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Can Cupping Therapy assist in Sports related injury recovery?


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Cupping therapy is an ancient form of treatment that has been used for over 2000 years in Eastern Medicine e.g. Chinese medicine and Unani Tibb. Despite this long history of existence, it only recently became popular again globally after some of the Olympians in 2016 appeared with circular bruise marks over their bodies. Michael Phelps, an American Olympian swimmer was known for using cupping therapy to improve performance, because it reduces stiffness, reduces muscle cramps, removes scar tissue, and helps speeds up the healing process [1].


How is cupping therapy performed?

Generally, cupping therapy is performed by a qualified and registered practitioner Chinese medicine or Unani Tibb practitioner (under South African AHPCSA regulation) who is trained to do so safely.


The practitioner will first do a medial consult and evaluation of the patient and determine if the person is stable enough for cupping therapy and also which form of cupping therapy is suitable for the condition the person presents with. This will include checking the persons Blood pressure and other vitals, pulse and general health status. Massage therapy with specific medicinal oils is used preparatory to the cupping therapy to improve blood circulation and warm up the muscles. There are various forms of cupping therapy but mainly 2 categories: Dry cupping and Wet cupping therapy. Both involve suction cups applied on specific parts of the body but wet cupping will additionally include superficial incisions of the skin to extract small amounts of blood as a form of detoxification.


Dry Cupping can be implemented with vacuum cups by means of a vacuum pump and specialised cups or by flame and glass cups which create a suction effect once the cups are applied to the skin. This draws blood flow to the affected area providing nutrients and oxygen to the tense muscles and joints, speeding up the natural healing process of the body thus aiding recovery.



Image: Dry cupping with the use of vacuum pump and specialised cups


Image: Dry cupping with the use of flame and glass cups


How does cupping therapy work for sports injury and recovery?

Various forms of sports injuries can occur depending on the type of exercise or sport ther person indulges in. Most of the injuries are related to poor training methods, structural abnormalities, weakness in the muscles, tendons, ligaments and unsafe exercising environments. Another common issue is increasing the intensity of exercise to rapidly and not providing your body with time to rest and recover [2].


Common sport injuries include:

  • Sprains. Overstretching or tearing the ligaments results in a sprain. Ligaments are pieces of tissue that connect two bones to one another in a joint.

  • Strains. Overstretching or tearing muscles or tendons results in a sprain. Tendons are thick, fibrous cords of tissue that connect bone to muscle. Strains are commonly mistaken for sprains. Here’s how tell them apart.

  • Knee injuries. Any injury that interferes with how the knee joint moves could be a sports injury. It could range from an overstretch to a tear in the muscles or tissues in the knee.

  • Swollen muscles. Swelling is a natural reaction to an injury. Swollen muscles may also be painful and weak.

  • Achilles tendon rupture. The Achilles tendon is a thin, powerful tendon at the back of your ankle. During sports, this tendon can break or rupture. When it does, you may experience sudden, severe pain and difficulty walking.

  • Dislocations. Sports injuries may dislocate a bone in your body. When that happens, a bone is forced out of its socket. This can be painful and lead to swelling and weakness.

  • Rotator cuff injury. Four pieces of muscle work together to form the rotator cuff. The rotator cuff keeps your shoulder moving in all directions. A tear in any of these muscles can weaken the rotator cuff [6]


The process of tendon/muscle healing follows a pattern similar to that of other healing tissues. There are three phases of healing: (1) hemostasis/inflammation, (2) reparative phase, and (3) re‐modeling and maturation phase. Ligament healing goes through the same stages as tendonhealing. Platelets aggregate at the wound and create a fibrin clot to stabilize the torn tendon edges. The clot contains cells and platelets that immediately begin to release a variety of molecules, most notably growth factors (such as platelet-derived growth factor, transforming growth factor β, and insulin-like growth factor -I and –II) causing acute local inflammation. During this inflammatory phase that usually lasts three to five days, there is an invasion of extrinsic cells such as neutrophils and macrophages which clean up necrotic debris by phagocytosis and together with intrinsic cells (such as endotenon and epitenon cells) produce a second pool of cytokines to initiate the reparative phase which can take up to 3-6 weeks [3].


Common treatment involves the RICE methods: Rest, Ice , Compression and Elevation, but is this the only and best method for recovery? Let's explore what cupping therapy offers.


Cupping therapy utilises the negative pressure to induce therapeutic effects. Research on the underlying mechanism of therapeutic effects of cupping-negative pressure which can dilate local blood vessels to improve microcirculation, promote capillary endothelial cells repair, accelerate granulation and angiogenesis, etc., in the regional tissues, normalizing the patients' functional state [4].


Other mechanisms of action of cupping therapy that have been hypothesized include enhancing skin circulation, loosening adhesions and lifting connective tissue, changing the biomechanical properties of skin, altering pressure pain thresholds, adjusting serum P substance levels, stimulating the peripheral nervous system, decreasing oxidative stress, and modulating the immune system. Cupping may be an effective and low-cost option with low risk in treating nonspecific, musculoskeletal pain. suggesting that it may increase muscle strength and endurance for individuals undergoing rehabilitation or sport-specific training by mimicking the low oxygen environment during exercise [5].



Overall cupping therapy has potential to improve recovery in sport injury and musculoskeletal conditions due to its mechanism of action of assisting the body's natural healing and repair process thereby could be used in conjunction with other rehabilitation treatments to provide a better outcome and overall health in these patients. If you suffer from frequent injuries related to exercise/sport which could be hindering your performance, pharmaceutical pain killers is not the only option available for relief, cupping therapy is a natural form of treatment that could assist you in recovery and get you back into action.



*Disclaimer


The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. Please consult a qualified practitioner if you suffer from any of the conditions mentioned.




References:


3. (PDF) The Physiology of Sports Injuries and Repair Processes. Available from: https://www.researchgate.net/publication/241623404_The_Physiology_of_Sports_Injuries_and_Repair_Processes [accessed Feb 22 2021

5. Trofa, D. P., Obana, K. K., Herndon, C. L., Noticewala, M. S., Parisien, R. L., Popkin, C. A., & Ahmad, C. S. (2020). The Evidence for Common Nonsurgical Modalities in Sports Medicine, Part 2: Cupping and Blood Flow Restriction. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 4(1), e1900105. https://doi.org/10.5435/JAAOSGlobal-D-19-00105







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