Cupping Therapy Explained: What the Marks Actually Mean
What the round marks are, what the reviews found condition by condition, the harms reported, who should skip it, and what clinics list for a session.
Short answer: Cupping uses suction cups to pull the skin upward. The round marks are blood from tiny vessels the suction breaks under the skin, and Cleveland Clinic says they should fade in a week or two. NCCIH says cupping may help reduce pain, but the evidence is not very strong: in a 2020 pooled analysis of 18 trials it beat no treatment in the short term, but not sham cupping. It can burn, scar or infect the skin. Skip it if you are pregnant or have a bleeding or clotting disorder, anemia, a pacemaker, heart disease, seizures, eczema or psoriasis, and ask your prescriber first if you take a blood thinner.
We read the sources behind this guide between Oct. 29 and Nov. 1, 2026: NCCIH, Cleveland Clinic, the MSD Manual, the FDA’s device records, and the systematic reviews and case reports cited below. Prices are as listed on each business’s own page on Nov. 1, 2026. Tendground does not book or sell treatments and has not visited these businesses.
Cupping at a glance
| Cupping | |
|---|---|
| What it is | Cups on the skin, with suction made by a flame or a pump; dry, running (cups moved over oiled skin) or wet (skin pierced first) |
| Cups and time | Three to five cups on average, rarely more than seven, left on for several minutes (Cleveland Clinic) |
| The marks | Blood from capillaries the suction breaks; they should fade in a week or two (Cleveland Clinic) |
| Evidence | Pain is the only use with a body of trials, and NCCIH calls it not very strong; no clear edge over sham cupping |
| Main risks | Burns, infections, scars, persistent discoloration, worse eczema or psoriasis (NCCIH) |
| Skip it if | Pregnant; bleeding or clotting disorder; anemia; pacemaker; heart disease; seizures; eczema or psoriasis (Cleveland Clinic) |
| Ask first if | You take a blood thinner or are in cancer treatment |
What cupping is: dry, running and wet cupping
Cupping is a practice from traditional medicine in several parts of the world, including China and the Middle East. It creates suction on the skin using a glass, ceramic, bamboo or plastic cup (NCCIH); Cleveland Clinic adds silicone and metal cups.
The suction comes from a flame put in the cup to remove oxygen before it goes on the skin, or from a suction device attached afterward. In the traditional fire method an alcohol-soaked cotton ball is set alight; the modern alternative is a pump.
Dry cupping does not pierce the skin. In running cupping, the practitioner oils the skin and moves the cups over it. In wet cupping, called hijama in Arabic, the skin is pierced and blood flows into the cup.
How cupping works is not fully understood. A 2019 review lists six competing theories, from the pain-gate theory to nitric oxide and blood flow (Al-Bedah and colleagues, Journal of Traditional and Complementary Medicine, 2019). Its use is documented in early Egyptian and Chinese medicine, though the exact origin is disputed (Qureshi and colleagues, Journal of Integrative Medicine, 2017).
What happens in a cupping session
A provider places cups on your back, stomach, arms, legs or elsewhere and leaves them in place for several minutes; some treatments briefly move the cups to stretch and massage the area (Cleveland Clinic). On average providers use three to five cups, and more than seven in one treatment is uncommon.
Cupping should not hurt, though your skin may feel tight while the cups are on. Afterward you may feel bruised and slightly sore. Cleveland Clinic also lists fatigue, headaches, nausea and muscle soreness, and rare fainting, most often after wet cupping in people who faint with needle sticks.
At the businesses we checked, a cupping session on its own was listed at 25, 30 or 50 minutes. At one Asheville clinic, a regular acupuncture visit may also include cupping.
Call a doctor after cupping if you have burns, extreme pain or soreness, or fever or other signs of skin infection, such as redness, tenderness or yellow discharge (Cleveland Clinic).
What the cupping marks are, and how long they last
The suction expands and breaks open tiny blood vessels (capillaries) under the skin, and the blood that leaks out makes the round mark. Medical papers call these marks petechiae and ecchymosis: blood that has escaped from the vessels into the tissue under the skin (Nielsen and colleagues, Complementary Therapies in Medicine, 2012).
They look like bruises. Cleveland Clinic says they are not true bruises that injure muscle fibers. A 2013 case report describes the sequence: redness and swelling first, then bruising (Klempner and colleagues, Journal of Alternative and Complementary Medicine, 2013).
Cleveland Clinic says the marks should fade in a week or two. NCCIH lists persistent skin discoloration and scars among the side effects, and after almost 30 sessions in two months one patient’s skin stayed pigmented (Kim and colleagues, Acupuncture in Medicine, 2012).
Tell your doctors about the marks. NCCIH says their origin should be explained so they are not mistaken for signs of physical abuse.
What the colors of cupping marks mean
Cupping marks are sometimes read as a diagnostic sign: one research group notes that cupping is also used as a diagnostic method (Kim and Lee, Journal of Acupuncture and Meridian Studies, 2014).
What the color tracks is the cup. A 2009 Chinese experiment tested 3 durations and 4 suction levels on 12 sites on the back. The marks got darker as the stimulation got stronger, and suction pressure had the largest effect, in a straight-line relationship; the effect of time was less consistent (Zhao and colleagues, Zhongguo Zhen Jiu, 2009).
So a darker mark mostly means stronger suction. We found no study showing that the color of a mark diagnoses anything.
Does cupping work? What the research shows
NCCIH’s summary, last updated in November 2018, has three parts. There has been some research on cupping, but most of it is of low quality. Cupping may help reduce pain, but the evidence is not very strong. And there is not enough high-quality research to reach conclusions about other conditions.
Later reviews have not changed that picture. A 2011 overview of systematic reviews found relatively clear evidence for only one use, pain, and even there doubts remained (Lee and colleagues, Journal of Acupuncture and Meridian Studies, 2011).
A 2023 map of 14 meta-analyses covering five pain conditions found no high-quality evidence that cupping works for any of them, and rated the methods of most of those meta-analyses critically low (36%) or low (50.0%). Its authors still called cupping promising (Wang and colleagues, Frontiers in Neurology, 2023).
The MSD Manual, reviewed in October 2025 by a Mayo Clinic physician, says cupping can help reduce neck and low back pain, but that its use for metabolic syndrome, facial paralysis, acne and respiratory symptoms is not supported by high-quality evidence.
Cupping vs sham cupping: the placebo question
A sham comparison asks whether the suction itself does the work. In a 2020 pooled analysis of 18 trials (1,172 people with chronic pain), cupping had large short-term effects on pain compared with no treatment, but no significant effect compared with sham cupping or with other active treatments. Adverse events were more frequent with cupping than with no treatment (Cramer and colleagues, Journal of Pain, 2020).
A 2026 review of five trials (281 people) that compared dry cupping with placebo cupping for musculoskeletal pain found only very-low-certainty evidence, and called the effects on pain very uncertain at every time point. Four of the trials were at high risk of bias.
Its advice: try treatments with higher-certainty evidence of effectiveness before cupping (Jenkins and colleagues, JOSPT Open, 2026).
Cupping evidence by condition
We built this table from the reviews we read on Nov. 1, 2026, one row per condition people ask about. Each row gives the most recent review we found, its size, what it found, and how sure its authors were, in their own grading where they gave one.
| Condition | Review (year, size) | What it found | Certainty, as the review rated it |
|---|---|---|---|
| Chronic pain, all kinds | Cramer, Journal of Pain, 2020: 18 trials, 1,172 people | Large short-term pain relief compared with no treatment; no significant difference compared with sham cupping or other treatments | Limited by clinical heterogeneity and risk of bias |
| Musculoskeletal pain, compared with placebo cupping | Jenkins, JOSPT Open, 2026: 5 trials, 281 people | Effects on pain very uncertain at all time points | Very low (GRADE) |
| Chronic musculoskeletal pain | Jia, BMJ Open, 2025 | Less pain right after treatment; no improvement in disability or mental health | Moderate for pain (GRADE) |
| Neck pain | Kim, BMJ Open, 2018: 18 trials. Torad, Journal of Back and Musculoskeletal Rehabilitation, 2026: 9 trials, 401 people | Less pain than no treatment or other treatments (2018); better function and less pain (2026) | Low, no definitive conclusions (2018). Stronger for function than for pain, with methodological limitations (2026) |
| Low back pain | Zhang, Complementary Therapies in Medicine, 2024: 11 trials, 921 people | Less pain at 2 to 8 weeks; no continued improvement at one month or at 3 to 6 months; a sustained edge over medication and usual care | The authors call it high to moderate, but say the heterogeneity raises concerns about certainty. A Cochrane review was at the protocol stage in 2025 |
| Knee osteoarthritis | Li, Complementary Therapies in Clinical Practice, 2017: 7 trials | Better scores on a knee arthritis index when dry cupping was added to Western medicine; no difference on a pain scale | Only weak evidence; most trials of low quality |
| Fibromyalgia | Salazar-Méndez, Journal of Bodywork and Movement Therapies, 2023: 2 trials, 155 people | Results discrepant across pain, sleep and quality of life | Low for most outcomes |
| Migraine | Seo, Evidence-Based Complementary and Alternative Medicine, 2021: 6 trials | Could be effective; wet cupping beat drugs on one response measure | Low |
| Plantar fasciitis | Szlosek, Journal of Sport Rehabilitation, 2023: 3 studies (a critically appraised topic, not a full systematic review) | Better pain and function than exercise and stretching or electrical stimulation; no sham comparison | Moderate (level B), the authors’ rating |
| Athletes and recovery | Bridgett, Journal of Alternative and Complementary Medicine, 2018: 11 trials, 498 athletes | Benefits reported, mostly against untreated groups | No recommendation for or against; most trials at unclear or high risk of bias; none reported safety |
| Wet cupping, any condition | Al Bedah, Journal of Alternative and Complementary Medicine, 2016: 14 trials | 9 favored wet cupping; 5 found no difference | Variable risk of bias; better-quality trials needed |
| Shingles and other conditions | Cao, PLoS One, 2012: 135 trials from 1992 through 2010 | A possible effect on shingles when combined with other traditional Chinese treatments | Generally low methodological quality |
What the table shows: against no treatment, most reviews found less pain, at least in the short term. Against sham or placebo cupping, the two pooled analyses found no clear benefit. The certainty is low or very low in most rows, and the one review that calls its evidence high to moderate found no continued low back pain improvement at one month.
Cupping for athletes and sports recovery
Athletes revived interest in cupping. A 2018 review found 11 trials with 498 athletes, among them soccer, football and handball players, swimmers, gymnasts and track and field athletes. Cupping was reported to help pain, disability and range of motion and to lower a blood marker, creatine kinase, mostly against untreated groups.
Most of those trials had an unclear or high risk of bias, none reported safety, and the authors could make no recommendation for or against cupping in athletes (Bridgett and colleagues, Journal of Alternative and Complementary Medicine, 2018).
A 2023 review of 22 studies in musculoskeletal and sports rehabilitation rated the evidence moderate for soft tissue flexibility, low to moderate for low back or neck pain, and very low to low for other conditions. It found adverse events very low (Mohamed and colleagues, Journal of Back and Musculoskeletal Rehabilitation, 2023).
Wet cupping (hijama): what is different
In wet cupping the skin is pierced first, so blood flows into the cup (NCCIH). Cleveland Clinic calls it bleeding cupping: a needle lightly punctures the skin before the cups go on.
That adds the risks of blood. NCCIH reports rare cases of anemia from blood loss after repeated wet cupping. In one Korean case, almost 30 sessions with blood loss over two months, by an unqualified practitioner, ended in a hospital admission and a blood transfusion (Kim and colleagues, 2012). A 2008 case report describes iron deficiency anemia from cupping in a healthy man (Lee and colleagues, American Journal of Medicine, 2008).
Infection is the other risk. After wet cupping, a 33-year-old woman with a normal immune system developed a disseminated Staphylococcus aureus infection, with acute liver and kidney injury and an abscess (Wang and colleagues, BMC Complementary Medicine and Therapies, 2023). Fainting, rare overall, is most common after wet cupping.
The trial evidence is thin: a 2016 review found 14 trials, with a variable risk of bias, and asked for better ones.
Is cupping safe? Side effects and rare harms
Cleveland Clinic calls cupping a relatively low-risk therapy. NCCIH lists its side effects: persistent skin discoloration, scars, burns and infections, and it may worsen eczema or psoriasis. Rare severe harms have been reported, including bleeding inside the skull after cupping on the scalp.
Burns come from heated cups and fire cupping; surgeons in Australia, Germany and Turkey have published cases (Seifman and colleagues, Medical Journal of Australia, 2017; Iblher and Stark, Journal of Burn Care and Research, 2007; Kose and colleagues, Burns, 2006).
Infections happen after dry cupping too: a healthy 59-year-old woman developed recurring skin lesions from Mycobacterium massiliense after noninvasive cupping (Lee and colleagues, Clinical and Experimental Dermatology, 2014). NCCIH says equipment can be contaminated with blood, on purpose in wet cupping or by accident in dry cupping, so sharing it without sterilization can spread hepatitis B and C.
Cupping with psoriasis, and the rare brain and nerve complications
With psoriasis, cupping can trigger new patches exactly where the cups sat, the Koebner phenomenon (Vender and Vender, Journal of Cutaneous Medicine and Surgery, 2015; Demir and Kutlubay, New England Journal of Medicine, 2026).
A 2025 review found 14 patients with neurological complications in 12 published studies. Subdural hemorrhage, a kind of bleeding inside the skull, was the most common (4 of 14); most patients (11 of 14) had no underlying disease, and all but 3 recovered with surgical and medical treatment (Daneshfard and colleagues, Complementary Medicine Research, 2025).
Who should not get cupping, and who should ask first
Cleveland Clinic says not to have cupping if you are pregnant, because so little is known about its effects in pregnancy. It also says to avoid cupping if you have:
- Anemia
- A pacemaker
- A bleeding disorder, such as hemophilia
- A blood clotting problem, such as deep vein thrombosis (DVT) or a history of stroke
- Cardiovascular disease
- A skin condition, including eczema and psoriasis
- Seizures (epilepsy)
Ask first in these cases:
- Blood thinners. Cleveland Clinic’s list does not name them, but the marks are blood from broken capillaries. Ask the prescriber; our guide to wellness on blood thinners says to skip cupping.
- Cancer treatment. A 2013 case report found no safety data for cupping during one targeted cancer drug (bevacizumab), and the patient had not told his doctors. Tell your oncology team first; our guide to massage during and after cancer treatment covers massage.
- Children, and people with diabetes. We found no official guidance on cupping for either. Ask the child’s pediatrician or your own doctor first.
What cupping costs
Prices are as each business listed them on its own site on Nov. 1, 2026, per session:
- White Pine Acupuncture, Asheville, North Carolina: $85 for a 30-minute cupping session.
- Jemez Springs Bath House, New Mexico: $42 for 25 minutes, before New Mexico sales tax.
- Woodhouse Spa, Kingston, Pennsylvania: $140 for 50 minutes.
- Massage by Gail (Gail Schneider, LMT), Bryan, Texas: $60 for 30 minutes of abdominal cupping, and $75 for 60 minutes of light cupping over the whole body (sold as lymphatic drainage). Added to a massage: $5 for one body region, $10 for two or more.
- Colleen E. Johnson, LMT, Beverly, Massachusetts: an additional $15 when added to any massage.
Five listings are a sample, not a market average. Acupuncture visits can include cupping at no separate price: at White Pine Acupuncture, the one-hour follow-up visit ($130) may include it.
How to choose a cupping practitioner
Acupuncturists, chiropractors, massage therapists, medical doctors and physical therapists can all train in cupping (Cleveland Clinic). Some therapists advertise a cupping certificate, but we found no national standard for one.
A 2012 safety paper found that neither the research literature nor the acupuncture profession’s national standards adequately covered safety for cupping, and proposed hospital-style protocols. A Korean case report of anemia after cupping by an unqualified therapist ends with the same advice: use qualified health professionals.
Ask three things before the first session:
- What training and license do you have? Our guide to checking a practitioner’s credentials shows how to look up a state license.
- How are the cups cleaned? NCCIH says cupping equipment can spread bloodborne diseases if it is not sterilized or disinfected between patients.
- Do you use a flame or a pump? Burns from heated cups are on Cleveland Clinic’s list of risks.
Be wary of anyone who promises to cure a disease. Cleveland Clinic says most healthcare providers recommend cupping as a complement to standard medicine, not a stand-alone treatment.
Home cupping sets and the FDA
We found no FDA rule written for cupping. In the FDA’s device database (GUDID), the cupping cup we checked is filed under a general product code, pressure-applying device, in Class I, the class the FDA describes as the lowest risk, and is exempt from premarket notification.
The regulation behind that code describes a different device: a table with an adjustable overhead weight that presses on the back of a patient lying face down. The cup’s record lists it as reusable and not sterile.
We found no official guidance on cupping at home. The safety points above apply whoever holds the cup: burns from heated cups, infection from cups that are not cleaned, and the who-should-skip list.
FAQ: cupping therapy
Does cupping hurt?
It should not. Cleveland Clinic says your skin may feel tight while the cups are on, and you may feel bruised and slightly sore afterward, but not severe discomfort. Burns or extreme pain are reasons to call a doctor.
How long do cupping marks last?
Cleveland Clinic says they should fade in a week or two. NCCIH lists persistent discoloration and scars as possible side effects, so show a doctor a mark that does not fade.
What do the colors of cupping marks mean?
Mostly how strong the suction was. In a 2009 experiment, marks darkened as the suction got stronger, and pressure had the largest effect. We found no study showing that mark color diagnoses anything.
Does cupping work for back pain?
For low back pain, a 2024 review of 11 trials found less pain at 2 to 8 weeks that was not sustained at one month or at 3 to 6 months. NCCIH describes a 2017 review of 6 studies (458 participants) with better results than usual care or medication, but says it is uncertain whether the differences are real. A Cochrane review was at the protocol stage in 2025.
Is cupping safe?
For most people it is low risk (Cleveland Clinic). It can cause burns, infections, scars and persistent discoloration, and rare severe harms have been reported (NCCIH). Check the who-should-skip list first.
What is the difference between wet and dry cupping?
Dry cupping uses suction only. Wet cupping pierces the skin first, so blood flows into the cup. That adds the risks of anemia with repeated sessions and of bloodborne infection from shared equipment (NCCIH).
Does cupping remove toxins?
We found no trial showing it. Detoxification is one of six proposed theories in a 2019 review, which says more research is needed to support or refute them.
How often can you get cupping?
We found no guideline. Trials in athletes gave between 1 and 20 sessions, daily or weekly. With wet cupping, repeated sessions have caused anemia.
Is cupping the same as a massage?
No. Massage presses into the tissue; cupping pulls the skin up into the cup. Some massage therapists sell cupping as an add-on to a massage. See also our guides to Thai massage and bodywork and deep tissue and sports massage.
The bottom line on cupping
Cupping is low risk for most people, and many who try it report less tightness. The evidence that it relieves pain is not very strong, it has not beaten sham cupping in pooled trials, and for other conditions the research is too weak to say.
If you want to try it, check the who-should-skip list, ask how the cups are cleaned, and treat it as an add-on to treatments with stronger evidence.
Related reading on cupping
- Acupuncture: what a session is like, and what the evidence honestly shows
- Gua Sha Explained: Body Tool vs. Facial Trend, What’s Real
- Wellness on blood thinners: massage pressure, cupping, wet floors and what is actually safe
- Wellness with eczema or psoriasis: saunas, salt water, floats and what to tell a therapist
- Deep tissue and sports massage: what they are, how they differ, and what the evidence shows
- How to check a wellness practitioner’s credentials
- Which bodywork for which complaint: a decision guide
Want Google to show you more from Tendground? Add us as a preferred source.