Massage cupping combines well with other modalities, is easy to integrate into a massage session, and is valuable as an assessment tool.

Just as there are many different approaches to massage, there are many types of cupping therapy.

A cup replaces the hand in vacuum manual therapies, where a machine is used to create a sucking effect.

We cannot create suction with our hands. The cup is held in the hand and the practitioner performs movements as they would with massage, except it is done with suction.

A cup may also be used for meridian and point work in traditional cupping therapies. Hybrids of these two approaches are coming into use as well. The beauty of adding cups into bodywork is the synergistic aspect of an integrated treatment.

Synergy means “made up of aspects or parts that work well together” (Encarta Dictionary). Traditional Chinese Medicine, for example, features the concept of yin and yang as synergistic forces. We have all noticed more impressive results as we learn and integrate new modalities into our work, because synergy increases the benefits of our treatment.

Massage cupping combines well with other modalities, is easy to integrate into a massage session, and is valuable as an assessment tool. The vacuum creates a lift and separation in tissue that complements the compression of most manual therapies.

You can add cupping to other techniques you have learned and use in your practice. For example, with a pin-and-stretch technique you could try using the cup to pin, or place it on a trouble spot along the muscle and perform the movement as you usually do.

Benefits of Cupping

Cupping affects several areas, including circulation, fascia, lymph and muscle tissue.

Circulation: The vacuum creates vasodilation, which draws blood flow into the tissue. The expansion of blood vessels also offers a vehicle for release of deep inflammation to the skin surface. (If the skin becomes hot during vacuum therapy, it is usually a good time to move on to another area of the body.)

Fascia: Separation of strands of fascia is profound when tissue is stretched in multiple directions by the cup. Observe the tissue in and around the cup to see that the stretch often extends into the surrounding tissue. Separation of the strands and structures creates space for fascia to move properly. (View Strolling Under the Skin, a video presentation on fascia by Jean-Claude Guimberteau, MD.)

Lymph: The vacuum is used to release adhesions that can block drainage and create congestion and vascular stress in the affected area. Adhesions are defined as “the joining of normally unconnected body parts by bands of fibrous tissue” (Encarta Dictionary).

This can be scar tissue; tangled and torqued fascia; and even a compression mark from such clothing as bras, tight bike shorts or socks; or marks from a chair where the person sat and worked for years. (Apply moist heat prior to treatment for better drainage of congestion, scar tissue release, and hydration of stiff, hard tissue.)

Once the restriction of flow is removed, congestion can be liquefied and directed to the nodes using a combination of manual and vacuum therapies. Vacuum therapies also work well in combination with lymphatic taping techniques and manual lymph drainage.

Muscle tissue: Using the vacuum cup on all types of muscle tissue produces effective results. The tissue visibly softens, feeling plump with hydration and blood flow when palpated. Attachments can be toned or released depending on the techniques used. The park-and-manipulate technique, for example, enables the practitioner to lift attachments as the joint is slowly moved through its range.

An adhesion being addressed with light suction (left) and stronger suction (right).
An adhesion being addressed with light suction (left) and stronger suction (right).

An Overview of Cupping

Cup size matters. A larger cup will provide the best evaluation of the tissue in and around the cup, and also disperse a stronger suction over a larger area for more comfort. Smaller cups allow for precise work in challenging areas such as the face, neck, hands and feet.

When working on a muscular athlete, using extra-large cups that can cover a large portion of the muscle or muscle group has benefits that cannot be produced with the hands. Pre-treating with vacuum therapy prior to deep tissue techniques significantly increases the effectiveness of manual methods, along with less strain on both therapist and client.

Softening and decompressing the lateral leg structures is crucial when working with lower back and gait issues or athletic performance regimens, and the vacuum cups can do this very comfortably.

Pumping modes and continuous suction are effective in different ways:

• Pumping, which creates a vacuum effect inside the cup, begins the gentle separation of fascia strands without the stress of continuous suction. Pumping is a technique that creates suction and then releases the tissue. Pumping can be very superficial, using a fast timing on the suction and release, or deeper if the suction is held longer. Static, or constant, suction is used to glide across the tissue or perform other movement that requires the cup to maintain suction until manually released.

• Pumping can encourage tone in hypotonic tissue, while long, gliding movements or traction are beneficial for loosening hypertonic tissue.

• Pumping is best for gentle work, while continuous suction techniques work well for those who have limited sensation due to congested or dense tissue.

• Pumping is useful for working lightly over lymph nodes, and continuous suction is used to separate and decongest tissue.

• Pumping is often used to stimulate tissue and is especially beneficial for organs and weak vascular walls.

An adhesion being addressed with light suction (left) and stronger suction (right).
An adhesion being addressed with light suction (left) and stronger suction (right).

Zone by Zone

Abdominal work: Cupping therapiescombine well with colon therapies and are used to release the diaphragm and intercostals. These techniques are always an important part of working with scoliosis.

Head and neck: Vacuum therapy techniques merge with chiropractic and a variety of manual therapy techniques by releasing tissue prior to the adjustment or movement, allowing freer realignment of the skeletal system.

Small cups and pumping modes can be used to address a variety of issues in the face, head and neck. Sinus and ear congestion and headaches are some of the conditions that benefit from such applications.

Research on 50 subjects with chronic, nonspecific neck pain, published in Complementary Medicine Research in 2017, found those who received cupping massage “reported significantly less neck pain post intervention” than those assigned to a wait list. “Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain,” the authors noted. “More rigorous studies are needed to confirm and extend these results.”

Shoulders and back: Once the neck structures are released, the anterior and posterior muscle groups of the upper trunk must be addressed. Pectoral hypertonicity with trapezius hypotonicity is a common problem that pulls the shoulders forward.

One of the most effective parts of anterior release techniques is working along the sternum and pectoral attachments, moving into the muscle mass and then up to the shoulder attachments. The cups also make it very easy to work deep in the axilla to liberate the joint from restriction of movement.

The most familiar application of cupping therapies is on the back. The goal of long, gliding movements along the erector spinae and intervertebral structures is to create space for the discs and relieve pressure or compression. Another favorite area on which to use vacuum cups is the typically stiff thoracolumbar fascia of the lower back.

Arms and legs: If there is a complaint of carpal tunnel syndrome, the work begins with the head, neck, shoulders and back, and then continues into the arm and hand to identify and release chronic issues resulting from repetitive movement patterns or old injury. Small cups and strong suction used on the wrist and hand after the other areas have been addressed can then produce effective results.

Results of a randomized controlled trial on 52 outpatients published in 2009 in the Journal of Pain indicated, the authors noted, that “[c]upping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.”

Plantar fasciitis is very similar in that the treatment begins with the back and hips and works down to the feet to discover the true origin of the imbalance. Many people with lymphatic challenges in the legs experience loss of sensation or pain in their feet, and vacuum drainage of lymphatic congestion combined with taping works well to relieve pressure on the nerves and blood vessels.

Skin: The skin is often overlooked in bodywork, but observation of this tissue in and around the cup can reveal clues to client conditions. Restrictive patterns can be seen and traced, tissue inflammation can be detected if the skin becomes hot, and old debris from life experiences can be seen and sometimes smelled coming through the skin. (Read more about this in the section titled “Debris in the Tissues?” below.)

The skin can also be tightened and toned using vacuum therapies, providing a great preparation or even alternative to surgical treatments. (Note, however, that the information in this article does not replace medical advice.)

Facials and other skin care procedures such as dermabrasion have included vacuum therapy for decades, well before the recent resurgence of interest. If you hold a certification or credential that puts skin care within your scope of practice, cupping could be a valuable addition to your clients’ care.

A deep adhesion undergoing vacuum cupping.

A deep adhesion undergoing vacuum cupping.

Debris in the Tissues?

There is much dissension on the subject of toxins and debris in the tissues of the body. Toxins are defined as “a substance that accumulates in the body and causes it harm” (Encarta Dictionary) and are usually associated with slow poisoning. We are exposed to quite a few substances in our daily lives, from the cacophony of synthetic scents we are assaulted by to fuel exhaust and other pollutants.

The experiences we have had in classes and at trade shows are puzzling. During one demonstration, a student being treated had worked in baggage handling for over 10 years before becoming a therapist nine years prior to the class. During the cupping therapy, we had to have everyone leave the classroom after the smell of jet fuel became overwhelming. While there may not be an easy explanation, the experience left a vivid memory and many questions.

The discolorations under the skin that we often see from cupping therapies might provide perspective on this therapy’s effect on pollutants in the body. My opinion is that many people have compromised immune function and are not able to effectively eliminate all of the residue from surgeries or injuries thatcould not be eliminated by the immune and lymphatic systems.

Based on in-session experiences, I believe that a dark purple or black color can indicate a very old injury, graduating to brown colors and then red tones from more recent issues.

When working on the upper back over the lungs of smokers, a yellow-and-gray discoloration will often appear. People exposed to things such as secondhand cigarette smoke, campfires, fireplaces, and wood or pellet stoves often present a gray color in the skin on their back during cupping therapies.

We see these things when we work with vacuum cups, but without a body of research into this therapy we don’t have substantiated explanations for them. It appears that the body is not able to eliminate the residue from medications, pollutants, injuries, surgeries and other life events, and it finds a safe place to store the material.

It would seem that the vacuum will often pull that material from storage and the body will then eliminate it via the lymphatic and eliminatory systems, just as it would be eliminated at the time of injury.

The Future of Cupping

There are a plethora of classes available today, but nothing replaces a live workshop. Because it can be difficult to travel to a class or you are not sure if this modality fits into your work, there are also online classes that will provide a vast amount of information.

Begin with an online course and practice on willing volunteers, and then attend a workshop to study with an experienced instructor, as well as hear questions and experiences from other students.

Cupping is an ancient art that is finding a new place in modern health care. However, research into cupping is lacking.

One review of cupping in athletes, published in the Journal of Alternative and Complementary Medicine in March 2018, looked at 11 trials—and while the authors found that “cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups,” they also noted that most of the trials had “an unclear or high risk of bias” and that further research is needed.

Vacuum therapies, or massage cupping with vacuum action, do combine with current medical practices as an integral part of surgical preparation and recovery, along with injury rehabilitation, functional medicine and wellness.

Medical professionals refer to practitioners, often after a patient or two comes in and shows them a big shift in their issue, such as a change in dense breast tissue or in post-surgical scarring.

Massage cupping is an effective tool and vacuum therapy is a modern technique. Both may benefit your clients in ways your hands alone cannot. As research into cupping matures, so too will the opportunities to practice it in a variety of venues.

Take this quiz to determine if contemporary vacuum therapies would be an added asset to your business! The quiz is appropriate for all health care providers, including nursing, PT, OT, chiropractic, and massage therapy.

About the Author:

Anita Shannon

Anita Shannon, LMT, ( has been licensed in massage therapy and cosmetology since 1983. An educator since 1990, she appears at national chiropractic, massage, and spa conventions and currently presents workshops on ACE Massage Cupping and MediCupping at international locations since developing these brands of bodywork in 2002. She has created five educational videos on vacuum therapies. She was inducted into the Massage Therapy Hall of Fame in 2011. Her articles for MASSAGE Magazine include  “Conquer Clients’ Confusion About Massage Cupping.”

Credit: Photos courtesy of ACE Massage Cupping and MediCupping