By Daniel Owens and Jeremy Grunden
Cupping is form of alternative medicine that is said to help with pain, inflammation and blood flow. All of this can lead to better well-being and relaxation as it acts as a form of deep tissue massage. While not that popular, you may have seen it being used during the Rio Summer Olympic games in 2016. Many athletes, such as Michael Phelps, were seen with large purple spots along their body. This is the result of cupping therapy. Cupping is usually put into two categories; wet and dry. Dry cupping involves the suction of the skin into the cup. Wet cupping has one extra step in which an incision is made, and blood is drawn from the suctioned area. While Olympic athletes seem convinced, is there any scientific data to support cupping as a valid therapy for recovery and rehabilitation?
First, we will look into rehabilitation. A study from Evidence-Based Complementary and Alternative Medicine attempted to prove the efficacy of cupping therapy for treating chronic neck and shoulder pain. The three things that they were looking for was skin surface temperature, blood pressure, and pain intensity. They had a cupping and a control group and found cupping to be statistically significant in raising the skin surface temperature and lowering the pain intensity (Figure 1). The conclusion was that cupping causes vasodilation and can increase blood circulation and is therefore an effective therapy for chronic neck and shoulder pain. These results are not without some cause for concern. First off the sample size was relatively small and similar. Also the increase in skin surface temperature is to be expected, however the pain intensity could be attributed to a number of things. Pain tolerance between patients is different and the decrease in pain intensity of the cupping group could be a result of the placebo effect.
One case study looked into utilizing cupping therapy as a means of treatment for vascular thoracic outlet syndrome. Vascular thoracic outlet syndrome is when blood vessels and nerves near the collarbone are compressed. This restricts blood flow and can lead to pain and numbness along the shoulder and down to the fingers. The case study focused on a collegiate baseball pitcher who had been diagnosed with the disease. The pitcher was put on a program that included cupping therapy on alternating days combined with certain range of motion exercises. The patient began to pitch again and noted no swelling, increased range of motion and significantly less pain. All of this would suggest that the cupping therapy was effective in treating this ailment. However, some issues with the case study is that they did not continue to follow up with the patient after the 3 week period and the sudden improved health could be attributed to a number of different factors. The authors do admit that more research and testing must be conducted to fully understand the efficacy of cupping therapy.
In regards to recovery, a study was done by a team of Greek researchers to find how cupping therapy compares to other treatments in the combating of myofascial pain syndrome. Myofascial pain syndrome is caused by painful spots in the fascia surrounding the skeletal muscle due to repetitive injury, training overload, and muscular overuse. Cupping was done to 20 amateur soccer athletes once a week for three weeks, and their pain pressure threshold (PPT) and visual analogue scale (VAS) was taken before and after the treatment sessions. An increase in PPT and a decrease in VAS was observed in the athletes after cupping. These changes suggest that cupping does have an effect on the body. It’s stated in the article that researchers believe cupping causes hyperemia and local stretching, which is similar to what the first study concluded.
These results show that cupping seems to improve recovery, however other recovery techniques appear to be more effective. Cupping saw the smallest change in the pre and post values. Additionally, it’s always important to consider each participant’s pain tolerance varies. This helps to explain why the standard deviation was ~1.5 for all values in table one.
Compiling all of the evidence, it seems cupping does have an effect on rehabilitation and recovery. Cupping causes vasodilation and hyperemia. This increase in blood circulation and dilation of the blood vessels helps to combat illness that are caused by constricted/compressed blood vessels, like vascular thoracic outlet syndrome. According to the third article though, cupping may not be the most effective recovery solution. When considering the cost of each treatment method, availability, and preference, cupping may not always be the best solution for recovery.
Questions to Consider:
- When would cupping therapy be ideal to use?
- How is cupping therapy better than other therapies?
- Can cupping therapy be combined with other techniques to boost its performance?
Ahmadi, Alireza, et al. “The Efficacy of Wet-Cupping in the Treatment of Tension and Migraine Headache.” The American Journal of Chinese Medicine, vol. 36, no. 01, 2008, pp. 37–44., doi:10.1142/s0192415x08005564.
Bridgett, Rhianna, et al. “Effects of Cupping Therapy in Amateur and Professional Athletes: Systematic Review of Randomized Controlled Trials.” The Journal of Alternative and Complementary Medicine, vol. 24, no. 3, 2018, pp. 208–219., doi:10.1089/acm.2017.0191.
Jun, Wu. “Experimental Study on Treatment of Chronic Soft Tissue Injuries with Fire-Needle Therapy.” Chinese Acupuncture & Moxibustion, 2002, doi: R245.316.
“Fire Cupping-2.” Flickr, www.flickr.com/photos/psit/4827714792.
I have used cupping therapy in the past and am a fan of it. Even if it has only small benefits, I enjoy the way it feels and for me it is convenient and inexpensive because I have it in my house. When I used cupping therapy it was in combination with chiropractics, transcutaneous electrical nerve stimulation(TENS), icing, and massage.
I think cupping therapy is ideal to help those who are trying to remain active through minor injuries and pain, to get even a small amount of pain relief and it’s not meant as a fix for major injuries.
I remember researching cupping during the Olympics when I noticed the spots on Phelps’ back. It’s considered “alternative medicine” – does that mean it’s not prescribed by doctors like physical therapy? Since cupping caused vasodilation, which can be proven, cupping is probably best used when more blood flow to an area would help heal it. Cupping is little work for the patient (in contrast to physical therapy) which could be a pro to patients that can’t or don’t want to put in the work.
I think it would work well with ASTYM in addition
To my knowledge alternative medicine would not be prescribed by a doctor because it is not part of the medical curricula yet. This can be for a number of reason such as risk or lack of data supporting it, so I’m assuming doctors just don’t know enough about it yet to start using it as a solution.
I hadn’t heard of cupping therapy before, so I still have a few logistics questions. As a form of therapy, I assumed that someone would have to be certified to administer it, and that it takes place at a rehabilitation center. But Jackie says she has it at her house, so I guess that’s not the case. So how is cupping regulated, if it’s regulated at all? Also, can the cups be placed on any muscles or only specific ones?
Cupping can be done professionally at a massage or physical therapy institution. For this it would require the therapist to be certified, however you can purchase all the equipment yourself and follow the procedure too. It similar to why barbers and hair stylists get certification but you can still give yourself a haircut at home. As far as the placement of the cups go, it completely depends on the patient’s needs. You can read into some of the locations and when they would be targeted here; https://cuppingresource.com/cupping-hijama-points/.
Very interesting take on cupping. Considering olympic and professional level athletes use this often, their must be some well designed, large sample size studies that have shown an increase in recovery and rehabilitation. However, to me it seems like a lot of the studies show short term effects, similarly to simply a massage or other soft tissue work. The body feels better for the time being, however is this treatment effective in the long run? This would be very interesting to find out.
This is exactly what I’m wondering! There seems to be fairly repeated results indicating the short-term benefits, but I wonder how repeatedly cupping over a longer period of time could affect the soft tissues being treated. Certainly they would adapt to the added stresses, but how?
I agree with your take, not many long term studies have been conducted on the matter. The ones that have such as this; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481764/, draw little to no conclusions on the subject. Long term studies are difficult to conduct, it would require a lot of resources to examine and analyze people for years. Personally I think that cupping would be best used for minor injuries and pain in the short run.
I think I personally would need a large body of evidence on the efficacy of both long and short term effects of cupping before I would try it over more studied and validated methods of therapy. I can see how it would be difficult to get studies like these funded since main stream science is fairly critical of “alternative medicine” seeing as it could just be the placebo effect, but if it were proven to have good outcomes, I think it would be a good option for people who want to go with more natural or less invasive/less drug-centric therapies.
I have never tried cupping, but it sounds a lot like acupuncture where it may have benefits in specific situations, but as an overall could be a little more dangerous than what the possible benefits may be.
I agree that when I first looked into cupping therapy it seemed to be along the same alternative medicine line as acupuncture. With this being said, I wonder if there is data that supports acupuncture over cupping therapy or if the two treatments are too different to evenly compare.
I have tried cupping before and I will admit it does have short term pain relief. So to me it would make sense why high level athletes would use this in the olympics because even if it were to be a placebo effect, your body does feel better. Im curious to know that if I continuously did it, what kind of effects I would see.
I’ve always been curious of the origins of cupping and the physiological reasoning behind how it’s able to reduce pain and inflammation. After reading, I could see how some athletes experience short term benefits and pain relief, but am still skeptical of its practice. I would like to see the results of a longer term study to really assess its effectiveness and observe whether it could be damaging to the body.
Have studies been done to see why cupping causes vasodilation or hyperemia, or is it just known that it does? Perhaps studying this may give insight to the actual effectiveness of cupping to treat pain. Also, is wet cupping a traditional method, or does it have different effect than dry cupping?
The suction created by the cups causes a negative pressure and this is the reason that the vessels open up more and increase blood flow. As far as wet cupping goes, there is not much in terms of studies or literature proving its efficacy. Although, people who subscribe to cupping as an effective treatment think that wet cupping removes harmful substances and toxins from the blood.
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