It’s tempting to follow the lead of elite athletes and try every training method they use—but are they really useful for the everyday runner or swimmer?
If you were able to pull your eyes away from all those medals around Michael Phelps’s neck at the 2016 Olympics, you might have noticed some other round things on his skin— the tell-tale circular marks of an ancient Chinese medicine practice called cupping, also used in many other cultures for centuries. Cupping involves using heat or an air pump to suck out air from glass or hard plastic cups placed on the skin: the suction causes capillaries to burst under the skin and leaves perfect circles of purple hickey marks.
And just like eating our Wheaties, if Olympians do it, we more typical mortals often want to try it too. But should we?
Here we’ll look at three popular tricks elite athletes are using to improve their performance and whether the evidence supports it. Spoiler: sometimes it does, but you will need to think twice about whether to incorporate into your own daily workout.
Cupping dates back to at least 1500 B.C. Athletes are attracted to the claim that cupping pulls blood to the area where the cups are placed to reduce soreness and speed up the healing of overworked muscles. Other described mechanisms of cupping include “releasing toxins” from body tissues, activating the lymphatic system and clearing and “activating” blood vessels, among others.
Just because something has been used for millennia, however, doesn’t mean it works. Over the years, cupping has been recommended by its various practitioners to treat a long list of conditions: pain, shingles, cough, asthma, acne, common colds, hives, stretched or torn ligaments, frozen shoulder, mastitis … The list goes on.
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“Normally, one does suspect that a ‘cure all’ is, in fact, a ‘cure nothing,’” said Dr. Edzard Ernst, an emeritus professor of complementary medicine at the University of Exeter in the United Kingdom. “If one treatment is recommended for a wide range of conditions, it does in all likelihood cure none.”
The evidence on cupping mostly bears this out: no evidence exists to support the biological mechanisms described above, and Ernst noted the studies “are flimsy in almost every respect.” A research review concluded “there is insufficient high-quality evidence to support the use of cupping therapy on relevant diseases.”
But some evidence suggests cupping might help with one thing—pain. For example, a small study on cupping for neck pain and another on cupping for knee pain found mild benefits compared to a different therapy or no therapy. These studies also had significant flaws, and a 2011 meta-review called for more rigorous studies before recommending cupping for pain. But Ernst describes one way cupping could help with pain: counter-irritation.
“One pain can make another one disappear or appear to be less,” he explained. “If you hit yourself accidentally with a hammer, your headache will seem less for a while. The crucial point is that the effect is neither curative nor long-lasting.”
And the practice is not without risks or harm. Dry cupping is mildly painful, costs money, leaves those characteristic purple hickeys, and may dissuade people from seeking more effective treatments. (I can also attest that the pain can last several days after dry cupping with heat is done.) Wet cupping, in which the skin is pricked or sliced multiple times so the person bleeds into the cups, can lead to dangerous infections.
Transcranial direct current stimulation (tDCS)
Some elite athletes head in the opposite direction for a cutting-edge technology called transcranial direct current stimulation, or tDCS. A device worn on the head non-invasively transmits a low-intensity direct current that reaches the brain, which already uses electricity to function.
“You can get the current to go to different parts of the brain and when it gets to the brain, it can change the way the brain operates,” explained Marom Bikson, a dTCS expert and professor of biomedical engineering at the City University of New York. TDCS is regarded as very safe when used in a very limited dose and with high-grade technology, he said.
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Though not approved by the FDA in the U.S., tDCS has been approved in Europe for treating depression and types of chronic pain such as migraine. Now some elite athletes have begun using it to add an edge to their performance, but the evidence for that edge is limited.
Bikson points out that sports performance involves everything from an athlete’s speed to their focus and attention to their perception of fatigue. And one recent lab study found that tDCS affected cyclists’ perception of their effort and how tired they were, which translated into an estimated four percent better performance. But Bikson cautions not to get caught up in percentages, especially from just one small trial (a mere 10 cyclists).
“You can get this performance in the lab, but we need to be careful about saying that it will necessarily work in the real world,” he said. Similarly, some lab tests show a possible effect on motor performance, but it hasn’t been replicated. The athletes using it, however, don’t seem to care.
“Maybe they feel something,” Bikson said, “but it’s not scientific proof that it’s working, and it’s not scientific proof that it doesn’t work.”
Hypoxia refers to oxygen deficiency. The “thin air” at the top of a mountain is hypoxic, making it harder to breathe than at sea level because you’re not getting as much oxygen with each breath. If you stay in that environment long enough, your body adjusts by churning out more oxygen-carrying red blood cells to ensure your tissues get enough oxygen. When you then return to sea level, you may feel a bit more energetic for a few days because the air is now rich with oxygen while your body still has all those bonus red blood cells.
It seems logical, then, that training in environments with low oxygen might boost performance at lower elevations, and a number of products claim to take advantage of that, from hypoxic masks that reduce the oxygen you breathe in to specially designed hypoxic rooms or “altitude tents” to train in.
But there’s a hitch: training in a hypoxic environment doesn’t actually help performance.
For decades, Olympic athletes experimented with training at higher altitudes to improve sea-level performance, but the evidence was mixed, explained Jim Stray-Gundersen, M.D., the sports science advisor for the U.S. Ski and Snowboard Association in Park City, Utah. He and a colleague conducted a study in 1996 that discovered the secret to maximizing the benefits of high altitude: live high, train low. They compared three groups of college runners: one group living and training at sea level in Dallas, one living and training at altitude in Park City, and one living in Park City but training at sea level in Salt Lake City.
“The big finding from our study was that it’s not the training in hypoxia that’s helpful. It’s living at altitude that’s important to get sea level performance,” Stray-Gundersen said.
And the masks? They don’t work, said Stray-Gundersen, who has studied several of them.
Meanwhile, Stray-Gundersen said, practices such as cupping or tDCS come from a long line of things Olympians will try for any extra edge they can get, but for ordinary athletes, the best way to improve performance doesn’t need to be as complicated as building a hypoxic room.
“Most athletes don’t train right in the first place,” he said. “Improving a performance can be done by just getting your training right.”
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