The authors of this systematic review aimed to summarize the evidence of clinical trials on cupping for athletes. Randomized controlled trials on cupping therapy with no restriction regarding the technique, or co-interventions, were included, if they measured the effects of cupping compared with any other intervention on health and performance outcomes in professionals, semi-professionals, and leisure athletes. Data extraction and risk of bias assessment using the Cochrane Risk of Bias Tool were conducted independently by two pairs of reviewers.
Eleven trials with n = 498 participants from China, the United States, Greece, Iran, and the United Arab Emirates were included, reporting effects on different populations, including soccer, football, and handball players, swimmers, gymnasts, and track and field athletes of both amateur and professional nature. Cupping was applied between 1 and 20 times, in daily or weekly intervals, alone or in combination with, for example, acupuncture. Outcomes varied greatly from symptom intensity, recovery measures, functional measures, serum markers, and experimental outcomes. Cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups. The majority of trials had an unclear or high risk of bias. None of the studies reported safety.
The authors concluded that no explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary for conclusive judgment on the efficacy and safety of cupping in athletes.
Considering the authors’ stated aim, this conclusion seems odd. Surely, they should have concluded that THERE IS NO CONVINCING EVIDENCE FOR THE USE OF CUPPING IN ATHLETES. But this sounds rather negative, and the JCAM does not seem to tolerate negative conclusions, as discussed repeatedly on this blog.
The discussion section of this paper is bar of any noticeable critical input (for those who don’t know: the aim of any systematic review must be to CRITICALLY EVALUATE THE PRIMARY DATA). The authors even go as far as stating that the trials reported in this systematic review found beneficial effects of cupping in athletes when compared to no intervention. I find this surprising and bordering on scientific misconduct. The RCTs were mostly not on cupping but on cupping in combination with some other treatments. More importantly, they were of such deplorable quality that they allow no conclusions about effectiveness. Lastly, they mostly failed to report on adverse effects which, as I have often stated, is a violation of research ethics.
In essence, all this paper proves is that, if you have rubbish trials, you can produce a rubbish review and publish it in a rubbish journal.
Thinking about the original trials, one has to question how on Earth the ethics committees at the researchers’ institutions allowed such ‘research’ to proceed. Or did the researchers even bother to obtain ethical approval? Ethics committees should not allow research on human subjects to proceed if the therapy under study is devoid of plausibility. Which certainly applies to ‘cupping’. Otherwise, the time of everyone involved -especially the participants- is wasted, which is ethically unacceptable. Worse, participants must be fed a lie -namely that there might be something useful in cupping worthy of investigation- otherwise rational people would not sign up for such a study. Anyway, the ridiculous studies have been done, and written up into the review Edzard has trenchantly critiqued. But, despite no good evidence of efficacy from such trials, we can be fairly sure that, in forthcoming years (indeed perhaps forever), more of these ‘cupping’ studies will be conducted, wasting participants time, deceiving them, and risking the occasional false positive finding that will then be paraded as evidence that cupping ‘works’. Shame on ethics committees that permit this, and shame on researchers who circumvent the need for ethical approval.
The author affiliations should make it clear. This study was produced at two of the four Australian ‘Hogwarts Schools of Magic’ namely Endeavour College and University of Technology Sydney (UTS). The other two being Western Sydney University and RMIT in Melbourne (not affiliated with this publication, but they do come up with rubbish like this all by themselves).
Junk science, junk medicine, junk journal.
From junk universities