After the polarizing red circles on Michael Phelps shoulders surfaced last week at the 2016 Rio Olympic Games, many questions arose pertaining to the science, application and efficacy of the myofascial decompression technique also known as cupping.

As claims and debate started to rip through the world of sports performance and physical therapy, and now even into mainstream worldwide media over the past two weeks on this therapeutic topic, many questions were left unanswered. But now, it’s time to take an unbiased, scientific look at the research and application of the technique known as cupping.

Here is the science behind why Gold Medalist Olympic athletes are choosing to be treated with cupping, and a complete review of the current scientific literature behind this technique from Dr. Mario Novo.


The Emergence of Cupping In Elite Sports Performance

cupping michael phelps

At the top of the sport performance food chain, are the Olympians. These almost god like beings have chiseled away at their human form, with countless hours of practice to become the very best at their sport. In the pursuit of greatness, one is required to take risks with pushing their bodies to the limit. When it is down to the hundredth of a second between winning the gold, or silver for your country, you learn to become comfortable with stress. Although these Olympians break themselves in the training room day in and day out to adapt to stress, the secret is truly in their ability to recovery.

Let’s take a dive into cupping as a form of recovery and how best we can apply the body of known studies to create a frame work worth looking into.

Cupping therapy is defined as a complementary and alternative medicine (CAM) within the world of holistic medicine, and traditional Chinese medicine (TCM). Cupping like many other CAM based treatments are provided as a conservative and alternative method towards improving human health through the reduction of pain when present, and tissue healing.

With nearly 80% of all general doctor’s visits involving pain, as well the rise in American based chronic or recurrent pain costing an estimated $200 billion annually and the rise of prescription based addiction and accidental death; implementing pain science, and holistic approaches towards pain management is as we should view it, a fundamental right towards health and independence of drugs. Here is where cupping plays a role alongside other CAM’s, and advanced medical provider forms of therapy can make the largest difference in how individuals consume healthcare, towards improving quality of life.

The Various Methods of Cupping

cupping fire

Depending on where you look, there can be nearly 7 to 10 different methods for applying cupping. All methods involve the application of a cup or dome to promote localized negative pressure to an area of the body for alleviating pain, and improving tissue recovery.

Dry cupping is by far the most commonly applied methods, which uses either a heat element or pneumatic device, to create the suction required to raise the soft tissue into the cup or dome. Either method produces a gentle and painless, bruise on the skin, which has now become the hallmark of our 2016 Summer Olympic games.

Cupping is applied to various regions of the body, which are individually unique to the athlete/clients/patient needs. The most common areas of application are the back, chest, abdomen, and buttock. The cups are typically left in place 5–10 minutes with the after effects of erythema, edema, and ecchymosis subsiding within a few weeks.

An interesting way of viewing cupping when compared to massage is that massage or external applied force into soft tissue, is noted by a positive pressure change in the surrounding soft tissue structures. The novel stimulus of negative pressure is also used like massage to alter sensory and or pain perception but it also influences the microcirculation of specific body area, which has been demonstrated to change local tissue circulation.

The Mechanism of Effect of Cupping

cupping

Specific mechanisms of acute metabolic tissue change and pressure pain thresholds have been studied with dry cupping. Such studies have demonstrated that while participants received dry cupping, observed increases in blood flow (hyperemia) occurred. This increased blood flow or vasodilatation does appear to also influence tissue temperature but more importantly, appears to increase capillary endothelial cell repair, accelerated tissue granulation, and angiogenesis (formation of new blood vessels) within the regional treated tissue.

Emerich et al found that following cupping participants demonstrated a rise in the lactate/pyruvate ratios which indicated an increase in the anaerobic metabolism of the surrounding tissue.

What this can mean to a patient or athlete, is the potential for a rise of key ischemic (low oxygen) chemical mediators that are involved with promoting cellular/metabolic adaptation, and tissue recovery.

When cupping was compared to wait-list groups, heat modalities, and certain conventional pain medications, cupping showed better effectiveness for pain reduction. It’s no guess that when compared to exercise cupping demonstrated no change, but for many individuals that are unable to train secondary to pain, or over-reaching; cupping appears to be another powerful tool such as dry needling, IASTM, taping, and neuromuscular/musculoskeletal manual therapy based modalities, which all uniquely play a role in the modulation of pain perception, improved muscle recruitment and tissue recovery.

Because, we should all be able to agree that pain plays an inverse role with the ability for an individual to recruit muscle and process useful sensory feedback (proprioception, kinesthetic awareness) via inhibitory feedback systems; the promotion of improved musculoskeletal function should be promoted through the restoration of sensory input via various methods of pain modulation.

Cupping within the context of sport performance can be viewed as a practical method to pre/post activity sensory modulation, which also plays a role with soft tissue health. For Olympic athletes, who have gone the distance, one can imagine they will set no limits to their performance while at the games. Hence, administering cupping can be viewed as a quick treatment session (5-10 min) where they can restore sensory awareness, and already begin increasing the local chemical signaling pathways that influence tissue recovery. For our non-Olympians in the room, I included; pain should be a respected symptom, which often plays a role in teaching us about harm. Hence, we should not be applying cupping at such high frequencies as these athletes, due to the potential for adverse effects as well the potential for increased tissue injury secondary to altering our pain perception.

Because pain plays a role with learning, we can also learn to be in pain. This is apparent with individuals who express chronic pain that lack acute tissue damage. Hence, there is more to pain than chemical irritants and trauma. In regards to chronic pain, cupping may play a role for some individuals seeking a novel approach towards improved function as a complimentary program leading towards the progressions of an exercise prescription.

Relative Safety and Precautions

cupping bleeding

While cupping therapy offer benefits, it goes without mentioning that adverse effects do exist. As with any modality, there are inherent risks that a skilled therapist should be aware of. With cupping, there appears to be an associated risk with the types of application, and frequency that can lead to injury.

Cupping is not advised to be used over excoriated, oozing, or infected areas, as this may promote enhanced D-dimmer (a fibrin protein found in tissue inflammation). As mentioned earlier, cupping will result in the reddening of skin with a the presence of a bruise (ecchymosis) which is regarded as a normal reaction after cupping that should resolve in a manner of 2-5 days. There are adverse effects of swelling, and or burns in some cases, with rare occurrences of an increased pain at the site of supping, and very rare occurrences of reported muscle soreness or tingling in the original site of treatment.

About The Author

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Dr. Mario Novo is a results driven sports orthopedic physical therapist who specializes in strength and conditioning. Known well by his clients/patients as a mentor and educator, Mario’s passion is to unify the highest levels of rehab science with successful mind and body strength coaching. With Mario’s research having focused on new advancements in muscle hypertrophy periodization and joint health, his goals are to share his knowledge and improve on the human condition through personalized cutting edge program design. Mario currently resides in middle Tennessee where he plans on integrating his skills and knowledge in resistance exercise and rehab to empower and inspire those individuals ready to make a change in their lives through health and fitness. He is also the owner of TheLiftersClinic.com, an integrated platform of strength training and physical therapy.


References

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  3. Farhadi, D. Schwebel, M. Saeb, M. Choubsaz, R. Mohammadi, A. Ahmadi The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial Complement Ther Med, 17 (2009), pp. 9–15
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  17. Shekarforoush, M. Foadoddini, A. Noroozzadeh, H. Akbarinia, A. Khoshbaten Cardiac effects of cupping: myocardial infarction, arrhythmias, heart rate and mean arterial blood pressure in the rat heart Chin J Physiol, 55 (2012), pp. 253–258
  18. Schumann, R. Lauche, C. Hohmann, T. Zirbes, G. Dobos, F. Saha Development of lipoma following a single cupping massage-a case report Forsch Komplementmed, 19 (2012), pp. 202–205
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