The dark red splotches visible on the bodies of U.S. swimmer Michael Phelps and gymnast Alex Naddour during the Olympic Games has sent interest in cupping, the traditional eastern medicine technique, soaring in recent days.
But the benefits of this and other therapeutic techniques used on athletes are often unclear. According to the International Olympic Committee, a proper warm-down and certain recovery therapies can help athletes address increased blood pressure, elevated heart rates and stiff muscles that follow extreme physical exertion. But the IOC points out that not all therapy techniques are scientifically proven.
The NewsHour reached out to two health researchers for some perspective on the efficacy of cupping and other common recovery and healing therapies used by Olympians.
Tim Caulfield is research director of the Health Law Institute at the University of Alberta. He has studied how science and health are represented in the public sphere for more than a decade. “Some people call it debunking,” he says of his work.
Pam Peeke is national spokesperson and fellow of the American College of Sports Medicine. Peeke is also a Senior Olympic triathlete and an assistant professor of medicine at the University of Maryland. Her work focuses on integrative and preventive medicine.
While their opinions varied, both agreed on one thing: Even if the only edge a therapy provides is a psychological one, what’s the harm?
“When you are talking about an athlete, we shouldn’t discount placebo effect,” Caulfield said. “For someone like [Michael] Phelps who is at the very end of the bell curve, that slight effect that you might get from some therapy, whether it is placebo or otherwise, can be significant and have a significant impact on outcome.”
“All of us have rituals that we believe help us with winning,” Peeke said. “And when you are winning by .04 of a second, anything we think helps will really help us tremendously.”
Cupping — which uses the heating or pumping of glass or clay cups to create localized suction on the skin — dates back nearly 2,000 years. Olympians typically use “dry cupping,” which relies solely on the suction, rather than “wet cupping” which adds bloodletting to the process by lancing the skin.
Traditional practitioners use this technique to manipulate chi, or life-force energy, in the body. Modern health practitioners claim the suction expands the skin to promote blood flow in targeted areas. In a recent Rio press conference, American swimmer Dana Vollmer described the process as an opposite massage. “Instead of compressing the muscle, you are actually able to do the opposite,” she said.
Those performing cupping also claim the process helps flush out toxins in fatigued muscles. Peeke takes issue with that theory. “This drives me nuts, because it is supposed to ‘detoxify the body,’” she said. “As a physician and scientist, let’s not insult the body. The human body is really great at detoxifying itself. It does not need extra help.”
Caulfield also remains skeptical. “Basically what you are doing is pinching a part of the body. There’s no magic behind it. The more contemporary justification is that it may increase blood flow to a particular part of the body or perhaps create a little microtrauma that could help inflammation, but the data to date is relatively weak.”
A 2015 review of 75 scientific studies done on traditional Chinese medicine treatments did find that cupping provided temporary relief to neck and lower back pain but called for more robust and long-term studies.
Acupuncture is another healing therapy based in traditional Chinese medicine and used in recovery. Acupuncture, along with a similar treatment known as dry needling, involves placing unmedicated needles in various places around the body. Acupuncturists place the needles in portions of the body associated with chi energy flows, while physical therapists performing dry needling place the needles directly into pain-causing trigger points in muscles and connective tissue.
Practitioners say the methods can alter pain perception, increase blood flow and prompt tight muscles to relax. Canadian snowboarder Mark Morris partly credited acupuncture for helping him recover from a broken rib before the 2014 games in Sochi.
Peeke believes acupuncture can be effective and said studies have shown it helps with back pain and vomiting in women who are pregnant. But she adds the mechanism behind the therapy is unknown. “[Researchers] believe we are tapping into energy pathways that work to be able to reinforce and augment an anti-inflammatory effect.”
Caulfield admits there is some intriguing evidence that acupuncture may have an impact on recovery, but declined to back the procedure. “Given the fact that you have studies that show it doesn’t really matter where you place the needle or if you use a toothpick, you still get the same effect. It really demonstrates that it may be this elaborate placebo theater.”
A 2005 review of 35 acupuncture and dry needling studies found the acupuncture is more effective on chronic lower back pain in the immediate and short-term than no treatment or a mimicking sham treatment. The authors suggested the two techniques may be useful when combined with other therapies but said more research was needed in order to understand its efficacy.
The call for more research was echoed by this 2016 review in the International Journal of Sports Physical Therapy. It found dry needling helped reduce pain in the short-term but had no positive effect on function, range of motion or strength.
Massage consists of the rubbing and kneading of sore and fatigued muscle areas. It is one of the recovery techniques recommended for athletes by the International Olympic Committee. Therapists claim the rhythmic pummeling of the muscles can help athletes recover from strenuous exertions by increasing blood flow and flushing out lactic acid — a compound produced when the body must produce energy with limited oxygen.
Peeke believes massage, when done correctly, can help relieve soreness and relieve stress at the same time. “If you are in the right hands and you are getting a sports massage, as opposed to Swedish massage, then what you are doing is breaking up old adhesions,” she said. “And at the same time it’s also very soothing.
Caulfield said there is some evidence that massage can help athletes recover from strenuous activity but thinks part of any effect is a placebo. “Whether it actually improves athletic performance is questionable,” he said. “It’s more relaxing and de-stressing than anything else.”
A small 2004 study published in the British Journal of Sports Medicine found massage has no impact on blood lactic acid concentrations or heart rate, but did find lower fatigue levels in participants who had massages.
However, wider evidence of the efficacy of massage remains scarce. A 2016 Sports Medicine review looked at 22 randomized trials related to massage and performance recovery. It found some evidence that massage helps improve performance but the boost was small and not well understood.
The most notable use of hot tubs in the Olympics comes in the diving competition. Viewers routinely see the athletes sit in the heated pools before and after dives. The common explanation? The pool water and swimming facility are often colder than divers would like, and the heated water helps keep their muscles warm and relaxed. It is akin to runners and other athletes wearing sweatsuits as they prepare for competition.
Peeke, a swimmer herself, can understand the need for at least some warm water. “You notice a lot of the swimmers in swirling whirlpools and that is to juice up their muscles. It feels really good,” she said.
But heat’s therapeutic effect on the body is not well understood. A 2006 Cochrane Library review of nine trials and more than 1,000 participants found some evidence that heat helps relieve low-back pain. However, the study’s authors said the evidence was limited and called for more high-quality research trials.
Applying ice to the body is a commonly used recovery and healing technique. It is the “I” in the popular “RICE” acronym touted by physical therapists and other health professionals. (The other letters stand for rest, compression and elevation.)
Trainers and EMTs are quick to place ice packs on injuries, and professional and Olympic athletes alike are routinely shown dunking their bodies in ice-chilled baths after bouts of vigorous exertions. On the whole, the explanation for applying cold temperature to the body is that it triggers blood vessels to constrict, in turn flushing out waste products and reducing inflammation.
Some research, like this small 2007 study of 20 men doing 90-minute bouts of running training, have found ice baths can reduce blood markers associated with muscle-injury. But athletes should use caution when returning to their activity after applying ice. A 2012 Sports Medicine research review found evidence that the icing of muscles for longer than 20 minutes was associated with decreased strength, dexterity and accuracy. The numbness associated with icing could also make an existing injury worse.
Still, Peeke believes research on cold baths benefits is inconclusive. She even tried an ice bath once after a triathlon. “It was the worst experience of my life,” she said. “Nothing felt right. It was painful getting in, and all seven minutes were absolutely no fun. I couldn’t wait to get out, and I frankly did not notice any better post recovery than my normal warm to cool bath.”
For Caulfield, there is not enough scientific evidence to support common icing techniques. “I’ve spent my life sitting on frozen peas thinking it was going to have some benefit,” he said. “But it’s actually kind of hard to internally change your body temperature. Your body doesn’t really react that way.”
Some competitors are taking the idea of chilling the body to an extreme. In recent years, various NFL, NBA, MLB and Olympic athletes have used a treatment known as whole-body cryotherapy as a recovery method.
During a cryotherapy treatment, an athlete strips down to underwear, socks and gloves and is shut in a room or body-sized chamber. Dry, nitrogen-chilled air then blasts the body with temperatures as low as -300 degrees Fahrenheit for two to four minutes.
The theory behind the cryotherapy is that ultra-cold temperatures cause the body to enter a survival mode and rushes blood to the central organs. Then, when the athlete exits the chamber, oxygen-rich blood rushes back to the extremities to aid in muscle recovery. Those providing cryotherapy claim it it can be effective in treating migraines, rheumatoid arthritis, depression, chronic pain and even Alzheimer’s. Some even say it’s an effective weight-loss method.
“I’ve read some claims that it burns 500 to 800 calories almost instantaneously and that’s just scientifically absurd,” said Caufield. “I’m sure you feel revitalized when you step out of the chamber, but with respect to long-term effect, there is no evidence to support it, and I would I imagine there is a massive placebo effect.”
Peeke said the efficacy of cryotherapy has yet to be proven but some athletes still swear by it. “It’s one of those ‘do what feels best for you’ things,’ she said.
The IOC does list cryotherapy as a recommended recovery technique, but evidence of its efficacy is scant. In July, the FDA released a consumer update warning against the therapy, stating “the healing benefits of cryotherapy remain unconfirmed.” The FDA added that those using the therapy should consult a medical professional and that potential risks — such as frostbite, burns and a loss of consciousness from a lack of oxygen — are “readily apparent.”
The warning follows the death of a salon worker in 2015. Her frozen body was found in the salon’s cryotherapy machine 10 hours after she entered the chamber unsupervised.
Cold therapy compression systems
Cold compression systems combine two of the components of the “R.I.C.E.” dictum: ice and compression. Application of the therapy can be as simple as bandaging ice packs to add compression. Mechanical systems, like those made by Game Ready, provide cycles of compression by pumping cooled water into wraps placed around the body. They are meant to treat pain and ease swelling after trauma or strenuous exercise.
American gymnast Jake Dalton had surgery on his shoulder last season. He told USA Today he regularly uses a Game Ready system to help with his soreness-plagued joint.
Peeke confirmed cold compression systems are routinely used by physical therapists, but Caulfield remains skeptical. “There is evidence of pain relief, but not so much regarding actual improved outcomes,” he said.
A 2010 Journal of Sports Medicine review of clinical findings did find that cold compression provided better outcomes following knee-replacement surgery than other therapies. Similarly, a 2016 review of randomized trials showed evidence that knee surgery patients who received cold compression had less pain over the course of recovery than those who used cold therapy alone.
Kinesiology tape, or kinesio tape, was the (highly visible) trending therapy tech at the 2012 Olympics Games in London and is still used by many athletes in Rio. Manufacturers say the lightweight, elastic tape can provide support and pain relief to muscles, ligaments and tendons.
But does kinesio tape deliver on its promises? “Nope, not at all,” Peeke said.
In fact, there is little research to back up those claims. A 2014 Journal of Physiotherapy review of 12 randomized trials involving nearly 500 participants found kinesio tape either provided no significant benefit or the benefit was so small that it was not deemed as worthwhile.
For Caulfield, the physics just don’t add up. “If you think about it, how could it possibly work? …You’ll see every single sprinter at the starting line with KTape on some part of their body, and when you think about the tremendous force that is used in those moments, how can a little bit of tape on your quad have any kind of impact on the underlying tissue?”