Olympic Cupping – what is it and why do athletes use it?

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You may have noticed several Olympic athletes covered in bruises, including swimmer Michael Phelps and US gymnast Alex Naddour.

No, these are not minor injuries sustained during training; they look oddly circular and are located symmetrically all over the body. In fact, they are self-inflicted marks caused by an ancient form of therapy called “cupping”.

American swimmer Michael Phelps competed at Rio with cupping marks clearly visible.

American swimmer Michael Phelps competed at Rio with cupping marks clearly visible.

Cupping has long existed in many cultures including China, ostensibly to stimulate the flow of energy in the body. In recent months, however, there has been a flurry of renewed interest in it. It seems that cupping is having a comeback, and one does not need to be a clairvoyant to predict that, after the Olympic games, cupping will become flavour of the month.

Essentially there are two types: dry and wet cupping. Dry cupping involves a warm cup being placed over the skin. As the air in the cup cools it creates a suction effect which draws in the skin as the cup is placed on it. The suction is usually strong enough to create a haematoma, a swelling of blood within the tissues that is much larger than a normal bruise. As the cup normally has a circular shape, the haematoma is circular as well. These are the strange marks we see on the Olympic athletes.

Wet and dry

Wet cupping involves causing a superficial injury to the skin and then applying a cup over the injured site. This procedure will draw a small amount of blood into the cup. Wet cupping is painful and carries a risk of infection. By contrast, dry cupping is harmless and almost painless – when done correctly.

When, about 40 years ago, I worked in a homeopathic hospital, we used dry cupping regularly. There are several techniques, but the method we used was simple: all you need is a small glass cup, some cotton wool and white spirit. You soak a bit of cotton wool in the white spirit, set it alight, place it in the glass cup and then swiftly place the cup on the patient’s skin. The fire stops instantly, and the change in temperature creates the desired suction. After a while, the effect recedes and the cup falls off by itself. This method is simple but I do not advise anyone to try it at home. If you make a mistake, you can burn yourself badly.

Wet cupping is done in much the same way. Only one thing is different: one has to injure the skin before placing the cup over it, and this is what causes the pain. We used to do this with a little device that had multiple needles on it and looked like a miniature hedgehog; alternatively, we employed a scalpel to cut small, superficial incisions into the skin.

Back then, we used cupping mainly for musculoskeletal problems, such as back pain, neck pain or shoulder pain. Did it work? My impression was that it helped ease the pain of most patients. However, there weren’t any proper clinical trials to tell us more back then.

This lack of evidence continued until recently. I suspect it was Hollywood actress Gwyneth Paltrow who prompted some research into cupping. In 2004, she was photographed in a shoulderless evening dress which displayed the typical circular haematomas of cupping on her back. These photos went around the world and got people interested in this forgotten form of therapy.

Since then, there have been several clinical trials of cupping showing that it can work for pain, but I am not impressed. These studies are of very poor quality – many do not have good controls and/or are subject to bias, and some report results which, quite frankly, are too good to be true.

Yet I can well believe that cupping is effective – after all, I have seen it working with my own eyes. The question is how does it work? The procedure is clearly most impressive to the patient. It would be hardly surprising if cupping generated a significant placebo effect. In addition, it might work via a phenomenon called “counter irritation”. If you have a mild toothache and accidentally hit your thumb with a hammer, you will find that the counter irritation of the hammer strike made your tooth ache disappear instantly, at least for a while.

Of course, this is not what the cupping therapists will tell you. Depending on which tradition they subscribe to, they will spin a long yarn about life forces, chi or energies being put back into order. Like cupping itself, these explanations originate from the pre-scientific era and do not make the slightest sense in the light of what we know today.

Naturally, all this does not matter to the Olympic athletes who obviously swear by cupping. They want to ease the pain of overexertion and, because of the doping regulations, they have to be careful with many types of medicines. So any drug-free method to alleviate their pain is more than welcome. And whether it works via a pronounced placebo effect, counter irritation or some mystical energy is the least of their worries.

This article was originally published on The Conversation.