Does Blue Cross and Blue Shield Pay for Cupping if Used in Conjunction With Other Therapies

Have you ever noticed a famous athlete or Hollywood celebrity sporting large circle-shaped marks on their bodies and wondered, "What is that?!" Those discoloration marks are created by an ancient therapy known as "cupping," in which a suction process moves blood through the body and is believed to remove toxins. Cupping has been practiced for thousands of years in Egyptian, Chinese, and Middle Eastern cultures, but it has only gained popularity and notoriety in the United States over the past 20 years, thanks to celebrities and athletes showing off their cupping marks.¹

Documented in one of the world's oldest medical textbooks (from 1550 B.C.),²  cupping is now used by physical therapists , massage therapists, acupuncturists, physicians, and chiropractors. It is believed to treat conditions that cause pain, but it is also used to treat various other ailments. The practice of cupping is not without controversy, as a lack of conclusive evidence has led some to claim that it only offers a placebo effect.³ This post provides an overview of cupping therapy, including tips on whom it is and isn't recommended for and where you're likely to find cupping offered.

Cupping Therapy Explained

Cupping is a therapeutic process using a glass, ceramic, bamboo, or plastic cup to create suction on the skin. Typically, the practitioner applies a flame to the inside of the cup to remove oxygen before placing the cup on the skin, creating negative pressure that draws the skin into the cup. Some cups feature a suction device so that heating the cup is not necessary.⁴ Cupping increases blood circulation on target areas where the cups are placed, relieving muscle tension and promoting cell repair.

History of Cupping

It turns out that cupping has not only been a staple traditional Chinese medicine but also in ancient Egypt, Greece, and Islam culture. Records show that ancient Egyptians practiced cupping as early as 1500 B.C. to treat menstrual imbalances, vertigo, and fever. The Chinese attribute cupping to Ge Hong, a famous herbalist during the Jin dynasty. Ancient Greek doctors prescribed cupping treatment for internal disease and pain relief.

Types of Cupping Therapy

There are two main types of cupping: wet and dry. The practice of wet cupping involves lightly piercing the skin with a needle, allowing blood to flow into the cup. Dry cupping does not incorporate the skin piercings; thus, the skin remains dry.⁵

Beyond these two main methods, there are a variety of cupping practices to explore, including:⁶

• Needle cupping : In this combination of acupuncture and cupping, acupuncture needles are first applied, and cups are then placed over each needle.
• Massage cupping : After creating the suction, the therapist moves the cups across the skin.
• Facial cupping : Small silicone cups are placed on the face to assist with rejuvenating and detoxifying the skin.
• Water cupping : One-third of each cup is filled with warm water, then inverted onto the skin for suction.

How Does Cupping Therapy Work?

The driving theory for how cupping works is that the suction involved encourages improved circulation, thus promoting healing and reducing pain. One acupuncturist at Cedars-Sinai Integrative Health in Los Angeles noted that her patients feel immediate benefits. "I often hear them say their pain went from an 8 to a 3 on a scale of 10," she said.⁷

During Treatment^{8 4}

Your cupping session will vary slightly based on which treatment you've selected. The practitioner will ask you to lie face down or face up on a table, depending on the area to be treated.

In a dry cupping process known as "fire cupping therapy," the practitioner uses a flammable substance—such as herbs, alcohol, or paper—that they place in the cup and then light on fire. Once the fire extinguishes itself, the practitioner quickly places the cup upside down on the area needing treatment. A vacuum is created as the air inside the cup cools and raises the skin within the cup opening.

The same suction effect can be achieved with modern cups featuring air pumps that allow the practitioner to control the amount of air removed from within.

Some therapists leave the dry cups in place for approximately 3 minutes and then remove them, while others opt to massage or stretch the area by briefly moving the cup.

In wet cupping, also known as "hijama," the practitioner places the cups on the skin before making any needle piercings or cuts. After several minutes of suction, the cup is removed so that the practitioner can administer small cuts to the raised skin to release blood and toxins. The therapist may use pressure to speed the blood flow before placing another cup over the location for several more minutes.

The cupping process is typically not painful, creating only mild discomfort. Writing about his experience with fire cupping, one journalist reported, "I couldn't see the flame with my head buried in the massage board, but I could feel the heat. I winced and tensed. I needn't have bothered; it was painless."⁹

After Treatment and Potential Side Effects

Post-treatment, the notorious circular marks caused by the bursting of capillaries may appear on your skin. These bruise-like discolorations do not hurt and typically heal on their own within 7 to 10 days.⁷ Infrequent side effects may include skin infection, burns, scar formation, nausea, anemia, headaches, and dizziness. Many of these potential risks are preventable, and researchers generally consider cupping therapy to be a safe practice. ¹⁰

Amanda Baiada, Senior Director of Brand and Content at the University of St. Augustine for Health Sciences, is a longtime cupping enthusiast. "Regular fire cupping therapy has given me greater mobility and relief from my chronic neck and shoulder pain," she says. "As soon as the cups are removed, I am able to move more freely, and tension subsides."

Benefits of Cupping Therapy

Proponents of cupping claim a broad scope of benefits from the practice. Principally, it's believed to promote healing and muscle recovery. It is also used to treat:^{11 4}

• Neck, shoulder, back, and knee pain
• Skin issues such as acne and hives
• High blood pressure
• Fibromyalgia
• Migraines
• Arthritis
• Gastrointestinal disorders

Scientists have researched the benefits of cupping over the years from a variety of angles. A 2018 report found that wet cupping may help clear excess heavy metals from the blood, having an excretory effect on the kidneys. And evidence shows that it can be an effective treatment for those suffering from neck pain, a health condition that is the second most significant cause of chronic disability worldwide​​.

Cupping Therapy for Athletes

As evidenced by the repeated appearance of cupping marks on elite athletes at both the 2016 and 2021 Olympic Games, many high-performing athletic stars endorse cupping. Athletic trainers and sports clinical specialists (physical therapists trained to treat amateur and elite athletes) often use cupping to help athletes' muscles recover following intense and repetitive physical activity.

Olympic swimming star Michael Phelps is one of the most renowned athletes to wear cupping marks in competition, sparking worldwide interest at the 2016 Games in Rio. His record-breaking swims made him the winningest Olympian of all time, with 23 gold medals to his name.¹² His trainer told ESPN in 2016 that he had been using the treatment on Phelps since 2014.

Cupping was still visible at the 2021 Olympic Games in Tokyo, even though Phelps is no longer competing. The swimmers Adam Peaty of Great Britain,¹³ Akira Namba of Japan, and Kyle Chambers of Australia¹⁴  were all seen sporting the tell-tale circles during competition.

Over the years, professional athletes in sports like basketball and baseball have also incorporated cupping into their treatment modalities. Athletic trainers for NBA's Oklahoma City Thunder¹⁵ and MLB's Washington Nationals¹⁶ use the practice with their players. However, research on the effectiveness of cupping for athletes has so far delivered inconclusive results.¹⁷

Who Should Avoid Cupping Therapy?^{18 4}

Although cupping is generally considered safe, it's not recommended for everyone. People with certain medical conditions should avoid cupping, specifically those with the following conditions:

• Epilepsy
• Hemophilia
• History of stroke
• Eczema
• Psoriasis

Other factors to consider are:

• Age : Cupping should either be avoided or very closely monitored on seniors and children due to the fragility of their skin.
• Pregnancy : Avoid cupping in the abdomen and lower back areas.
• Medications : If you take blood thinners, do not try cupping.

Research Behind Cupping

Research on cupping has often delivered inconclusive results. As a result, some medical professionals are vocal about their skepticism of cupping, with one UCLA physiologist recently calling it "pseudoscience" in a piece about the Michael Phelps cupping phenomenon. Their perspective is based on multiple research sources that cite statistically weak data. For example:

• A 2019 report could not identify a unified theory to explain the effects of cupping, contending that large clinical trials are needed for future data substantiation.¹⁹
• A 2017 study on cupping used to treat knee osteoarthritis states, "Only weak evidence can support the hypothesis that cupping therapy can effectively improve the treatment efficacy and physical function in patients."²⁰
• Research from 2011 acknowledged that cupping may help reduce pain, but in the next sentence stated, "even for this indication doubts remain."²¹
• In a recent blog post, a Mayo Clinic physician noted, "While some of the available studies do suggest a possible role for cupping in treating fibromyalgia, the definitive answer to its actual role will have to wait for larger and more rigorous studies to be completed."²²

Where Can I Get Cupping Therapy?

You can find trained cupping practitioners across the field of health and wellness—from massage therapists and acupuncturists to physical therapists, doctors, and chiropractors. The type of cupping expert you need may depend on the type of treatment you want. ⁴

Cupping in Physical Therapy

Studies have shown that cupping is a viable treatment option among physical therapy modalities . It can create positive effects on a patient's flexibility, pain threshold, and range of motion.²³

Physical therapist Rob Stanborough , PT, DPT, MHSc, MTC, CMPTP, FAAOMPT, a faculty member of the University of St. Augustine for Health Sciences (USAHS), has incorporated cupping into his treatments for years in an effort to manipulate his patients' soft tissue. He notes, " We use our hands and elbows but can also use instrument-assisted soft tissue manipulation, dry needling where permitted, cupping, and a variety of other methods, all to get those tissues moving. Our goal is to increase mobility, promote healing, and restore function."

Average Cost of Cupping Therapy

The cost of cupping therapy most likely will be impacted by your geographic location, but $30–$80 is the average range for a treatment.¹¹ Around the world, the price is typically considered affordable in comparison to other treatment modalities such as acupuncture.²⁴

Overall, questions still linger around the true benefits of cupping therapy. More research is needed into the modern-day efficacy of this ancient treatment method.

The largest PT school in the United States,* the University of St. Augustine for Health Sciences (USAHS) offers a hands-on Doctor of Physical Therapy (DPT) degree. Join a collaborative cohort of peers who learn under the mentorship of expert faculty-practitioners. Practice with mock and real patients in our state-of-the-art simulation centers and learn anatomy with our high-tech tools. Prepare for clinical practice with a wide range of patients, as well as for advanced roles in research, practice leadership, and policymaking. Residential (blended didactic courses + in-person labs on weekdays) and Flex (online coursework + in-person labs on weekends) formats are available.

*Based on total DPT degrees conferred, as reported by the Integrated Postsecondary Education Data System (IPEDS). Data is captured by IPEDS through interrelated surveys conducted annually by the U.S. Department of Education's National Center for Education Statistics (NCES). https://nces.ed.gov/ipeds/

Effective April 28, 2020, the University of St. Augustine for Health Sciences' Doctor of Physical Therapy program at the Dallas, Texas campus has been granted Candidate for Accreditation status by the Commission on Accreditation in Physical Therapy Education (CAPTE), 3030 Potomac Ave., Suite 100, Alexandria, VA, 22305-3085; phone: 703-706-3245; email: [email protected]). If needing to contact the program/institution directly specifically about accreditation, please call or email Dr. Thomas P. Werner at 469-498-5740 or [email protected] . All application-related questions need to be directed to [email protected] Candidate for Accreditation is an accreditation status of affiliation with the Commission on Accreditation in Physical Therapy Education that indicates the program may matriculate students in technical/professional courses. Achievement of Candidate for Accreditation status does not assure that the program will be granted Initial Accreditation.

1. Robert Shmerling, "What exactly is cupping?" Harvard Health Publishing, June 22, 2020: https://www.health.harvard.edu/blog/what-exactly-is-cupping-2016093010402 [↩]
2. Katie Rosenblum, "What Is Cupping? Does It Work?" Cedars-Sinai Blog, Jan. 13, 2020: https://www.cedars-sinai.org/blog/cupping-therapy.html [↩]
3. Cleveland Clinic, "Cupping," last reviewed Aug. 19, 2020: https://my.clevelandclinic.org/health/treatments/16554-cupping [↩]
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12. Rahul Venkat, "Michael Phelps: The man who dominated the Olympic pool like no other," Olympics.com, Sept. 5, 2020: https://olympics.com/en/featured-news/michael-phelps-olympic-medals-record-how-many-gold-swimmer-world-record [↩]
13. Murad Ahmed, "Olympian Adam Peaty has a plan to be the greatest of all time," Financial Times, July 21, 2021: ​​https://w​​ww.ft.com/content/4e388cc2-acd1-41b8-8439-8e87f94480ed [↩]
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16. Stephen Pimpo Jr, "Nationals' Bryce Harper posts picture of back covered in therapy suction cups," WJLA, Jan. 25, 2018: ​​https://wjla.com/sports/content/nationals-bryce-harper-posts-picture-of-back-covered-in-therapy-suction-cups [↩]
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22. Brent Bauer, "Cupping therapy: Can it relieve fibromyalgia pain?" Mayo Clinic, March 20, 2020: https://www.mayoclinic.org/diseases-conditions/fibromyalgia/expert-answers/cupping/faq-20058053 [↩]
23. Jaeeun Kim et al., "Effect of Cupping Therapy on Range of Motion, Pain Threshold, and Muscle Activity of the Hamstring Muscle Compared to Passive Stretching," Journal of the Korean Society of Physical Medicine, Aug. 2017: https://www.researchgate.net/publication/319567134_Effect_of_Cupping_Therapy_on_Range_of_Motion_Pain_Threshold_and_Muscle_Activity_of_the_Hamstring_Muscle_Compared_to_Passive_Stretching [↩]
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Source: https://www.usa.edu/blog/what-is-cupping-therapy/

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