Cupping therapy, or decompression therapy, has been around for a very long time. It has been used for generations in humans to treat a vast array of diseases and conditions, and in the past few years has been used in the veterinary and veterinary rehabilitation professions as a complementary therapy to help combat pain and musculoskeletal dysfunction in our patients.
There is plenty of evidence to support the use of cupping therapy in humans, but, so far, scant evidence to support its use in veterinary rehabilitation. Two research articles have specifically evaluated the use of cupping therapy in canines and equines in the rehabilitation setting. We will discuss some of the proposed mechanisms of action, as well as the findings of these two published articles.
A little history
In human medicine and healing, cupping has been used for millennia. One of the oldest medical texts to mention cupping is Eber’s papyrus from ancient Egypt, dating back to 1550 BC. Cupping also forms part of the healing cultures and medicines of the Chinese, Unani, Koreans, Tibetans, and the Arabic and Islamic countries (Aboushanab & AlSanad, 2018).
Ancient Greeks used it, too. Hippocrates describes cupping therapy, differentiating between two cup shapes and purposes: a cup with a narrow opening and a long handle was used to treat deep fluid accumulation, while a wider cup was used to treat pain.
During the Renaissance (1450–1650), cupping made its way to Italy and the rest of Europe, becoming a common treatment for arthritis and gout (Aboushanab & AlSanad, 2018).
Cupping therapy is now being used in canine and equine patients as a complementary therapy to treat pain and musculoskeletal or fascial dysfunction.
Mechanisms of action
Mechanisms of action should always be one of our first considerations when we’re thinking about using a new modality.
Cupping therapy is the application of a cup to the skin to allow the creation of negative pressure within the cup space. This negative pressure is created through either heat or suction – although for animals, heat would rarely be used, owing to increased risk of burning.
The pressure caused by suction creates a decompression of the tissue within the cup, and a compression of the tissue under the rim of the cup. The tissue is put under tension, ‘pulling’ fluid into and towards the cup and creating a mechanical change within the tissue (Roostayi et al., 2016).
Many benefits to cupping have been reported, including:
- Promoting superficial blood flow
Superficial blood flow has been shown to increase as a result of cupping, especially directly beneath the applied cups (Liu et al., 2013).
- Changing the biomechanical properties of the skin
Changes in the biomechanical properties of the skin include an increase in elasticity (Miyata et al., 2024).
- Increasing pain thresholds
Pain thresholds have been shown to increase directly after the application of cupping (Long et al., 2020).
- Improving local anaerobic metabolism
Due to the partial deprivation of oxygen created by the vacuum, there will be an increase in anaerobic metabolism, which can lead to changes in nitric oxide release.
- Cellular immunomodulation
When a physical change or stimulation is applied to the skin, it is converted into biological signals that activate the neuroendocrine immune system. This is similar to the mechanism of acupuncture (Aboushanab & AlSanad, 2018).
Cupping therefore has mechanical, cellular and systemic mechanisms of action that are not yet fully understood, and require further research, especially in horses and dogs.
Cupping types and sets
There are many kinds of cupping sets available. They are generally classified according to their material, the method of suction, and their use or purpose. Within the sphere of veterinary rehabilitation, we lean towards the use of
- silicone cupping sets, where manual suction is applied through compression of the cup;
- plastic cups, where manual suction is applied with the use of a hand pump;
- electrical cupping systems, with cups of glass, plastic or steel, where suction is created through a machine (Aboushanab & AlSanad, 2018).
Certain cupping systems, such as wet cupping or heat-based cupping, carry a dramatically increased risk of injury, infection or complication and are not used in veterinary rehabilitation practices.
There is a significant difference between cupping applications that use an electrical suction system and those that use a manual suction system. With an electrical system, suction is continuously generated through a single cup. The practitioner moves the cup around the affected area, rather than holding it statically in one place. Several massage techniques are easily incorporated into the application. Hair coat in patients becomes less of a challenge, and ultrasound gel or other coupling mediums are not necessary.
Manual suction cups – either silicone cups that can be compressed and applied or rigid cups that require a hand pump – are applied in one position for a period of time and then moved. While massage and movement techniques can still be used, the vacuum seal needs to be maintained, which can be challenging. Coupling mediums like ultrasound gel improve contact and help to create a vacuum. Multiple cups can be applied at the same time over a wide area of treatment.
Cupping in canines
In 2024, Miyata et al. conducted a pilot study to assess the mechanical and circulatory effects of cupping with an electrical cupping system. They used the Medicell Mini Pro8 with a 1 cm diameter cup size, at a pressure of 15–20 kPa for 20 minutes over the dorsocervical region.
This was a well-designed study involving 15 healthy beagles divided into control and treatment groups. After cupping, testers measured body surface temperature through thermography, rectal temperature, pulse rate and respiratory rate, as well as skin elasticity/stretching with the skin pinch test. Testers were unaware of which dogs fell into the treatment and control groups.
They found that 20 minutes of dermal suctioning, or cupping, resulted in an increase in body surface temperature five minutes after treatment, and that skin extensibility increased significantly in the treatment group following cupping.
With these results, the researchers hypothesised that cupping increased the surface temperature as a result of an increased superficial blood flow, and that the mechanical suction led to stretching of the skin and superficial fascia resulting in increased extensibility (Miyata et al., 2024).
Cupping in equines
In 2022, Nagahara et al. performed a pilot study in racehorses to determine the effect of cupping on moderate back pain. They used the same Medicell Mini with a 4.5 cm cup, at a pressure of 50 kPa, for five minutes per side in the thoracolumbar region of the back.
They included 15 Thoroughbred racehorses from the same training stable, who showed escape behaviour and pain on palpation of the back. A palpation scale from 0–3 was used to increase objectivity during palpation (Ericson et al., 2020; Varcoe-Cocks et al., 2006).
All included horses had a palpation score of two, indicating moderate back pain, and a lameness score of 0. Outcome measures tested included a palpated pain score, mechanical nociceptive threshold, plasma cortisol levels and heart rate variability.
The only measured outcome that showed any change following treatment was the palpable pain score, which lowered following treatment. Cortisol concentrations, heart rate variability and mechanical nociceptive thresholds remained unchanged.
Ten minutes following the treatment, palpable pain scores were once again the same as their baseline. This indicated a short-term pain-relieving effect that did not persist over time. (Nagahara et al., 2022).
Conclusion
While cupping therapy has been validated in the human literature for many years, the veterinary profession is still far behind in validating this modality for use in canines and equines. Future researchers should collaborate to create a standard of practice that may be repeated in research studies, allowing studies to be compared to one another. The above articles use the same cupping modality, but have significant differences in the size of the cup used, pressure applied and the duration of treatment. Although we expect these treatment variables to change with the size of the area treated, it is worth noting that horses were treated for a far shorter period, over a far larger surface area, than the dogs.
Resources
Sozo Equine
Equine Cupping Therapy, Facebook Group
RockTape FMT courses
Cupping with the New RockPods Podcast
Equine Cupping, Diana Landskron
References
Aboushanab, T.S., AlSanad, S. 2018. Cupping therapy: An overview from a modern medicine perspective. J Acupunct Meridian Stud 11, 83–87. https://doi.org/https://doi.org/10.1016/j.jams.2018.02.001
Liu, W., Piao, S., Meng, X., Wei, L. 2013. Effects of cupping on blood flow under skin of back in healthy human. World Journal of Acupuncture – Moxibustion 23, 50–52. https://doi.org/10.1016/S1003-5257(13)60061-6
Long, K., McGowan, C.M., Hyytiäinen, H.K. 2020. Effect of caudal traction on mechanical nociceptive thresholds of epaxial and pelvic musculature on a group of horses with signs of back pain. J Equine Vet Sci 93, 103197. https://doi.org/https://doi.org/10.1016/j.jevs.2020.103197
Miyata, T., Shibayama, Y., Kawai, S., Watanabe, A., Shibutani, H., Shibutani, T., Ishioka, K. 2024. A pilot study of skin stretching and blood circulation effects of dermal suctioning in dogs. Res Vet Sci 166, 105081. https://doi.org/https://doi.org/10.1016/j.rvsc.2023.105081
Nagahara, R., Suganuma, S., Tsuda, T., Shibutani, T., Enomoto, S. 2022. Acute effects of dermal suctioning on back pain in racehorses: a pilot study. Comp Exerc Physiol 18, 339–347. https://doi.org/10.3920/CEP220007
Roostayi, M.M., Norouzali, T., Manshadi, F.D., Abbasi, M., Baghban, A.A. 2016. The effects of cupping therapy on skin’s biomechanical properties in Wistar rats. Chin Med 07, 25–30. https://doi.org/10.4236/cm.2016.71004
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