WASHINGTON — As Michael Phelps helped Team USA nail first place in the 4×100 meter freestyle relay at the Rio Games, purplish circles on the swimmer’s back and shoulders may have distracted some viewers from his stunning accomplishment – 19 Olympic gold medals.

Cupping, an ancient medical practice believed to have been in existence for thousands of years was put in the spotlight for the whole wide world.

It was gospel for those offering the service, serendipity carrying the promise of new businesses.

“As soon as I saw those marks on his arms, I said ‘he’s having cupping, and we’re going to have a lot of phone calls,’” said Frances Lutz, still elated at the news as the Olympic Games enter the stretch run.

Lutz is a licensed acupuncturist at the Lavender Retreat Wellness Club located on Pennsylvania Avenue in Washington. Before moving to Washington in 2012, she had worked in a pain rehabilitation clinic for six years in the New York state where she earned a Master’s degree in Oriental Medicine as well as her first license in acupuncture.

Lutz’s hunch was confirmed. Lavender Retreat soon received about 20 phone calls inquiring specifically about cupping therapy, said Jaime Bohl, owner of the business. And most of them are coming for the “entertainment value,” as Bohl observed. “They just want to try it out.”

The therapy usually includes applying a plastic or glass cup to the skin. Either by burning the air inside the cup or suctioning the air out, the skin and certain muscles are drawn into the cup and held together by the air pressure difference. Such stretching of skin and muscle can easily cause bruises – the purple mark.

Practitioners believe that the darker the mark, the more stagnant the area’s microcirculation, the more serious the bruise.

For Phelps and other athletes, the idea is to relax stressed muscles from the exertion of competition – legal under Olympic rules.

The therapy, widely recognized as part of traditional Chinese medicine, is believed by its practitioners to assist in the treatment of several conditions, including respiratory diseases like chronic bronchitis and asthma, digestive problems like gastritis, pain syndromes, even cancer. Yet Western researchers tend to disclaim such effects, often calling cupping, together with acupuncture, pseudoscience.

Celeste Homan, an assistant professor in acupuncture at the Maryland University of Integrative Health, who also holds a Masters’ degree in electrical engineering, said she understands that argument. But she’s more interested in patient outcomes.

To Homan, Chinese medicine utilizes various methods as a “holistic medicine” as part of a treating process.

“The mechanisms are difficult to study from a research perspective, but the outcomes don’t have to be,” said Homan. “Most of my patients pay out-of-pocket and I have a successful practice, so there must be something they are getting from treatment.”

Formerly the Traditional Acupuncture Institute, the university’s acupuncture program in Laurel, Md. has been accredited by the Accreditation Commission for Acupuncture and Oriental Medicine since 1985.

As the buzz about cupping therapy grew louder, and more inquiries from clients looking to receive cupping treatments started flooding into its Natural Care Center, the university also rolled out a brief overview on cupping.

Lavender Retreat’s Washington location has four treatment rooms, but Jaime Bohl said she expects to expand to eight. That was her original plan, but it became a more attractive option with the public attention brought by the Phelps phenomenon.

Bohl said she expects publicity about cupping therapy will increase interest in oriental medicine as a whole.

At the Bench Gym in Washington, Andon Kostadinov, a licensed massage therapist at Healthy Self Therapy & Wellness Center is updating his website to include more about cupping therapy.

To promote cupping, Kostadinov also used cupping bruises on a friend’s back to form the shape of the Olympic Rings with the words “Bench Gym’s tribute to Michael Phelps, the greatest Olympian ever” to be posted on his website.

Andon Kostadinov plans to use the media exposure of cupping therapy at the Rio Games to promote his business inside the Bench Gym in Washington. (Bench Gym)

Andon Kostadinov plans to use the media exposure of cupping therapy at the Rio Games to promote his business inside the Bench Gym in Washington. (Bench Gym)

First the confusion: is cupping similar to acupuncture and should it be regulated in a similar way, or should it simply be seen as a type of massage therapy? Such blurriness can also be found among those offering the service – some facilities list it under massage, while others list it as acupuncture on websites.

“But because of the effect that it (cupping) has on the tissue, which is very similar to massage, which is opening, relaxing, increasing circulation, reducing tension, it can fall under both categories,” said Natalie Boulware, a naturopathic physician at Lavender Retreat.

As the online professional license search provided by the D.C. Department of Health shows, all 192 actively licensed acupuncturists in Washington are listed under the “medicine” profession, separate from the “massage therapy” category. Their applications are handled by an advisory committee within the D.C. Board of Medicine. But neither the D.C. Municipal Regulations for Massage Therapy, nor the Municipal Regulations for Acupuncture mention cupping therapy as within its jurisdiction.

The lack of unified, federal licensing requirements also raised questions. Each state regulatory board carries its own requirements for licensure of acupuncture, but not for cupping, said Mina Larson, media aide at National Certification Commission for Acupuncture and Oriental Medicine.

According to the commission’s records, updated in February, five states don’t require licensure for acupuncturists. One of them, Kansas, passed a bill in the state Senate in March requiring acupuncturists to be licensed, but the bill died in the House.

The concern shared among Larson, Homan and Lutz lies in the easy accessibility of cupping sets. A 12-cup set is available on Amazon for $21.95.

Cupping therapy isn’t for everybody. The consequences of misuse by the untrained can merely provide no therapeutic effect, or result in serious internal bleeding, or even life-threatening conditions for some people with complicated medical history, said Larson.

Although Michael Phelps’ Olympic journey may already be a legend, the tale of cupping therapy is just beginning.