Sport injuries Cupping Therapy

Sports Injuries


Sports injuries are quite common, especially for people who tend to be active or exercise a lot. Over the years I have treated numerous sportsmen/women, applying cupping therapy in conjunction with acupuncture and many times on its own with numerous benefits to the athlete. Although many sportsmen/women come seeking help as a result of an injury, I have also treated many, and in particular long distance (endurance) runners, before the event took place. Without any overstatement I can testify that almost all athletes reported some form of improvement to their overall health, including feeling ‘refreshed’, ‘light’ and ‘more flexible’, and having ‘less pain’ and ‘more energy’. For the reasons I have listed below, I believe cupping therapy can be employed quite successfully during the management phase of many injuries as well as before the sporting activity, in order to help the athlete deliver their maximum performance.

Sport injuries Cupping Therapy



Cupping therapy immediately following sports injury should not be attempted at the site of the injury until the practitioner is absolutely certain that the bleeding into the injured tissues has completely stopped. It is of paramount importance that this safety measure is adhered to, in order to avoid further damage to the tissues involved.

In the acute stages of sports injuries the normally acceptable treatment is to apply an ice pack to minimize swelling and bleeding into the muscle. After the initial treatment has been undertaken, rest, physiotherapy or, if necessary in the case of extreme injuries, surgical intervention might be the next course of action. Cupping therapy is most effective in the subsequent stages of the injury (usually around 24 hours later) and is certainly not suggested as an immediate treatment directly following an injury.

 This is because the instant physiological reaction to injury is a rush of synovial fluid and blood into the injury site in order to ‘protect’ the injured area (hence the swelling of the injured site).

If the injury is severe, blood also escapes into the tissues, resulting in a black and blue swelling. At this stage cupping therapy is not an appropriate form of treatment, as the condition could worsen due to the power of suction that is created inside the cup. From the TCM energetic point of view, we can safely conclude that all forms of injury, anywhere on the body, cause local stasis and stagnation of Qi, Blood and Fluids.

The purpose of cupping therapy, therefore, is to remove and eliminate this adverse stagnation (Qi, Blood and Fluid) by dispersing the stasis and harmonizing the smooth flow of Qi, Blood and Fluids. Consequently, the best time to administer cupping therapy is when the practitioner is quite satisfied that the bleeding has completely stopped which, in most cases, will be the next day. The cupping application forces the stagnant blood, fluid and Qi into movement towards the cup. When this treatment is administered by means of the Bleeding cupping technique, some blood and fluid will also be removed from the swollen site into the cup. This action will have the immediate effect of decreasing the localized pressure and reducing both swelling and pain. Consequently, it offers welcome relief and benefit to the patient.

With regard to the question: ‘Should cupping therapy be administered to an open wound?’, the answer is, most definitely not! Wound healing takes time and depends on several factors. Local tissue oxygenation, infection, patient-related factors such as diabetes, nutritional deficiencies, smoking and medications are amongst the important healing factors.1 Once again, to reiterate the point I have made above, cupping therapy is not the appropriate choice of treatment in the acute stages, but is most effective in the healing and recovery phases of the injury. 

Sport injuries Cupping Therapy

Why Cupping Therapy?

One of the most authoritative books available on sports medicine is Sports Medicine: A Comprehensive Approach by Scuderi and McCann.1 In Chapter 10, entitled Wound Healing (contributed by Dr Susan Craig Scott), a very clear account of the healing process is described:

Factors that affect wound healing: Local tissue oxygenation (pO2 tissue partial pressure of oxygen) is the single most important factor in wound healing. It is poor local pO2 that ultimately accounts for healing problems in irradiated tissue or in a patient with diabetes mellitus, peripheral vascular disease, chronic infection, and pressure sores. Interestingly, the fibroblast, which lays down the collagen for wound healing, is oxygen sensitive. Collagen synthesis requires a pO2 in the range of 90 to 95 mmHg; in patients on a normal diet with adequate vitamin C, the availability of O2, to the fibroblast is the rate-limiting factor for collagen production. Adequate local pO2 depends on several factors. There must be adequate inspired O2 and haemoglobin must be adequate in level and normal in structure to allow the transfer of O2 on demand by local tissue.

Let us take a pause for a moment and remind ourselves of the reasoning as well as the purpose of the cupping application itself. Cupping suction is due to the negative pressure created inside the cup either by introducing a fire into the cup or by manual/ mechanical influences over the cup. This negative pressure forces the oxygen-rich blood to move towards the cup, thus saturating the damaged tissues with oxygen-rich blood and consequently precipitating the healing process. This is precisely why cupping therapy has an advantage over all other forms of healing systems, and one that is considered the most fundamental requirement in the healing process, according to Scuderi and McCann.

As far as cupping therapy is concerned, we can further group the injuries into two categories: overuse injuries and on-field trauma injuries. Overuse injuries are the result of repetitive, cumulative mini-injuries to the same part of the body. They do not appear as a sudden onset complaint but rather as a slow onset aggravation that gets worse with each activity or exercise. Consequently, when the complaint becomes sufficiently intolerable for the athlete to seek help, the injury has penetrated into the deeper energetic layers of body tissue, resulting in the need for much more extensive treatment. However, when on-field trauma injuries are involved, after waiting for the initial acute stage of the injury to settle, the management of the injury is more rapidly responsive. This will therefore reflect favourably on the long-term outcome of the treatment.

Ligament and Tendon Injuries

Tendons and ligaments are both potentially vulnerable to many incapacitating sports injuries. Together they bind, support and give stability, flexibility and strength to the entire musculoskeletal system as well as being responsible for the stretching and movement of the joints. I would like to take a brief look at the structure and functions of both ligaments and tendons.


Ligament injuries vary from mild injuries involving the tearing of only a few fibres to complete tears of the ligament, which may lead to instability of the joint. Ligament injuries are divided into three grades:

• A grade I sprain represents some stretched fibres but clinical testing reveals a normal range of motion on stressing the ligament.4 Cupping therapy is applicable to a grade I injury.

• A grade II sprain involves a considerable quantity of fibres and, therefore, stretching of the joint and stressing the ligament show increased laxity but a definite end point.4 Cupping therapy is also applicable to grade II sprains.

• A grade III sprain is a complete tear of the ligament with extreme joint laxity and no firm end point. Although they are often painful conditions, grade III sprains can also be pain-free as sensory fibres are completely divided in the injury.4 Cupping therapy in grade III sprains is contraindicated until after the necessary intervention, i.e. after surgery, and well into the healing and building phase of the injured tissue.


Tendons connect or attach muscles to bones; they provide the ‘pulling’ action on the bones. Tendons comprise tough and flexible bands of fibrous tissue which transmit power from muscle to bone and also act as shock absorbers. Tendons often become inflamed - a condition known as tendonitis. Rupture of a tendon, especially the Achilles tendon, is a common complaint amongst sportsmen and women. The composition of a tendon is similar to that of ligament: mainly water, fibrous and collagenous fibres. Both tendons and ligaments lack the presence of blood vessels (hence the familiar grey or white colouring in anatomical charts).

In the event of an injury, both of these tissue forms are deprived of the oxygen necessary for repair work. The application of cupping therapy, either directly or proximally on the tendons and ligaments, will facilitate the blood flow through the method described earlier, providing more evidence to support the opinion that cupping therapy is an effective treatment for muscular as well as tendon and ligament injuries.


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