Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review

This systematic review represents the first comprehensive study to evaluate the level of evidence for cupping therapy in musculoskeletal and sports rehabilitation. The researchers analyzed 2,214 studies initially identified, of which only 22 met rigorous inclusion criteria, highlighting the need for more high-quality research in the field.

The methodology followed international guidelines for systematic reviews, using five major databases (Scopus, PubMed, Web of Science, EBSCO, and CrossRef) and focusing on randomized studies and case series published between 1990 and 2019. Study quality was assessed using the PEDro scale, revealing significant variability in the methodologic quality of the included studies.

The results show that cupping therapy, both dry and wet, demonstrates variable efficacy depending on the condition treated. For improving soft tissue flexibility, the evidence was rated as moderate, suggesting consistent benefits in increasing range of motion and reducing muscle stiffness. In the treatment of low back and neck pain, evidence was considered low to moderate, with several studies showing significant reductions in pain levels and functional improvement.

For other musculoskeletal conditions, including carpal tunnel syndrome, plantar fasciitis, fibromyalgia, and osteoarthritis, evidence was rated as very low to low. This is mainly due to the limited number of studies, small sample sizes, and inconsistent methodologic quality. Notably, no study directly investigated the effects of cupping therapy on muscle fatigue or delayed-onset muscle soreness, areas of great interest for athletes.

Proposed mechanisms of action include stimulation of mechanoreceptors through negative pressure, improvement of local blood circulation, reduction of muscle tension, and possible anti-inflammatory effects. The pain control theory suggests that mechanical stimulation can block pain signals through spinal modulation, while increased blood flow may facilitate removal of metabolites and toxins from affected tissues.

In terms of safety, the review found a very low incidence of adverse events. Reported side effects were primarily minor, including bruising at the application site, transient muscle soreness lasting 1–2 days, and occasional brief headache. No serious adverse events were reported, suggesting that cupping therapy is a relatively safe intervention when properly applied.

The clinical implications indicate that, despite limited evidence, cupping therapy can be considered a useful adjunctive therapy in musculoskeletal and sports rehabilitation. It is particularly promising for conditions involving pain and muscle stiffness, where it can complement other traditional physiotherapeutic interventions. The low incidence of adverse effects makes it an attractive option for patients seeking alternatives or complements to conventional treatments.