“I’m retiring.” Or at least that’s what Michael Phelps, one of the most decorated athletes ever, said after the 2012 Summer Olympics in London. Come 2016, however, the world still saw him in the water at Rio games. He bagged five gold medals and one silver for his swan song as an Olympian.
There was something different about him in that last stint, which was clearly seen on his skin. There were huge, dark circular marks all over his body, from his arms to his back and legs. And so the ancient Chinese practice of “cupping” was introduced into public awareness.
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The Rio Olympics was just the start, as athletes and physical therapists from all over the world have since then used the healing technique. Physiologically, cupping causes blood to be drawn to areas of the body, which should reduce soreness and speed up the healing of certain muscles.
“It’s actually an old technique. If you’re familiar with ventosa, that is it. But the tradition of ventosa died a natural death. Those from the Americas and Europe realized that Chinese concepts about healing are effective,” says Maria Angela Borras, an experienced sports physical therapist. “So they traveled to China, and discovered the science behind it.”
Cupping is used as a way to relax, Borras explains further, a way to relieve pain and tension. But it was only in recent years that experts were able to connect the practice with who needs it the most: athletes.
In the country, De La Salle University is just one of the eight schools participating in the University Athletic Association of the Philippines (UAAP). It has a great track record in the league, with countless championships under its belt, and legendary athletes coming in and out of the institution.
The school is also a big believer in cupping, as their athletes began using the treatment late last year. “It’s actually a new method for our profession. It’s a big help because it can lighten our load, and our work as therapists,” says Marco Villanueva, one of the physical therapists for the De La Salle Lady Spikers. “More often than not, we do manual therapy. But through cupping, the energy expenditure from our end is lessened. We have more time to treat other patients.”
Villanueva says that they attended a seminar for it late last year before they implemented it on their athletes. “We saw progression in their performance, and it was indeed effective. So we also started using it as part of the rehabilitation program. Aside from our volleyball team, we also use cupping treatment on our athletes in basketball, taekwondo, and football.”
The practice is experiencing a rebirth today, with these schools relying on it a lot. But with volleyball currently in the spotlight, its athletes are seen as the main users. Popular players such as UST’s Sisi Rondina and Eya Laure, UP’s Tots Carlos, and DLSU’s Desiree Cheng and Jolina Dela Cruz were just some of the players with the circular purple marks on their skin this season.
Finding paint points
So what exactly happens when a person undergoes cupping?
Borras, who herself was present at the 2016 Games, says that the traditional approach for physical therapists is to break trigger points. “In physiology, if there is a trigger point or nodule, you put pressure—sometimes pain–on it to break it,” she says. “That breaks your pain spasm. It stops the pain cycle.” What cupping does, she explains, is the exact opposite. Instead of breaking it by putting pressure, they create a space by pulling. “The pain will go away not because there was any trigger point that was broken, but because the body is perceiving the pulling sensation.”
She compares it to the beating that an athlete’s body experiences throughout the course of training or a game. “When you get hit multiple times during competition, that’s considered a pushing sensation by your body. When you get bumped by an opposing player, a ball hits you, or in whatever way your body gets hit, that’s painful isn’t it? What we are doing is we introduce a different aspect of that. It’s the opposite.” What cupping does is create a space in the trigger area, in the painful part of the body, so the sensation after that will be of relief. The intention is not to correct the muscle, but rather the sensation in the brain.
Both Villanueva and Borras, however, are quick to say that not all athletes and patients should undergo cupping right away. “We don’t do cupping right away, even if a patient requests us to. We need to do an assessment first,” Villanueva says.
Borras supports this and adds that they always start with the location of the pain. “We also need to ask ‘Where is this connected to?’ Sometimes if we target just a specific location, the pain will eventually return because we didn’t correct all the other factors surrounding it.”
What follows is movement analysis, where patients are asked to do test specific moves to test whether or not they cause pain. After which, the proper cupping session begins, which they refer to as intervention.
Upon location of the pain and confirmation of which muscle needs intervention, it’s quite easy from that point on. First, they put the patient in a position of comfort, and apply the cups on the affected area, where the pain, trigger points, or muscle tightness is found. Using a pump gun, they apply two to three pressures and leave it for around five to 10 minutes.
There is actually two methods of cupping, static and active.
Static cupping leaves the cup on the affected part while the patient lays idle. On the other hand, active cupping (or sometimes called gliding), requires patients to move the specific body parts. For example, if you are using cupping for the quadriceps muscles above the knee, you need to do leg extensions while the cups are in place.
Recover and perform
Treatment still varies from time to time, from place to place, from therapist to therapist. Villanueva likes to mix it up, sometimes a little bit static and then a little bit active. Borras, meanwhile, says that all physical therapists in the UP Diliman College of Human Kinetics prefer to make use of the active method. “After that we test them again. We check if they can do the movements and if there was relief compared to before. Did the pain go down? Is it the same intensity?” says Borras.
“Our goal is to lessen the pain. If the patient’s pain scale is six out of 10, and we were able to bring that down to let’s say two or three out of 10, that’s an achievement for us,” Villanueva adds.
Anj is quick to note however that since they are dealing with athletes, they need to make sure that their patients can still perform after the session. “It can’t simply just be to relieve pain and the athlete still cannot perform after. We do cupping because there is no down time. If we do cupping in the morning, it’s most likely because they have a game or training in the afternoon. So the patient or athlete is good to go. This is totally different from other techniques like dry needling. With dry needling, the athlete will feel down, they will not have the energy to perform right after because it is direct to the muscle.”
The athletes themselves attest that they feel better after a session, their muscles are loose, and that they can move and perform to the best of their ability.
For former De La Salle Lady Spiker and UAAP Season 80 Finals MVP Dawn Macandili, the effect has been immediate since she began doing it a few months back. “I usually do regular maintenance to keep my muscles from getting too tight. Our PT is responsible for finding the best method for specific muscles areas. But as for cupping, I usually do it once of twice a week.” It may really have been effective for her as she just won the Best Libero award as part of the F2 Logistics Cargo Movers in the recently concluded Philippine Superliga Grand Prix.
As for soon-to-be crowned UAAP Season 81 Most Valuable Player Sisi Rondina of the University of Santo Tomas Golden Tigresses, she actually found out about it accidentally. “During my fourth year, I was not aware our therapist tried it on me. It felt very itchy at first. But I think it is effective because more and more athletes are starting to do it,” says the graduating skipper who will look to end UST’s 9-year championship drought this week in the Women’s Volleyball Finals.
Her teammate, Rookie of the Year winner Eya Laure, adds that cupping helped her become aware of an injury within her shoulder. “I became aware which muscles I need to work on, which I needed to strengthen. I did it twice during the eliminations and it definitely helped me perform better.”
Despite these testimonies from the top players, Villanueva still reminds everyone that cupping is just a tool that can help athletes recover and perform well. But the players still need to do their part. Therapists and treatments exist to help them play well in upcoming games, but it is up to the athletes to do the extra work for them to be successful in their sport.
“The tendency for athletes is they become dependent on certain tools, especially if it’s something new. They should not be spoiled. That’s what we want to avoid. If there’s an improvement in their bodies, no matter how little, the tendency is to slack off and avoid the extra work in the gym,” he says, emphasizing that it has to work both ways. “If they do their exercises in addition to the treatment, then it will result in a better performance in games.”
Borras says that with cupping, technically, you do not “do any structural correction. It’s not a magic pill or trick. But again, because of the sensation, patients feel they are looser. After a session with their calves, they feel their muscles are not as tight, that’s why they can tip-toe or jump higher.”
“I used to believe it was geared toward specific sports only, the ones where the body is almost always beat up such as football. But I realized that with any function, as long as you know the movement patterns, you can use cupping in different sports,” she finishes.