The festival includes ritualistic practices of Kavadi Aattam, a ceremonial act of sacrifice carrying a physical burden as a means of balancing a spiritual debt.

Worshipers often carry a pot of cow milk as an offering and also do mortification of the flesh by piercing the skin, tongue or cheeks with vel skewers.

Thaipusam is observed by Tamils in India, Sri Lanka, Southeast Asia notably in Malaysia, Singapore, and Indonesia.

[1] According to the Kanda Puranam (the Tamil version of the Skanda Purana), three asuras (a race of celestial beings) Surapadman, Tarakasuran, and Singamukhan performed austerities to propitiate the Hindu god Shiva.

[5] Murugan was accompanied by Virabahu who served as his commander-in-chief and eight others, who were sons bore by nine shaktis who arose from the gems of the broken anklet of Parvati, when she ran from her seat due to the heat generated by the sparks emanating from Shiva.

[7] Murugan is a deity associated with yogic discipline and austerities in Hinduism and is regarded by his adherents to be capable of offering mukti (spiritual liberation) to those who venerate him.

[8] Thaipusam occurs annually and is celebrated on the full moon day in the Tamil month of Thai on the confluence of star Pusam.

By bearing the Kavadi, the devotees implore Murugan for assistance, usually as a means of balancing a spiritual debt or on behalf of a loved one who is in need of help or healing.

[9] Worshipers often carry one or more pots of cow milk as an offering (pal kavadi) or other objects such as sugarcane, tender coconut, and flowers.

[10] The most extreme and spectacular practice is the carrying of Vel kavadi, a portable altar up to 2 metres (6 ft 7 in) tall and weighing up to 30 kg (66 lb), decorated with peacock feathers and is attached to the body of the devotee through multiple skewers and metal hooks pierced into the skin on the chest and back.

[17][18] At Subramaniya Swamy Temple, Tiruchendur, where Murugan was supposed to have emerged victorious against the asuras, the festival attracts lakhs of pilgrims every year for the ritual procession.

At Medan, pilgrims accompany a hundred year old chariot locally known as Radhoo to Sri Mariamman Temple at Kampung Madras.