United States’ Michael Phelps competes in a heat of the men’s 200-meter butterfly during the swimming competitions at the 2016 Summer Olympics, Monday, Aug. 8, 2016, in Rio de Janeiro, Brazil. (Matt Slocum, AP)
Written by Daniel Webster.
What is an ancient Eastern medicine modality doing in elite sports performance and recovery?
Is dry cupping the undiscovered secret to winning 23 Olympic gold medals?
What is the evidence behind this unique, yet misunderstood form of treatment?
This week Michael Phelps has become the most decorated and successful Olympic athlete in history with 23 Olympic Gold Medals. He has now won more than double the number of gold medals than any other athlete in the history of Olympic competition. There has been a lot of speculation around the distinct purple circles over his back and shoulders and the potential effects cupping therapy may have as advocated by athletes such as Phelps, and celebrities a like.
Cupping is one of the oldest known practical medicinal therapies, used to treat pain and a wide variety of other medical conditions. While Traditional Chinese Medicine practitioners continue to routinely utilize cupping techniques, it has almost vanished from the therapeutic spectrum of mainstream western medicine (Huang, Choong & Li, 2013).
Dry cupping involves placing glass or plastic suction cups over myofascial trigger points (knots) in muscle or fascia. Suction or heat is applied, stimulating blood flow to the target tissues, which facilitates recovery by bringing nutrients, and removing unwanted cell debris. The effects include but are not limited to loosening adhesions, lifting connective tissue, improved blood flow, and stimulation of the peripheral nervous system (Lee et al., 2011). The circular bruised appearance is painless and represents more of a hickey than a bruise or haematoma. It is important to distinguish the difference between wet and dry cupping in the literature and clinical practice, as wet cupping involves small skin lacerations beyond the scope of physiotherapy practice.
Physiotherapists were rarely exposed to TCM modalities until recently, however dry needling, acupuncture and (now) dry cupping are utilized by physiotherapists within public hospital outpatient departments, sports clubs and private practice settings.
While traditional cupping has an extensive history in Eastern medicine, there is only limited evidence of its effectiveness in the literature, and it is often termed a pseudo-science. Preliminary database searches were unable to identify any trials measuring the effects of dry cupping for athletes, adolescents or children, or in acute pain conditions. It is clear that we don’t know if cupping has a place in elite sports performance and recovery, and could well be a component to Michael Phelps’ success. Perhaps we will see more research conducted as a result of his tremendous Olympic campaign. There are however, some very promising findings in the literature in regard to chronic pain.
The preliminary results from a study by Lauche et al. (2011) showed that two weeks of dry cupping is effective in reducing chronic non-specific neck pain in an adult population. This was both statistically significant and a clinically significant difference. A number of other studies also displayed statistically significant changes compared to standard medical care after 2 weeks for chronic neck pain (Cramer et al., 2011), and 4 weeks of dry cupping improved symptoms for at least 12 weeks in patients with knee osteoarthritis, compared to waiting whilst taking paracetamol (Teut et al., 2012).
Neck pain guidelines certainly recommend traditional physiotherapy treatments such as spinal mobilization, proprioceptive and strength exercises, which reduce pain in chronic neck pain patients, and should continue to be routinely practiced by physiotherapists (Childs et al., 2008). Perhaps with an increased interest in this area, and more high-quality clinical trials, cupping will become a part of future physiotherapy treatment guidelines, in these chronic (and possibly acute) pain conditions. The effects of dry cupping in regard to elite sports recovery and performance have not been studied and may warrant clinical consideration in future trials. Without this evidence, the definitive effects of cupping for athletes such as Michael Phelps remain undiscovered.
At LifeCare Cottesloe/Claremont we have Chronic Pain, Musculoskeletal and Sports Physiotherapists to assist if you are experiencing pain, or want to improve your athletic performance with an evidence-based approach to assessment and treatment! Call us on (08)93843269 or book online for an assessment today!
Childs, J., Cleland, J., Elliott, J., Teyhen, D., Wainner, R., Whitman, J., … Flynn, T. (2008). Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic and Sports Physical Therapy, 38(9). doi: 10.2519/jospt.2008.0303
Cramer, H., Lauche, R., Hohmann, C., Choi, K., Musial, F., Langhorst, J., & Dobos, G. (2011). Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Forschende Komplementaermedizin (Research in Complementary Medicine), 18(6), 327-334.
Huang, C., Choong, M., & Li, T. (2013). Effectiveness of cupping therapy for low back pain: a systematic review. Acupuncture in Medicine, 31(3), 336-337.
Lauche, R., Cramer, H., Choi, K., Rampp, T., Saha, F., Dobos, G., & Musial, F. (2011). The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain- a randomized controlled pilot study. BioMed Central Complementary and Alternative Medicine, 11(63).
Lee, M., Kim, J., Lee, D, Boddy, K., & Ernst, E. (2011). Cupping for treating pain: A systematic review. Evidence-based Complementary and Alternative Medicine. doi: 10.1093/ecam/nep035
Teut, M., Kaiser, S., Ortiz, M., Roll, S., Binting, S., Willich, S., & Brinkhaus, B. (2012). Pulsatile dry cupping in patients with osteoarthritis of the knee- a randomized controlled exploratory trial. BioMed Central Complementary and Alternative Medicine, 12. doi: 10.1186/1472-6882-12-184