Most people see the marks before they ever hear the word. Neat purple circles across a shoulder at the pool, or on the back of a swimmer in an Olympic photograph.
Cupping has moved out of the corners of health care and into ordinary conversation, and the question that follows is always the same one.
Does it actually do anything, or does it just leave a mark?
If you are in your sixties or seventies with a low back that has been aching since spring, that question is not idle curiosity.
You have already tried the heating pad and the over-the-counter bottle, and something different sounds worth a try.
If you are the adult son or daughter, you may be coming at this from the other direction. You saw circular marks on your mother’s back, she mentioned a woman at church who swears by it, and now you want to know whether to be supportive or concerned.
Here is what the research genuinely shows, what it does not show, and the safety questions that change after sixty.
Quick Answer
Cupping is a suction technique. A cup is placed on the skin, air is drawn out of it, and the skin and soft tissue underneath lift into the cup for a few minutes.
The National Center for Complementary and Integrative Health, part of the National Institutes of Health, sums up the evidence in one sentence worth reading twice. There has been some research on cupping, but most of it is of low quality, and while cupping may help reduce pain, the evidence for this is not very strong.
That is not a dismissal and it is not an endorsement. It is an accurate description of a field where the studies are small, short, and rarely blinded well enough to separate the treatment from the experience of being treated.
For an older adult, the more useful question is not whether cupping works. It is whether it is reasonable for you specifically, given your skin, your medications, and what else you could be doing with that hour instead.
It is worth being plain about one thing before going further. Cupping is not a standard part of physical therapy training or scope of practice, which means there is no professional incentive here to talk you into it or out of it.
What Cupping Actually Is
NCCIH describes cupping as a practice used in traditional medicine in several parts of the world, including China and the Middle East, in which suction is created on the skin using a glass, ceramic, bamboo, or plastic cup.
The suction is made one of two ways.
Either a flame briefly heats the air inside the cup before it is placed, or a hand pump pulls the air out after it is on the skin.
The distinction that matters most is dry versus wet.
Dry cupping
The skin is never broken. NCCIH defines it simply as cupping that does not involve piercing the skin, and this is the version almost every American reader will encounter.
A related variation slides the cups along oiled skin instead of parking them in one spot. Physical therapists who use it often call that myofascial decompression rather than cupping, which is why you may hear two names for the same equipment.
Wet cupping
Here the skin is pierced so that a small amount of blood flows into the cup. NCCIH describes it in exactly those terms, and it carries a different and more serious risk profile than the dry version.
Any discussion of infection risk, blood loss, or scarring is weighted heavily toward this form. If you are considering cupping at all, knowing which one is being offered is the first question to ask.
About the marks
Cleveland Clinic describes a typical session as three to seven cups left in place for several minutes, leaving red round marks that should fade in a week or two.
Those marks have caused real trouble in emergency rooms and care settings.
NCCIH specifically advises telling your health care providers about cupping, because the discoloration it produces has been mistaken for signs of abuse.
Caregivers, that is worth filing away. If your parent is in and out of medical appointments, a quick mention at check-in prevents a conversation nobody wants to have.
How It Is Supposed to Work
Most hands-on treatments push tissue down. Cupping is unusual because it pulls up, and that reversal is the whole premise.
The proposed explanations fall into a few groups. Negative pressure lifts the skin away from the layers underneath, local blood flow increases, and the strong sensory input may change how the nervous system is processing pain in that area.
The blood flow part is not speculation. A 2020 study in Frontiers in Bioengineering and Biotechnology by Wang and colleagues measured skin blood flow directly under different cupping settings and found large increases, with higher suction pressure and a shorter five-minute application producing more blood flow than lower pressure or a longer ten-minute hold.
That is a real measured effect. It is also worth knowing that the study involved twelve healthy adults with an average age of about twenty-nine, which is roughly the opposite of the population reading this page.
Here is the part that gets skipped in most articles about cupping. A mechanism is not a benefit.
Plenty of things increase blood flow to a patch of skin, including a hot shower and a brisk rub with a towel. Showing that suction moves blood is a long way from showing that it makes a stiff back work better three weeks later.
What the Research Actually Shows
This is where most cupping articles either oversell or sneer. Neither is accurate, and the real picture is more interesting than both.
Pain scores improve. Function does not.
The most useful recent analysis came out in BMJ Open in 2025, by Jia and colleagues. They pooled ten randomized trials of cupping for chronic musculoskeletal pain, with 656 participants in the pain analysis.
Pain intensity dropped meaningfully, and the authors rated that finding moderate quality on the GRADE scale. So far so good.
Then look at the second outcome.
Functional disability, meaning what people could actually do, showed no significant improvement at all.
Mental health outcomes showed no difference either, and that null result was rated high quality, which is the strongest rating anything in this literature has earned.
The authors were candid about two further limits. Only the immediate effects could be analyzed because of when the trials collected their data, and the variation between studies was very high.
Put those pieces together and you get a fair summary. In the trials we have, cupping changed how people rated their pain right afterward, and it did not change what they were able to do.
One subgroup finding is worth passing along, carefully. Neck and shoulder pain responded more than back pain did, and participants over forty-five did somewhat better than younger ones, though subgroup results inside a small meta-analysis are a hint rather than a conclusion.
What happens when you compare it to fake cupping
This is the test that separates a treatment from the experience of receiving one.
In 2025, Jenkins and colleagues published a systematic review in JOSPT Open, a journal of the Academy of Orthopaedic Physical Therapy, asking a narrower question than anyone else had. Not cupping versus nothing, but dry cupping versus placebo cupping, where the cups go on and the suction does not.
They found only five eligible trials, four of which could be pooled, covering 281 people in total.
The results were rated very low certainty at every time point, short term, medium term, and long term. The authors’ conclusion was direct: the evidence for cupping compared to a placebo is very uncertain for treating musculoskeletal pain.
That sentence deserves to be understood correctly, because it is easy to misread in both directions. It does not say cupping is useless, and it does not say cupping is proven. It says that after decades of practice, nobody has yet run the studies that would tell us.
The quality problem, stated plainly
In 2025, Wang and colleagues published an updated systematic review in the Journal of Traditional Chinese Medicine covering 72 randomized trials and 5,720 participants. That is a substantial body of research by any measure.
Every single one of those 72 trials was assessed as having a high risk of bias.
None reported adequate blinding, most were missing details on how participants were assigned to groups, and the authors rated the overall evidence low to very low quality. Their conclusion still leaned positive, but they attached that quality rating to it in the same breath.
A separate 2023 evidence-mapping study in Frontiers in Neurology by Wang and colleagues went a level higher and reviewed fourteen meta-analyses of cupping for pain. Across twenty-one different outcomes, not one was supported by high-quality evidence.
When they graded the reviews themselves using the AMSTAR-2 tool, half came out low quality and another five were rated critically low.
What Cochrane has, and has not, published
Cochrane reviews are generally treated as the strictest summaries in medicine, so people reasonably go looking for one here.
There is not one yet. In June 2025, Saragiotto and colleagues published a Cochrane protocol on cupping therapy for chronic non-specific low back pain, which is the written plan for a review rather than the review itself.
No results, no pooled numbers, no conclusions. Anyone citing “a Cochrane review on cupping” at this point is citing something that does not exist yet.
It is genuinely good news that the work is underway. It is also a reasonable argument for waiting before you spend much money on a series of sessions.
The Absence Nobody Mentions
Sometimes what is missing from a document tells you more than what is in it.
The American College of Physicians publishes the most widely used American guideline on treating low back pain without drugs or surgery. It is not a conservative document, and it is not hostile to traditional or complementary approaches.
For acute and subacute low back pain it recommends superficial heat, massage, acupuncture, or spinal manipulation. For chronic low back pain the list runs long: exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, and spinal manipulation.
Acupuncture made the list. Tai chi made the list. Cupping did not.
That absence is not a verdict that cupping fails. It reflects that the trial evidence was not strong enough or consistent enough to be recommended alongside the others, which lines up exactly with what the meta-analyses keep finding.
If your back is the reason you are reading this, the therapies on that list are the ones with the stronger case behind them. Our guide to what actually causes low back pain in older adults walks through why the cause matters more than the treatment you pick first.
Safety Questions That Change After Sixty
The general safety record of dry cupping is reassuring. A 2023 review in the Journal of Back and Musculoskeletal Rehabilitation by Mohamed, Zhang, and Jan concluded that the incidence of adverse events is very low.
There is a catch in that reassurance, though, and the 2025 review of 72 trials exposed it. Only two of those 72 trials reported adverse events at all.
A clean safety record built on research that mostly was not looking for problems is not the same as a clean safety record. Hold both facts at once.
Skin that is genuinely different now
This is the piece almost no cupping article addresses, and it is the one that matters most for this audience.
MedlinePlus, the patient library run by the National Library of Medicine, describes what changes with age in specific terms. The outer skin layer thins, the fat layer beneath it thins so there is less padding, and the blood vessels in the dermis become more fragile.
Those fragile vessels break easily.
The result is the bruising, flat purple patches, and raised collections of blood that can form after even a minor injury.
MedlinePlus states it directly: as you age, you are at increased risk for skin injury. It also notes that aging skin repairs itself more slowly, with wound healing up to four times slower than in younger skin.
Now apply that to a technique whose entire method is sustained suction on the skin. The marks that fade in a week on a thirty-year-old swimmer are not guaranteed to behave the same way on skin that is thinner, less padded, and slower to heal.
None of the trials discussed above were designed around older adults with fragile skin. That gap is real, and it is a reason for lower suction and shorter applications rather than a reason for alarm.
Blood thinners, and an honest non-answer
This is the most common question I get on this topic, and I am not going to pretend there is a tidy published answer.
Cleveland Clinic’s contraindication list says to avoid cupping if you are pregnant or anemic, or if you have bleeding disorders, blood clotting problems, cardiovascular disease, a pacemaker, skin conditions such as eczema or psoriasis, or a seizure disorder.
Read that list again and notice what it does not say. It names bleeding and clotting disorders, not prescribed anticoagulants such as warfarin, apixaban, or rivaroxaban.
No major body publishes a cupping-specific recommendation for people taking those medications, and the trials did not enroll enough of them to generate one. Anyone who tells you confidently that it is fine, or confidently that it is forbidden, is going beyond the evidence.
What I would tell a patient is this. The decision belongs to whoever prescribed the medication, the question takes about ninety seconds to ask, and it should be asked before the appointment rather than after the marks appear.
Never stop or adjust a blood thinner on your own in order to make a treatment possible. That trade is not close to worth it.
The problems that have actually been reported
NCCIH lists the complications that show up in the literature. Persistent skin discoloration, scars, burns, and infections, along with worsening of eczema or psoriasis.
Rare but severe effects have been reported too, including bleeding inside the skull and anemia caused by blood loss from repeated wet cupping.
Cleveland Clinic adds the everyday ones that are far more likely: bruising, burns, fatigue, headache, muscle soreness, nausea, and skin infection.
One more risk is entirely preventable. NCCIH warns that if cupping equipment is not properly sterilized between patients, bloodborne diseases including hepatitis B and hepatitis C can be spread, which is a wet cupping concern above all.
Where It Sits Alongside Physical Therapy
Some physical therapists do offer cupping, often under the name myofascial decompression. Whether they may do so is decided by each state’s practice act rather than nationally, since the American Physical Therapy Association describes the legal scope of practice as set by the state that issued the license.
So the honest answer to “can my physical therapist do this” is that it depends on where you live and on that individual therapist’s training. Ask directly.
The more useful question is what role it could reasonably play.
Cupping is a passive treatment.
You lie still and something is done to you, which puts it in the same category as heat, ultrasound, and hands-on joint work.
Passive treatments are not worthless. They are frequently the thing that makes movement tolerable enough to start, and our explainer on how manual therapy works and what it cannot do covers the same trade-off in more detail.
But the BMJ Open result should stay in view. Pain ratings moved and function did not, which is the signature of something that changes how a body feels rather than what it can do.
Strength and capacity come from loading tissue and asking more of it over weeks. No cup does that.
In my practice, the pattern I watch for is a patient who has assembled a full week of passive appointments and no active program. That person is busy, they are spending real money, and they are usually no stronger in March than they were in January.
If cupping takes the edge off enough that you finish your sit-to-stand reps that afternoon, it has earned its place in the plan. If it replaces them, it has quietly become the problem.
What a Doctor or Physical Therapist Will Typically Check First
Before any hands-on treatment, the useful work is figuring out what the pain is. Cupping is aimed at soft tissue, and a fair amount of stubborn pain in older adults is not primarily a soft tissue problem.
- A medication review. Anticoagulants and antiplatelet drugs come first, and so do long-term oral corticosteroids, which thin the skin further on top of normal aging changes.
- A look at the actual skin over the area in question, checking for thinning, existing purple patches, open areas, eczema or psoriasis, and how fast recent bruises have been clearing.
- Whether the pain has a mechanical pattern. Pain that changes predictably with position or activity behaves differently from pain that is constant and unrelated to movement, and the second kind needs a diagnosis before it needs a technique.
- Screening for nerve involvement, meaning numbness, pins and needles, or weakness, since those point away from muscle tissue and toward a nerve root or a peripheral nerve.
- Bone health history, including any osteoporosis diagnosis or prior fragility fracture. This does not rule out cupping, and it does change how much pressure any clinician should be putting anywhere near a spine or a rib cage.
- Range of motion and a strength baseline, often measured as how many times you can rise from a chair in thirty seconds without using your arms. Without a starting number, there is no way to tell later whether anything helped.
- What you have already tried, for how long, and at what dose, because “physical therapy did not work” often turns out to mean four visits eighteen months ago.
Caregivers, the chair-rise number is the single most useful thing you can help track. Count it once before any new treatment starts, write the number and the date on the calendar, and count it again a month later.
Memory is generous toward whatever we just spent money on. A number written down is not.
What Not to Do
- Do not use cupping instead of getting new or changing pain evaluated. Pain that wakes you at night, comes with unexplained weight loss or fever, or follows a fall needs a physician, not a soft tissue technique.
- Do not buy a home cupping kit and use it on your own back or on a parent’s back without training. The suction level, the placement, and the duration are the entire safety margin, and none of them are obvious.
- Do not accept fire cupping over fragile or thin skin without a direct conversation about burn risk first.
- Do not have wet cupping performed anywhere you cannot confirm that equipment is single-use or properly sterilized between patients.
- Do not stop or reduce a blood thinner, or any other prescribed medication, so that a treatment can go ahead. Ask the prescriber instead.
- Do not let a mark that is still dark after two weeks, or any area that becomes painful, warm, swollen, or blistered, go unexamined. That is a call to your physician, not something to wait out.
- Do not sign up for a package of ten sessions before you have seen whether two or three change anything.
Frequently Asked Questions
What are the proven benefits of cupping therapy?
Proven is a stronger word than the research supports. The most defensible statement is that pooled trials show a short-term reduction in reported pain for chronic musculoskeletal complaints, rated moderate quality in the 2025 BMJ Open analysis.
In that same analysis, physical function and mental health did not improve. NCCIH’s summary remains the fairest one-line version: cupping may help reduce pain, but the evidence is not very strong.
Is cupping safe for someone in their seventies or eighties?
Dry cupping is generally low risk, but the studies behind that statement were not run on older adults with thin skin, and most of them did not record adverse events at all.
Age itself is not a barrier. Fragile skin, a bleeding or clotting disorder, prescribed anticoagulants, long-term steroid use, poor wound healing, and diabetes-related skin changes are all reasons to have the conversation with a physician first.
My mother has marks on her back and I am worried. What should I be looking for?
Ordinary cupping marks are round, evenly colored, and not especially tender, and Cleveland Clinic describes them as fading within a week or two.
What warrants a call is a mark that blisters, breaks open, becomes hot or swollen, or is still dark after two weeks. Also worth noticing is whether she is on a blood thinner, since that is a conversation for her prescriber rather than for the practitioner who applied the cups.
One gentle suggestion on approach. Asking what she is hoping it will help with goes considerably further than leading with your concern about the marks.
Does cupping help arthritis?
The knee osteoarthritis research is among the better-studied corners of this field, but the 2023 evidence map still found no high-quality evidence for any pain outcome, cupping for knee arthritis included.
Cupping also does nothing about the muscle weakness around an arthritic joint, which is the part that determines how far you can walk. That is a strength problem, and it responds to loading.
How many sessions would it take to know if it is working?
The trials are inconsistent enough that no honest protocol exists, which is itself worth knowing before someone quotes you a package price.
A practical approach is to give it two or three sessions with a specific outcome written down beforehand, such as your chair-rise count or how far you walked before the back started aching. If neither number has moved, you have your answer.
Is it covered by Medicare?
Generally no. Cupping is typically paid out of pocket, and that cost belongs in the decision alongside the evidence, particularly if it is money that could fund a course of supervised exercise instead.
Coverage rules do vary by plan, so confirm with your own plan before assuming either way.
Final Thoughts for Adults Over 50
A great deal of writing about cupping is sorted into two piles. One says an ancient practice has been healing people for thousands of years, and the other says it is theater with a suction cup.
The research sits in neither pile. It shows short-term changes in how pain is rated, no measurable change in what people can do, and a literature so thin that the strictest reviewers in medicine are only now writing their plan to examine it.
If you want to try it, that is a reasonable choice, and I would not talk you out of it. Clear it with the person who prescribes your medications, start with lower suction and shorter applications given what age does to skin, and write down one number you expect to change.
If you are the one helping, the job here is not to be the skeptic in the room. It is to make sure the passive hour has an active hour somewhere near it.
Neck pain has its own version of this question, and neck arthritis in older adults is worth reading if that is where your stiffness lives, since it explains why the same treatment lands differently depending on what is causing the pain.
Whatever else goes on your calendar, keep the thing that builds capacity. A cup can change an afternoon, and it is the standing up out of the chair that changes a year.
Medical Disclaimer
This article is for general educational purposes and does not replace personalized medical advice. It is written by a licensed physical therapist who does not perform cupping and holds no certification in it, and it is not an endorsement or a recommendation of the practice.
Talk with your physician before trying cupping, especially if you take a blood thinner or antiplatelet medication, use long-term oral steroids, have a bleeding or clotting disorder, have diabetes, have fragile or easily damaged skin, or have an active skin condition.
New, severe, or unexplained pain should be evaluated before any hands-on treatment is applied to it. Never stop or change a prescribed medication on your own.
You Might Also Be Wondering
- How electrical stimulation therapy differs from the passive treatments it gets confused with, and what the evidence behind it looks like.
- Practical ways to manage ongoing pain at home between appointments.
- How to tell whether physical therapy is the right next step for you.
