Cupping therapy
What is cupping ?
An ancestral therapy used by the Egyptians and Chinese medicine, cupping has experienced a surge in popularity thanks to their use by world-famous athletes such as Michael Phelps at the 2016 Rio Olympics.
The aim of these suction cups is to create, with the help of a pump or a flame, a depression to give a strong suction effect on the skin. The pump suction cups are more practical to use, but the glass suction cups have a better suction effect, especially for the mobile suction cups. With glass suction cups, the heating effect is added, which can also be interesting for the circulation and the local tissues.
In this article we will only discuss dry cupping, i.e. cupping therapy without scarification (or bloodletting). These other ancient techniques may have their advantages, but are based on manipulations that are much more intrusive and aggressive to the body.
What effects ?
Cupping can be used in a post-exercise recovery setting and can affect the body’s fatigue. Potential mechanisms for this muscle fatigue include the accumulation of metabolites in the muscle and the generation of insufficient motor commands by the motor cortex during exercise (1).
It has been hypothesised that cupping may improve local microcirculation and thus improve muscle function in the affected areas, leading to a reduction in hypersensitive trigger points but also better transport of sub-metabolic products such as lactate, thus playing a direct role in tissue muscle regeneration and indirectly improving sports performance (2)(3). Another marker must be taken into account in parallel with lactate. This is creatine kinase, which is used to assess training-induced muscle damage, allowing the potential state of recovery and training preparation to be deduced(4)(5). It is assumed that a decrease in the values of this enzyme following therapeutic interventions represents an improvement in muscle regeneration and thus performance readiness. The literature shows a decrease in the concentration of creatine kinase in athletes after heavy exertion in people who have used cupping therapy compared to control groups. This further supports the benefits of this technique for recovery. The cupping will also be responsible for localised hypoxia which will induce vasodilation of all surrounding tissues, potentially improving microcirculation over the long term (6). The increased blood flow offered by cupping thus allows for faster elimination of metabolic waste products and more efficient physiological recovery. However, although the delayed effect on recovery is proven and scientifically documented, the immediate effects on the effectiveness of this technique are still debatable.
Suction cups also have other strings to their bow as they also affect the amplitudes of movement. These modifications can be explained by involving the fascias which contain mechanoreceptors and smooth muscle receptors. These structures, when stimulated, can help to reduce sympathetic tone, leading to changes in muscle tone (7). Proper relaxation of all of these soft tissues increases mobility and plays a role in healthy biomechanics in athletes. As fascias also contain nociceptors, they are often synonymous with joint or muscle pain. By using suction, suction cups have the ability to lift and stretch fascial tissue, which can modify or decrease pain messages to the brain (8).
How can they be used ?
It is possible to use the cups simply statically on specific acupuncture points, along the muscles to aid recovery but also around and on painful areas. Cupping should generally last between 15 and 20 minutes, with careful attention to the patient’s feelings.
However, they can also be used in a mobile way, the suction is maintained and the therapist moves the cup slowly along the targeted muscles.
Cupping marks are normal and do not present any particular risks, although they can be impressive if the athlete is not warned.
What role can cupping play in injury prevention ?
Cupping therapy can thus play a role in injury prevention by maintaining good mobility of all tissues together as this good mobility will limit the number of adhesions or biomechanical restrictions that can lead to injury. It also plays an important role in ensuring, with the help of other techniques, a more thorough recovery.
References :
1. Enoka RM, Duchateau J. Muscle fatigue: what, why and how it influences muscle function. J Physiol. 1 janv 2008;586(1):11‑23.
2. Cramer H, Lauche R, Hohmann C, Choi KE, Rampp T, Musial F, et al. Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Forsch Komplementarmedizin 2006. 2011;18(6):327‑34.
3. Bridgett R, Klose P, Duffield R, Mydock S, Lauche R. Effects of Cupping Therapy in Amateur and Professional Athletes: Systematic Review of Randomized Controlled Trials. J Altern Complement Med N Y N. mars 2018;24(3):208‑19.
4. Brancaccio P, Maffulli N, Limongelli FM. Creatine kinase monitoring in sport medicine. Br Med Bull. 2007;81‑82:209‑30.
5. Koch AJ, Pereira R, Machado M. The creatine kinase response to resistance exercise. J Musculoskelet Neuronal Interact. mars 2014;14(1):68‑77.
6. Emerich M, Braeunig M, Clement HW, Lüdtke R, Huber R. Mode of action of cupping–local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Ther Med. févr 2014;22(1):148‑58.
7. Schleip R. Fascial plasticity – a new neurobiological explanation: Part 1. J Bodyw Mov Ther. janv 2003;7(1):11‑9.
8. Tham LM, Lee HP, Lu C. Cupping: from a biomechanical perspective. J Biomech. 2006;39(12):2183‑93.