Mid-February every year, as Major League Baseball (MLB) spring training commences, the Boys of Summer roll into the Cactus and Grapefruit Leagues held in Arizona and Florida, respectively. That was never of importance to me as I kept busy at home in Florida with local athletes, from marathon runners, triathletes and CrossFit athletes to the occasional world-ranked tennis player and LPGA professional.
That all changed in 2007 when the Cincinnati Reds called me for an interview with their head trainer, looking to find their go-to massage therapist in the area. This connection resulted in baseball player referrals through spring training of 2009, after which the Reds would leave Florida, going to the Cactus League the following year. In spring of 2010, just when I thought I was done with baseball, baseball wasn’t done with me.
That following spring, the Baltimore Orioles found themselves a training facility where the Reds had previously trained. As fate would have it, a player with whom I had worked while he was on the Reds, found himself traded to the Orioles and wanted to continue our work. The Orioles’ strength-and-conditioning coordinator was referred to me and had a player by the name of Adam Jones, an up-and-coming baseball player who, having just received his first Gold Glove award and All-Star game appearance, was wanting two to three sessions a week off the field.
At the start of our first session, I explained to Jones that, since 2005, I began incorporating therapeutic cupping therapy prior to other modalities and techniques. Jones shared that he had received cupping before. I explained that my approach was different than the Traditional Chinese Medicine, TCM cupping method, that it may or may not leave visible marks on the skin, and I would employ cups to promote lymph drainage, which would likely leave no cup marks at all. I never could’ve imagined the journey we were about to embark on would last a decade.
As I was comfortably moving the cup on Jones’s back, he says, “This doesn’t hurt.” I replied back that it shouldn’t hurt; “Cups should not hurt!” He went on to explain about his previous cupping experience that hurt and left him uncomfortable. Once Jones mentioned this to the therapist, he simply laughed it off and said it’s supposed to hurt and kept going. I explained to Jones that what he received in those previous sessions was possibly TCM cupping, or a lack of safe and proper training for that bodyworker.
I told him that I use a modified version of the TCM cupping that is geared for bodyworkers to manipulate soft tissue. While both applications use the same tool, the techniques and approach differ greatly.
Depending on the tool, cupping is done by creating a vacuum to lift the tissue, thereby bringing blood and lymph to the area while enhancing the body’s natural fluid exchange processes. It has often been referred to as “fascial decompression” among physical therapists. Therapeutic cupping affects not only fascia—giving it a lift and a stretch from the inside out—but also many body systems simultaneously, potentially penetrating up to four inches into the tissue and preparing it for the other manual therapies to follow.
Due to the negative pressure created from the vacuum effect lifting the tissue, cups create a forced separation within the layers of tissue and should be used with the recipient’s comfort in mind. This is especially important for someone receiving this modality for the first time, whether they are an athlete or not.
That was the beginning of a decade-long rapport, keeping Jones’ body healthy and injury-free through 2019. Using therapeutic cupping, outfielder Adam Jones went on to get more Gold Gloves, Silver Slugger, All-Star game appearances, and the MVP while representing Team USA in the World Cup series March 2017. In September 2019, as our decade was coming to a close, a tweet by Baltimore news personality Mark Viviano stated that Jones was at the top of the list for most games played for the decade.
During that span of 10 years, Jones was never on the injured list as we maintained a consistent working schedule using therapeutic cupping in conjunction with other soft tissue bodywork therapies. “Cupping wasn’t just a method, it was a culture that my body needed to be able to perform,” said Jones. “Unlocking my body in ways that kept me on the field and playing the most game in the MLB from 2010-2019.”
The approach was different, as Jones had experienced, and many baseball players after him would recognize that the therapeutic cupping I used was more of an integrated therapy, taking into consideration the client’s comfort and the overall goal of the session. The athletes often expressed they had only ever received cupping on their back and typically the trainers would just line cups up and leave them.
When I incorporate cupping into a session, I will employ cups on the glutes, thighs, and all the way down to the foot, for example. After assessing the tissue with my hands, there will be a cup to prepare the canvas before the very first therapeutic stroke is applied.
“I look to therapeutic cupping as one of the most effective methods to render soft tissue treatment because of its versatility and ease of use,” says Andrew Edwards, ATC, a medical assistant at Heckers Sports Medicine in Fort Collins, Colorado. “As I’m usually limited on time to work with an athlete, cupping therapy is a great way to provide a wide array of treatment options.”
The strange thing about cupping is, although it has been around for thousands of years and is culturally rich, it was not widely known—until Michael Phelps, the most decorated Olympian of all time, put the cup mark on the map during the 2016 Olympics in Rio. (Interestingly, cup marks can tell a story and by the looks of Phelps’s cup marks, I’d speculate that cupping therapy was almost certainly a new modality to him with cup placement left for five minutes or more, leaving behind the deep, dark cup marks from the interstitial debris that has been trapped in the tissue from previous old injuries or overuse.)
Another athlete, a starting pitcher with the Pittsburgh Pirates (we have completed our fifth spring training working together), doesn’t let anyone use cups on him during the off-season. This lack of off-season cupping bodywork results in the accumulation of interstitial debris from his winter training. When he arrives at his spring training in mid-February, he says that he feels the initial cupping sessions feel more productive and the sessions tend to yield more cupping marks, which are caused by this accumulation of interstitial debris in the off-season.
As visits continue during spring training, cupping marks made from the residual interstitial debris become less frequent, leaving behind lighter, pink cup marks, if any cup marks at all. With TCM cupping, the goal is to bring up marks. In contrast, with the modernized adaptation of cupping, marks are not the goal; in fact, depending on the intent of the session, oftentimes no marks are left at all.
Sometimes the athlete just needs to get some things moving. Take the Pirates starting pitcher on game day. I would do a short therapeutic cupping session using either a lift-and-release or light, moving technique to stretch the tissue from the inside out, while bringing hydration into the area and clearing lymph.
The application would need to be limited in time so as not to dehydrate the area for the pitcher. He would need to sufficiently hydrate after our session and need several hours before pitching in a live game.
“I personally use therapeutic cupping with my athletes on a daily basis, whether the end goal of the treatment is to provide complete lymphatic drainage, increase blood flow to an area or promote tissue relaxation,” said Edwards. “As an athletic trainer working with professional athletes for years, I find this interactive cupping approach better for the athlete’s range of motion, function, mobility and keeping them healthy and on the field with hydrated tissue like only therapeutic cupping can.”
With local triathletes and marathon runners, a full-body therapeutic cupping for lymph drainage is a welcome relief after an Ironman or marathon; they are typically very sore for many days after this type of event.
Once they have sufficiently hydrated post event, it is encouraged that they come in and get therapeutic cupping for lymph drainage to move the delayed-onset muscle soreness, all the trapped lymph created by the heat of the event, while gently stretching the tissue at the same time. This is often a more welcome approach to bodywork than the positive pressure of manual therapy alone.
Thank you, Michael Phelps, for putting cupping therapy on the map for bodyworkers and all the world to see. As we now know, there is a difference between the Traditional Chinese Medicine cupping method of application and this adapted, modernized approach to cupping, oftentimes using the same tools but with an entirely different intent for the session.
Stacie Nevelus is an LMT in Florida (1999), cupping therapy practitioner (2005) and educator (2009). She is the cofounding owner/educator at Modern Cupping Therapy Education Company. She specializes in therapeutic and sports massage applications and is known as a specialist in acute and chronic injuries as well as for working with competing, professional and elite athletes. She has worked with world-ranked tennis professionals, triathletes, national and Olympics runners, and MLB and NFL players.
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