If you are on our website the odds are that you have been watching the Olympics. You will then have spotted the marks on Michael Phelps’s shoulders and the discussion that started on the topic.
Cupping: explained by Dr John Rusin


  • cupping therapy

After the polarizing red circles on Michael Phelps shoulders surfaced last week at the 2016 Rio Olympic Games, many questions arose pertaining to the science, application and efficacy of the myofascial decompression technique also known as cupping.

As claims and debate started to rip through the world of sports performance and physical therapy, and now even into mainstream worldwide media over the past two weeks on this therapeutic topic, many questions were left unanswered. But now, it’s time to take an unbiased, scientific look at the research and application of the technique known as cupping.

Here is the science behind why Gold Medalist Olympic athletes are choosing to be treated with cupping, and a complete review of the current scientific literature behind this technique from Dr. Mario Novo.

The Emergence of Cupping In Elite Sports Performance

cupping michael phelps

At the top of the sport performance food chain, are the Olympians. These almost god like beings have chiseled away at their human form, with countless hours of practice to become the very best at their sport. In the pursuit of greatness, one is required to take risks with pushing their bodies to the limit. When it is down to the hundredth of a second between winning the gold, or silver for your country, you learn to become comfortable with stress. Although these Olympians break themselves in the training room day in and day out to adapt to stress, the secret is truly in their ability to recovery.

Let’s take a dive into cupping as a form of recovery and how best we can apply the body of known studies to create a frame work worth looking into.

Cupping therapy is defined as a complementary and alternative medicine (CAM) within the world of holistic medicine, and traditional Chinese medicine (TCM). Cupping like many other CAM based treatments are provided as a conservative and alternative method towards improving human health through the reduction of pain when present, and tissue healing.

With nearly 80% of all general doctor’s visits involving pain, as well the rise in American based chronic or recurrent pain costing an estimated $200 billion annually and the rise of prescription based addiction and accidental death; implementing pain science, and holistic approaches towards pain management is as we should view it, a fundamental right towards health and independence of drugs. Here is where cupping plays a role alongside other CAM’s, and advanced medical provider forms of therapy can make the largest difference in how individuals consume healthcare, towards improving quality of life.

The Various Methods of Cupping

cupping fire

Depending on where you look, there can be nearly 7 to 10 different methods for applying cupping. All methods involve the application of a cup or dome to promote localized negative pressure to an area of the body for alleviating pain, and improving tissue recovery.

Dry cupping is by far the most commonly applied methods, which uses either a heat element or pneumatic device, to create the suction required to raise the soft tissue into the cup or dome. Either method produces a gentle and painless, bruise on the skin, which has now become the hallmark of our 2016 Summer Olympic games.

Cupping is applied to various regions of the body, which are individually unique to the athlete/clients/patient needs. The most common areas of application are the back, chest, abdomen, and buttock. The cups are typically left in place 5–10 minutes with the after effects of erythema, edema, and ecchymosis subsiding within a few weeks.

An interesting way of viewing cupping when compared to massage is that massage or external applied force into soft tissue, is noted by a positive pressure change in the surrounding soft tissue structures. The novel stimulus of negative pressure is also used like massage to alter sensory and or pain perception but it also influences the microcirculation of specific body area, which has been demonstrated to change local tissue circulation.

The Mechanism of Effect of Cupping


Specific mechanisms of acute metabolic tissue change and pressure pain thresholds have been studied with dry cupping. Such studies have demonstrated that while participants received dry cupping, observed increases in blood flow (hyperemia) occurred. This increased blood flow or vasodilatation does appear to also influence tissue temperature but more importantly, appears to increase capillary endothelial cell repair, accelerated tissue granulation, and angiogenesis (formation of new blood vessels) within the regional treated tissue.

Emerich et al found that following cupping participants demonstrated a rise in the lactate/pyruvate ratios which indicated an increase in the anaerobic metabolism of the surrounding tissue.

What this can mean to a patient or athlete, is the potential for a rise of key ischemic (low oxygen) chemical mediators that are involved with promoting cellular/metabolic adaptation, and tissue recovery.

When cupping was compared to wait-list groups, heat modalities, and certain conventional pain medications, cupping showed better effectiveness for pain reduction. It’s no guess that when compared to exercise cupping demonstrated no change, but for many individuals that are unable to train secondary to pain, or over-reaching; cupping appears to be another powerful tool such as dry needling, IASTM, taping, and neuromuscular/musculoskeletal manual therapy based modalities, which all uniquely play a role in the modulation of pain perception, improved muscle recruitment and tissue recovery.

Because, we should all be able to agree that pain plays an inverse role with the ability for an individual to recruit muscle and process useful sensory feedback (proprioception, kinesthetic awareness) via inhibitory feedback systems; the promotion of improved musculoskeletal function should be promoted through the restoration of sensory input via various methods of pain modulation.

Cupping within the context of sport performance can be viewed as a practical method to pre/post activity sensory modulation, which also plays a role with soft tissue health. For Olympic athletes, who have gone the distance, one can imagine they will set no limits to their performance while at the games. Hence, administering cupping can be viewed as a quick treatment session (5-10 min) where they can restore sensory awareness, and already begin increasing the local chemical signaling pathways that influence tissue recovery. For our non-Olympians in the room, I included; pain should be a respected symptom, which often plays a role in teaching us about harm. Hence, we should not be applying cupping at such high frequencies as these athletes, due to the potential for adverse effects as well the potential for increased tissue injury secondary to altering our pain perception.

Because pain plays a role with learning, we can also learn to be in pain. This is apparent with individuals who express chronic pain that lack acute tissue damage. Hence, there is more to pain than chemical irritants and trauma. In regards to chronic pain, cupping may play a role for some individuals seeking a novel approach towards improved function as a complimentary program leading towards the progressions of an exercise prescription.

Relative Safety and Precautions

cupping bleeding

While cupping therapy offer benefits, it goes without mentioning that adverse effects do exist. As with any modality, there are inherent risks that a skilled therapist should be aware of. With cupping, there appears to be an associated risk with the types of application, and frequency that can lead to injury.

Cupping is not advised to be used over excoriated, oozing, or infected areas, as this may promote enhanced D-dimmer (a fibrin protein found in tissue inflammation). As mentioned earlier, cupping will result in the reddening of skin with a the presence of a bruise (ecchymosis) which is regarded as a normal reaction after cupping that should resolve in a manner of 2-5 days. There are adverse effects of swelling, and or burns in some cases, with rare occurrences of an increased pain at the site of supping, and very rare occurrences of reported muscle soreness or tingling in the original site of treatment.

About The Author

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Dr. Mario Novo is a results driven sports orthopedic physical therapist who specializes in strength and conditioning. Known well by his clients/patients as a mentor and educator, Mario’s passion is to unify the highest levels of rehab science with successful mind and body strength coaching. With Mario’s research having focused on new advancements in muscle hypertrophy periodization and joint health, his goals are to share his knowledge and improve on the human condition through personalized cutting edge program design. Mario currently resides in middle Tennessee where he plans on integrating his skills and knowledge in resistance exercise and rehab to empower and inspire those individuals ready to make a change in their lives through health and fitness. He is also the owner of, an integrated platform of strength training and physical therapy.


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  2. Huber, M. Emerich, M. Braeunig Cupping – is it reproducible? Experiments about factors determining the vacuum Complement Ther Med, 19 (2011), pp. 78–83
  3. Farhadi, D. Schwebel, M. Saeb, M. Choubsaz, R. Mohammadi, A. Ahmadi The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial Complement Ther Med, 17 (2009), pp. 9–15
  4. Michalsen, S. Bock, R. Ludtke, et al. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial J Pain, 10 (2009), pp. 601–608
  5. Moetaz El-Domyati, F. Saleh, M. Barakat, N. Mohamed Evaluation of cupping therapy in some dermatoses Egyptian Dermatol Online J, 9 (2013), pp. 1–15
  6. Anjum, S. Jamil, A. Hannan, J. Akhtar, B. Ahmad Clinical efficacy of Hijamat (Cupping) in Waja-ul-Mafasil (Arthritis) Indian J Tradit Knowl, 4 (2005), pp. 412–415
  7. Chirali Cupping Therapy: Traditional Chinese Medicine (1st ed.)Elsevier Health Sciences, London (1999)
  8. Teut, S. Kaiser, M. Ortiz, et al. Pulsatile dry cupping in patients with osteoarthritis of the knee–a randomized controlled exploratory trial BMC Complement Altern Med, 12 (2012), pp. 1–9
  9. Ullah, A. Younis, M. Wali An investigation into the effect of cupping therapy as a treatment for anterior knee pain and its potential role in health promotion Internet J Altern Med, 4 (2007), p. 1
  10. Lauche, S. Materdey, H. Cramer, et al. Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain- A randomized controlled trial PLOS ONE, 8 (2013), pp. 1–9
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  14. Hanan, S. Eman Cupping Therapy (Al-Hijama): it’s impact on persistent non-specific lower back pain and client disability Life Sci J, 10 (2013), pp. 631–642
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  18. Schumann, R. Lauche, C. Hohmann, T. Zirbes, G. Dobos, F. Saha Development of lipoma following a single cupping massage-a case report Forsch Komplementmed, 19 (2012), pp. 202–205
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The Cover Model Myth (why being shredded sucks for you and I)

A topic that is luckily getting more and more exposure: it’s so important to raise awareness about what it actually take to be ‘shredded’ – for most of us, it’s really not worth it!

Thanks for this brilliant article Joey Percia!


I got shredded. I looked the guys you see on the cover of Men’s Health. For the first time, I had veins popping out of my stomach.

It felt good on the outside but I felt like shit on the inside.

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People say they want to get shredded. They envy men with a 6-pack so defined, they look like a statue of a greek god. They’re excited about a body that’s shredded, but few are willing to do what it takes to get to that point.

I want to pull back the curtain on what is takes to look like a cover model(ish).

People often confuse shredded with lean. Being lean it an attainable goal for pretty much everyone, being shredded is a painful, shitty, long drawn out process.

Lean can be attained by maintaining a social life and do normal people things. Shredded will make you an outcast.

It sucks more than trying to eat a bowl of cinnamon toast crunch with a big spoon. It sucks more than getting to the gym and realizing you forget your headphones (every day of your entire life.) You get it, it sucks.

To get lean, consistently eat healthy, nail your training and diet. Make sure you are in a calorie deficit, train hard, eat enough protein to preserve muscle, learn tricks to manage hunger and make smart choices.

Being shredded is another beast and takes things to another level. You will:

  • Feel levels of hunger you never knew existed
  • Learn what it’s like to feel existed day.
  • Go to sleep earlier because you ate your last meal of the day and realize then next time you eat will have to be breakfast.
  • Find yourself dragging through the day and through workouts
  • Develop a weird relationship with food (usually not good)

A shredded physique for long periods of time is an unattainable goal for normal folk. Especially for those who want to have a social life, but being lean is not. That can be done with hard work and time.

My Journey to Hell and Back

I think every fitness coach and trainer should get shredded at least once in their life. By shredded, I am talking about 4-6% body fat for men.

Even if you have no desire to step on stage. Even if you don’t want to stay that way or have clients that want to get shredded. It is a huge learning experience.

A lot of your clients (or patients) are going to want to look better by losing fat. You want to know exactly what that process feels like, even if you’ve read everything about it for years.

You know a tattoo hurts because everyone tells you. But you don’t know what it feels like to have someone jab needle into your skin for  6 hours straight until you do it. It fucking hurts, believe me. But you should still get it done if you really want to know what it feels like.

January of 2015 I was having knee pain and decided to bail on a powerlifting competition I was training for. I wanted to get shredded instead.

I entered a 12-week transformation challenge because it ended up lining up exactly the same time. Plus I wanted the extra accountability and a chance at 100k. All good things.

My starting point was roughly 14% body fat in January. This was a little higher than normal (I’m usually 12-13 most of the year.) I ended the fat loss phase the first week of April at ~6%.

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I got pretty damn lean. While I was still about 1 month or 2 away from being able to step on stage at a bodybuilding show and hold my own, this was leanest I’ve ever been.

I also got sick and learned that when my body gets run down and put under too much stress I develop a style. I don’t mean mental stress either. My body was so run down, tired and weak that the physical stress took a toll on me and my body fought back.

The last 3-4 weeks of the diet I only lost ~1lb because I felt so shitty and did want to risk my health for cutting calories even lower.

So, it wasn’t worth it?

Hey, I never said that! It sucked (a lot), but it was a process that I am glad I went through.

Some have great genetics and walk around shredded year round.  I’m not one of those people and I assume you aren’t either.

Here’s where I went wrong:

  • I created an unhealthy relationship with food
  • I ran myself into the ground from going 110% in the gym and into my business
  • I secluded myself from having fun in social situations
  • I went balls deep and paid for it later

I was doing it for the wrong person and for the wrong reason. I wasn’t doing it for me and I wasn’t happy doing it.

My body is happy around 11-13% body fat so that is where I keep it now. There are some times while I will cut some bodyfat and others where I let it go up a little bit.

I can be a normal person and juggle my business, health, and social life in a comfortable way. I can have a few beers and ice cream cake to celebrate my engagement with my family.

Will I ever get that lean again? You bet your ass I will, but right now I have a life to live so I will stick to being lean.

Joey’s Habits to Stay Lean Year Round

  1. Wake-up and drink lots of water (like even more than what you’re thinking.)
  2. Take my vitamins:
  3. 1st meal is a protein, veggie and moderate fat meal (little to no carbohydrates)
  4. Protein at every meal (veggies at most) — the only veggie exception is when I am having a shake, pre or post workout meals, sometimes I omit the veggies.
  5. Keep carbohydrates to the first 1-2 meals after a workout 
  6. Eat until satisfied, not full (70-80% full)
  7. Only have protein shakes when I can’t get to real food. They don’t keep me full enough, sometimes just make me hungrier.
  8. Don’t multitask while eating, and put down my fork/spoon in between bites.

There’s a large difference between the dieting to get shredded vs. dieting to get lean that will take some time learn. You will figure out what foods to stay away from because they cause cravings, while other foods to eat more of because they keep you more full.

There’s obviously a big difference between the two physqiues as well as the two diets…

Fed with Fish acos and Tequila -- Healthy and Sustainable Year Round

Navigating Road Blocks Around Events to Stay Lean

  1. Skip breakfast and fast. In that case, drink black coffee and sparkling water to suppress appetite and function like a normal human being
  2. Keep protein high throughout the day but cut extra carbs and fat throughout the day to save calories for a bigger meal
  3. Keep things moderate man. Don’t be a dick about this. If you want to have a few beers do it, but don’t say “fuck it”, try to drink a keg and eat 12 burgers.
  4. If they have fish tacos, get them. Always. And Tequila, get the Tequila too.

If you have ANY questions at all, please email and I will get back to you ASAP.

I will teach you how to lose fat eating foods you love

Look and Feel Better Than Ever: Escape Fad Diets and Burn Through Fat Loss Plateaus Eating Foods You Love.