Summary
Physical therapists Josh and Brandon from the Better Faster Podcast provide an evidence-based clinical perspective on cupping therapy. They discuss the science (or lack thereof) behind cupping, proposed mechanisms of action, and how they practically use it in their rehab clinic with athletes, particularly CrossFitters. Brandon shares his first exposure to cupping during a humanitarian trip in Haiti in 2014, where a therapist used cups on rice farmers' lumbar spines with movement to improve mobility and reduce pain. The episode distinguishes three types of cupping: static (cups left in place), dynamic (cups moved or patient moves while cups are on), and wet cupping (involving skin cuts, which they do not practice). Josh describes his preferred protocol of combining dynamic cupping with progressive movement, starting with cat-cow in quadruped, progressing to rocking, then standing toe touches or Jefferson curls. They acknowledge the research is weak and mixed, but argue the most plausible mechanism is neurosensory modulation rather than tissue changes like angiogenesis or toxin removal. They candidly dismiss traditional explanations like "removing toxins" or "altering chi" while supporting cupping as a valid tool when combined with movement, proper framing, and patient expectations. They recommend keeping cups on for under 10 minutes to avoid unnecessary bruising.
Key Points
- Three types of cupping: static (left in place), dynamic (cups moved or patient moves), and wet cupping (with skin cuts)
- The most plausible mechanism is neurosensory modulation rather than tissue changes like toxin removal or fascia release
- Dynamic cupping combined with progressive movement (cat-cow to Jefferson curls) produces the best clinical results
- Research on cupping is weak and mixed; no definitive evidence supports specific tissue-level mechanisms
- Bruising is not necessary and does not make treatment more effective; keep cups on under 10 minutes to minimize marks
- Cupping works similarly to other manual therapy tools as a sensory input that can modulate pain perception
- Best used as a recovery tool post-workout alongside nutrition, sleep, and active recovery like easy cycling or swimming
- Patient expectations and psychology matter; if an athlete believes in cupping, it can enhance treatment outcomes
Key Moments
Cupping likely works through neurosensory modulation rather than tissue changes
The physical therapist hosts argue that the most plausible mechanism for cupping's effects is neurosensory modulation rather than tissue-level changes like angiogenesis. By modifying sensory input and reducing pain perception, cupping may improve performance by removing inhibitory pain responses.
"I really don't look at all that stuff and think, yeah, that's probably what's going on. I think, yeah, there's obviously an acute increase to blood flow to the area. But for me, where there might be some decent literature on the effects of cupping have to do with the nervous system."
Dynamic cupping combined with movement for low back pain
Brandon describes his go-to clinical approach of combining cups with progressive movement: starting in quadruped with cat-cow, progressing to rocking, then standing toe touches or Jefferson curls. The test-retest approach typically shows improved movement and reduced pain.
"And then after doing that for a little while, I actually, I guess, go back to static and get the patient up off the table. And usually, you know, classic example here is, this is one of my go-tos, is I have a patient who has mechanical low back pain, or maybe they are hypomobile in the lumbar spine. They're lacking flexion as compared to the rest of the spine. I'll put their cups on. I usually start them out quadruped, do a little bit of a stretch, and then I'll go back to static."
Cupping bruises are painless hickeys and 10 minutes is the cutoff
Brandon explains that 10 minutes is the general cutoff for leaving cups on, as bruising tends to occur beyond that point. He clarifies that cupping bruises are essentially painless hickeys and that bruising is not necessary for an effective treatment.
"generally 10 minutes is kind of the cutoff. And the reason for that is because it seems to be around that 10 minute mark for most people, they're going to get some kind of bruising. And, and,"
