What is cupping and why are athletes into it?

USA swimmer Michael Phelps sports a circular mark following cupping treatment. Photo by Getty Images

Cupping has become quite the phenomenon with athletes at Rio 2016. Gold-winning USA swimmer Michael Phelps hit the headlines last week for the strange purple circles marking his shoulders and back. Gymnast Alex Naddour has displayed the same marks on his shoulders, swimmer Nathalie Coughlin has also been seen with the marks on her chest and the US track and field team are also reportedly fans of the practice.

Registered cupping practitioner Umm Ayyub cites some of the benefits for athletes as faster recovery, improved muscle movements and reduced aches and pains.

But what exactly is it?

Cupping is a form of alternative therapy designed to relieve pain by improving blood flow in the affected area. It's been linked with relieving muscular pains and providing more flexible muscles. This is because cupping acts as an inverted massage: rather than applying pressure, the skin is pulled away with similar effects.

This can also be seen in the smooth sheet of connective tissue (fascia) that covers the muscles. Connective tissue can become stiff, restricting muscle and joint movements. Cupping may relieve stiff fascia, making it more elastic and pliable, increasing mobility.

Cupping is a historic practice, having roots in Ancient Egyptian and traditional Chinese medicine where it has been used as a remedy for many disorders.

How does it work?

According to the British Cupping Society, there are four common theories as to how cupping works: the pain gate theory, detox theory, immune system activation theory and muscle relaxation theory.

The pain gate theory describes stimulating specific nerve fibres at the location of pain. Applying the heated cup stimulates neurons that may block these pain signals, reducing pain in the individual.

Detox theory believes that restoring homeostasis is key. The negative pressure relieves the body from congestions due to poor circulation.

Immune system activation theory offers an explanation through promoting the production of natural killer cells and cytokines which secrete anti-inflammatory properties.

Finally, the muscle relaxation theory dictates that vasodilation increases parasympathetic nervous activity, leading to muscle relaxation.

How is it done?

First, oxygen in the cup must be removed before application. Usually a cotton ball is soaked in alcohol, or a similar flammable liquid, then set alight before being placed in the cup.

This heats the cup, allowing a vacuum to be created when applied to the patient’s skin. As the air inside cools, the skin is gently pulled away from the body, allowing blood to pool in the area. The cups can remain in place on the skin for several minutes, allowing affected tissue to receive more nutrients and oxygen. Circular red or purple bruises may remain on the skin for up to two weeks after a session due to ruptured capillaries and improved circulation in the area.

This is all known as ‘dry’ cupping, and a suction pump may be used in place of a flame. The ‘wet’ form of cupping (or ‘hijama’) involves making a small incision in the skin before applying the cup. Umm says that wet cupping releases toxins. This occurs because drawing out a small amount of blood activates the immune system, destroying pathogens and lowering blood pressure.

Why cup?

A 2016 study published in the Evidence-Based Complementary and Alternative Medicine journal found that a group of patients with shoulder and neck pain reported significantly less pain after receiving cupping therapy.

Umm says improving circulation will improve poor Qi (‘vital energy’) by placing the cups at selected meridian points. Umm mentions that pain can be caused from blood congestion if blood cells are deprived of oxygen and plasma. The darker the marks left by the cups, the more sluggish the person’s circulation.

The British Cupping Society claims cupping therapy can be used to treat physical conditions like back pain, osteoarthritis or rheumatism, in addition to psychological conditions such as anxiety.

Who can’t cup?

Umm cites the neck, shoulders and back as the most common areas of the body to cup as this is where the majority of toxins build up. Areas to be avoided include the front of the neck, inner wrists, in front of the ears, the armpits and genitalia. Broken skin, eczema, psoriasis, varicose veins and recent surgical scars should also be avoided. Children and the elderly should be treated by an experienced practitioner as a result of their sensitive skin. People with a history of heart problems and taking blood-thinning medications should be monitored carefully.