It's hard to dismiss the possibility that cupping, an ancient medicinal practice involving suction on the skin, has real benefits, after Michael Phelps won his 23rd gold medal on Sunday. Yet only a handful of credible studies back up its advocates' claims. And its pseudoscientific underpinnings mean that the more questions you ask, the further down the rabbit hole you go.
The spate of media coverage of the practice over the past week has taught most Americans the basics of cupping: placing glass cups on the body and creating suction that leaves round, red hickeys on the skin. In the traditional method, a small flame heats the air inside the glass vessel, creating a vacuum as the air cools. Another common method is to pump air from the glass through an attached hose.
Some believe it helps relieve pain and heals sore muscles. One of Michael Phelps' coaches, Keenan Robinson, told Time magazine that Phelps began the practice in 2015 as a way to recover faster from training, and that it helps loosen connective tissue in muscles. Others claim it can fix a seemingly endless litany of ailments, from digestion problems to acne to the common cold.
Mainstream medicine doesn't want to touch the subject. The American Medical Association declines to comment on cupping, says spokeswoman Sarah Petitt.
In Arizona, cupping and similar traditional Chinese medicine techniques like acupuncture receive an air of legitimacy by association with the prestigious University of Arizona. A call from New Times to the public relations office there was quickly referred to the university's Center for Integrative Medicine.
The center, founded by Dr. Andrew Weil in 1994, is one of the leading alternative-medicine research outfits in the nation. It touts its 1,000-hour distance-learning fellowship program as the "leading integrative medical education program in the world."
Dr. Ann Marie Chiasson, an M.D. and assistant director of the center's fellowship program, tells New Times that cupping has many benefits. She acknowledges that accepted studies on it are rare, but says that recently it has been shown to relieve pain and stimulate healing. A 2012 study published in the Journal of Occupational Health, Chiasson points out, found cupping to be far more effective in treating neck pain than heating pads.
How cupping works, however, is a trickier matter.
Chiasson boils it down to three possible reasons: the placebo effect, the workings of the circulation system combined with changes in electricity on the skin, and the mysterious energy forces postulated by believers in ancient Chinese techniques. Chiasson thinks all three factors play a role in providing cupping's benefits.
The placebo effect can't be underestimated. It might provide up to 60 percent of the perceived benefits of various alternative medicines studied at the UA, Chiasson says.
Suction causes inflammation and increased blood flow to the area being cupped, and blood and inflammation cause healing. When the skin turns red, Chiasson says, it indicates that substances that promote an immune-system response have arrived, flushing the area with T cells and antibodies. That same phenomenon, she notes, has led some alternative-medicine doctors to turn to therapy with leeches, the squishy, blood-sucking creatures used widely in medieval medicine.
But the suction has another important effect, according to Chiasson: "To remove stagnation of blocked chi, which is also called energy."
Chiasson says chi (also known as qi) has been documented through Kirlian photography, a process by which electrical discharges are sent through objects resting a photographic plate. She describes chi as "a biophoton field of emissions."
A 2012 article in the Massachusetts Institute of Technology's Technology Review calls biophotons — optical and ultraviolet photons emitted by cells — one of the "curious backwaters of biology." According to the article, some scientists believe cells may use biophotons to send key signals to one another.
Do biophotons comprise the energy of chi? Chiasson thinks they might.
(Skeptics counter that Kirlian photography doesn't show anything beyond expected energy discharges, and that the images are auras of inanimate objects, not a "life force.")
Chi flows through the so-called meridian system, a structure of lines and points on the body that are a bulwark of traditional Chinese medicine, including acupuncture and acupressure. When performing cupping, practitioners center the glass vessels over meridian points — the aim being to manage the energy flow through the meridian lines to other regions of the body.
But do meridian lines and points have an actual physical structure that could be proven scientifically?
"I don't know the answer to that," Chiasson says. The Center for Integrative Medicine used to include a Center for Energy Research, but it folded a few years ago, she says, adding that a lot of study still needs to be done on the subject.
She refers New Times to Melinda Connor, an associate professor at the Arizona School of Acupuncture and Oriental Medicine in Tucson.
Trained as a psychologist, Connor worked for three years on a postdoctoral fellowship with Chiasson and Weil at the Center for Integrative Medicine. (In the foreword to Connor's 2014 book, Advanced Body Reading, Chiasson lauds the author's "stunning" ability to create energy fields and her "extremely clear clairvoyant vision.")
But it's her research in electrodermal skin response that might bring us back around to the triumphs of Michael Phelps.
Skin, the body's largest organ, conducts electricity that interacts with the water contained in the body, Connor explains, and cupping takes away the electrical resistance found in individual cells. That change in electrical gradient dilates the capillaries where the cups are applied and causes micro capillary action — an effect she says has been measured in a lab.
"When you get more blood flow to an area, that blood flow takes away that extra electrical resistance," she says. So the increased circulation to the area, she says, "changes the electrical response that runs over the skin and muscles."
As for meridian points and lines, Connor says studies have pointed to the possible existence of an actual physical structure, which might be related to the lymphatic system or contained within the connective tissue between muscle and bone. Connor cites several studies published in alternative-medicine journals that offer a range of evidence for meridian-line structures, whether through fluids squeezing through "perivascular spaces" or biophoton-channel "Bonghan ducts."
She also says she can tell, visually — by looking at a person — if the energy has been properly cleared from a meridian point.
"I'm a visual. I see in non-normal ranges," she says, explaining that she has also done work with people who claim to see in near-infrared and ultraviolet ranges. (Her 2009 self-published book, See Auras!, offers instruction in how to see energy fields. In the foreword to that work, Chiasson writes that Connor's ability to see in non-normal frequency ranges has "been tested and confirmed in the laboratory.")
Yet you don't have to believe in traditional Chinese medicine or visit a practitioner to get cupped.
Publicity about cupping over the past week had the phones ringing at Camelback Sports Therapy in Phoenix, which offers a range of mainstream and alternative therapies. Camelback has been performing cupping on athletes and other clients for about seven years, says physical therapist Hailey Alfred.
"One body part — the entire lower back, or the leg — it's $35," Alfred says. The clinic uses the vacuum method, which, Alfred says, is a "little bit quicker" than applying heat.
Therapists place the cups directly over the target muscles with little or no regard for meridian points, depending on their own training. Cupping can be used to combat pain or as part of an overall strength and conditioning program, Alfred says. Depending on the shape of the skin tissue under the cups, circular bruises may only barely appear or may last for up to 10 days.
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A blurb on the clinic's website offers theories about the practice: "Cupping enhances self-healing by improving the lymphatic system, blood flow, and causing the body to regenerate capillaries, reducing inflammation and toxins, and promoting homeostasis."
Or, to put it another way: "Athletes at the Olympic level are looking at anything they can find that's legal that will give them any kind of competitive advantage — real or perceived," says Will Humble, former director of the Arizona Department of Health Services.
Thirty-three medals, 16 of them gold, are proof that the 2016 U.S. swim team had the right energy flow, one way or another.