No, they aren’t hickeys or some chlorine-related ailment. The round bruises are signs of “cupping,” or myofascial decompression — an ancient Chinese healing practice intended to promote blood flow and help with muscle recovery.
Rio 2016 may have propelled cupping into the international spotlight, but the technique isn’t some wacky new fad, according to Eugene Hong, MD, a sports medicine doctor and chair of Family, Community and Preventive Medicine at Drexel University College of Medicine.
Hong has worked with athletes who have practiced cupping and has observed a practitioner use the technique on patients.
“The concept is not necessarily anything new,” Hong said. “There are many other techniques athletes use to increase blood flow and heal injured tissue.”
How does it work?
A cup with combustible material is placed on the skin. Once the flame goes out, the heated air creates a vacuum under the sealed cup as it cools, which promotes increased blood flow to that area. At the Olympics, athletes are using a vacuum pump to cause this effect when applied to the top of the glass cups.
“It can cause the breaking of capillaries, which causes the red spots,” Hong said.
For chronically injured muscles and tendons, Hong and other sports medicine doctors may similarly attempt to increase blood flow through intentional injury with a needle, scalpel or even surgery. The same basic concept also applies to massage.
Although cupping is not taught in western medical schools, Hong said doctors are taught to at least recognize it.
“When we see these bruises on our patients, we need to be aware that it can be a healing real technique used in certain communities and cultures and not a form of physical abuse,” he said.
Acupuncturists and others may also perform cupping to ease lower back pain, carpel tunnel syndrome or to treat infectious diseases. As far as its effectiveness — well, most of the evidence is anecdotal or experiential. Doctors at least know that there does not seem to be any harm in suctioning hot cups on your body, but the amount of medical literature on its benefits is limited.
Hong said the technique has been studied to some extent in terms of treating shoulder and neck pain, but has not necessarily been shown to enhance recovery and performance in the western medical literature.
“As a physician, I’m not aware of the utility of cupping as a way of muscle recovery. It makes sense, but I’d be interested in seeing more evidence,” Hong said.
It’s not uncommon for athletes to try different treatments that may relieve pain, whether or not they are supported by science, said Tom Trojian, MD, director of the Sports Medicine Fellowship program in the College of Medicine.
“There are too few studies to definitely say whether cupping works or like a lot of treatments by just doing something people believe they are better for a short-period of time. This is called the placebo effect,” Trojian said.
You might remember the bright adhesive “Kinesio tape” athletes could be seen wearing during the 2008 and 2012 Olympics. The special tape was developed by a Japanese chiropractor Kenzo Kase. It is touted to reduce pain and supports muscles without restricting movement, like other traditional sports tape.
Whether or not cupping therapy actually reduces pain, simply believing in its usefulness could yield positive results, according to Trojian. He published a 2008 study documenting the benefits of the placebo effect.
“The results showed that people, including athletes, who think they are doing something special will find a bigger benefit,” he said.
Fighting Through the Blues
Olympic athletes aren’t only taking care of their bodies this year, but their mental health, too.
It’s no secret that having the entire world watching your performance can lead to enormous stress that most of us non-athletes can hardly imagine.
This year, USA Swimming partnered with nonprofit organization Domesti-PUPS to bring a bunch of four-legged companions to the U.S. Olympic swimming trials in Nebraska. The therapy dogs helped relieve anxiety and were a hit among the athletes.
“I love the idea,” Hong said. “I can’t see any downsides. And if it enhances athlete wellness, it may enhances performance too.”
U.S. Olympic swimmers have recently helped to put a face on mental illness and erase some of the stigma attached to athletes with depression.
In an NBC interview with Bob Costas, Phelps opened up about his battle with suicidal thoughts following the 2012 Olympics. The months leading up to those games he said he “hated” the sport, and after, he struggled to fill the void.
“I found myself in the darkest place you could ever imagine,” he said in the interview.
U.S. Olympic swimming medalist Allison Schmitt has also been vocal about her own bouts of depression. ESPN chronicled her journey in a recent story.
Hong helped to bring attention to the issue of athletes and depression when he published the largest study to date that looked at depressive symptoms in college athletes this past winter. The study found that nearly a quarter of Division I athletes reported depressive symptoms, and women were almost two times more likely to experience symptoms than their male peers.
While swimmers were not a group of athletes included in the study sample, the researchers did find that among nine different sports, track and field athletes were the most at risk for reporting depressive symptoms.
Hong sees parallels between swimming and track: The athletes compete as individuals rather than on a team, for instance, and it’s mere seconds that separate winners and losers, which only increases the pressure.
But Hong also theorizes that we may be seeing so many swimmers coming forward with stories of depression, because speaking out can have a domino effect, not necessarily because one group of athletes is more susceptible to the blues.
“Athletes worry about what is acceptable in their own culture,” he said. “If one high profile person comes out about his or her own experiences, it becomes more acceptable within that world to talk about it.”
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