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At the 2016 Summer Olympics, Michael Phelps added to the collection of medals that make him "the most decorated Olympian of all time." But the medallions hanging around his neck weren't the only "decorations" that generated attention. The media and public also became fascinated by the tennis ball-sized red circles on his upper back and shoulders.

These welts are the result of cupping, a technique dating back to ancient Greece (making it an appropriate topic during the Olympics) that is common practice in traditional Chinese medicine.

Dry cupping involves the use of negative pressure to create a suctioning effect without any skin perforation.2 Wet cupping also uses skin suctioning, but with added superficial skin incisions to induce bleeding.3 Cups typically are left on the skin for 5-20 minutes, creating a circular-shaped ecchymosis, which may last for days or weeks. Increasing the time and/or pressure exacerbates the ecchymosis.2

Thanks to Phelps, an ancient technique seemed new again. And, in a cycle that's all too familiar, viewers became intrigued by some "sanctioned," never-before-seen performance enhancer that gets worldwide exposure on the Olympic stage.

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  1. Turk JL, Allen E. Bleeding and cupping. Ann R Coll Surg Engl. 1983;65:128-131.
  2. Rozenfeld E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther. 2016;20:173-178.
  3. Arslan M, Gokgoz N, Dane S. The effect of traditional wet cupping on shoulder pain and neck pain: A pilot study. Complement Ther Clin Pract. 2016;23:30-33.
  4. Musial F, Michalsen A, Dobos G. Functional chronic pain syndromes and naturopathic treatments: neurobiological foundations. Forsch Komplementmed. 2008;15:97-103.
  5. Lauche R, Cramer H, Hohmann C, et al. The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: a randomised controlled pilot study. Evid Based Complement Alternat Med. 2012;2012:429718.
  6. 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. J Altern Complement Med. 2014;20:113-117.
  7. Emerich M, Braeunig M, Clement HW, Ludtke R, Huber R. Mode of action of cupping--local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Ther Med. 2014;22:148-158.
  8. AlBedah A, Khalil M, Elolemy A, et al. The Use of Wet Cupping for Persistent Nonspecific Low Back Pain: Randomized Controlled Clinical Trial. J Altern Complement Med. 2015;21:504-508.
  9. Chi LM, Lin LM, Chen CL, Wang SF, Lai HL, Peng TC. The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2016;2016:7358918.
  10. Lauche R, Langhorst J, Dobos GJ, Cramer H. Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain - a reanalysis of 4 randomized controlled trials of cupping therapy. Complement Ther Med. 2013;21:342-347.
  11. Michalsen A, Bock S, Ludtke R, et al. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial. J Pain. 2009;10:601-608.
  12. Teut M, Kaiser S, Ortiz M, et al. Pulsatile dry cupping in patients with osteoarthritis of the knee - a randomized controlled exploratory trial. BMC Complement Altern Med. 2012;12:184.
  13. Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for treating pain: a systematic review. Evid Based Complement Alternat Med. 2011;2011:467014.
  14. Ernst E. Testing traditional cupping therapy. J Pain. 2009;10:555.
  15. Haik MN, Alburquerque-Sendin F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016.
  16. Marinko LN, Chacko JM, Dalton D, Chacko CC. The effectiveness of therapeutic exercise for painful shoulder conditions: a meta-analysis. J Shoulder Elbow Surg. 2011;20:1351-1359.
  17. Camarinos J, Marinko L. Effectiveness of manual physical therapy for painful shoulder conditions: a systematic review. J Man Manip Ther. 2009;17:206-215.
  18. Lewis J, McCreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. J Orthop Sports Phys Ther. 2015;45:923-937.

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