Cupping, Tape & The Olympics…Oh My!

The Olympics are in full gear and most everyone is watching.  If you have been on twitter over the past 3 days, you can tell PTs have been watching.  There have been a number of you all out there commenting on the amazing ability of the Olympic athletes seen on our TVs.  What has been more interesting is the prevalence of healthcare practitioners and healthcare consumers alike commenting on the red circles or colorful tape seen on some of the athletes.  One writer called the Olympics the “International Festival of Sports Pseudoscience.”  Pretty funny…pretty true.

I almost hesitate to write up this post to bring more attention to this finding, but I am somewhat amazed by the attention of all of this.  In fact, I will keep this quick.  I hope PTs can keep their distance from these overzealous “interventions”.  We all know (and have experienced) our patients coming in this week asking about the red circles and colorful tape.  I hope we can put things into perspective for them.  I hope we don’t sink to the fads seen on TV.  I hope we are better than this.

@ShepDPT

8 responses to “Cupping, Tape & The Olympics…Oh My!

  1. Robert Vaughn, PT says:

    Mark,

    Excellent post, and to the point. I couldn’t agree more.

    Robert

    1. Mark Shepherd says:

      Thanks for reading!

  2. Brad Grohovsky says:

    Mark,
    What I am seeing is an amazing opportunity for the physical therapy profession to use this “attention” as an opportunity to generate intelligent discussion and excitement in the general public – two things the public does not generally associate with PT.

    Our profession is so good at asking the general public and medical providers to recognize us and our valuable tools/interventions, yet when we are offered the opportunity to speak we shy away, call others in our own profession out, and point fingers about how an intervention doesn’t have 10 high-quality RCT’s behind it showing it’s efficacy.

    I have clinically observed and incorporated the “overzealous” intervention of cupping make major ROM and joint mobility changes in my patients when used appropriately. (In one patient with chronic knee pain where joint/soft tissue mobs, strengthening, stretching, modalities had resulted in minimal improvement, cupping addressed the myofascial system in ways that no other intervention would and was the answer I would not have found in this patient had i not challenged my paradigm and used clinical judgement.)

    I use cupping sparingly to address primarily myofascial restrictions using sound clinical judgement based on clinical experience with patient outcomes – in no way am I overzealous (actually, I am always skeptical until proven wrong), but because of my experience it has opened up some great discussions with people about the Olympic athletes. Without thinking outside of my PT box my patient, while incorporating sound clinical judgement, and pre-test/post-test objective measures, my patient would have never “moved forward” – and neither will our profession.

    Let’s use these opportunities to open the doors of discussion and educate the public about physical therapy and all that our awesome profession has to offer!

    Best.

    1. Mark Shepherd says:

      Hey Brad!

      Thanks for reading and commenting on the post. I whole-heartedly agree with using this opportunity to really grab the attention of the public in general on why PT is essential for optimal movement–something that is evident in those athletes performing in the Olympics. I have been following the chatter on cupping in particular during the current Olympics and find it helpful to have some healthy discussion on the efficacy of this intervention. I will be the first to say that we need to be cautious of saying that we need a number of RCTs supporting what we do day in and day out. Let’s face it, this is not the case for a number of specific interventions that we as PTs use on a daily basis. As you mentioned, this is where sound clinical reasoning comes in to play. Like you, I try to be a healthy skeptic on when I use certain techniques and/or have certain outcomes. I appreciate your case in which you used “cupping” to help your patient. Where I struggle with this treatment is saying because I did treatment “x” and had “y” results I was able to have this effect on the patient’s body system (in this case myofascial). I just feel that there are so many variables that are at play that it is challenging to make that connection. Honestly, this is the case with many interventions we use…even exercise. My mind wonders about those “non-specific” effects that play into that intervention (your communication, the novelty of the intervention, the perception behind that intervention, etc.). These factors have really made me think about the intervention at hand and am sure you are tracking on this. With this being said, I get concerned when we see passive modalities being pulled to the forefront of the general public eye. I think it starts to bias the therapist and patient into thinking this is the way to go. I also get concerned behind the explanation of what this intervention does as this can play into the ever present nocebo we see in healthcare.

      Thanks for your thoughts, Brad, and for continuing the conversation!

      1. Brad Grohovsky says:

        Thanks for the thoughtful discussion Mark!

    2. Joe Miller says:

      I would add that these interventions are patient and situation specific. Just because Olympic Athletes used it at the games, doesn’t we all should in our daily life. The other thing we do not know is whether the change was through the power of the individual believing this “new” thing will help.

      Just because it worked when other things failed, does not always mean that treatement is effective. I have experienced that if I do something the patient perceived as never having (just a slight variation of what they had) they get better. The belief that it is different and maybe will help me could be the overriding factor.
      We should not attempt to “fit” our patients to a treatment but rather treat based on the individual patients presentation and examination.

      1. Mark Shepherd says:

        Joe- Thanks for chiming in and your points are well taken. This relates back to my comment of what the true effect might have been? This is really hard to show and will take ages for RCTs to show as well. I agree that novel interventions tend to enhance the short term woo. I have been hammered with this in clinical practice. Often times I will get short term effects, but with little carry over in the long term. I once might have been amazed by that response, which may bias me going forward (confirmation bias) and this ends up infiltrating my reasoning. Once I started to see how cases ultimately ended up, I realized that I had to keep short term effects in context–use them for buy in, but make sure to “move it and move on.” Acknowledging that there are a number of confounding variables that are challenging to rule out or control for in practice will keep one humble and skeptical, as Brad mentioned. I just continue to find that going back to the basics and keeping things simple are key in practice. We know that simple is always easy, but striving for this, in my mind, is important.

    3. Brian D'Orazio DPT, MS, OCS says:

      Brad,

      As you state, this does provide us the opportunity to comment about a specific treatment technique. At the Olympics, the professional questioned ( profession was not identified as I recall ) stated the cupping technique increased local circulation and provided faster healing of damaged, painful or stressed tissues. How do we know this? You state that we shy away from techniques that don’t have 10 high quality RCT’s behind it. Do we have any research at all on this technique? This technique isn’t new. It was taught in basic massage books in the 50’s and 60’s, but we were always told that the technique wasn’t in current use because of failure to provide results…not because of research. Does cupping even increase local blood flow to the muscle in question? If so, for how long? If not, what might the effect be? Is this an effect similar to TENS, which has largely been abandoned for lack of meaningful results ( as evidenced by a drug company coming out with an over the counter version of TENS, which always signals the death of a modality )?

      So, what do we say to the public? Do we just start cupping patients because they saw it on the Olympic coverage? What science do we cite as a reason for performing this treatment, because a license comes with the expectation that the professional satisfactorily has mastered the science of their respective profession? It appears to disrupt capillary beds in the skin, but does that mean anything? I wouldn’t know what to say; I have no meaningful or authoritative voice that can be lent to the discussion. Does anyone have that voice? We can’t just throw anecdotes at the public.

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