Round, circular marks on a client’s back have become a familiar sight in clinics, gyms and on social media, and more clients now ask their therapists about cupping by name. For massage therapists, physiotherapists, kinesiologists and other healthcare practitioners, the practical questions are the same as for any adjunct technique: what does the research actually show, how safe is it, and what training should you have before you use it? This article answers those questions from the published literature, and then looks at what to consider when choosing a cupping therapy course in Ontario.

What Is Cupping Therapy?

Cupping applies cups to the skin to create negative pressure (suction) over a treatment area. It is an ancient practice, and today it is used mainly for musculoskeletal pain and soft tissue complaints [5]. Clinicians describe several types, including dry cupping, wet cupping, and cupping massage, where cups are moved over lubricated skin [7]. A typical cupping set contains a range of cup sizes and a method of creating suction [7].

It is worth being upfront about mechanism. A modern medicine overview concluded that there is no clearly identified mechanism of action for cupping, and called for more clinical research on how it works [7]. Proposed explanations, such as increased local blood flow and changes in pain signalling, remain theories rather than established facts.

What Does the Research Show?

As with many manual therapy tools, the evidence is encouraging in places but limited in quality. The findings depend on the condition, what cupping is compared against, and the time point measured.

Evidence suggesting a benefit

Chronic pain. A meta-analysis of 18 randomized trials (1,172 participants) found large short-term reductions in pain intensity with cupping compared with no treatment, and medium-sized improvements in disability compared with both no treatment and other active treatments [2].

Neck pain. A systematic review and meta-analysis of randomized trials found that cupping reduced neck pain compared with no intervention or active controls, and also when added to another treatment [1].

Musculoskeletal and sports rehabilitation. A systematic review of 22 studies rated the evidence for improving soft tissue flexibility as moderate, and the evidence for low back pain and cervical pain as low to moderate [5].

Mapping the wider literature. An evidence-mapping study of 14 meta-analyses concluded that very low to moderate quality evidence supports cupping for several pain-related conditions, including neck pain, low back pain and knee osteoarthritis [3].

Evidence suggesting limited or uncertain benefit

Sham-controlled comparisons. In the same chronic pain meta-analysis, the effect of cupping on pain was not statistically significant when compared with sham cupping [2]. This suggests that part of the observed benefit may come from non-specific effects such as touch, expectation and the treatment ritual.

No high-quality evidence. The evidence-mapping study found no high-quality evidence, using the GRADE system, demonstrating that cupping works for pain-related outcomes, and graded the methodological quality of the included reviews as mostly low or critically low [3].

Review quality and athletes. An umbrella review of systematic reviews found that most had low methodological quality. It reported that cupping performed better than passive interventions such as heat therapy, usual care, medication or no treatment, but showed similar effectiveness to acupuncture, and concluded there was not enough evidence to recommend cupping for athletes [4].

Why the evidence is inconsistent

Across these reviews, the recurring limitations are small trials, clinical heterogeneity (different cupping types, cup sizes, pressures and durations), risk of bias, and the difficulty of creating a convincing sham [2][3][4]. The sensible reading is that cupping may offer short-term benefit for some people with musculoskeletal pain, but the research does not yet allow strong claims.

Is Cupping Safe? Adverse Events and Contraindications

Cupping is generally considered relatively safe, but adverse events are not zero. A review of adverse events concluded that cupping-related events were infrequently reported but not rare, and that most were mild to moderate in severity [7]. Reported events include bruising (hematoma), pain at the application site, increased pain, tingling and dizziness [4]. In the chronic pain meta-analysis, adverse events were more frequent with cupping than with no treatment, though not significantly different from sham or other active treatment [2]. In the neck pain review, only 8 of 18 studies reported adverse events at all, and those that did described them as mostly mild and temporary [1].

An important point for training: reviews of adverse events conclude that many are avoidable when treatment is delivered by trained personnel who follow safety guidelines and infection control practices [6][7].

Commonly listed contraindications and precautions include [7]:

• Do not apply over: veins, arteries, nerves, inflamed or damaged skin, body orifices, the eyes, lymph nodes or varicose veins.
• Absolute contraindications include: open wounds, bone fractures and sites of deep vein thrombosis.
• Relative contraindications include: acute infection, use of anticoagulants, severe chronic disease such as heart disease, pregnancy, menstruation, anemia, recent blood donation and a recent wet cupping session.

Good practice also means a proper intake, clear informed consent, explaining to clients that marks are expected and usually fade, and stopping if a client feels faint, or has blistering or significant pain.

What This Means for Your Practice

• Treat it as an adjunct. Several trials tested cupping alone and as an add-on, and the add-on findings are the most practical for clinic work [1].
• Set honest expectations. Tell clients that the research is promising but limited, and that benefits, when seen, are mostly short term [2].
• Measure and reassess. Record pain and function before and after, and stop if the client is not benefiting.
• Screen carefully. A thorough health history is the main protection against preventable adverse events [6][7].
• Know your scope. Check with your regulatory college and professional liability insurer that cupping is within your scope and covered before adding it to your services.

Choosing a Cupping Therapy Course in Ontario

If you decide to add cupping to your treatments, the quality of your training matters, because safe technique, screening and infection control are what the safety literature points to [6][7]. When comparing a cupping therapy course in Ontario, it helps to ask:

• Is it hands-on? Cup selection, pressure, and technique are practical skills best learned with supervised practice.
• Does it cover contraindications, consent and infection control? These should be core content, not an afterthought.
• Does it teach clinical reasoning? You should leave knowing when to use cupping, when to modify it and when to refer.
• Does it give you a certificate you can use? Confirm that the certificate meets your regulatory college or association’s continuing education requirements.
• Is it convenient? Practitioners across the Peel region look for cupping therapy training in Mississauga or Brampton to avoid long commutes.

Frequently Asked Questions

Does cupping therapy work for pain?

The evidence is mixed but suggests short-term benefit compared with no treatment, particularly for neck and low back pain. However, it was not significantly better than sham cupping in a major meta-analysis, and no high-quality evidence has been found [2][3].

Is cupping therapy safe?

It is relatively safe when performed by trained practitioners who screen clients properly. Adverse events such as bruising and pain at the site are mostly mild to moderate, but they are not rare [4][7].

Do I need certification to learn cupping?

Requirements depend on your profession and regulatory body. Regardless, formal training in technique, contraindications and infection control is strongly supported by the safety literature [6][7]. Check your college and insurer.

Is cupping the same as Gua Sha?

No. Cupping uses suction, while Gua Sha uses a tool to scrape or glide over the skin. Read our guide to Gua Sha vs. IASTM for how tool-based soft tissue techniques compare.

Conclusion

Cupping is a popular, generally well-tolerated technique that may give some clients short-term relief from musculoskeletal pain, particularly as an add-on to other care. The research does not yet show that it outperforms sham treatment, and the quality of the evidence is limited. For practitioners, the value lies in careful screening, skilled and hygienic technique, honest communication and regular reassessment.

If you would like to learn cupping in a supervised, hands-on setting, explore The Canadian Health Academy’s Cupping Therapy course at our Mississauga location, or visit our Registration page for upcoming dates. Practitioners in Brampton can also see our Continuing Education Brampton page for healthcare continuing education options. As a health academy in Ontario, we offer healthcare training and therapy courses for practitioners who want to expand their skills, and you can browse all of our courses here.

This article is for educational purposes for healthcare and wellness professionals and does not replace individual clinical assessment. Check your regulatory college and insurer regarding scope of practice.

References

1. 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. doi:10.1136/bmjopen-2017-021070
2. Cramer H, Klose P, Teut M, et al. Cupping for patients with chronic pain: a systematic review and meta-analysis. Journal of Pain. 2020;21(9-10):943-956. doi:10.1016/j.jpain.2020.01.002
3. Wang L, Cai Z, Li X, Zhu A. Efficacy of cupping therapy on pain outcomes: an evidence-mapping study. Frontiers in Neurology. 2023;14:1266712. doi:10.3389/fneur.2023.1266712
4. Elmeligie MM, Yehia AH, Hamada Mohamed M, et al. Effectiveness of cupping therapy for musculoskeletal pain: an umbrella review. Human Movement
5. 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. Journal of Back and Musculoskeletal Rehabilitation. 2023;36(1):3-19. doi:10.3233/BMR-210242
6. Kim TH, Kim KH, Choi JY, Lee MS. Adverse events related to cupping therapy in studies conducted in Korea: a systematic review. European Journal of Integrative Medicine. 2014;6(4):434-440.
7. Cupping Therapy: An Overview from a Modern Medicine Perspective. Journal of Acupuncture and Meridian Studies. 2018. iam.biomedcentral.com