritual of treatment, as with many hands-on therapies. That does not make the relief imaginary, but it does mean the specific effect of suction is smaller and less certain than the before-and-after experience suggests.

Athletic recovery and performance

Cupping became widely known in the UK after swimmers appeared with circular marks at the 2016 Olympics. A 2018 systematic review by Bridgett and colleagues looked at eleven trials in amateur and professional athletes. Cupping was associated with less perceived pain, better range of motion and lower creatine kinase (a blood marker of muscle damage) compared with mostly untreated controls, but the trials were small, most were at unclear or high risk of bias, and none reported on safety. The authors concluded that they could neither recommend for nor against cupping for athletes [12]. If your main goal is recovery between sessions, it is worth reading our guide to compression boots and massage guns, where the evidence for reduced soreness is somewhat better developed.

Other conditions

Kim and colleagues' 2011 systematic review of cupping for pain found seven trials, most small and at high risk of bias, with suggestive but not conclusive evidence of benefit [13]. Cao and colleagues' 2012 review of 135 randomised trials, mostly from China, found potential benefit for conditions such as herpes zoster, almost always when cupping was combined with other treatments, and again rated the methodological quality as low [14].

A fair summary

What a session feels like

Most people describe a tight, pulling sensation as the cup draws the skin up, which settles into a dull pressure within a minute or so. It should not be sharply painful. With gliding cupping, the feeling is similar to a firm massage stroke. Cups are usually in place for five to fifteen minutes. Afterwards the area often feels warm and loose, and the skin may be red, raised or marked where the cups sat. Some tenderness for a day or two is normal.

Cupping marks

The circular marks that cupping leaves are the first thing most people ask about. They are not bruises in the usual sense of a blow to the tissue, but they do involve blood leaving small vessels, which is why they range from pink to deep purple and fade over several days to two weeks. Practitioners often "read" the colour of a mark, but there is very little research behind those interpretations. We cover the mechanism, the colour spectrum, duration and when a mark is a warning sign in cupping marks explained.

Side effects and who should avoid cupping

For dry cupping on healthy skin, the common effects are marks, mild soreness, redness and occasionally small blisters if suction is too strong or left too long. Serious complications are rare, and most of the serious cases in the medical literature involve wet cupping, fire cupping or people with underlying conditions. The Cramer meta-analysis found adverse events to be more frequent with cupping than with no treatment, though not significantly different from sham or active treatments [11].

Cupping should be avoided, or only used after medical advice, if you have a bleeding disorder or take anticoagulant medicines, have skin that is broken, infected, sunburnt or affected by eczema or psoriasis in the treatment area, have a deep vein thrombosis or varicose veins in the area, are pregnant, or have severe heart, kidney or liver disease. Our article on cupping therapy side effects and contraindications explains the reasoning behind each and sets out when to stop and seek help.

At home or with a practitioner

Dry pump cupping is one of the few manual therapies that a sensible adult can learn to apply safely at home, which is a large part of its appeal.

• See a practitioner if you have a specific injury or diagnosis, if you want cupping as part of a broader treatment plan, if you want wet or fire cupping, or if you have any of the conditions listed above. A good practitioner will assess you first and will tell you if cupping is not the right tool.
• Use a set at home if you are managing general muscle tightness, post-training stiffness or recurring tension in areas you can reach, and you are otherwise healthy. Start with light suction and short durations. Our how to use a cupping set at home guide walks through preparation, placement, timing, removal and cleaning.

For therapists, cupping pairs naturally with soft-tissue work and exercise rehabilitation. In a sports setting it sits alongside shockwave therapy for tendon problems and compression for recovery; each addresses a different part of the picture.

Choosing cupping equipment

The main choices are cup material (rigid plastic, silicone or glass), the method of suction (hand pump, squeeze or electric), and the number and sizes of cups. For most clinics and home users, a rigid plastic pump set offers the best balance of control, hygiene and value. Silicone cups suit gliding work. Glass is for fire cupping and is best left to practitioners trained in it.

Our cupping therapy collection is built around two Hansol professional pump sets made in Korea, a 17-cup set that covers most needs and a 30-cup set for clinics treating several areas at once, plus an electric option. We compare them, and explain what to look for in any set, in best cupping sets in the UK.

Frequently asked questions

Does cupping hurt? It should not. Expect a strong pulling sensation that settles quickly. Sharp pain, burning or numbness means the suction is too strong or the cup is in the wrong place, and it should be released straight away.

How often can you have cupping? There is no evidence-based schedule. Most practitioners space sessions by at least a few days and wait for marks from the previous session to fade before treating the same area again. For home use, once or twice a week on a given area is a sensible upper limit.

Is cupping available on the NHS? Not as a standard treatment. NICE does not recommend it for back pain, and NHS physiotherapy departments rarely offer it. It is almost always a private or self-administered treatment in the UK.

Can cupping help with cellulite, weight loss or detox? There is no good evidence for any of these. Cupping changes local blood flow and tissue tension for a short time; it does not remove fat or toxins.

References

1. Tham LM, Lee HP, Lu C. Cupping: from a biomechanical perspective. Journal of Biomechanics. 2006;39(12):2183-2193. Record
2. Wang X, Zhang X, Elliott J, Liao F, Tao J, Jan YK. Effect of pressures and durations of cupping therapy on skin blood flow responses. Frontiers in Bioengineering and Biotechnology. 2020;8:608509. Full text
3. Lowe DT. Cupping therapy: an analysis of the effects of suction on skin and the possible influence on human health. Complementary Therapies in Clinical Practice. 2017;29:162-168. PubMed
4. Zhang P, Lv J, Ge C, et al. Quantitative evaluation of microenvironmental changes and efficacy of cupping therapy under different pressures based on photoacoustic imaging. Photoacoustics. 2024;40:100661. Record
5. Al-Bedah AMN, Elsubai IS, Qureshi NA, et al. The medical perspective of cupping therapy: effects and mechanisms of action. Journal of Traditional and Complementary Medicine. 2019;9(2):90-97. PubMed
6. Seifman MA, Alexander KS, Lo CH, Cleland H. Cupping: the risk of burns. Medical Journal of Australia. 2017;206(11):500. Full text
7. Moura CC, Chaves ECL, Cardoso ACLR, Nogueira DA, Corrêa HP, Chianca TCM. Cupping therapy and chronic back pain: systematic review and meta-analysis. Revista Latino-Americana de Enfermagem. 2018;26:e3094. Full text
8. Choi TY, Ang L, Ku B, Jun JH, Lee MS. Evidence map of cupping therapy. Journal of Clinical Medicine. 2021;10(8):1750. Full text
9. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. Published 2016, last updated December 2020. nice.org.uk/guidance/ng59
10. Kim S, Lee SH, Kim MR, et al. Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis. BMJ Open. 2018;8(11):e021070. Full text
11. Cramer H, Klose P, Teut M, et al. Cupping for patients with chronic pain: a systematic review and meta-analysis. The Journal of Pain. 2020;21(9-10):943-956. PubMed
12. Bridgett R, Klose P, Duffield R, Mydock S, Lauche R. Effects of cupping therapy in amateur and professional athletes: systematic review of randomized controlled trials. Journal of Alternative and Complementary Medicine. 2018;24(3):208-219. Record
13. Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for treating pain: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2011;2011:467014. Full text
14. Cao H, Li X, Liu J. An updated review of the efficacy of cupping therapy. PLoS ONE. 2012;7(2):e31793. PubMed

This article is for general information only and is not medical advice. Always follow the instructions supplied with your equipment, and consult a qualified healthcare professional if you have a medical condition or are unsure whether a treatment is right for you.