Although cupping therapy or Tissue Distraction Release (TDR) has been done for thousands of years, the research supporting its efficacy remains quite poor. I can find just one study that has shown that cupping therapy increases skin surface temperature and may temporarily improve chronic neck and shoulder symptoms.

The benefits I see anecdotally in my patients may be due to proper patient selection and of course the placebo effect.

However, since treatment takes only 2-3 minutes and the only adverse effect is temporary skin colour changes, for certain musculoskeletal conditions, I endorse it more than other modalities or NSAIDs.

I most often use only one cup at a time but why not use 4 cups at the same time? I learnt this option from James Mally, ND for managing certain conditions such as shoulder or quads stiffness.

You may number the cups 1 to 4 from smallest to largest, and place the cups in the following order.

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#1 – Over the supraspinatus

#2 – On the lateral border of the scapula over attachments for teres major and minor

#3 – Over the pectoralis major

#4 – Over the infraspinatus

With the cups left on, the patient is asked to actively elevate the arm as high as possible 5-10 times and repeat 2-3 sets.

In my experience over the past 3 years, only 2-3 sessions of cupping are required. If the technique fails to provide immediate improvement in symptoms and mobility, I simply do not repeat it.

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You may also try multiple cups on the quadriceps muscles. The theory is that sometimes the rectus femoris muscle can get adhered to the vasti muscles underneath it leading to limited knee flexion. In that scenario you may either try TDR with movement where you use just one large cup and slide it along the muscle as the patient actively flexes and extends their knee or you may statically place 4 different cups on the quads while the patient actively flexes and extends their knee.

Again, there are no studies to support any of this.

References: Dr. James Mally. Hands on Healing
Chi LM et al The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2016;2016:7358918.
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