The athletically-inclined population worldwide have been glued to the coverage of this year’s Olympics in Rio de Janeiro since Friday, and the fierce competition between the planet’s most passionate athletes has had us all enthralled. But there’s a puzzled question on many people’s lips: what exactly are those circular bruises on so many athletes’ bodies?

In cupping therapies, suction cups are applied to increase blood flow. [Photo credit: Amy Selleck via Flickr CC-BY 2.0]

The answer is suction marks from cupping therapy. Cupping therapy is a form of alternative medicine in which cups made from glass, bamboo, or earthenware are placed on the skin to create suction. Supporters of the technique believe the suction of the cups mobilizes blood flow, promoting the healing of a broad range of medical ailments, including muscle soreness. Cupping therapy dates back to ancient Chinese and Middle Eastern cultures. According to many historical texts, the ancient Egyptians were using cupping therapy as early as 1,550 B.C.¹

Empirical Treatment Reviews

But mere agedness does not a valid muscle therapy make. In a 2012 review published in the journal PLoS ONE, Australian and Chinese researchers looked at 135 studies on cupping therapy published between 1992 and 2010 and concluded that cupping therapy was only effective when combined with acupuncture or other relevant medications. A good deal of the research also only showed evidence in the treatment of conditions such as herpes zoster, acne, and facial paralysis – not muscle soreness.

With that said, there is some empirical evidence to support the technique. A 2012 study of 61 people with chronic neck pain compared cupping to a technique called progressive muscle relaxation, during which a patient deliberately tenses his muscles and then focuses on relaxing them. Both patient groups reported similar reductions in pain after 12 weeks of treatment, but the cupping patients scored higher on measurements of wellbeing and felt less pain when pressure was applied to the area.

Another experiment involving 40 patients who suffered from knee arthritis found that people who underwent cupping reported less pain after four months compared to a control group, but the cupped group knew they were being treated. This leads to inevitable speculation around a placebo effect. More studies were needed, in all cases.²

Popularity Amongst Elite Athletes

So why the sudden appearance of these marks on the athletes in Rio, most notably on Team USA’s swim team?

Anecdotally, the treatment has been found to be supremely effective. Michigan State University’s gymnastics team has seen incredible results with the technique, most notably with a member who suffers from compartment syndrome. The circulation issues of the individual caused her to be unable to participate in bars during her freshman and sophomore seasons, but the athlete has gone on to compete to an astonishing level on the bars in her junior year after experimenting with cupping techniques under the supervision of her trainer. Her teammates also report less muscle tension and soreness using cupping on a regular basis.³

In Rio, Team USA gymnast Alexander Naddour told USA Today: [It’s] the secret that I have had through this year that keeps me healthy…[cupping] is better than any money I’ve spent on anything else^.”2

A Final Verdict?

As with other alternative athletic therapies, it’s up to you to decide if it works or not. Empirical studies test measurable outcomes, but nothing does a treatment technique more credit than a trial limited to you, the athlete. For me, the body awareness of elite athletes is at such a level that their testimony alone is compelling.

And a placebo effect is still a positive. So there’s still a case for cupping to be the new vogue treatment for the perennial problem of athlete muscle soreness.

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I’ve been using MFD in my practice for over a year now. I’ve used it therapeutically to treat almost any injury, from plantar fasciitis to hamstring strains to myofascial restrictions unrelated to injury. I’m surprisingly pleased with how many of the athletes are asking for repeat treatments. Although they all complain about how sore it makes them, they are pleased and excited with the outcomes: increased flexibility, fewer restrictions, and an overall feeling of being better.

Those key words from the athletes are what keep me using and expanding my knowledge of MFD. I’ve even done a before and after with several of them. I assess their range of motion before the treatment, especially hamstrings, and compare it with post-treatment results. I have found three techniques that are most helpful. Two of the three require active movement from the athlete after the cups have been placed:

1. The first is an active flexion/extension movement. Although painful at the start, most of the athletes indicate more movement. After treatment the range of motion increases by ten to fifteen degrees.
2. The more aggressive technique has that athlete prone, leg off the table, hip flexed, and knee flexed. The goal is to get the heel down and extend the knee. If they can get the heel to touch the ground then that is excellent progress. For runners, this mimics more the motion required to propel forward. Again, this is painful when the person move, but the gains are invaluable.

Swimmers have also inquired about MFD and there are two clients in particular I’ve worked with. Both were having “reach and pull” issues on their strokes. The focus was placed on the latissimus dorsi and teres major. After the cups were placed, they were asked to extend and slightly pull down with the arm. Motion increased in both. One of them even had the fastest swim of his career! He is so happy with the results he plans on doing another treatment before conference. It’s wonderfully exciting to see the success achieved by the athletes.

MFD has its benefits for everyone. I tend to focus on athletes and their return to play or improved performance enhancement. I cannot say if it is the right treatment for everyone. It depends on what you are trying to achieve. My focus is on active motion with MFD. Other professionals prefer to use MFD as a way of relaxation.

The traditional way of using MFD is following the meridian lines of the body. The cups are placed along these particular lines to elicit change within the body. I’ve even seen someone cry after being treated because it fell along one of the emotional lines. It was surprising to see, but I knew to expect it. I have also known people who had it done to help with general back pain and soreness. Funny thing is, they fell asleep with the cups on them. When it’s being used in this manner, anything is possible.

Two completely different methods, using the same equipment, can elicit such different results. It’s really interesting to see the old methods intertwined with new concepts and theories. As we move forward with research and literature, we continue to see so many amazing changes to traditional theories, with MFD being a good example. From the early years, where it was solely used for medicinal and relaxation to purposes to the current trend of using movement patterns with MFD, the treatment practice has grown immensely. Now, it’s the en vogue treatment for athletes and weekend warriors.

Anyone who is interested in experiencing either form of this treatment needs to seek out a practitioner qualified in MFD. If you want a relaxing experience with MFD, then it is recommended to seek out a licensed acupuncturist. Most will generally have knowledge and skill in the use of MFD. If you are seeking the more aggressive MFD utilizing movement, that will be more difficult to locate. In the athletic realm, some physical therapists and athletic trainers have taken coursework in incorporating MFD and movement. More professionals on the West Coast may have exposure to such techniques. As with anything, please make sure to ask questions before jumping into something new. Make sure it’s what is right for you.

Have you tried MFD or cupping? What was your experience?

Photos courtesy of Shutterstock.

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