How I Learned To Hate Cupping.
Lately the news and social media have been filled with reports on an ancient practice used by Michael Phelps and a few other athletes to manage pain. In response, many healthcare practitioners, including Physical Therapists(PTs), have posted their opinions on this technique- some in support, others opposing. However, my post is not about cups. In my opinion there are a few issues at play in the “Cuppingate”. Primarily, it helps to elucidate other, deeper conflicts in the profession of Physical Therapy. It’s not just cupping, taping, craniosacral therapy or any other intervention used by PTs. True, these may have a place in our practice as clearly they provide relief for some patients.
However I believe that the identity of our profession is at a crossroads. We have come a long way from the days of “heat and massage.” There are PhD programs and million dollar grants supporting research. We no longer require a physician script to treat patients. We work in ERs and in Oncology- fields previously closed to PTs. Our education strives to be grounded in evidence based practice. We are now independent healthcare practitioners that practice in some settings as equal, valued members of the treatment team.
Yet these advances have been contributing to a proverbial fork in the road. Do we embrace the scientific method as a foundation, even if it means we have to change the way we practice? Or do we move toward the complementary and alternative medicine(CAM) route? Right now it appears that we are on the fence, dabbling in both, never fully committing to either. On one hand a lot of PT research is limited in application, underpowered and mostly conducted by the academic community, at times disconnected from the clinicians. The summary of research is : movement works, but it often takes time. The clinical community says: we need fast results with a lot of pain relief, because that’s why our patients most often seek help. Some CAM techniques help to fill that need for quick relief, even if the mechanisms of action are unclear. However the CAM spectrum is fully occupied by other practitioners: acupuncturists, various “bodywork” and “functional” movement specialists. PTs struggle to carve a niche in this potentially lucrative market, because it’s difficult to make the case of why our methods are better than the next provider. As the result of this split identity, there’s a growing chasm, at least in the orthopedic/sports specialty. There are also other significant factors to consider such as reimbursement, how our referral sources perceive us and what the consumers think about the PT profession. I don’t know the answer, but I suspect that at some point this conflict will have to be addressed by the whole profession.
