Yes, Cupping does suck. Obviously.

Hello!

I bet you saw the photos of Michael Phelps at the Olympics recently with the cupping marks on his shoulders.  You people have been linking me to photos and telling me all about it for weeks.  It is glorious.  And very cool to see cupping on a wider, more public stage.  I especially doted on the cupping mark over his right serratus anterior, which is over his ribs and below his armpit.  Tightness in this muscle prevents you from reaching up above your head.  I see what they did there.

I was also linked to this article called “Cupping Sucks” by Dr Brad McKay, who is one of the doctors on Embarrassing Bodies Australia – http://www.news.com.au/lifestyle/health/why-team-usas-use-of-cupping-therapy-really-sucks/news-story/39e6da472eba56e564139cc17e38ee5b

I was actually thinking seriously about emailing him and explaining why that article was so odd and poorly informed, but you know what?  It’s not him that I am interested in impressing.  What I do care about is the spread of misinformation.  I care about my clients and anyone else who might stumble across this thing having enough valid information to make their own informed decisions.  So here goes.  You might want to go and get yourself a cup of tea and a bickie.  This is long.

I’m going to make a point of only linking to articles and research from databases that are publicly accessible to anyone with the internet.  I want you to be able to check out what I’m saying for yourselves.  I want to be held accountable for what I’m saying and I want to prove that Dr McKay could have done a lot better had he performed just a simple google search.

 

“These mysterious marks are the result of placing hot glass cups on bare skin. The heat creates a vacuum which sucks up the underlying tissue, supposedly mobilising your blood and helping it to pump throughout your body.

Cupping advocates will tell you that the practice draws toxins out of your skin and helps you to heal and relax after exercise.”

 

  1. It isn’t heat that causes cups to stick to the skin. It is the displacement of oxygen that causes a vacuum. This is Grade 8 science.  I do warm the glass cups, but that isn’t why.
  2. To my understanding of cupping therapy (I have an Advanced Certificate in Cupping Therapy, which is currently the highest qualification for cupping in this country, and it is fully endorsed by my professional associations and the private health funds. I am only just starting to dip my toe in the water as far as Eastern medicine goes, so I cannot claim what I say is completely accurate and all-encompassing as far as Traditional Chinese Medicine goes) we don’t claim the benefits come from mobilising the blood. We’re not witch doctors and we’re not that goth.  One of the main benefits from modern cupping practice, as I was taught by Bruce Bentley at Health Traditions (www.healthtraditions.com.au) is to relieve tightness in the muscles by stretching out the fascia.  Fascia is the silvery connective tissue that lines around muscles and connects all the bones, ligaments, muscles, tendons and organs together.  You’ve seen it before when you’ve cut up meat.  The book “Anatomy Trains” Thomas W. Myers explains how the different layers of fascia string certain areas of the body together, allowing for set movement patterns like walking, which is an amazingly complicated process.  Disordered, tight fascia or weakened, fraying fascia can cause altered posture, infirmity, hernias, muscle wasting and can exacerbate the symptoms of physical diseases such as IBS.  Bruce explains beautifully how cupping can help heal physical infirmity caused by old injuries in his article “Modern Cupping and Fascia” http://www.healthtraditions.com.au/uploads/AAMT%20Summer%202014%20p22-24.pdf .
  3. On drawing out toxins: Yes? From my perspective as a Western medicine practitioner, it can, on a primarily local level.  I wouldn’t recommend cupping as the only treatment for an overburdened, fatty liver.  I do find that cupping can aid in mobilising circulation and therefore drawing out toxins on a local level.  Meaning: directly below the cup.  If I’m treating musculoskeletal problems, I’ll find the “knots” (areas of very tightly fused muscle, usually about the size of half an apricot), apply the cups directly over the top of them and leave them there for around ten minutes.  After ten minutes there is usually a darker circle where the cup was.  This is fine.  There are still studies and debates being carried out as to what is actually this substance that gets drawn to the surface of the skin.  “Toxins” is too simplistic, and so is “blood”.  It is definitely not a bruise, as explained by Bruce again in his article “A Cupping Mark is Not a Bruise” http://www.healthtraditions.com.au/uploads/212-cupping-proof.pdf .

Elite athletes, and in particular sprinters like Michael Phelps, who go through bursts of very intense activity and don’t have a chance to aerate their cells by breathing as much as they would need to in order to fuel this level of activity switch to anaerobic respiration, which involves burning glucose to provide energy and leaves lactic acid as its waste product.  Lactic acid is the substance that causes delayed onset muscle soreness (DOMS).  You’ve felt it before the day after you’ve done some unaccustomed activity.  Well.  I know athletes are used to pain, but I don’t think world records are going to be broken when they have DOMS, especially if, like Phelps they’re competing in multiple events.

Or rather, if they CAN prevent it in a way that won’t get them disqualified, why not?  It seems rational enough that cupping can draw out lactic acid from deep within the muscle and allowing it to be picked up by the capillaries and then moved into the bloodstream, where it will be cleaned up by the liver.  Not that cupping will physically draw lactic acid directly to the surface of the skin.  Bruce talks about the redness produced during cupping as being “heat toxin”.  He is a Traditional Chinese Medicine practitioner and has been one for around thirty years.  I’ll bow to his superior knowledge on that one.  I do tend to see it more when there’s inflammation and injury to the area.

 

“If you’re really adventurous you can explore “wet” cupping, which involves puncturing your skin before applying the cups, and sucking out your “bad blood”.

This traditional therapy is believed to date back to 3000BC and is used in Islamic and Chinese traditional medicines.”

 

Wet cupping in the Islamic tradition is called Hijama, and it is a very sacred thing.  To my knowledge it isn’t widely practiced in Australia.  I get asked for it around twice a year by people who have absolutely raved about it.  I’m not interested at this stage in offering it in my practice.  There’s a whole lot of different certifications you need if you do anything that involves puncturing the skin, and even if I was interested in doing this as yet there isn’t any government accredited course that my associations also recognise, which means that I wouldn’t be able to get insured for performing it.

As far as I know, wet cupping isn’t routinely practiced in TCM either.  At least not in this country.  There’s some pretty wild things to be seen on youtube, but any registered practitioner over here who is able to provide health fund rebates for their services has to abide by a lot of rules and regulations that are put there to ensure public safety.

 

“There is no scientific evidence that cupping works for any of these things. Sucking your skin into a glass cup doesn’t get rid of toxins or help you to heal more quickly. It only sucks the sweat out of the pores in your skin and gives you a nasty round bruise. Same goes for wet cupping, which just causes an impressive looking scar.”

 

Would you like to come have a cruise over to PubMed and Google Scholar with me?  Both of these are available to everyone to go and have a look.  Quite often you can’t get access to the full text of the research article, which is a bit of a pest, but you will see the abstract.

Pubmed.gov is the US National Library of Medicine at the National Institutes of Health.  If you want to go and look up what I’ve found you can go and type in the PMID at the end of the citations that I’ve provided.  (Bear in mind that the way I am presenting this information is not the correct way of providing citations in research papers, I am just collating data here.)  On the first page of results after I typed “cupping therapy” into the search bar I found:

“Evaluation of Wet Cupping Therapy: Systematic Review of Randomised Clinical Trials” 2016, Journal of Alternative and Complimentary Medicine – PMID 27557333

“Yang’s Pricking Cupping Therapy for Knee Osteorarthritis: A Multi-Centre Randomised Controlled Trial” –  Feb 2016, PMID 27348903

“Moving Cupping at Hechelu Combined with Rubbing Method for Depression of Diabetes Mellitus” Mar 2016 PMID 27344826

“Clinical efficacy of Trigonella foenum graecum (fenugreek) and dry cupping therapy on intensity of pain in patients with primary dysmenorrhea”, May 2016 Chinese Journal of Integrated Medicine PMID 27225291

“Repeated cupping manipulation temporary decreases natural killer lymphocyte frequency, activity and cytoxicity” Journal of Integrated Medicine May 2016 PMID 27181126

“The effect of traditional wet cupping on shoulder pain and neck pain: A Pilot Study” May 2016 Complementary Therapies in Clinical Practice PMID 27157955

“Hijama therapy (wet cupping) – its potential use to complement British healthcare in practice, understanding, evidence and regulation” May 2016 Complementary Therapies in Clinical Practice, PMID 2715951

“The effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomised Controlled Trial” March 2016, Evidence-Based Complimentary and Alternative Medicine PMID 27073404

“Comparison of the Effect of Dry Cupping Therapy and Acupressure at BL23 on Intensity of Postpartum Perineal Pain Based on the Short Form of McGill Pain Questionnaire” January 2016, Journal of Reproductive Infertility PMID 26962482

 

Notice how these were all published just this year?

And

Just for fun

“New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine” Jan 2015, Journal of Bodywork and Movement Therapies PMID 26891653

 

At google scholar we can see, as well as a lot of the above:

“The use of cupping as a myofascial release tool to increase iliotibial band flexibility in collegiate football athletes” by Doozan, Ashley, M.S., LAMAR UNIVERSITY – BEAUMONT, 2015, 34 pages; 1598426  http://gradworks.umi.com/15/98/1598426.html

“Observation on clinical effects of acupuncture plus cupping therapy for cervical radiculopathy” Journal of Acupuncture and Tuina Science July 2016, Volume 14, Issue 4, pp 290–294

“Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials” Journal of Traditional Chinese Medical Sciences Volume 1, Issue 1, 1 July 2014, Pages 49–61 http://www.sciencedirect.com/science/article/pii/S2095754814000040

“An overview of systematic reviews of clinical evidence for cupping therapy” Journal of Traditional Chinese Medical SciencesVolume 2, Issue 1, January 2015, Pages 3–10

http://www.sciencedirect.com/science/article/pii/S2095754815000277

“A Pilot Study Analyzing the Effects of Chinese Cupping as an Adjunct Treatment for Patients with Subacute Low Back Pain on Relieving Pain, Improving Range of Motion, and Improving Function” Markowski Alycia, Sanford Susan, Pikowski Jenna, Fauvell Daniel, Cimino David, and Caplan Scott. The Journal of Alternative and Complementary Medicine. February 2014, 20(2): 113-117. doi:10.1089/acm.2012.0769. http://online.liebertpub.com/doi/abs/10.1089/acm.2012.0769

“The Effectiveness of Instrument-assisted Soft Tissue Mobilization Technique (Ergon© Technique), Cupping and Ischaemic Pressure Techniques in the Treatment of Amateur Athletes΄ Myofascial Trigger Points” Fousekis K, Kounavi E, Doriadis S, Mylonas K, Kallistratos E, et al. (2016) J Nov Physiother S3:009. doi:10.4172/2165-7025.S3-009

http://www.omicsgroup.org/journals/the-effectiveness-of-instrumentassisted-soft-tissue-mobilization-techniqueergon-technique-cupping-and-ischaemic-pressure-technique-2165-7025-S3-009.php?aid=76473

“Effectiveness of Home-Based Cupping Massage Compared to Progressive Muscle Relaxation in Patients with Chronic Neck Pain—A Randomized Controlled Trial” Romy Lauche , Svitlana Materdey, Holger Cramer, Heidemarie Haller, Rainer Stange, Gustav Dobos, Thomas Rampp  Published: June 7, 2013 http://dx.doi.org/10.1371/journal.pone.0065378

“Cupping for Treating Neck Pain in Video Display Terminal (VDT) Users: A Randomized Controlled Pilot Trial” Journal of Occupational Health Vol. 54 (2012) No. 6 p. 416-426 https://www.jstage.jst.go.jp/article/joh/54/6/54_12-0133-OA/_article

“Effect of moving cupping therapy on β-Endorphin in the nonspecific low back pain” The Journal of Cervicodynia and Lumbodynia 2012-05 UANG Jun,WU Jian-xian.(Department of Physical Medicine and Rehabilitation, the 105th Hospital of PLA,He Fei 230031,China)

“Tissue Distraction Release with Movement (TDR-WM): A Novel Method of Soft-tissue Release” Dr. Bahram Jam, PT Advanced Physical Therapy Education Institute (APTEI), Thornhill, ON, Canada

May 27, 2016

http://www.aptei.ca/wp-content/uploads/Tissue-Distraction-Release-with-Movement-TDR-WM-2016.pdf

“Clinical Effect Observation of Cupping Therapy for Different Syndrome Types of Periarthritis of Shoulder” Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine 2013-04

 Feng Xiao-lin,Ren Xiao-xiao,Liu Jian-wu  

http://en.cnki.com.cn/Article_en/CJFDTOTAL-SZXL201304006.htm

 

I think there’s evidence, don’t you?

 

“The suction from cupping causes capillaries in your skin to break and bleed. At best, this causes a superficial bruise, but at worst it can cause deep bruises (haematomas), abrasions, skin infections, blisters, and the heat can even cause third degree burns.”

 

Uhh…  Any practitioner causing these problems is negligent.  Just saying.  Haematomas are incredibly unlikely when cupping is performed by a qualified, registered practitioner.  The plastic cups that were used on Michael Phelps (see the photo in the article) are applied using a pump, and it is physically impossible to apply them harder after you’ve squeezed the pump five times.  The valve in the top of the cup won’t let it happen.  I’ve tried.  On myself.  Similarly, it is physically impossible to apply a glass cup hard enough to cause that amount of damage.  The atmospheric pressure within the cup once it is sealed on skin is only so strong.  Silicone cups (which I love) are only able to be applied as hard as they can be squeezed before application.  Their size limits their pressure.

Where I can see there being problems is if the client has fragile skin or is on blood thinning medication.  It is up to the practitioner to investigate this, and it is the client’s prerogative to disclose it.  The very first time I ever saw cupping therapy performed was on a tiny eighty-four year old woman with bronchiectasis, which is pretty much bronchitis that lasts for twenty years.  It blew my mind.  She came in with a cough that sounded like it came from her toes.  By the end of the treatment it was a normal sounding cough that came from her chest.  She’d been having that treatment weekly for four years.

These days I’ve done a lot of training since and have developed my own treatment for lung conditions incorporating cupping, aromatherapy and herbal medicine that I get pretty good results from.  Would I do it on the elderly and infirm?  Yes.  With adaptations based on their condition.  This is what I have been trained to do.

 

CONTENT WARNING FOR THE NEXT BIT

“Only this year a man in China was left with burnt holes in his back after ongoing treatment”

 

Well.  Doesn’t that look like it crawled out of the bowels of Reddit.  If ever there was a case of criminal negligence this is it.  I highly, highly doubt this treatment was carried out by a properly qualified practitioner.  If you’ve ever talked to a TCM practitioner or read anything on the subject you’ll know that they’re all about restoring balance.  This is not balance.  A legit practitioner would not apply cups that hard to the same place every day.  They would not keep applying them over blisters.  They would not apply them after the blisters were burst.  They would not keep applying them once the wounds went septic and certainly not once the tissue started dying.  You with me?  Any therapist in their right mind would be mortified at even seeing this on their computer screen.

 

“It won’t improve the healing time for athletes, and cupping actually has the potential of slowing them down from pain or tissue damage.”

 

If their therapists are both negligent and extremely silly  Remember that this is Michael Phelps they put the cups on.  The man has spent the past twenty years being more cossetted than Makybe Diva ever was and has always benefited from the best that sports medicine has to offer.  Do you think the USA Swimming Team would be taking risks on his treatment?  Really?

 

“By showing off their useless bruises with pride, Team USA could be conducting an incredible psychological campaign to intimidate their fellow Olympians, but they appear to be fiercely uneducated about the pseudoscientific nature of this ancient (but useless) traditional therapy.”

 

Somebody is.

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