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Cupping in Physical Therapy

Cupping is a technique that has been utilized since at 3000 B.C. (1).  Recently this technique has been utilized by health professionals to treat a various injuries.  There are two types of cupping typically performed, dry and wet cupping.  Wet cupping involves a small incision of the skin before placing the cups on the target area whereas dry cupping does not involve incision of the skin.

How does it work

Cupping can increase circulation to an injured area.   Often when a muscle is injured, circulation can be comprised due to increased tone of muscle compressing on vessels. It is important for a muscle to have proper circulation, so the healing process can occur naturally.  Cupping can also affect nerve in the muscles which can block pain messages.  Placing the cups near points where nerves are irritated can alleviate symptoms in this region.

How is cupping done?

There are many types of cupping instruments available (2), but typically is performed using a small round cup made of thick glass and rolled edge.  Cups can also come in the plastic, bamboo, rubber, silicone, ceramic and metal material.  There are also various methods to apply the suction, but a common one is the suction gun which is the technique we utilize in our clinic.

Is cupping safe?

Complications with the use of dry cupping has been found to be rare in studies available.  In the few cases where complications were reported the cups were left in target area for more than 20 minutes.  Adverse effects of cupping can include increased redness, bruising, and or hematoma.  The risk of these adverse effects is minimal as the types of techniques we utilize do not require more than 5-10 minutes typically.

How cupping can be used in physical therapy.

Static cupping is when cups are placed in pain points and left for 5-20 minutes.  Dynamic cupping involves placing the cups on affected area and then having patient perform certain movements to increase muscle stretch.  Dynamic cupping can also be utilized to treat nerve issues when used in conjunction with proper gliding techniques.  The most important thing to remember is that not every injury or symptom is the same and it is important to have proper evaluation by a physical therapist to see if cupping or any of our other techniques will be effective for you!



  1. Rozenfeld, E., Kalichman, L., New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine, Journal of Bodywork & Movement Therapies (2015), http://dx.doi.org/10.1016/j.jbmt.2015.11.009
  2. Aboushanab TS, AlSana S., Cupping Therapy: An Overview from a Modern Medicine Persipective, J Acupunct Meridian Stud.2018 Jun;11(3):83-87. doi: 10.1016/j.jams.2018.02.001. Epub 2018 Feb 7.

Picture references

Cup types. [online image].  Retrieved January 10, 2019 from https://www.chaudhryclinic.ca/cups-types/

 sylv1rob1 Deposit Photos. What’s up with cupping therapy used by Olympians? [online image]. Retrieved January 10, 2019 from https://healthyaging.net/healthy-lifestyle/cupping-therapy/

Is there scientific support for cupping [online image]. (2018). Retrieved January 10, 2019 from https://libguides.gwumc.edu/c.php?g=27779&p=170351

Do I need a referral to see a Physical Therapist?


Can I see a physical therapist without a referral?

Yes.  That’s the short answer.  The rest of the blog will discuss the relevance of this in more detail.  The ability to choose who you see in the healthcare industry has been increasingly and unnecessarily complicated.  Many times the type of treatment can be dictated by the healthcare system you are part of and be further complicated by the regulations created to sustain it.

What is Physical therapy Direct Access?

Direct access is the ability to be treated by a licensed Physical Therapy provider of your choice without a referral from a physician.  Every state has some form of direct access for physical therapy.

What is the direct access law in Oklahoma ?

Evaluation and treatment is allowed  without referral for 30 days, referral is required for worker’s comp claims.  At the end of the 30 days, patient must acquire referral for further treatment if needed.  Basically you can walk into any physical therapy clinic and be treated for 30 days without a doctor.

Why come see a Physical Therapist first?

The ability to diagnose and  perform proper medical screening is important to avoid adverse effects or additional injury, It is important to be seen by a qualified Licensed Physical Therapist instead of someone with less training in body mechanics and anatomy. Suffice to say, physical therapists are highly trained healthcare professionals capable of being the first point of care after a muscle of joint injury. There are many benefits to having your first stop be to a Physical Therapist, including lowering your number of visits to the hospital or physician as well as minimizing the amount of tests and images performed.

  • Patients who had PT earlier in treatment showed there was significantly lower probability of having opioid prescriptions, advanced imaging service, and emergency department visits. (Frogner et al 2018)

There are both financial and health benefits to seeking treatment by a physical therapist for muscle and joint issues.  Finding a healthcare provider you can trust is essential in regaining or maintaining a healthy lifestyle. Physical therapy direct access is about putting the choice back in the hands of the patient.

  • Patients with Low back pain experienced less surgery, injections, specialists, and emergency department visits, and lower health care charges if a primary care physician referred the patient to Physical Therapy before referring patient to advanced imaging (Fritz et al 2015)

Each healthcare professional has his or her own expertise.  As a physical therapist, we are movement specialist as well extensively trained to be able to recognize and treat muscle and joint injuries.

As part of the healthcare profession, it is our job to maintain evidenced based practice and provide patients the best care possible within our scope.  Maintaining one on one interaction and consistently seeing the same licensed Physical Therapist has been studied and shown to improve patient outcomes. In our office, consistency of care with the same physical therapist throughout is a priority for us to deliver the best care possible.  

A recent study  examined the potential benefits of seeing the same physical therapy provider throughout treatment. 

  • Patients who experienced greater physical therapy provider continuity had a decreased likelihood of receiving lumbar surgery. Difference in cost is $1,737 vs $2,577 on average.  (Magel et al 2018)


Physical therapy can treat a multitude of injuries using many of the services offered here at Heinen Physical therapy.  In future blogs many of the tools and techniques provided in our office as well as various other health and wellness topics pertaining to physical therapy will be discussed.



Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015;15:150. Published 2015 Apr 9. doi:10.1186/s12913-015-0830-3

Frogner, Bianca & Harwood, Kenneth & Holly A. Andrilla, C & Schwartz, Malaika & Pines, Jesse. (2018). Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Services Research. 53. 10.1111/1475-6773.12984.

John Magel, Jaewhan Kim, Anne Thackeray, Charles Hawley, Sterling Petersen, Julie M Fritz; Associations Between Physical Therapy Continuity of Care and Health Care Utilization and Costs in Patients With Low Back Pain: A Retrospective Cohort Study, Physical Therapy, Volume 98, Issue 12, 1 December 2018, Pages 990–999, https://doi.org/10.1093/ptj/pzy103

Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA.2017;317(14):1451–1460. doi:10.1001/jama.2017.3086