Olympic athletes claim cupping works--but what does science say?

By John Murphy, MDLinx
Published August 18, 2016

Key Takeaways

Athletes at this year’s Summer Olympics—including U.S. swimmer Michael Phelps and gymnast Alex Naddour, among others—have appeared in Rio de Janiero with marks of cupping, notably large circular bruises, that they sport like badges of honor.

Cupping isn’t just this year’s fad. It’s an ancient Chinese traditional medicine that dates back two millennia. But notwithstanding its time-honored heritage, the big question is: Does it work?

“Cupping relieves muscle tension much, much quicker than massage and it improves the blood flow—that's why you get the marks. It's just kind of a quicker way to work on the problem areas,” said former Team USA swimmer and Olympic medalist Natalie Coughlin in an interview with the UK’s Daily Mail.

Coughlin explained that she introduced Phelps to the ancient treatment a decade ago. “We all really love it. It relieves a lot of muscle pressure and we see those marks as being like a badge of honor—they mean you've been working hard in the pool,” she said. 

But these kinds of claims are not well supported by studies in the medical literature (of which, in fact, there are few).

"In the scientific and sports medicine community, we don’t fully understand what its effects are just yet,” said Corey Snyder, DPT, OCS, SCS, MTC, physical therapy manager at the University of Michigan Health System MedSport sports therapy center, in Ann Arbor, MI.

“Anecdotal evidence in case studies does purport the use of cupping for common soft tissue problems like plantar fasciitis and iliotibial band syndrome, so it may be worth the effort in some cases,” Dr. Snyder said. “However, there is not a lot of solid research behind its use. I think this is why it hasn’t become a fully utilized modality in physical therapy practice.”

Of the available research, a 2015 systematic review in PLoS One reported that only one large study showed moderate evidence with clinical significance that cupping was more effective than usual care in treating pain and disability in the short term for chronic lower back pain. Besides this, several small and lower-quality studies showed low evidence with modest clinical significance that cupping was more effective than medications, such as NSAIDs, in reducing pain and disability for chronic lower back pain.

“These studies are poorly powered and can’t fully translate to the general population—but do pose some promise or at least clinical questions for future study and possible benefit,” Dr. Snyder noted.

To perform cupping, the therapist or practitioner warms round glass cups and then places them on the athlete’s or patient’s body. As the warm and expanded air inside the glass cup cools, it contracts, which creates a vacuum that pulls on the skin.

So, how exactly does that help relieve pain or tension?

“The theory would be that the mechanical suction creates a localized vascular response and possibly signals the body to undergo a healing process or inflammatory process to promote healing in a treated area,” Dr. Snyder explained. “Additional theories suggest the cupping creates a mechanical response to ‘mobilize’ or ‘break-up’ adhesions in scar tissue, which may prevent full range of motion in some patients.”

But, because there’s so little research to support or explain cupping, these are little more than educated guesses.

“Pain relief using cupping is poorly understood and could be related to the aforementioned theories, or simply could be a placebo effect,” Dr. Snyder said.

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