Join me as I take a look at foam rolling and wet cupping.
If you have been to see a physical therapist in the last decade, chances are that you have been told to foam roll. So what’s the deal? Coach Kevin Don takes a look. Plus: what's up with wet cupping?
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Hi listeners, old and new, Coach Kevin Don here with another weekly injection of fitness facts! This week's episode is centered around an eyebrow-raising experience I had recently with a couple of different physical therapists. In my quest to always understand, rather than blindly follow, I couldn’t help myself but to try and unravel the mysteries of their recommendations…
If you are a long-time listener of the show (thank you), you will know that I play a few different sports—gymnastics, judo, and karate mostly, but I also enjoy the anti-aging hedge of resistance training. So, it’s fair to say that my physical avatar has some ongoing wear and tear! I had some knee surgery in 2011 that affected my gait, so I often have pain in my hip and glute on the same side.
In the last couple of weeks, I have seen a couple of different people, both of whom recommended protocols that I would have considered to be “pseudoscience.” So, with their definitive claims that I “needed” to do these protocols to recover and that their patients “all” see relief from doing them, was it the case that I was the one who was misinformed and biased? Join me as I take a look at foam rolling and wet cupping.
I was first introduced to foam rolling at least 20 years ago, so it’s been around a while and was, in fact, created in the 1970s by Moshé Feldenkrais, the originator of what was known as the Feldenkrais method. The aim of the method was to improve pain and mobility issues. In 1987, one of Feldenkrais’s students, a physical therapist named Sean Gallagher, was hired to keep a Broadway dancing troupe in a condition where they could dance every night. This led to the deployment of foam rollers across the dancing industry, and it eventually made its way into the gym arena via a book called Integrated Training For The New Millenium, where it was being championed as a tool for “self-myofascial release.”
So, now we know where it came from, but you didn’t come here for a history lesson. You want to know: does foam rolling work for what it claims to? Does it help break up muscle knots and aid recovery? Well, thankfully, there have now been quite a few studies on this. In 2015, one study determined that foam rolling increased range of motion and decreased pain in subjects for up to 20 minutes. The relief likely came from increased blood flow to the area helping to clear metabolites (similar to the action of heat therapy), rather than any effect on fascia, which is the sheath of tissue that surrounds muscle, as well as other structures in the body, like nerve bundles. It is a layer of fibrous, connective tissue. Foam rolling claims to release ‘tightness’ in these tissues.
A 2019 meta-analysis concluded that foam rolling can provide short-term improvements in flexibility without decreases in muscle performance. This meta-analysis did, however, conclude that any improvements in pain were contradictory and that any mechanism by which this occurred was unclear. It was noted that the effects were most likely psychological and that if an athlete were to feel a decrease in perceived discomfort due to a psychological effect, rather than a physiological one, it would still be worthwhile to deploy it as an intervention.
This is something I often cover with my clients. When they ask my opinion on if something works, my question back to them is always: “Does it provide you with any relief or benefit?” If their answer is yes, then I will allow them to continue, because most of these kinds of therapies are not harmful interventions and the placebo effect has been demonstrated to work across human history. What I am very careful about though, is ensuring that a placebo doesn't flip to become a “nocebo,” which is the opposite end of the spectrum, where we see an athlete underperform because they forgot their lucky socks or they only flicked a light switch 3 times instead of 5 before going to the field of play. If someone starts telling me that they can't squat heavy today because they forgot their foam roller, then we have a nocebo situation, so this has to be monitored carefully.
So, does foam rolling work? If it provides you with relief, then yes. However, the mechanism of action is very murky at best, and it’s likely that any relief you feel is either psychological or coming from a related reaction, like increased blood flow. Unless you are nocebo-ing yourself, I don’t see any harm in foam rolling.
So, on to the next recommended protocol: wet cupping.. They told me: “We need to book you in for wet cupping—I just had a boxer in who had a torn knee ligament and this fixed him up in one session.” This immediately set off red flags for me. Torn knee ligaments don’t generally improve in one session of anything and generally require surgical intervention. So, needless to say, I didn’t book in for a wet cupping session. Rather, I immediately booked myself in for a session with my computer to research these lofty claims.
Let's start with what wet cupping is. Unlike foam rolling, which is seen as a recovery tool, wet cupping is an alternative medicine. The American Cancer Society, several international Ministries of Health, and subject matter experts at University College London have classified wet cupping as “utterly implausible,” going so far as to say “it has no place in modern medicine.”
Pretty strong words I’d say. And yet, there are hundreds of locations nationwide in the U.S. where you can go for what amounts to “blood letting.” In wet cupping, the skin is scored or covered in small incisions. Suction cups are then placed on top of the scores, sucking out the blood. It has its roots in practices in many locations across the world, including Ancient Greece, where Hippocrates used cupping in 460-370 BC, as well as in ancient Babylon, Persia, and China. But just because something has been around a long time doesn’t give it efficacy in healing. It just means it’s been around since before modern medicine.
As I was writing this episode out, I had a look at a wet cupping centre website near me. Their own description was vague at best: “Cupping is something a lot of people know of but haven't yet been majorly exposed to or don't exactly understand the benefits of it. Whether you're someone who's keen on fitness, or someone who's fairly inactive; cupping has benefits which will only improve your health and quality of life.”
So, to recap: cupping has benefits that you don’t understand, and I’m not going to explain them to you or help you to understand, but rest assured, it will improve your health.
Sounds good.
A bit more digging got me to another wet cupping provider who had a helpful FAQ page, where they answered the question “what is wet cupping good for?”
According to them, wet cupping helps us in many ways:
As objective thinkers, I hope that you will arrive at the same conclusion as a myriad of doctors, medical experts, and health ministries. It’s definitely admirable to seek out all alternatives for health, including non-pharmaceutical interventions, but I just can't get on board with sucking some blood out to improve psychiatric or any other issues.
I have to note that there are some studies out of China that demonstrate some positive effects of wet cupping, but these studies were shown in a recent meta-analysis to be lacking in adequate randomization and blinding, and the lack of
ethical review affects the credibility of such studies. The biggest takeaway from the meta-analysis was that “some trials in the systematic review had a high risk of bias.”
In the absence of any peer-reviewed evidence and in the presence of overwhelming put-downs of wet cupping by the established medical community, I wouldn’t even put this in the category of placebo. I just can’t get on board with anything related to blood being practiced by non-medical practitioners.
So, for me, it’s a hard pass on wet cupping.
There will be links to the studies in the transcript for this episode if you want to check my sources and do your own digging—head to the show notes for a link.
Remember, if you have any questions for me, email me at getfitguy@quickanddirtytips.com and I will do my best to get a reply to you or answer your question on the show!
Get-Fit Guy is a Quick and Dirty Tips podcast. Thanks to the team at Quick and Dirty Tips, Adam Cecil (SEE-sill), Morgan Christianson, Holly Hutchings, and Davina Tomlin (Duh-VEE-nuh TOM-lin) and our intern is Kamryn Lacy. I’m your host, Kevin Don. If you have a question for me, leave me a voicemail at 510-353-3104 or send me an email at getfitguy@quickanddirtytips.com. For more information about the show, visit quickanddirtytips.com, or check out the shownotes in your podcast app.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637917/
2. https://www.frontiersin.org/articles/10.3389/fphys.2019.00376/full
3. https://www.researchgate.net/publication/230241459_Hijama_cupping_A_review_of_the_evidence