Here we go, another article of a growing health topic: cupping! Before we begin, I HIGHLY recommend you watch this video that explain pain.
In 2012, Olympic volleyball players popularized KinesoTape, which may have some beneficial effects. However, they got got sued in 2015 for making false claims about other benefits (click here). This year's Olympic is bound to increase the interest in cupping since it is seen on Michael Phelps and other athletes.
What is it?
Cupping is when glass or plastic "cups" are used to cause a vacuum effect on the skin by either using a pump or heat to generate negative pressure. It can cause edema (swelling), errythremia (redness of skin), and ecchymosis (bruising) which is thought to increase healing.
Who SHOULDN'T Use It?
Because it causes bruising and swelling, below populations and/or regions should not have cupping applied. These are contraindications:
- Pregnant women
- Women menstruating
- Cancer (metastatic)
- Bone fracture
- Deep Vein Thrombosis
- On arteries where pulses are felt
- On sunburn, abrasions, rash, contusion, and bruises
- High altitude (Yes, a review stated a guy wound up in the hospital when it was applied on his private jet and atmospheric pressure aggressively increased and ruptured his capillaries).
Why Do People Want It?
Some people claim or are told that it can:
- Increase flexibility (range of motion aka ROM)
- Decrease pain
- Decrease healing time
Does It Actually Help?
Did you watch the video above on pain? If not, it is highly recommended before you proceed.
Multiple studies show that it decreases chronic pain in the neck and shoulder, lower back pain, and even acute severe neck pain. Additionally, it was shown to increase flexibility for movements similar to touching your toes when applied to a few of the back muscles (erector spinae). There were no studies that compared healing times to a control group or other methods of treatment, therefore it can not be accurately claimed to decrease healing time.
Here are other highlights from the literature:
- Cups can vary from 38mm - 120mm, with larger cups generating more suction (Not necessarily a good thing; no studies to identify optimal pressure for claimed effects).
- One study claimed muscle layers are deformed, however more recent studies showed only the epidermis and dermis is deformed. This means capillaries can be deformed in regards to depth, but not muscle or fascia.
- There was no significant difference between "standard medical care" (aka medication) and cupping. This means for those in severe pain who want to get off meds could benefit from this to tolerate other effective treatments for impairments. It is also interesting to note that the group that received cupping was also given exercise. Because of this, it is hard to say that cupping independently decreased pain.
- One study looked at perineal pain (region of your organs) of postpartum women, and reported decreased pain. However as explained before, perception of pain is complex and multifactoral. Pain can also come from emotions, such as loneliness. The study discussed that pain could have decreased because of time spent with the practitioner so they do not feel lonely. In addition, the practitioners' touch on the site of pain can also affect emotion and feeling of being cared for. They stated that the practitioner's presence and touch could have been a variable as well.
Now for the fun part, HOW does it help?
Well...HOW Does it Help (What's the Mechanism)?
All studies proposed theories, but there was really no clear explanation. They all agreed there is no reliable evidence that clarifies the exact mechanism of cupping.
First of all, let's address the aspect of increased range of motion (ROM). We CAN dismiss the theory that it deforms muscle and fascia tissue (stretching the fascia, breaking adhesion, etc.) from this post regarding foam rolling (click here). In fact, the increase in ROM may also be attributed to the same mechanism as foam rolling, which we explained as autonomic inhibition of the muscle not deformation of fascia. With that said, let's go over the proposed theories about PAIN:
- Greek Theory in the Ancient Times: It bring pathogens and "toxins" to the surface of the body so they can release into the environment. This is a bit out there with very little evidence, if any at all. We do know that pathogens and toxins (if there was such a thing as toxins) are filtered through the body and organs to eliminate them. They can not be released into the environment through our skin (maybe sweat, not likely).
- Eastern Medicine Theory: Pathogens block the flow of Qi (energy), and cupping increased the flow to restore natural balance of Qi in the body. This theory is very hard to measure, and many in western medicine dismiss this theory.
- Western Medicine Theory (Counter Irritation Theory): You cause a stimulus, perhaps even discomfort and pain, in another region of the body so that the original site of pain no longer feels as painful. Or you increase pain or pressure substantially in the affected area, so that pain threshold increases. This theory is still supported and studied today, and has some evidence. However, are you really solving the issue? If this is the mechanism or are you merely getting rid of the symptom?
- Neural Mechanism Theory: Small nerve fibers which carry pain are stimulated from the pressure and sends impulses to the spinal cord, midbrain, and pituitary. These are the sites that are well-studied to regulate pain signals. This then releases serotonin, cortisol, and endorphin which are hormones and neurotransmitters that can inhibit pain signals. This is the most comprehensive scientific theory for pain, that many of the healthcare experts propose now. With that said, even if this is the reason that pain subsides, do you want this as a sole treatment? Are you treating the main issue? Pain is very complex and here's the video...again...if you haven't watched it by now:
So What does All This Mean? Should You Use It or Have It Done? (Closing thoughts)
- For the consumer, patient, client, and customer: Cupping has been shown to decrease pain, however we know that the idea pain can be a perception and symptom. Your perception of pain may be decreased, but it will comeback if you do not address your actual impairments. Ways to fix your impairments is by regular exercise and correct exercise, among other aspects. If you use it for increased flexibility, be sure you understand how it works and what to actually do to maintain that new ROM through proper programming or exercises. The point of this article is for you to be cautious of practitioners using this as a means to fix all your problems and giving you false information. You will most likely rely on them for months and years, but independence and a pain-free life should be the true goal. Be sure to really do your research on the practitioner because there have been stories of tissue damage, burns, and infections from unsanitary cups, cups left on too long, and improper heating for heat cupping. Cupping may help manage pain, especially for Olympic athletes who need it daily, however it does not fix the underlying cause. A licensed physical therapist can both educate you in this and treat your impairments in movement and pain.
- For practitioners: Yes, we need to decrease pain in order for some patients to tolerate exercise, but think about your patients and consider their time and money. Is cupping appropriate for the fastest and optimal treatment plan? I think not, but I do not have all the answers nor am I always right. This article is meant for you to critically consider the uses, appropriateness, and mechanisms of cupping. It is also to remind you it is imperative to educate patients on pain, benefits of exercise, and being transparent of how cupping actually works (We really don't know, but we should go toward the neural mechanism theory based on evidence). Educate them to keep them moving.
As always, Thank you for reading. Be sure to comment below on questions, comments, agreements, and disagreements.
- Akbarzade, M., Ghaemmaghami, M., Yazdanpanahi, Z., Zare, N., Mohagheghzadeh, A., and Azizi, A. Comparison of the Effecct of Dry Cupping Therapy and Acupressure at BL23 Point on Intensity of Postparum on intensity of postpartum perineal pain based on the short form of Mcgill Pain Questionaire. Journal of Reproduction and Infertility. 2015. 17(1): 39-46
- Choi, J.Y., Huh, C.W., Choi, C.H., and Lee, J.L. Extracranial vertebral artery rupture likely secondary to "cupping therapy" superimposed on spontaneous dissection. Interventional Neuroradiology. 2016. 1-4
- Chi, L.M., Lin, L.M., Chen, C.L., Wang, S.F., Lai, H.L., Peng, and T.C. The effectiveness of cupping therapy on relieving chronic neck and shoulder pain: a randomized controlled trial. 2016. 1-7
- Dons'koi, B.V., Chernyshov, V.P. Osypchuk, D.V., and Baksheev, S.M. Repeated cupping manipulation temporary decreases natural killer lymphocyte frequency, activity, and cytotoxicity. 2016. 14 (3): 197-203
- Effectiveness of cupping therapy for low back pain: a systematic review. Acupuncture Medicine. 2013. 31: 336-337.
- Lim, K.G., Chuah, S.W., Shan, M.E., Wong, Z.G., Murugesan, A., Azman, S.S. A cross sectional study of chronic pain relief after bekam (traciditional malay "cupping") therapy. 2015. 9(2): 32-36.
- Rozenfeld, E. and Kalichman, L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Body and Movement Therapies (2016): 20, 173 -178
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