Is it safe to perform cupping therapy on the neck?

Cupping Therapy on the Neck: Safety Considerations

Cupping therapy on the neck is not recommended due to potential serious risks including vascular injury, and the lack of strong evidence supporting its safety in this anatomical region.

Anatomical Risks of Neck Cupping

• The neck contains critical vascular structures including the carotid arteries and jugular veins, which could be damaged by the negative pressure applied during cupping therapy 1, 2
• The American Academy of Otolaryngology-Head and Neck Surgery guidelines indicate that the neck is a high-risk area that requires careful evaluation and protection from potential injury 1, 3
• The proximity of vital structures in the neck makes this area particularly vulnerable to complications from procedures that apply significant pressure or suction 1, 3

Documented Complications of Cupping

• Case reports have documented adverse events from cupping therapy including factitious panniculitis (inflammation of subcutaneous fat tissue) when applied to the neck and shoulder regions 4
• Development of lipomas (benign fatty tumors) has been reported following cupping massage in the neck area 5
• Repeated cupping therapy on the neck can lead to persistent subcutaneous masses that may require surgical intervention 4

Vascular Injury Concerns

• CT angiography studies show that neck vessels are vulnerable to injury from external pressure or manipulation, with potential for serious complications including arterial dissection 2, 3
• The American Heart Association guidelines emphasize the importance of protecting the neck from unnecessary manipulation when there's any concern for potential vascular injury 1
• Vertebral artery dissection from abrupt cervical manipulation is a rare but serious complication that could potentially occur with aggressive cupping 6

Alternative Approaches for Neck Pain

• For chronic neck pain, evidence-based treatments include graded physical exercise, vestibular rehabilitation, and manual therapy performed by qualified healthcare professionals 1
• Psychological approaches and oculomotor vision treatment may be beneficial for certain types of neck pain 1
• If cupping therapy is being considered for neck pain, it should only be performed on safer anatomical locations away from major vessels and by practitioners with appropriate training 7, 8

Research Evidence on Cupping for Neck Pain

• While some studies suggest cupping may temporarily reduce pain and increase local blood flow in musculoskeletal conditions, these studies have significant limitations 7, 9
• A systematic review found only low to moderate quality evidence for cupping therapy in neck pain, with most studies having small sample sizes and short follow-up periods 9
• When cupping has been studied for neck pain, the cups are typically placed on the upper trapezius or shoulder regions, not directly on the anterior or lateral neck where major vessels are located 8, 9

Conclusion

For safety reasons, cupping therapy should be avoided on the anterior and lateral aspects of the neck due to the risk of vascular injury and other complications. If seeking treatment for neck pain, patients should pursue evidence-based approaches under the guidance of qualified healthcare providers 1, 2, 3.