What Is Cupping And Why You Should Know About It

By: Rachel Boccard, SPT

Cupping Camillus 1


With the 2016 Summer Olympics coming to an end, many viewers were wondering what those perfectly round bruises were on many of the athletes. Michael Phelps has been a prominent athlete in the media for both his talent and cupping marks during the Rio Olympics, and he can be seen with red and purple circular bruises located along his shoulders, arms, and back.


Cupping was first recorded in 1550 BCE by Egyptians who believed it would rid the body of foreign matter and toxins, and has since become popular tool for healing in traditional Chinese medicine (TCM)5. Cupping works by lifting the layers of tissues underneath the cup through suction and negative pressure. Cups of varying sizes and materials are placed over a problematic area for up to 15 minutes, and the suction is created through an air pump or heat.  Cupping can be static, where the cups are placed over one localized area, or they can be dynamic and glided across the skin with the use of a lubricant. There are many proposed mechanisms by which cupping works; however it is evident that it leads to increased blood flow to the area, hence the creation of bruises. By increasing blood flow, cupping can help facilitate cellular repair, tissue recovery, and angiogenesis, which is the development of new blood vessels. Other theories propose effects on the body’s immune system, gate control theory of pain, increases in lymph flow, and “decompression” of collagen and fibrosis within and surrounding the tissue1,6.


 Cupping is a useful tool for Olympians who train year round and are required to perform at an exceptional level.  It is understood that if an athlete has movement restrictions, it can significantly impact their performance.  Adhesions in the utilized tissues are formed through training and can lead to compensatory movement patterns and inefficiencies. By decompressing the layers of tissues and addressing these adhesions, cupping can help restore both normal and adequate movement patterns1. Cupping is also appropriate in targeting musculoskeletal pain in the average person. Research has shown improvements following cupping in pain, function, and quality of life in individuals who suffer from neck pain2,3, low back pain4, knee OA7, cancer pain, trigeminal neuralgia, carpal tunnel, and arm pain2,6.


If you are suffering from pain or you are an athlete who would like to optimize their performance, cupping therapy may be an appropriate tool. PT’s and PTA’s can use cupping and will decide if you can benefit from the effects of cupping therapy.


Cupping Camillus 2



For more information ask for physical therapist or refer to:







  1. Daprato, C. (n.d.). Myofascial decompression. Retrieved August 11, 2016, from http://www.cuptherapy.com/
  2. Kim JI, Lee, M.S., Lee, D.H., Boddy, K., and Ernst, E. Cupping for treating pain: a systematic review.Evid. Based Complement. Altern. Med. eCAM. 2011; 2011: 467014.
  3. Lauche R, Crmaer, H., Choi, K.E., Rampp, T., Saha, F.J., Dobos, G.J., and Musial, F. The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain–a randomised controlled pilot study. BMC Complement. Altern. Med. 2011; 11: 63.
  4. Markowski A, Sanford S, Pikowski J, Fauvell D, Cimino D, Caplan S. A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. Journal of alternative and complementary medicine (New York, N.Y.). Feb 2014;20(2):113-117.
  5. Nickel, J.C. Management of urinary tract infections: historical perspective and current strategies: part 2-modern management. J. Urol. 2005; 173: 27–32
  6. Rozenfeld E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of bodywork and movement therapies. Jan 2016;20(1):173-178.
  7. Teut M, Kaiser, S., Ortiz, M., ROll, S., Binting, S., WIllich, S.N., and Brinkhaus, B. Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial. BMC Complement. Altern. Med. 2012; 12: 184.


Facts and Myths of a Concussion

By Aimee Alexander, PT, DPT, OCS, CPC


                                                brain injury


There are an estimated 1.8-3.6 million head injuries in adolescents each year. According to the Centers for Disease Control (CDC), concussions are thought to account for approximately 6-9% of the injuries in organized sports. Because of the vast amount of emerging research on concussion, and the number of head injuries in the media these days- it is more important than ever to educate athletes, parents, coaches, and the general population on the signs and symptoms of concussion


What is a concussion?


A concussion occurs when there is a rapid deceleration of the brain, either due to a direct or indirect blow to the head causing the soft tissue of the brain to collide with the hard skull. https://www.youtube.com/watch?v=fY7J7bccNoU


Concussion Signs and Symptoms:

There are several signs and symptoms to be aware of if you think someone you know has suffered a concussion. You only need to have one persisting symptom after a blow to the head to be diagnosed with a concussion.

  • Amnesia (of any  kind)
  • Confusion or appearing dazed
  • Loss of consciousness (*not necessary  to be diagnosed with a concussion)
  • Irritability, sadness or other changes in personality
  • Feeling sluggish, “foggy”, or lightheaded
  • Slowed reaction time
  • Headache or head pressure
  • Difficulty concentrating
  • Sensitivity to light and/or sound
  • Double or blurry vision
  • Dizziness
  • Nausea, vomiting, or loss of appetite
  • Sleep disturbances (sleeping more or less than usual)


This video answers many FAQs regarding Facts and Myths of Concussions:





Do Your Genes Affect Your Concussion Recovery?

Concussion word cloud

By: Sarah Phan


                Concussion in the media is a growing topic, and rightfully so, as 1.7 million people in the United States sustain a concussion each year, resulting in 1.3 million emergency room visits and 275,000 hospitalizations, costing $60 billion in health care dollars.1


Concussion is sustained through a variety of traumas, including motor vehicle accidents and sports, which causes the brain to bounce around within the skill. This results in cellular and chemical changes which are known as concussion.  Symptoms include headache, nausea, vomiting, balance problems, dizziness, fatigue, problems with sleep, feeling slowed down or foggy, memory problems, and difficulty concentrating.1


The good news is that for 50% of people, symptoms go away within 10-14 days of sustaining a concussion.2  Other people have persistent symptoms after several weeks.  This phenomenon is called prolonged post-concussion syndrome (PPCS).  These people who have difficulty recovering from a concussion and require physical therapy to aide in their cognitive and physical rehabilitation.  Physical therapy for PPCS includes retraining of the vestibular-ocular system as well as static and dynamic balance retraining, and functional reactivation.3,4


Though risk factors such as high age, female gender, prior trauma, and history of headaches have been thoroughly explored in their relationship to PPCS, genetics have recently been linked as well.5  A gene called methylenetetrahydrofolate (MTHFR) has specifically shown to be associated in decreased ability to recover from the cellular and chemical damages associated with brain injury such as concussion.6


MTHFR is essentially the amino acid which the body needs to convert folic acid, which is ingested from food, into methyl-folate, the active form of folate the body is able to process and breakdown.6  The body needs methyl-folate in order to regulate homocysteine and methionine, amino acids responsible for proper cell growth, maintaining healthy blood vessels, providing oxygen to blood cells, and cardiac health.6,7  Mutations in the MTHFR gene can cause further damage to cells and blood vessels supplying the brain, which results in poor recovery after a concussion. 


With about ½ of the population having some type of MTHFR genetic mutation and the increasing number of people sustaining a concussion each year, a solution must be made to the public in order to decrease the incidence of PPCS related to MTHFR gene mutation.6 Luckily, there is a fairly simple solution which many physicians are beginning to implement.  Firstly, blood tests may be done to determine the levels of homocysteine in your blood.7 ,8 If the levels read high and you are having difficulty recovering from your concussion, you likely have an MTHFR mutation.  


When high homocysteine levels are confirmed by blood test, supplementation of methyl-folate would be the next step. Methyl-folate supplementation has been shown to provide appropriate levels of homocysteine and methionine in the blood, thus allow proper cardiac and vascular health, subsequently allowing appropriate recovery of the brain after a trauma.9 Methyl-folate is available both as a prescription and over the counter.  It is important to consult with your physician prior to taking any supplementation in order to decide what is most appropriate for you as an individual in your specific situation.  A combination of physical therapy and methyl-folate supplementation might be the solution to appropriate recovery from PPCS.




  1. S. Alla, S.J. Sullivan, P. McCrory, L. Hale.  Spreading the word on sports concussion: citation analysis of summary and agreement, position and consensus statements on sports concussion. British Journal of Sports Medicine, 45 (2) (2010), pp. 132–135.
  2. S. John Sullivana, Sridhar Allaa, et al. The understanding of the concept of ‘rest’ in the management of a sports concussion by physical therapy students: A descriptive study. Physical Therapy in Sport. 13 (4) (2012), pp 209-213.
  3. Alsalaheen B, Whitney S, Mucha A, Morris L, Furman J, Sparto P. Exercise Prescription Patterns in Patients Treated with Vestibular Rehabilitation After Concussion. Physiotherapy Research International [serial online]. June 2013;18(2):100-108. Available from: CINAHL with Full Text, Ipswich, MA.
  4. American Physical Therapy Association. The Physical Therapist’s Role in Management of the Person With Concussion, HOD P06-12-12-10 [Amended HOD P06-11-15-18], 2012. Available at: https:// www.apta.org/uploadedFiles/APTAorg/ About_Us/Policies/Practice/Management Concussion.pdf.
  5. S. Mondello, K. Schmid, R.P. Berger, F. Kobeissy, D. Italiano, A. Jeromin, et al. The challenge of mild traumatic brain injury: role of biochemical markers in diagnosis of brain damage. Med Res Rev, 34 (2014), pp. 503–531 2.
  6.   Genetics Home Reference. MTHFR. April 2016. https://ghr.nlm.nih.gov/gene/MTHFR.
  7. Asghar Rahmani, Masoud Hatefi, et al. Correlation Between Serum Homocysteine Levels and Outcome of Patients with Severe Traumatic Brain Injury. World Neurosurgery. (27) (2016), pp 507-515.
  8. Miller AL. The methionine-homocysteine cycle and its effects on cognitive diseases. Altern Med Rev. 2003;8:7-19.
  9. Dr. McCaddon, Dr. Hudson, et al. L-methylfolate, Methylcobalamin, and N-acetylcysteine in the Treatment of Alzheimer’s Disease-Related Cognitive Decline. Primary Psychiatry | May 21, 2013.

How Does Your Brain Affect ACL Rehabilitation?

By: Patrick Schroeder



             A torn ACL is one of the most common injuries among athletes of all ages. More than 200,000 ACL tears occur each year in the United States alone.1These injuries are treated surgically 76.6% of the time.2 After undergoing surgery for an ACL reconstruction, physical therapy is extremely important when attempting to return to participation in sport, or whatever it is your goal may be. Your physical therapist will work with you to recover your strength, power, range of motion, and balance in the injured knee in order for you to make a full recovery.


                There are also many other impairments that occur after sustaining an ACL injury. Research has shown that after an ACL injury, individuals have decreased proprioception in their affected knee3. Proprioception is the ability for your brain to recognize joint position and detect movement. This can lead to difficulties with movement and balance, which a skilled physical therapist will provide patients with exercises for in order to return an individual to their previous level of function.


                New research is also emerging that shows how the brain adapts when an individual suffers an injury to their ACL. Research has shown that different regions of the brain are activated to a greater or lesser degree with active movement of the knee after an injury to the ACL. This likely occurs as a method of compensating for the injury. An example is more activation in the region of the brain responsible for vision, which likely means that the brain is compensating for a decreased sense of proprioception by relying on the visual system to aid with movement, and position sense.3


              There is also an increased risk of a second ACL injury in individuals who have previously torn their ACL. Research has shown that you are 15 times more likely to tear your ACL if you have done so in the past.4 Some factors that have been proven to increase the likelihood of this occurring include abnormal mechanics while landing from a jump, and decreased postural stability4. These are variables that a physical therapist will focus on throughout the course of rehabilitation from an ACL tear, in order to allow patients to safely return to unrestricted participation in sports and other recreational activities.



  1. Prodromos CC, Han Y, Rogowski J, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy.2007;23:1320-1325. E1326.
  2. Joseph,Allan M, Comstock, R et al. A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics. J Athl Train. 2013 Nov-Dec; 48(6): 810–817.doi:10.4085/1062-6050-48.6.03
  3. Kapreli E, Athanasopoulos S. Anterior Cruciate Ligament Deficiency Causes Brain Plasticity: A Functional MRI Study. Am J Sports Med 2009 37: 2419 DOI: 10.1177/0363546509343201
  4. Paterno M, Hewett E. Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport. Am J Sports Med 2010 38: 1968 originally published online August 11, 2010. DOI: 10.1177/0263546510376053