Vacuum Cupping Therapy: Benefits, How It Works and Safe Use

Vacuum cupping therapy is a technique in which a special cup is placed on the skin and negative pressure is created inside it. Unlike traditional massage, which mainly compresses the tissues, a vacuum cup slightly lifts the skin and superficial soft tissues. For some people, this mechanical stimulus may temporarily reduce the sensation of muscle tightness, improve movement comfort and promote relaxation.

Vacuum cups are commonly used on the neck, back, shoulders, hips and leg muscles. They are used in physiotherapy and massage clinics as well as in sports, while silicone and electronic vacuum cups are also increasingly used at home.

At the same time, exaggerated claims should be avoided. Vacuum cups do not remove “toxins” from the body, dissolve scar tissue or heal injuries. Research suggests that cupping may be useful as an additional method for reducing pain and stiffness, but the quality of evidence varies considerably between different conditions. Cupping therapy is therefore best combined with movement, exercise and appropriate load management.

What is vacuum cupping therapy?

There are several types of cupping therapy, but dry cupping is the form most commonly used in everyday physiotherapy and self-massage. The skin is not intentionally broken or cut. Vacuum is created by compressing an elastic silicone cup, using a mechanical pump or using an electronic device.

There is also a technique known as wet cupping, in which the skin is intentionally broken before the cup is applied. This method involves bleeding and carries risks of infection and scarring, so it is not appropriate for self-care and is not the same as conventional silicone vacuum-cup massage. This article focuses specifically on dry cupping used for muscles and soft tissues.

Cups can be made from glass, plastic, rubber or silicone. Silicone cups are particularly practical for home use because they do not break, the strength of the vacuum can be adjusted by how much the cup is compressed, and they can be used both statically and while being moved across the skin.

How do vacuum cups work?

When the air pressure inside a cup placed on the skin is reduced, the skin and superficial soft tissues are drawn into the cup. This temporarily changes the mechanical load on the tissues and increases local blood flow. The nervous system receives a strong pressure and pulling stimulus, which may alter the perception of pain and muscle tightness.

The exact mechanisms behind cupping therapy are not fully understood. Its possible effects are unlikely to result from one single process, but rather from a combination of local circulatory responses, mechanical stimulation of the skin and superficial tissues, nervous-system responses and the relaxing sensation associated with the procedure.

It is sometimes claimed that vacuum cups “separate the fascia”, “break adhesions” or permanently alter tissue structure. Such claims should not be interpreted literally. Cupping may temporarily change the sensation of tissue mobility and reduce sensitivity, but there is no good reason to assume that one treatment can mechanically remodel deep connective tissue.

The visible circular marks that sometimes remain after treatment also do not indicate that toxins have been removed from the body. They result from mechanical pressure and the response of small blood vessels.

What are the potential benefits of vacuum cupping therapy?

The most extensively studied effect of cupping therapy is its influence on musculoskeletal pain. Systematic reviews suggest that it may temporarily reduce chronic lower-back pain and neck pain. Some studies have also reported improvements in self-reported function and movement comfort. However, results vary considerably between studies, treatment protocols are not standardised and many studies have a high risk of bias.

This means that vacuum cups may help an individual person, but the effect cannot be guaranteed. They are not necessarily more effective than exercise, massage, manual therapy or other active treatment approaches.

In practice, the most common benefit is a temporary reduction in pain and the sensation of muscle tightness. After treatment, the area may feel less restricted and movement may feel more comfortable. For some people, cupping therapy can also have a relaxing effect, particularly when the procedure is performed calmly and with a comfortable level of suction.

Some studies have observed improvements in range of motion, although these have usually been measured shortly after the procedure. This does not necessarily indicate long-term changes in tissue structure. Reduced discomfort and an altered nervous-system response may simply allow movement to be performed more freely. Overall, the evidence for dry cupping in relation to pain and mobility is generally considered low to moderate in quality.

What types of pain are vacuum cups most commonly used for?

Vacuum cupping therapy is most commonly used for non-specific neck, upper-back and lower-back pain. It may feel pleasant for people who experience stiffness and fatigue in the shoulder girdle or back muscles after prolonged sitting or physical work.

Cups are also used on the thigh, calf, gluteal and shoulder muscles after intensive physical activity. They are sometimes used around the knee or shoulder, but cupping should not be considered a treatment for a joint, tendon or ligament injury. The procedure may influence how the surrounding soft tissues feel, but it cannot repair a torn ligament, damaged meniscus or injured tendon.

If pain is associated with muscle tightness and the area responds well to manual massage, gentle cupping may also provide temporary comfort. However, sudden, severe or unexplained pain should first be properly assessed to determine its cause.

Vacuum cupping in sport and after training

Vacuum cups became particularly well known after circular cupping marks were seen on the shoulders and backs of high-level athletes. Since then, cupping therapy has frequently been promoted as a sports recovery method.

Athletes most commonly use cups to reduce the subjective sensation of muscle stiffness or soreness after training. Cupping can form part of a recovery routine in a similar way to light massage, foam rolling or heat therapy.

However, there is currently insufficient evidence that vacuum cupping significantly improves strength, sprint speed or endurance, or that it accelerates tissue healing after a sports injury. Studies involving athletes are generally small, highly variable and often associated with a high risk of methodological bias. It is therefore not possible to clearly recommend cupping as a necessary method for improving athletic performance or recovery.

In sport, cupping is best regarded as an optional additional tool. If the treatment helps an athlete feel less restricted and does not interfere with training, it can be included in a recovery plan. However, the priorities should remain adequate sleep, nutrition, hydration, load management and progressive strength and mobility exercises.

Static and dynamic vacuum cupping techniques

With the static technique, a cup is placed on the selected area and left in one position. This produces a more concentrated effect in one location and is more likely to leave visible circular marks. When starting, it is advisable to use relatively mild suction and a short treatment duration to assess how the skin reacts.

With the dynamic technique, the cup is slowly moved across the skin. A small amount of massage cream, oil or wax is applied beforehand so the cup can glide smoothly. Dynamic cupping generally requires less suction than static cupping because a cup that adheres too strongly will be difficult to move and may unnecessarily irritate or damage the skin. Adequate and consistent glide is particularly important during dynamic vacuum-cup massage. A product that is too thick can make the cup difficult to move, while a very thin product may need to be reapplied. The differences between lotion, oil and wax are compared in the article NAQI Massage Products – Which One Should You Choose?.

Sometimes the cup is left attached to a muscle while the person slowly moves the corresponding joint. This combines mechanical stimulation of the skin and superficial tissues with active movement. Maximum possible suction is not required here either. Treatment intensity should be determined not by how strongly the cup attaches, but by whether the person can tolerate the procedure without pain or an unwanted reaction.

How to use vacuum cups at home

Before the procedure, the skin should be clean and free from wounds, rashes or significant irritation. When using cups for the first time, choose an easily accessible area of the body and begin with mild suction.

Compress the silicone cup, place it on the skin and gradually release it. The more strongly the cup is compressed, the stronger the resulting suction. The procedure should be clearly noticeable, but it should not cause sharp pain, burning, numbness or pronounced pulsating sensations.

For static use, a few minutes are sufficient when starting. If the skin reacts well and the treatment is comfortable, the duration can gradually be increased, but there is no need to leave a cup on one location for a very long time. During dynamic massage, slowly move the cup over the muscle while avoiding bony areas and sensitive structures.

Afterwards, the skin can be washed and gently moisturised. Cups should be cleaned according to the manufacturer’s instructions and allowed to dry completely. In a professional environment, appropriate hygiene and cleaning of equipment between clients is particularly important.

The same area does not need to be treated every day. Allow the skin and superficial tissues to recover completely. If marked tenderness or dark skin marks remain, it is better to postpone another treatment on that area.

Why do circular marks remain after vacuum cupping?

Vacuum increases local blood flow and places mechanical stress on small blood vessels. As a result, pink, red or purple circular marks may appear on the skin. These resemble superficial bleeding beneath the skin more than the typical bruise caused by a direct impact.

The intensity of the marks depends on the strength of the suction, treatment duration, cup size, body area and individual sensitivity of the person’s skin and blood vessels. A darker circle does not indicate that more toxins are present in the area, that there is greater “blood stagnation” or that the tissues are more damaged.

The marks usually disappear within several days to approximately two weeks. If they are very painful or accompanied by blistering or skin damage, the treatment was too intensive. Cupping therapy may also cause more prolonged skin discolouration, scarring, burns or infection, particularly if excessive suction, heat or inadequately disinfected equipment is used.

When should vacuum cups not be used?

Vacuum cups should not be placed over open wounds, active skin infections, severely inflamed skin, fresh scar tissue or burns. They should also not be applied directly over an acutely injured area with significant swelling, fresh bleeding beneath the skin or a suspected fracture.

Cupping should also be avoided if:

• deep-vein thrombosis is suspected or one limb suddenly becomes swollen;
• the person has significant blood-clotting disorders;
• medication that significantly affects blood clotting is being used and the procedure has not been approved by a doctor;
• there is significantly reduced sensation in the treatment area;
• there is an active flare of a skin condition;
• sharp pain, numbness, dizziness or feeling unwell occurs during the procedure.

Additional caution is required during pregnancy and in people with vascular disease, pronounced varicose veins, diabetes-related sensory impairment or fragile skin. In these situations, it is advisable to consult a doctor or physiotherapist before using vacuum cups.

FASCIQ vacuum cups

FASCIQ is a brand specialising in fascia and soft-tissue therapy products, including IASTM instruments, massage rollers, massage balls and silicone vacuum cups. FASCIQ vacuum cups are available in different diameters, allowing smaller cups to be used on smaller body areas and larger cups on the back, hips and thighs. Their silicone construction allows suction to be created without an additional pump, and the cups can be used for both static and dynamic massage. Fiziopreces.lv offers individual cups, sets containing different sizes and the FASCIQ Sport set. The most suitable option depends mainly on the body area and intended treatment technique.

Can vacuum cups help with cellulite?

Dynamic vacuum massage can temporarily increase skin redness and fluid movement within the tissues and may create the visual impression of smoother skin. However, there is no convincing evidence that silicone vacuum cups can produce a lasting reduction in subcutaneous fat or permanently change the structure responsible for the appearance of cellulite.

Cellulite is a normal characteristic of the structure of subcutaneous fat and connective tissue. Its appearance is influenced by genetics, skin thickness, hormones and body-fat distribution. Vacuum massage can be used for wellbeing or cosmetic self-care, but its effects should not be equated with fat reduction or medical treatment.

Facial vacuum cups should also be used particularly gently. Facial skin and superficial blood vessels are more sensitive, meaning that considerably less suction should be used and the cup should not remain stationary in one area for a prolonged period.

Can vacuum cups replace physiotherapy and exercise?

Vacuum cups may temporarily reduce pain or the sensation of stiffness, but they do not restore muscle strength, movement control or the ability to tolerate everyday or sporting loads. For persistent or recurrent pain, passive treatment alone is therefore usually not enough.

In practical terms, cupping therapy is most useful when it makes it easier for the person to perform the necessary movements or exercises afterwards. For example, after a short treatment around the neck, neck-mobility and shoulder-girdle strengthening exercises may feel more comfortable. After cupping the thigh muscles, an athlete may feel less restricted during their warm-up.

If cupping is required every time simply to be able to move or train, the underlying cause of the problem and overall physical load should be assessed. Repeatedly suppressing symptoms without appropriate rehabilitation may delay finding a more suitable long-term solution.

Summary

Vacuum cupping therapy creates negative pressure that lifts the skin and superficial soft tissues. For some people, this mechanical and sensory stimulus may temporarily reduce neck, back or muscular pain, the sensation of tightness and discomfort during movement.

Research suggests a possible benefit primarily for chronic neck and back pain, but results are inconsistent and the quality of evidence remains limited in many reviews. Vacuum cups should not be promoted as a method for removing toxins, healing injuries or guaranteeing improvements in athletic performance.

They are best used as an additional method together with appropriate exercise, load management and other rehabilitation strategies. The procedure does not need to be painful, and dark circular marks on the skin are not required for the treatment to be effective.

References

Mohamed AA, Zhang X, Jan YK. Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: a systematic and evidence-based review. J Back Musculoskelet Rehabil. 2023;36(1):3–19.

Zhang Z, Pasapula M, Wang Z, Edwards K, Norrish A. The effectiveness of cupping therapy on low back pain: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2024;80:103013.

Wood S, Fryer G, Tan LLF, Cleary C. Dry cupping for musculoskeletal pain and range of motion: a systematic review and meta-analysis. J Bodyw Mov Ther. 2020;24(4):503–518.

Wang Y, Dong S, Li B, Han M, Cao H. Update evidence of effectiveness on pain relieving of cupping therapy: a systematic review and meta-analysis of randomized controlled trials. J Tradit Chin Med. 2025;45(2):234–253.

Moura CC, Chaves ECL, Cardoso ACLR, et al. Cupping therapy and chronic back pain: systematic review and meta-analysis. Rev Lat Am Enfermagem. 2018;26:e3094.

National Center for Complementary and Integrative Health. Cupping: What Do We Know? Updated health information on effectiveness and safety.

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Do Darker Marks After Cupping Mean the Treatment Was More Effective?

Aigars Caune
Physiotherapist

No. A darker skin reaction mainly indicates stronger or longer exposure to suction as well as the sensitivity of the particular body area and the person’s blood vessels. It does not indicate the amount of toxins present and is not a measure of treatment quality.

The goal of treatment should not be to produce the darkest possible marks. The best intensity is one that is comfortable, does not damage the skin and leaves the person feeling better or moving more comfortably afterwards. If significant pain, swelling, blistering or very sensitive bruising remains after treatment, the suction strength and treatment duration should be reduced next time.

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