Society has spoken: Cupping is in

Some spots on Michael Phelps’ back create the next big thing.

Susan Sanford uses a vacuum gun to suction air out of a cup along Chris Martin's lower back. – Photos by Stacey Rupolo

Susan Sanford lined up a set of clear plastic cups, one next to the other. Some large, some small, others tiny. But she wasn’t whipping up a spread of uniquely sized beverages, she was getting ready for her 9 am client.

At Vineyard Complementary Medicine (VCM) in West Tisbury, relief takes the form of a few reddish-brown circles along a sore back. Or leg. Or arm. Or anywhere, really. After about 3,500 years, the ancient Chinese therapy known as cupping had its coming-out party at the Rio Olympics when millions of people around the world asked, “What are those weird spots on Michael Phelps’ back?” Phelps has been getting cupping therapy to prepare for meets for a couple of years now.

“Think of your muscles like a stagnant pond, with all this debris or sludge sitting at the bottom,” Ms. Sanford said. “It’s not necessarily a bad thing, but it’s not ideal, and it’ll catch up with you. Once you bring it to the surface and mobilize it, you aerate the pond with movement and hydration.”

That’s the gist of what cupping therapy does: moves around bits of stagnant, unwanted muscle tissue to release tension and mobilize toxins.

Cupping began as a preparatory step in acupuncture therapy that readies the skin for needles. Now, it’s its own therapy, with its own functions, but is often still paired with acupuncture.

So how does it work?

The practice originated as an ancient Chinese therapy that works to enhance one’s inner qi (pronounced chi). Qi is a term used to describe the healthy flow of blood and inner life force.

The cupping process essentially creates a vacuum over the skin, using a set of either glass or plastic cups. First, the therapist palpates the patient, or applies pressure to the skin, assessing tightness, cup size, and cup placement. Then the cup is set over the spot of choice, and oxygen is suctioned out of the cup using heat or a hand pump, drawing the skin and muscle layer upward. At VCM, Ms. Sanford implements the hand pump and plastic cup approach — this way fire hazards and shattered glass remain a nonissue. The cups stay on no longer than 10 minutes, but what happens during those 10 minutes is noteworthy.

“It’s a treatment, but it’s also a diagnostic,” Ms. Sanford said. “The coloring of the skin shows you that there is in fact an injury. You can actually see the strain. The darker the marks, the more injury you have.”

So in the time the skin is held in the cup, the therapist looks to see exactly where the stress lies, and how intense it is, and decides further treatment. Cupping is essentially a two-for-one deal. It is deeply relieving, but also extremely telling.

Under pressure

So many aspects of cupping are completely dependent on the individual, and that’s why methods of measurement are a crucial part of the therapy. Consistency is key. So is a pressure gauge.

“Say I started applying pressure at about seven pounds, and the patient releases that ‘Ow!’ indicator or is really reactive. That’s their pressure-point threshold (PPT).” Ms. Sanford said.

A patient’s PPT is determined before treatment, and then revisited after. This gives the therapist a numeric benchmark to make comparisons to and draw conclusions from.

The size of the cups, the number of cups, and the level of suction pressure are also very client-dependent.

“I’ll take it easy on the first date,” Ms. Sanford said, “But if I have a client who says, ‘I don’t care, do anything,’ I’ll pump up the pressure and go for it.”

Sliding cups is another branch of the therapy. Ms. Sanford refers to it as the shotgun approach, because it covers a large area of skin.

“With sliding cups, you use lotion that allows you to slide the cup up and down,” she said, “I’ll do it on somebody who has a whiplash injury, where it hurts from their head all the way down to their tailbone.”

After treatment, it’s important to keep a few things in mind: “We’re mobilizing all this stuff, so you definitely want to hydrate and detox, otherwise it’s just going to float around and wreak havoc.”

It’s also crucial to properly seal and protect the marks. “It’s kind of like when Grandma said, Don’t run around after a shower with your pores open,” Ms. Sanford said, “After cupping, your skin is extra-susceptible to cold and wind, and you want to protect that area for 24 hours.”

In traditional Chinese medicine, moxibustion, which is a burning of dried mugwort on the skin, is used to the seal the marks. Westernized practices just use a heat pad.

My first cupping session

Moment of truth: It was time for my first cupping session. Ms. Sanford applied six different cups, two on my upper back, two on my lower back, and two small ones at the base of my neck. She also demonstrated sliding cups. In the interest of full disclosure, I’ve never had a professional massage before, and within seconds of Ms. Sanford’s pre-cup palpitations, she detected a great deal of tension in my back and shoulders.

“Oh my …” she said. “This is going to be so good for you.”

The sensation was strong but comfortable, with deep upward strokes almost pulling you off the table. The cups felt like they could dig further than what I envisioned any regular massage might achieve — like they were cleansing the absolute deepest rooted layers of my muscle tissue. I left feeling sleepy, happy, relaxed, and sold.

Like a lot of very big hickeys

The marks left after cupping indicate unhealthy qi, and repeating treatment until they lighten demonstrates healing. To my surprise (and disappointment), my marks faded by the end of the day. But the idea behind them is that the pressure from the vacuum causes the blood vessels under the skin to expand and redden. It’s essentially the same thing as a hickey, or as Ms. Sanford calls them, “therapeutic kisses.” In Chinese medicine, the deep embedded muscle tissue injury is referred to as blood stasis, and cupping helps mobilize that blood stasis. That’s why you get the dark marks.

“They can last anywhere from two to three days to two to three weeks,” Ms. Sanford said. “It depends how messed up you are.”

But there’s some twisted self-pride in getting a good mark. It’s injury, relief, and healing that you can physically see all at once. That’s a pretty remarkable thing if you ask me.

To cup or not to cup

According to Ms. Sanford, anyone can benefit from cupping therapy, but it is especially used on people with chronic back pain, athletes with tight muscles, or individuals with illnesses such as pneumonia, asthma, cancer, or Lyme disease.

“Cupping is actually really big for lungs,” Ms. Sanford said, “If they’re all built up with stagnant phlegm or pneumonia, it’s a great way to get some of that out of there.”

But there are situations where cupping shouldn’t be used, and that’s why Ms. Sanford implemented competency standards. Unlike acupuncture or massage therapy, you don’t need an official license to administer cupping. It’s part of the acupuncture curriculum, but it doesn’t have its own guidelines.

“You’re not supposed to do it over the low back or stomach of someone who’s pregnant. You don’t want to do it over an active cancer area, an open wound, or a possible infection. You want to keep it off of the bones,” she said, “I’ve created a test for my staff, but there’s no real set standard of competencies established yet.”

And that’s because it’s still in its early phases of being cool. As the practice gains clout with the evidence-based medicine community, more research, time, and resources will be dedicated to the alternative therapy. But Ms. Sanford has been behind it all along.

Since graduating from acupuncture school in 2002 and starting her practice in 2003, she’s been no stranger to cupping therapy. In 2010 she authored and designed one of its pioneering studies, working with Northeastern University.

“All the studies that the New York Times and other big publications are citing now never existed. There was nothing,” Ms Sanford said.

The study tested 50 people who had lower back pain and found that cupping improves range of motion and function, and decreases pain as well as lowering the PPT. She and Northeastern’s School of Physical Therapy plan to administer an extension of this original study with a larger subject group this spring.

As the world continues opening up to methods of alternative therapy, it’s people like Ms. Sanford whose energy, passionate nature, and desire to heal are keeping Western medicine on its toes.

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