Chinese Cupping Therapy: Six Questions Answered...
1. Why were people talking about Cupping Therapy so much during the Rio Olympics?
Cupping exploded into public attention during the Rio 2016 Olympics as Michael Phelps, the most successful Olympian of all time was seen with highly visible cupping marks on his shoulders and upper back, fuelling much renewed interest in the ancient technique.
2. What is cupping therapy?
Historically, cupping has been discussed both in the ancient Chinese literature and across different cultures and traditions (Cupping Resource, 2018). During its early stages Chinese cupping was was reputedly applied using animal horns by the Taoist alchemist Ge Hong (281-341 A.D.) and later ‘fire jar qi’ involved bamboo cups (Dharmananda, 2018).
Today cupping generally involves placing a hollow vessel on the skin and creating a vacuum using fire or a manual pump in order to achieve vascular, neural or mechanical stimulation to local tissue, offering a warm stretching or pulling sensation with the aim of reducing pain and tension, or enhancing a traditional acupuncture treatment. It is commonly used for musculoskeletal problems and pain but traditionally has been used for a wider range of health problems for example chronic respiratory problems. In acupuncture clinics it is usually used alongside acupuncture.
3. Why is Michael Phelps using cupping?
Michael Phelps is not the first athlete to turn to cupping. In the 2008 Beijing Olympics, swimmer Wang Qun was famously seen sporting the tell tale signs of cupping. Sports therapy interventions may be aimed at recovery, injury prevention or injury treatment. The Olympics are the culmination of a lifetime of swimming and 4 years of focussed work. Michael Phelps needs to be able to perform at his best without being limited by any injuries or pain that he might be carrying. Shoulder pain in elite swimmers is extremely common. One survey of elite swimmers (Sein et al., 2010) found 91% had shoulder pain, 84% had positive shoulder impingement and 67% had tendinopathy of the supraspinatus. Many turn to anti inflammatory medicine, but the usefulness of these may be detrimental to muscle growth (Schoenfeld, 2012) and additionally carry risk of several clinically meaningful adverse effects (Lippi et al., 2006). Cupping is a low risk non-invasive intervention that has demonstrated effectiveness in the treatment of pain, at least in the short term (Cao et al., 2012; Lee, Kim and Ernst, 2011). Phelps may be using cupping to help manage short-term pain during competition, or to aid recovery through stimulation of circulation through the tissues and muscles of the shoulder and upper back. As a mature and ultra-successful athlete with the weight of expectation on his shoulders, Phelps cannot afford to mess around with an intervention that may not compare favourably with another. You can be sure that he chooses cupping because he perceives it to be a worthwhile addition to his arsenal of therapeutic techniques.
4. How does it work?
There is a saying in Traditional Chinese Medicine that when the 'qi' is obstructed there is pain, but when the 'qi' flows properly there is no pain. Tension, trauma, inflammation, scar tissue, histological changes in the tissue structure during healing are all examples of physical causes of the obstruction of qi. Additionally emotional stress leads to voluntary (if unintentional) tension in the body. The simple strategy of traditional chinese medicine is to restore the correct function of qi circulation by treating the obstruction directly and addressing the cause of the obstruction. Pain is a complex and largely protective experience involving inflammatory, neural or structural inputs integrating with social and psychological influences. Cupping promotes circulation and gently encourages lengthening of the tissues by drawing them upwards into the vacuum space. Its is thought that this improves healing and reduces pain.
5. Is there any science?
The exact mechanism of how cupping works has not been established although hypotheses exist that suggest the analgesic effect may be similar to that of acupuncture e.g. through counter-irritation (The Medicine Publishing Company Ltd, 2005) or perhaps related to increased circulation to the affected area. Clinical studies on how this impacts recovery or pain is not yet conclusive. However, Cao et al., (2014) conducted a systematic review of all cupping therapy research to date, including both wet cupping (involves bleeding and is used in other clinics but not Belfast Community Acupuncture) and dry cupping (the type we use). Of 55 trials identified, 16 were high enough quality to make it through to final inclusion in the study (this is good, it means they eliminated poor quality studies). The results found overall that patients reported reduced short-term pain intensity after cupping compared with conventional care, wait list, heat therapy and drugs.
6. What are the circular marks, they look painful?
The classic cupping marks are essentially caused by extravasation from the small superficial capillaries during the therapeutic process. Although these appear bruise-like Cao et al., (2014) found that only 10% of patients reported mild adverse bruise-like marks with mild pain at the site of cupping. In our experience these marks are common but should fade within a few to several days. Phelps was shown grimacing during a treatment but there is no need for cupping to be this painful. The strength of the vacuum may be varied to suit. Causing a patient pain may lead to further contraction of muscles, and the British Acupuncture Council states that cupping should not be a painful procedure but as a specialist procedure should be given by a licenced acupuncturist (British Acupuncture Council, 2016).
References
British Acupuncture Council, 2016. Cupping. [online] Available at: <https://www.acupuncture.org.uk/public-content/public-styles/cupping.html> [Accessed 20 Nov. 2017].
Cao, H., Li, X., Yan, X., Wang, N.S., Bensoussan, A. and Liu, J., 2014. Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials. Journal of Traditional Chinese Medical Sciences, 1(1), pp.49–61.
Cupping Resource, 2018. History of Cupping. [online] Available at: <https://cuppingresource.com/history-of-cupping/> [Accessed 24 May 2018].
Dharmananda, S., 2018. Cupping. [online] Available at: <http://www.itmonline.org/arts/cupping.htm> [Accessed 24 May 2018].
Lee, M.S., Kim, J.-I. and Ernst, E., 2011. Is Cupping an Effective Treatment? An Overview of Systematic Reviews. Journal of Acupuncture and Meridian Studies, 4(1), pp.1–4.
Lippi, G., Franchini, M., Guidi, G.C. and Kean, W.F., 2006. Non-steroidal anti-inflammatory drugs in athletes. British journal of sports medicine, [online] 40(8), pp.661-2-3. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/16864562> [Accessed 20 Nov. 2017].
Schoenfeld, B.J., 2012. The Use of Nonsteroidal Anti-Inflammatory Drugs for Exercise-Induced Muscle Damage. Sports Medicine, [online] 42(12), pp.1017–1028. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/23013520> [Accessed 20 Nov. 2017].
Sein, M.L., Walton, J., Linklater, J., Appleyard, R., Kirkbride, B., Kuah, D. and Murrell, G.A.C., 2010. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British Journal of Sports Medicine, [online] 44(2), pp.105–113. Available at: <http://bjsm.bmj.com/cgi/doi/10.1136/bjsm.2008.047282> [Accessed 20 Nov. 2017].
The Medicine Publishing Company Ltd, 2005. Stimulation-produced analgesia: acupuncture, TENS and alternative techniques. [online] AnaesthesiaUK. Available at: <http://www.frca.co.uk/article.aspx?articleid=100547> [Accessed 20 Nov. 2017].
Listen to Emma talk about cupping on BBC Radio Ulster (ignore background noise at the start)
Emma Van Loock Lic.Ac 2016 (reviewed 2018)
1. Why were people talking about Cupping Therapy so much during the Rio Olympics?
Cupping exploded into public attention during the Rio 2016 Olympics as Michael Phelps, the most successful Olympian of all time was seen with highly visible cupping marks on his shoulders and upper back, fuelling much renewed interest in the ancient technique.
2. What is cupping therapy?
Historically, cupping has been discussed both in the ancient Chinese literature and across different cultures and traditions (Cupping Resource, 2018). During its early stages Chinese cupping was was reputedly applied using animal horns by the Taoist alchemist Ge Hong (281-341 A.D.) and later ‘fire jar qi’ involved bamboo cups (Dharmananda, 2018).
Today cupping generally involves placing a hollow vessel on the skin and creating a vacuum using fire or a manual pump in order to achieve vascular, neural or mechanical stimulation to local tissue, offering a warm stretching or pulling sensation with the aim of reducing pain and tension, or enhancing a traditional acupuncture treatment. It is commonly used for musculoskeletal problems and pain but traditionally has been used for a wider range of health problems for example chronic respiratory problems. In acupuncture clinics it is usually used alongside acupuncture.
3. Why is Michael Phelps using cupping?
Michael Phelps is not the first athlete to turn to cupping. In the 2008 Beijing Olympics, swimmer Wang Qun was famously seen sporting the tell tale signs of cupping. Sports therapy interventions may be aimed at recovery, injury prevention or injury treatment. The Olympics are the culmination of a lifetime of swimming and 4 years of focussed work. Michael Phelps needs to be able to perform at his best without being limited by any injuries or pain that he might be carrying. Shoulder pain in elite swimmers is extremely common. One survey of elite swimmers (Sein et al., 2010) found 91% had shoulder pain, 84% had positive shoulder impingement and 67% had tendinopathy of the supraspinatus. Many turn to anti inflammatory medicine, but the usefulness of these may be detrimental to muscle growth (Schoenfeld, 2012) and additionally carry risk of several clinically meaningful adverse effects (Lippi et al., 2006). Cupping is a low risk non-invasive intervention that has demonstrated effectiveness in the treatment of pain, at least in the short term (Cao et al., 2012; Lee, Kim and Ernst, 2011). Phelps may be using cupping to help manage short-term pain during competition, or to aid recovery through stimulation of circulation through the tissues and muscles of the shoulder and upper back. As a mature and ultra-successful athlete with the weight of expectation on his shoulders, Phelps cannot afford to mess around with an intervention that may not compare favourably with another. You can be sure that he chooses cupping because he perceives it to be a worthwhile addition to his arsenal of therapeutic techniques.
4. How does it work?
There is a saying in Traditional Chinese Medicine that when the 'qi' is obstructed there is pain, but when the 'qi' flows properly there is no pain. Tension, trauma, inflammation, scar tissue, histological changes in the tissue structure during healing are all examples of physical causes of the obstruction of qi. Additionally emotional stress leads to voluntary (if unintentional) tension in the body. The simple strategy of traditional chinese medicine is to restore the correct function of qi circulation by treating the obstruction directly and addressing the cause of the obstruction. Pain is a complex and largely protective experience involving inflammatory, neural or structural inputs integrating with social and psychological influences. Cupping promotes circulation and gently encourages lengthening of the tissues by drawing them upwards into the vacuum space. Its is thought that this improves healing and reduces pain.
5. Is there any science?
The exact mechanism of how cupping works has not been established although hypotheses exist that suggest the analgesic effect may be similar to that of acupuncture e.g. through counter-irritation (The Medicine Publishing Company Ltd, 2005) or perhaps related to increased circulation to the affected area. Clinical studies on how this impacts recovery or pain is not yet conclusive. However, Cao et al., (2014) conducted a systematic review of all cupping therapy research to date, including both wet cupping (involves bleeding and is used in other clinics but not Belfast Community Acupuncture) and dry cupping (the type we use). Of 55 trials identified, 16 were high enough quality to make it through to final inclusion in the study (this is good, it means they eliminated poor quality studies). The results found overall that patients reported reduced short-term pain intensity after cupping compared with conventional care, wait list, heat therapy and drugs.
6. What are the circular marks, they look painful?
The classic cupping marks are essentially caused by extravasation from the small superficial capillaries during the therapeutic process. Although these appear bruise-like Cao et al., (2014) found that only 10% of patients reported mild adverse bruise-like marks with mild pain at the site of cupping. In our experience these marks are common but should fade within a few to several days. Phelps was shown grimacing during a treatment but there is no need for cupping to be this painful. The strength of the vacuum may be varied to suit. Causing a patient pain may lead to further contraction of muscles, and the British Acupuncture Council states that cupping should not be a painful procedure but as a specialist procedure should be given by a licenced acupuncturist (British Acupuncture Council, 2016).
References
British Acupuncture Council, 2016. Cupping. [online] Available at: <https://www.acupuncture.org.uk/public-content/public-styles/cupping.html> [Accessed 20 Nov. 2017].
Cao, H., Li, X., Yan, X., Wang, N.S., Bensoussan, A. and Liu, J., 2014. Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials. Journal of Traditional Chinese Medical Sciences, 1(1), pp.49–61.
Cupping Resource, 2018. History of Cupping. [online] Available at: <https://cuppingresource.com/history-of-cupping/> [Accessed 24 May 2018].
Dharmananda, S., 2018. Cupping. [online] Available at: <http://www.itmonline.org/arts/cupping.htm> [Accessed 24 May 2018].
Lee, M.S., Kim, J.-I. and Ernst, E., 2011. Is Cupping an Effective Treatment? An Overview of Systematic Reviews. Journal of Acupuncture and Meridian Studies, 4(1), pp.1–4.
Lippi, G., Franchini, M., Guidi, G.C. and Kean, W.F., 2006. Non-steroidal anti-inflammatory drugs in athletes. British journal of sports medicine, [online] 40(8), pp.661-2-3. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/16864562> [Accessed 20 Nov. 2017].
Schoenfeld, B.J., 2012. The Use of Nonsteroidal Anti-Inflammatory Drugs for Exercise-Induced Muscle Damage. Sports Medicine, [online] 42(12), pp.1017–1028. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/23013520> [Accessed 20 Nov. 2017].
Sein, M.L., Walton, J., Linklater, J., Appleyard, R., Kirkbride, B., Kuah, D. and Murrell, G.A.C., 2010. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. British Journal of Sports Medicine, [online] 44(2), pp.105–113. Available at: <http://bjsm.bmj.com/cgi/doi/10.1136/bjsm.2008.047282> [Accessed 20 Nov. 2017].
The Medicine Publishing Company Ltd, 2005. Stimulation-produced analgesia: acupuncture, TENS and alternative techniques. [online] AnaesthesiaUK. Available at: <http://www.frca.co.uk/article.aspx?articleid=100547> [Accessed 20 Nov. 2017].
Listen to Emma talk about cupping on BBC Radio Ulster (ignore background noise at the start)
Emma Van Loock Lic.Ac 2016 (reviewed 2018)