The science of cupping: why the Olympic swimmer Michael Phelps is covered in purple blotches

Sports fans have noticed a rise in the number of athletes with purple marks on their skin, resulting from a practice that is supposed to aid recovery and boost performance.

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When the most decorated Olympian of all time turns up to Rio 2016 with purplish-red, circular blotches on his body, everyone is bound to notice. American swimmer Michael Phelps has been sporting these peculiar marks unabashedly, embracing them both in and out of the pool as a new tool with which he can establish further dominance over his international competitors.

And it’s not just Phelps sporting the patches either. Alex Naddour of the US gymnastics team has them too, along with others from the swimming and gymnastics squads. According to Naddour, the marks are as a result of something, “better than any money I’ve spent on anything else”. Neither Phelps nor Naddour shy away from marks that could easily double up as awful bruises from an intense session of paintballing. Or, as coyly suggested by a presenter on the BBC's Today programme, some particularly aggressive “lovebites”.

So what are they?

According to the athletes, their newly-adopted body marks are the product of cupping.

What is cupping and how does it work?

“I’ve been doing it for a while,” Phelps said, after racing through the semi-final of the 200-metre butterfly event. Cupping is a form of alternative therapy and acupuncture, which is currently under the spotlight at the Olympics.

It involves, as the name suggests, a series of glass or plastic cups being placed on the recipient’s skin. The cups are heated and come into effect upon cooling; the air trapped between the cup and skin contracts, creating a suction-like effect that pulls the skin upwards, drawing blood to the surface to increase blood flow and give the resulting marks their deep crimson-purple colour. At times, vacuum pumps can be used along with the cups to aid the process of suction.

The marks can last from anywhere between a few days to more than a week, but who came up with the idea in the first place?

Origins of cupping

Hailing from the east, the origins of cupping have been pinned to ancient China, where the practice was deemed to be a medical treatment serving as a form of healing and recovery. 3,000 years ago, cupping had an even greater significance to some Chinese practitioners, who would say that it, “helps open up channels of qi, or the body’s life force”.

It has roots in the Middle East too, with the practice of Hijama (the Arabic word for wet cupping) in the Muslim world well-documented. Hijama is slightly different to traditional cupping in that it involves a small skin incision and was endorsed by Greek physician Hippocrates.

Why are Olympic athletes using it?

Cupping advocates claim that the technique aids recovery, acting as a deep tissue massage, a form of rehabilitation, and a way of reducing pain. In a competition where quick recovery is pivotal to enhancing performance, athletes like Phelps are trying such methods.

Here's Phelps last year with his cupping therapist:

 

Thanks @arschmitty for my cupping today!!! #mpswim #mp @chasekalisz

A photo posted by Michael Phelps (@m_phelps00) on

 

Dr Ayaaz Farhat, co-director of the London Cupping Clinic told the Independent:

“The use of cupping therapy amongst athletes has grown over the last decade. Wang Qun, the then teenage Chinese swimmer being the most obvious in Beijing Olympics.

“Since then, Floyd Mayweather, Andy Murray, Amir Khan and more recently the Olympians in Rio have all been seen with cupping marks. Their increased use is for the same reasons that freeze tanks of oxygen rich blood injections are used by international sports teams and premiership footballers – to recover from the inevitable strains and knocks in time for the next round of competition.”

What does the science say?

Despite enthusiasm for the therapy from the world’s greatest Olympian, and its long history in various civilisations, it’s unclear how cupping can help athletic performance.

Very little evidence has come up in scientific literature to support the practice, but it’s important to note that little has been found to disprove it either. For some, it could just be the placebo effect at play.

A study in 2012 involving 61 people compared cupping to an alternate form of muscle relaxation during a 12-week trial seeking to understand the effectiveness of these therapies in reducing soreness; those who underwent cupping reported increased reduction in pain.

Cupping is one of the few alternative therapies that has been studied enough for a meta-analysis (a large review of current literature) to be undertaken. The meta-analysis results confirm that there is nothing damaging or dangerous about cupping.

One such review, which included over 550 different studies, concluded:

“The current evidence is not sufficient to allow recommendation for clinical use of cupping therapy for the treatment of above diseases of any etiology in people of any age group. The long-term effect of cupping therapy is not known, but use of cupping is generally safe based on long term clinical use and reports from the reviewed clinical studies.”

Verdict

A lot more research will need to be done to understand whether or not the rehabilitative aspects of cupping are merely a placebo. But in the knowledge that there is little to be worried about from cupping, many curious about the practice will no doubt keep their eyes peeled on the performances of the purple-patched Olympians.