Cupping Therapy in Athletes: Current Evidence on Effectiveness, Safety, Physiological Mechanisms, and Clinical Applications: A Narrative Review

Abstract

Background: Cupping therapy is used in athletic settings, although its reported popularity is more readily documented than evidence of its comparative efficacy. Suction-based procedures differ in their invasiveness, and evidence from patients with chronic pain cannot be assumed to apply directly to sports recovery. Objective: To critically examine athlete-specific research on symptom relief, physiological recovery, performance, harms and regulatory considerations, with mechanistic and non-athlete evidence interpreted separately. Methods: A targeted narrative search of peer-reviewed primary studies, systematic reviews and authoritative anti-doping guidance was complemented by citation tracking and verification of bibliographic records; evidence was appraised qualitatively without meta-analysis or a formal certainty-rating exercise. Results: A review of 11 historical athlete trials (498 participants) reported some favourable symptom and biomarker findings, mostly relative to untreated controls, but identified high or unclear risk of bias and no safety reporting. More recent trials showed mixed findings, including a randomised comparison involving 81 recreational runners that found no statistically significant benefit for muscle pain, fatigue, perceived recovery or vertical-jump height compared with sham manual intervention. A sham-controlled study of 40 baseball players found no advantage in objective exercise performance, whereas comparisons in taekwondo, table tennis and runners detected selected short-term subjective, autonomic or sleep outcomes. A 32-runner wet-versus-dry trial found no between-group advantage for measured endurance performance. A separate non-sham within-participant comparison in active men reported sprint-power differences, which cannot establish efficacy against sham treatment. Conclusions: Short-term symptom relief is possible, but evidence for accelerated tissue repair, durable recovery, injury prevention or performance enhancement is insufficient. Adverse-event rates cannot be estimated reliably, and blood-withdrawing wet cupping raises specific safety and 2026 anti-doping concerns.