Cupping therapy, an ancient practice using specialized cups to create suction on the skin, has gained attention for managing muscle pain and recovery. Hamstring strains, commonly known as pulled hamstrings, are frequent injuries, especially among athletes. This article examines the theoretical basis and current evidence for using cupping therapy as a treatment for a pulled hamstring.
Understanding a Pulled Hamstring
A pulled hamstring is a muscle strain where the fibers of the three muscles at the back of the thigh have been overstretched or torn. Healthcare providers classify these injuries into three grades based on the extent of the damage. A Grade I strain is a mild injury involving microscopic tearing without a major loss of function. Recovery typically requires a few days to a few weeks.
A Grade II injury is a moderate strain involving a partial tear of the muscle fibers, resulting in noticeable pain, swelling, and reduced strength. This injury often causes a limp and can require four to eight weeks of focused rehabilitation for a full return to activity. The most severe is a Grade III injury, which involves a complete rupture of the muscle, causing immediate, sharp pain and an inability to bear weight. Recovery for a Grade III injury may take several months or require surgical intervention.
How Cupping Therapy Works on Muscle Tissue
Cupping therapy involves placing cups on the skin and creating a vacuum, which lifts the skin, fascia, and underlying soft tissue. This negative pressure sets it apart from traditional massage, which applies positive pressure. The suction causes an outward pull on the tissues, which is thought to increase local blood flow, a process known as hyperemia. This surge of circulation may help deliver oxygen and nutrients while promoting the removal of metabolic waste products.
The mechanical action of the suction also creates a gentle stretching and decompression of the fascia, the connective tissue surrounding the muscles. This lifting and separating of tissue layers can temporarily relieve feelings of tightness and tension. Furthermore, the sensory stimulation from the suction may activate nerves and interrupt pain perception, similar to the gate control theory of pain. These proposed mechanisms are believed to prepare the muscle tissue for subsequent rehabilitation exercises.
Current Evidence for Cupping on Muscle Tears
While cupping is a centuries-old practice, scientific evidence supporting its ability to accelerate the healing of structural muscle tears, such as a Grade II or III hamstring strain, remains limited. Much of the available research focuses on its effectiveness for chronic musculoskeletal conditions, like long-standing neck or low back pain. Studies often show that cupping can lead to subjective pain relief and improved range of motion.
High-quality randomized controlled trials demonstrating that cupping therapy significantly speeds up the structural repair or recovery timeline for acute muscle tears are scarce. The benefits observed are often attributed to symptomatic relief, tissue mobility, and pain modulation rather than direct repair of the torn muscle fibers. Established physical therapy modalities, such as targeted strengthening and progressive loading exercises, remain the primary evidence-based approach for rebuilding muscle integrity. Cupping is generally considered a complementary treatment that might help reduce muscle guarding and stiffness, making subsequent rehabilitation easier.
Safety and Timing of Application
The safety and efficacy of cupping for a pulled hamstring depend heavily on the appropriate timing of its application. Cupping should never be applied directly over an area of acute, fresh tearing, especially with Grade II or Grade III injuries. Applying suction over a newly torn muscle can increase bleeding within the tissue, potentially worsening the injury and leading to greater bruising and swelling.
Cupping is generally reserved for the sub-acute phase, which begins several days to a week after the initial injury, or during the chronic phase. At this later stage, the focus shifts from controlling bleeding to addressing stiffness, muscle guarding, and scar tissue formation. Contraindications for cupping include having an active skin condition, being on blood-thinning medication (anticoagulants), or having severe swelling. To minimize risk, the therapy should only be performed by a certified practitioner who can accurately assess the injury’s grade and stage of healing.