Understanding cupping

Though athletes in Rio are making it popular, there is little documented evidence to show that cupping therapy is a cure for muscle pain


The purple circles seen on Michael Phelps’ body are the result of dry cupping. Photo: Odd Andersen/AFP
The purple circles seen on Michael Phelps’ body are the result of dry cupping. Photo: Odd Andersen/AFP

The purple circles on the body of swimmer Michael Phelps at the Rio Olympics have created a buzz among health experts.

What are those marks, and why does he have them in multiple places? The answer—an age-old muscle recovery method called cupping therapy—has the health fraternity divided on its benefits.

Phelps’ marks are the result of the dry cupping method, which involves heating glass cups. This is done by placing a ball of cotton on fire inside the cup for a few seconds. Once the cotton is removed, the glass, still hot, is placed on the area which has muscle pain for 10-15 minutes. This creates a vacuum inside the glass. The marks occur when blood collects beneath the surface of the skin as a result of suction. This process, it is said, helps the worn-out muscles relax.

When the dry cupping method is used on intact skin, it leaves purple-bluish marks.

Wet cupping, on the other hand, involves making a small incision in the skin to let out the harmful blood. The circular marks, seen on Phelps, actors Jennifer Aniston and Gwyneth Paltrow, and fashion designer Victoria Beckham, disappear within a few weeks. The back, chest, abdomen and buttocks—areas of abundant muscle—are generally where the cups are placed.

Hot glass cups are placed on the body. Photo: Heng Sinith/AP
Hot glass cups are placed on the body. Photo: Heng Sinith/AP

“A lot of the effects are psychosomatic. After all, there is no documented evidence of it actually working. But as far as I have seen, it doesn’t harm anyone. You can even modulate the pressure of the therapy by pulling less or more on the skin,” says Shayamal Vallabhjee, sports scientist and founder of Heal Institute, a Mumbai-based sports medicine clinic.

The earliest reference to cupping as the removal of “foreign matter” from the body can be found in the Egyptian Ebers Papyrus of 1550 BCE. Since then, it has been used by the Greeks, the Europeans and the Chinese. By 1999, cupping was accepted as an official therapeutic practice in Chinese hospitals—fuelling the belief that it originated in China.

According to an article published in the Journal Of Bodywork And Movement in January, “Cupping increases blood circulation, whereas, physiologically, it activates the immune system and stimulates the mechanosensitive fibres.” These fibres, which are sensitive to heat, get activated, leading to the flow of oxygenated blood to the area, which ignites the healing process.

"There doesn’t seem to be any agreement on the risks of cupping, and till the results of more research are available, health experts suggest a normal massage to relieve pain"

However, in another research article, “An Updated Review Of The Efficacy Of Cupping Therapy” (published in the journal PloS One in 2012), authors Huijuan Cao, Xun Li and Jianping Liu said that the beneficial effect of cupping therapy needs to be confirmed through more strictly designed research and trials.

Cupping is not yet popular in the country, and none of the experts we spoke to practise this method.

According to Heath Matthews, consultant sports physiotherapist and Mint columnist, “The effects of cupping are limited to the area where the vacuum is created. Therefore, pain relief will also be limited or temporary, at best.” Unconvinced about the positive effects of the therapy, he deems it to be based on anecdotal rather than scientific evidence.

Delhi-based health and wellness coach Priti Rao does not deny that the lack of research on alternative therapies such as cupping limits their use. She says that if a trained practitioner administers such therapies, they can bring relief. “The same pressure-point theory is used in the Ayurvedic Marma therapy, acupuncture and acupressure—where pressure on certain points can activate the healing of your body,” says Rao.

There doesn’t seem to be any agreement on the risks of cupping, however. “The skin is sucked in, inside a chamber with no blood flow in that area. This can injure the tissue beneath the skin, leading to infections and abscess (pus) formations,” says Shamsher Dwivedee, director and head of the department of neurology at the Fortis Memorial Research Institute in Gurgaon, adjoining Delhi. Dr Dwivedee recommends a gentle massage on the pressure points to relieve muscle spasm without causing tissue trauma, rather than other therapies.

According to research published in the Journal Of Traditional And Complementary Medicine in July 2015, cupping is a complex therapy with multidimensional roles and benefits in various diseases, including acne, herpes zoster, paralysis and pain management. However, till the results of more research are available, a normal massage would probably be a safer bet for people looking for quick relief. After all, as Dr Dwivedee says, “It could all just turn out to be a fad and die down in some time.”

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