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Does cupping work? The therapy practice used by Michael Phelps and more has a major following

In June, Katy Perry released the music video for her single, "Never Really Over," in which the singer partook in an array of activities while at a wellness repost — including cupping therapy. At a private fan event ahead of the video's release, Perry described practices like cupping as "new age" and "hippie", but while she may view the treatment as a recent addition to the therapy landscape, cupping actually dates back to ancient Egyptian and Chinese civilizations. Back then, it was used for treating various diseases, but these days, cupping is a fairly mainstream form of physical therapy favored by athletes and wellness-minded celebs. But does it actually work?

That’s a bit of a complicated question, and, to an extent, the answer depends on who you ask. Cupping has plenty of loyal followers who swear by it, including Michael Phelps; images of the swimmer bearing dark purple bruises on his back at the 2016 Rio Olympics attracted almost as much attention as his medal count. Phelps, along with U.S. gymnast Alexander Naddour and celebrities like Jennifer Aniston, Gwyneth Paltrow, Lady Gaga, and Kim Kardashian West, have all been known to undergo the treatment, per Elle India.

The idea behind cupping is that when a practitioner uses small cups (typically glass or plastic) on your skin, it creates “a vacuum pressure, making the blood vessels enlarge... thus increasing blood flow and circulation, and stretching the connective tissues,” Joseph Bax, DO, pain management and rehabilitation specialist at The Mount Sinai Health System in New York City, tells Mic.

There are a few different cupping methods, according to the National Center for Complementary and Integrative Health (NIH). With “dry” cupping, the oxygen is removed from each cup either with heat (think: lighting a cotton ball on fire and putting it inside the cup before it’s applied to your skin) or with a suction device (once the cup is on your skin). With “wet” cupping, meanwhile, the practitioner pierces your skin slightly before taking one of those steps, so blood flows into the cups.

With both types of cupping, “the suction of the cups physically lifts the layers of the skin, the [connective tissue] and the muscles to pull old debris — [like] toxins [and] dead cells — out of the tissues and up into circulation,” chiropractor Claire Jessen, DC, ART, SFMA, tells Mic. Through increased fluid circulation and increased oxygen flowing to tight muscles, she says, “cupping helps the body heal itself from any pain, inflammation and toxins.”

And while cupping marks are most frequently seen on celebrities’ and athletes’ backs, Jessen says the procedure can actually be done anywhere — including your face. “Certain areas are tricky — like an elbow — due to the reduced surface area of tissue to suction to, but it is awesome for shoulders, hamstrings and even chest,” she explains.

That said, like with any alternative therapy, cupping has its fair share of doubters. Much of the skepticism stems from the fact that, as the NIH notes, quality research on cupping is lacking. While there are studies out there that have determined cupping to be safe and effective, they "were not carefully done, and more high-quality studies need to be performed to determine its effectiveness,” according to Bax.

Physical therapist Karena Wu, PT, DPT, OCS, who performs cupping herself, adds that future studies on the practice need to focus on "true mechanical changes seen or chemical changes seen in the tissues." She likens cupping to kinesiology tape, which is often used to help heal and prevent injuries. Cupping "does provide a benefit that the patient is able to perceive. However the evidence is still lacking,” Wu explains.

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Still, many people who've undergone the treatment vouch for cupping's effects; as Jessen says, "more research would be amazing, but it isn’t required to prove results — just ask the patients!” And even if cupping is scientifically proven to be "no more effective than placebo," adds Bax, "if someone finds it helpful, it is a safe treatment option that can help" when used as a complement to other, more proven treatments.

Caitlyn Flynn, a freelance lifestyle and travel writer, does just this. She began cupping to relieve back and shoulder pain caused by her lupus (an autoimmune disease) based on a recommendation by her acupuncturist, and says that not only has it provided temporary pain relief, but it's a better fit for her than acupuncture. “Acupuncture helps, but I’m uncomfortable with needles — I have a bit of a phobia — so cupping is preferable,” Flynn tells Mic.

Carlos Escudero, a sales representative at wine importer Wilson Daniels, reveals that he first learned about cupping while watching Phelps the Rio games and decided to pursue the treatment to deal with his shoulder and back pain. "I’ve tried what feels like everything — [like] acupuncture, massages, and physical therapy — so I decided, why not try cupping?” he tells Mic. The treatment worked, and he continues to pursue cupping therapy today.

However, even for those who find benefits from cupping, there are still side effects. The most obvious is bruising, which Wu says can last up to 10 days, though the extent varies by application and your specific needs. For example, Escudero says his bruising usually lasts four to six days, while Flynn says hers lasts about three or four. But despite the bruising, neither of them find the process to be bothersome. “It was a slightly weird sensation at first, but it wasn’t painful,” Flynn says. Escudero adds that while “you feel a slight pinching” and a small amount of pain from cupping, he overall finds it to be “a very relaxing experience.”

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Jessen notes that people undergoing cupping may feel “slight tenderness” after the fact, but that it’s normal. While you "may feel a little ‘off’ the rest of the day due to...the toxins that can be released,” she says, “you can fend off this feeling by drinking a lot of water.” Wu adds that although some patients may faint from the process, particularly if they “freak out when looking at the cups (it is not the prettiest site) or psychologically stress out about it," that's certainly not the case for everyone.

Overall, many practitioners feel that cupping is safe, though there is potential for burns and infection (in addition to the aforementioned side effects), since it's a process that involves things like fire and extreme skin suction. “With wet cupping, where an incision or needle prick is made, there is a greater possibility of infection,” Bax explains. “This should be done in a clean environment to prevent [that] risk.”

The NIH notes on its website that there’s also the possibility of “persistent skin discoloration,” as well as scars and worsening of skin conditions like eczema and psoriasis. In rare, severe cases, the NIH states, repeated wet cupping can lead to anemia (a shortage of healthy red blood cells, according to the Mayo Clinic) from the blood loss, and cupping on the scalp can lead to bleeding in the skull. Wu states that people with certain health conditions — like a fever, serious heart disease, unhealed wounds, and certain blood and vascular issues — should avoid cupping.

Jessen says that you shouldn’t have cupping done over existing bruises or fluid-filled cysts, or on areas where you have an infection or bone fracture. Wu notes that it’s also important to not only avoid areas like eyes, genitalia, and hernias, but to be “mindful of delicate structures [like] veins and superficial nerves if, for some reason, [cupping] could potentially irritate it.”

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If you Google "cupping therapy" in your area, you're likely to find a variety of offerings, but as with any treatment, prices vary depending on the facility, provider, treatment time, and more. And while it's possible insurance may cover cupping, it'll depend on your specific case and your company's policy for alternative medicine. For example, Flynn's treatments — which cost $85 per hour after her initial 80-minute, $120 session — are covered by insurance, though she owes $25 co-pay for each visit. Escudero, on the other hand, pays $60 per hour, none of which is covered by his insurance.

Even if you find a price that works, do thorough research on the provider before booking your appointment to make sure they’re qualified. Wu says cupping can be performed by a variety of providers, including acupuncturists, physical therapists, chiropractors, and athletic trainers, but they should all have certificates or evidence of legitimate continuing medical education courses that they can show you.

“Ask [the provider] what courses they have taken, and then go online and see if you can find them,” Wu suggests. “You should be able to determine legitimacy by doing some research on the provider and coursework on your own.” She also recommends reading reviews and talking to past clients, if possible.

Ultimately, your provider should be someone who will “truly listen to you, and understand your condition, and be able to explain what their findings are, what the treatment would consist of and what the expected outcome would be,” says Wu. And if you’re unsure whether or not cupping is right for you, you can always make an appointment with your primary care physician first to discuss it before giving the treatment a go.