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The Physiological Response

Cupping falls well within the scope of practice for an LMT. Massage cupping is the combination of massage movements and negative pressure with the use of a suction device on the skin. Just as in the art of massage, the art of cupping draws fresh blood and lymph into the tissue to accelerate the healing response. The creation of suction (or negative pressure) from cupping disperses or drains stagnation caused by the accumulation of cellular waste, such as lactic acid and other toxins that form deep within muscle tissue or joint as a result of injury, trauma or overuse.  Excessive stagnation that resides within deep tissue reservoirs creates inflammation, pain, swelling, stiffness and decreased range of motion.

The application of the vacuum created with cupping penetrates into the deeper reservoirs of muscle tissue to relieve inflammation created by stagnation. The vasodilatation effect created with the application of cups is identical to the application of external heat; however, vasodilatation is reached faster due to the penetrating effect of the vacuum. As tissue layers release heat, congestion caused by toxic waste is liquefied and brought to the surface of the body where small blood capillaries and the lymph system carry away cellular waste. When there is less inflammation/heat within the tissue, it becomes more receptive to fluids (less dehydration), oxygenated blood flow and other nutrients. Separation of tissue in this manner can be a catalyst for change as the body begins to eliminate chronic congestion and lymph becomes more fluid.


Today, a variety of cups can be used to assist the bodyworker in the application of cupping massage techniques. When working on the larger areas of the body, like the back, the bodyworker can begin to practice various massage cupping techniques using silicone cups that do not require the use of fire. These cups allow the bodyworker to compress the bulb to remove oxygen from the cup to create suction. The level of suction, light or deep, can be manipulated by varying the compression of the bulb.

Silicone cups are flexible, come in different sizes and shapes, and can be applied on curved areas like the shoulder and neck for stationary cupping. MediCupping™ therapy, based on the foundation and structure of ACE Massage Cupping™ therapy, utilizes a machine with glass or plastic cups to create suction on the body surface. The ability of the MediCupping™ machine to control the vacuum and the release of tissue makes it unique. The equipment performs the pumping techniques while the therapist concentrates on the movements. Results are easy to document through regulation of equipment settings, and successful results are achieved due to the consistency of application.


A typical massage cupping treatment, just like massage with the hands, begins with warming up the fascia, engaging the parasympathetic nervous system to induce relaxation, and palpating tissue and joints to locate areas of restriction or immobilization due to injury or trauma. When heat is generated via friction from repetitive gliding massage strokes (effleurage), fascia becomes supple after 5 minutes for normal tissue and longer when its elasticity is compromised by injury or trauma. This same effect can be obtained with the application of cups using gliding strokes in half the time and at a higher level of efficiency and effectiveness.

The application of lightweight oil, such as sunflower or safflower, helps the cups move over the back as gliding massage strokes are applied. Further, suction allows the therapist to “lift” the skin when applying gliding strokes, releasing adhesions in the superficial fascia and toxins from associated deeper muscle tissue. A cup can be placed directly over the spine, sacrum, and iliac crest and the skin lifted to create more space and to break up adhesions in these areas.  Gliding cupping strokes applied over the paraspinal muscles create a soothing effect that engages the parasympathetic system.

As heat is generated through repetitive gliding cupping, different skin coloring will become apparent. The color of the skin is information that the therapist can use to determine specific massage cupping techniques. For example, areas that are deficient in blood and fluids are colder to the touch and will appear white to light pink/red. Areas where stagnation and excess toxins accumulate will feel hotter to the touch and will appear dark red to purple in color. Massage cup movements to address patterns can be sedating or stimulating. (Anita J. Shannon demonstrates these techniques in the video mentioned in the references.)

Stimulating Techniques: Shaking, Vibration and Friction

Deficient areas, identifiable by white to light pink/red coloring, require a lighter suction as the healing response is induced by stimulating strokes such as vibration and shaking.

  • With vibration, a stationary cup is placed over the area requiring stimulation and the skin is lifted up and down, no more than an inch, at a rapid pace for several seconds. The cup can be moved to adjacent areas and the technique repeated.
  • With the application of shaking, the cup is applied with a lighter suction and rapidly glided vigorously back and forth over identified areas. The skin and body will shake with this application. Shaking can be applied directly over bony prominences and areas of scar tissue to loosen attachments and adhesions.
  • A greater friction response to break up fascial adhesions can be applied using two cups applied side by side. Slowly, each cup is pulled away from one another, lengthening fascial tissues and the family of connective tissues, as similarly performed in Myofascial Release.

Sedating/Draining Techniques: Pumping, Rolling Rotation and Parking

Areas of excess/stagnation exhibited by darker reds to purples indicate inflammation or congestion and require draining or sedating techniques. When these areas are identified via palpation and coloring of the skin cues – pumping, rolling rotation and parking techniques are useful for breaking up the area of congestion. Static placement of a cup over an area for over three minutes, or parking, draws stagnation to the surface so it can be dispersed. Parking a cup allows for the following therapies:

  • Trigger point or neuro-lymphatic point work.
  • Joint manipulation, as attachments are lifted.
  • Two-cup soft tissue traction or fascial release techniques.
  • Scar release techniques that facilitate separation of tissue from bone or other soft tissue. Certain scar release techniques may require placement for longer than 3 minutes to facilitate release of an internal adhesion. Smaller cups are used and congestion dispersed after the adhesion is released.

Through the technique of suction and release, a pumping action is created to quickly drain areas of excess/stagnation. In this technique, the cup is placed on the skin for several seconds, and lifted up and off the skin repeatedly over an area.

Rolling rotation requires a stationary cup to lift the skin as the cup is moved in a circular motion.  As the cup is rotated over the same location, restrictions can be identified when the cup “pops” off of the skin. The direction that the cup pops off indicates the location of a fascial restriction.  Such restrictions can be addressed using stimulating techniques.

Role of the Practitioner

In massage cupping, the cup becomes an extension of the therapist. Many therapists say they feel no boundary when using a cup and can feel “issues in the tissues” even more so than with their bare hands. Clear glass or silicone cups tend to magnify the tissue, making it easier to observe tissue conditions such as restrictions, stagnation and inflammation, as indicated by various skin coloring. The cups will stop or drag in areas that reveal fascial restrictions and show the direction of the restriction. As the body reveals excess or deficient states, the therapist uses visual cues that are revealed through various skin coloring to customize a unique cupping treatment for each individual client.

Recommended Study:

Cupping for Massage Therapists
Cupping Therapy: A Step-by-Step Approach