High-profile athletes turn to these treatments for performance and recovery.

During the Rio 2016 Olympic Games, the world’s eyes were riveted on Michael Phelps’ back. Or rather, the big purple bruises on his back. They were the result of an ancient Chinese medicine treatment called cupping, and Phelps’ trainer said that it helped the record-breaking swimmer recover faster.

A flurry of articles debated the effectiveness of cupping — some called it a pseudoscience, others compared it to deep tissue massage. The controversy surrounding cupping therapy is not isolated — there are a myriad of alternative therapies that athletes use to recover faster, enhance performance and prevent injury. Here, we examine a few and look at the scientific evidence behind each.

Traditional Chinese Medicine

Acupuncture and Cupping


One of the most ancient methods of healing, acupuncture has its roots in Chinese traditional medicine. The first document to describe the system of acupuncture and treatment is a text called “The Yellow Emperor’s Classic of Internal Medicine,” dating from about 100 BCE. Acupuncture was popularized in Western culture in 1971 when a member of the U.S. press corps was given acupuncture during recovery from an emergency appendectomy in China. The journalist raved about his experience in The New York Times.

Acupuncturists insert very thin needles (about 0.006 to .018 inches thick) into trigger points along the body. Ancient practitioners believed that stimulating these trigger points would open up energy pathways along the body and help the body recover from disease. Patients generally report feeling a tingling sensation that radiates from the point where the needles are inserted. “You can look at the needle, which is metal, inserted into the fluid of the body as a battery. The battery creates the micro current electricity, going through the channels of connective tissue. It affects the movement of blood, nerve signals and performance,” says Natalie Miner, an acupuncturist in Los Altos, California. Miner says that acupuncture can help athletes prevent injury, recover from injury or manage stress and emotions.

Cupping is another component of Chinese traditional medicine. Practitioners use cups made of glass, bamboo or plastic to apply suction to the skin. The cups leave red or purple bruises on the skin that fade over a couple of days. Practitioners believe that cupping helps increase blood flow. Some studies suggest that cupping may be effective for pain and other specific conditions like herpes zoster, facial paralysis (Bell’s palsy), cough and dyspnea, acne, lumbar disc herniation and cervical spondylosis. However, many of these studies have been considered “low-quality” with high risk of bias.

While acupuncture and cupping generally have been regarded with skepticism from the Western medical community, several studies in recent years suggest that these ancient modes of healing may be effective for at least pain. In 2012, researchers published the most rigorous and robust study to date in the Archives of Internal Medicine. Researchers analyzed raw data from several studies on acupuncture funded by the National Institutes of Health (NIH) and found that 50 percent of patients who had received acupuncture experienced pain relief; this led the researchers to conclude that the effects of acupuncture extended beyond mere placebo effect. In the early 2000s, a group of German researchers set up four randomized control trials investigating the effects of acupuncture treatment for lower back pain, knee osteoarthritis, migraine prophylaxis and tension-type headache. The trials are considered to be one of the largest clinical studies in the field of acupuncture. They found that acupuncture was almost twice as effective in treating lower back pain as conventional therapy, and as a result, the German Federal Joint Committee ruled that public health insurance should cover the costs of acupuncture treatment for chronic back pain and knee osteoarthritis, but not migraines or headaches. There is still a lot of widespread skepticism about the effectiveness of acupuncture as a therapy beyond pain relief.

Acupuncture and cupping therapy have been used by NFL players, including Tony Richardson and Aaron Rodgers; NBA star Kobe Bryant and members of Team USA, including Nastia Liukin and Michael Phelps.

Alexander Technique


In the early 1900s, Australian actor Frederick Matthias Alexander lost his voice, a disorder which threatened his career. Doctors couldn’t figure out what was wrong with him. Desperate, Alexander tried to resolve the problem on his own. He observed himself speaking in multiple mirrors and noticed that he would pull his head back and tense his neck before he spoke. He wondered if this tension was causing him to lose his voice. After more experimentation, Alexander developed a comprehensive program for relaxing his body, which he taught to a variety of students and teachers.

The Alexander technique is based on the idea that the head and neck are the center of body balance. The average human head, which weighs 11 pounds, is often imbalanced on top of the neck, which causes various muscles in the neck to tense in order to keep it in place. This imbalance also radiates down the spine and causes various muscles in the back to tense. A series of Alexander techniques teach students better body awareness and how to balance their heads properly on top of their spine. Alexander teachers call this “primary control.”

“The Alexander technique teaches a posture with the head leading and neck following, which triggers the lengthening of the whole body,” said Dominique Jacques, a certified Alexander technique teacher in San Francisco, California. Jacques remembers working with a pair of Bulgarian volleyball players who used the Alexander technique to recover between games and to avoid injuries. “It helped them be more aware of where they hold tension in their bodies, and it gives them a tool to control their bodies better,” she said.

While the Alexander technique is used widely among actors and musicians, there are few good-quality clinical trials to prove its effectiveness. A systematic review of studies in 2003 suggested that the Alexander technique showed promise for treating Parkinson’s disease and lower back pain.

Craniosacral Therapy


Craniosacral therapy was developed by John Upledger, in the 1970s. Biographies of Upledger say that he first became interested in the concepts behind craniosacral therapy when he was assisting a surgeon who was conducting neck surgery. He noted that the membrane encasing the spinal cord kept pulsating and was difficult to hold. Neither he nor the surgeon had an explanation for the phenomenon. A few years later, Upledger attended a talk about cranial osteopathy, a branch of medicine based on the belief that many illnesses are caused by the tension we hold in our bodies. Osteopaths release tightened tissues to re-balance the body. Upledger took the principles of cranial osteopathy and simplified them to create a technique called craniosacral therapy that non-osteopaths could use.

Craniosacral therapists work on athletes by using light touch to manipulate the synarthrodial joints, immovable joints in which two bones are separated only by a membrane of tissue, in the cranium, spine and pelvis. Practitioners believe that this manipulation regulates the flow of cerebrospinal fluid, the clear, colorless fluid found in the brain and spine. The fluid acts as a cushion or buffer for the brain’s cortex, providing basic mechanical and immunological protection to the brain inside the skull. Studies have shown that cerebrospinal fluid plays an important role in flushing metabolic toxins or waste from the brain’s tissues’ cellular interstitial fluid, especially during REM sleep. Osteopaths and craniosacral therapists believe that massaging connective tissue to increase the flow of cerebrospinal fluid facilitates better movement throughout the body, from the head to the bottom of the spine.

Unlike massage or rolfing, craniosacral therapists use a very light touch to palpate the body. “Sometimes a light touch works even better because it doesn’t cause tissues to tighten up,” says Yonina Chernick, a certified craniosacral therapist and medical acupuncture practitioner in Ontario, Canada. Chernick says she treated a hockey player who came to see her complaining of tight muscles and an aching lower back and sacrum. After she worked with him, she said that the team’s general manager noted that he was skating much better and taking longer strides. “We facilitated better movement between the lumbar and pelvic spine, which allowed for better messaging throughout his nervous system,” said Chernick.
The therapy is often used by dancers and a few athletes. In 2015, six former NFL players participated in a study using craniosacral therapy and reported significant improvements in memory, cognition and mood.

Skeptics of craniosacral therapy argue that there have not been any conclusive scientific studies showing the benefits of the therapy. Chernick argues that alternative therapies such as craniosacral therapy don’t lend themselves to the traditional scientific protocol of double-blind randomized trials. “We can prove there is a positive effect after the therapy, but it’s difficult to say that the same treatment works the same for everybody because each treatment is different,” said Chernick.

Rolfing (Structural Integration)


In the early 1900s, Ida P. Rolf, a biochemist, developed the technique of rolfing. Rolf was one of the few women of her time to earn a doctorate in biological chemistry at Columbia University. After earning her degree, Rolf worked as a research scientist for the Rockefeller Institute, where her primary field of research was on lecithin and cephalin, two chemical compounds important to the function of cells. Rolf also went on to study mathematics and physics at the Swiss Technical University in Zurich. Faced with her own health issues and those of her family members, Rolf looked for ways to help. She explored osteopathy, chiropractic medicine, the Alexander technique and Korzybski’s work on the states of consciousness. Eventually, she used all this knowledge to develop a system of bodywork she called “structural integration.” The central belief of her program is that the human structure can be balanced to work with gravity instead of against it. In the 1940s, Rolf began working in a Manhattan apartment with people seeking help for their problems.

Rolfing is a system of soft tissue manipulation that manipulates the fascia in a body — the layers of soft tissue that encase muscles. Rolfers believe that people walk around with muscle and fascia tension and stress resulting from a constant fight against gravity. By using deep tissue massage, rolfing bodywork is supposed to ease and lengthen the tissues, leading to more efficient body use and better movement patterns. A course of treatment consists of about 10 sessions.

Many athletes have used rolfing, including former U.S. Nordic Ski Team member John Bauer, track and field star Amy Acuff and celebrated NBA coach Phil Jackson. Olympic skier Mickey Egan said in a testimonial for the Rolf Institute of Structural Integration, “Athletes tend to use the same muscles over and over. They get tighter and tighter, and this has an effect on the muscles. We can stretch but not reach everything. Rolfing helps me reach areas like the ribs, abdominals, upper body and hips that are hard to get.”

Many critics argue that there isn’t enough scientific evidence to prove that rolfing works. The few studies that have been conducted have been criticized for being too limited in scope. Others say that rolfing is extremely painful and potentially dangerous, especially for cancer patients. However, Tessie Awaa, a certified rolfer in Colorado, says, “That pain usually goes away after a while. And as you release your body, you may have some pain as your body readjusts to its new posture,” she said.

There’s renewed interest in better understanding the mechanisms behind rolfing: the National Institutes of Health provided a grant for the First International Fascia Research Congress in 2007, which brought together therapists, scientists and doctors. More recently, Eric Jacobson, a research associate at Spaulding Rehabilitation Hospital in Boston and a lecturer at Harvard Medical School’s department of global health and social medicine, received an NIH grant to study structural integration’s effect on chronic lower back pain, which affects 16 million American adults.

Despite the fact that many alternative therapies lack robust scientific evidence, they are gaining in popularity among the mainstream community. According to a study conducted in 2015, approximately 38 percent of adults in the U.S. are using some kind of complementary medicine. Perhaps the strongest endorsement for these alternative therapies is not from double-blind clinical trials, but rather from those who have firsthand experience.