Geoff was 76 years old. And more physically fit than many 35-year-olds. And he was putting his physical fitness to good use – single-handedly sailing a 30ft yacht around the coast of New Zealand. Literally single-handedly because he only had one working arm. The other arm was completely incapacitated by an apparent frozen shoulder. He had carried on like that for three years.
The shoulder had started off as quite a mild pain. At that time, Geoff justified not getting it treated by explaining that it wasn’t too bad. Then when the shoulder got worse, he conceded briefly that he should seek some help. Later, when the shoulder had not responded to medication, Geoff justified not seeking treatment by explaining that the shoulder was untreatable, or in his words, ‘old and completely f***ed’. All of which had left him living with a substantial amount of pain and physical limitation.
In the background to all this, Geoff had worked incredibly hard his whole life and created a very large and successful plumbing firm. Then, within months of his retirement to carry out his dream of a life on the high seas, his shoulder started hurting. And it was now seriously jeopardising his retirement dream.
But rather than continue to seek answers, Geoff decided the shoulder meant his time had nearly run out. So he was squeezing every bit out of what he had left, which meant pushing himself extremely hard physically. And the shoulder was not appreciating it.
Toughness is an admirable trait, and Geoff had it in bucketloads. Yet, when healthy toughness is repurposed, ignoring the body’s endless cries for help (in the form of pain) can become harmful. Geoff had been using his innate toughness to ignore pain and, in so doing, had created a serious disability.
Geoff’s shoulder was so ‘frozen’ he couldn’t lift his hand above waist height. Anyone who has had a frozen shoulder will let you know this means the use of the arm is essentially lost. Yet, Geoff was still managing to sail the open ocean for 9/10 weeks in the year.
It was Geoff’s first mate (wife) who marched the reluctant and brow-beaten Geoff into my office. As wives of the walking wounded often do.
Geoff had basically resigned himself to his fate. But his wife was still eager to seek solutions to the one-armed sailor problem. As well as hating to see Geoff suffer, she increasingly had to perform tasks on board a ship that she didn’t feel safe doing, which added to her sense that something needed to be done.
On examination, Geoff’s shoulder very much appeared to be classically ‘frozen’. In frozen shoulder, the fibrous capsule of the ball & socket joint becomes thickened. This causes severe loss of movement. And often severe pain. Most other shoulder problems leave the patient with far better function than a frozen shoulder. A frozen shoulder is a disability.
Frozen shoulder is not easy to treat. It usually takes months of regular focused shockwave therapy sessions, joint mobilisation, acupuncture, stress management and lifestyle changes. Progress tends to be meaningful but so gradual that it feels like trench warfare.
The little bit of shoulder movement Geoff did have came from shrugging his shoulder blade up because his shoulder joint itself was utterly immobile. This made the arm essentially useless. Clearly, it was just sheer grit and the support of his non-sailor wife making the improbable feat of sailing a large boat possible.
Despite appearing mostly like every other frozen shoulder, there were several curious aspects to Geoff’s presentation.
Geoff was a man, and most frozen shoulders affected the ladies. Geoff’s symptoms had come on far more slowly than most frozen shoulders. There were far more tender points around Geoff’s deltoid muscle than in a normal frozen shoulder. And Geoff hadn’t been acutely stressed in the lead-up to his shoulder pain, which is a feature of nearly all frozen shoulders.
With the benefit of hindsight, these facts should have cast serious doubt over whether Geoff’s shoulder was frozen. But at the time, I felt confident it must be a frozen shoulder because of the sheer lack of movement. I was seriously wrong, however. Geoff’s shoulder might have been stiff, but it was far from frozen. Without my knowing, it was inflamed beyond belief.
When it came to treatment, I had a very small window of opportunity. Geoff would be available for three consecutive days before sailing north to Auckland for two weeks. Then two weeks later, he would be available for a full week of treatment.
The first three days of treatment went without incident. Geoff received daily radial shockwave treatments, joint mobilisation and some dry needling. The combined impact of which was typical of a true frozen shoulder. He reported a 20% improvement in movement, which slowly dissipated once he stopped getting treatment and resumed sailing north.
However, on day 2 of Geoff’s second treatment window, something happened that I will never forget.
Geoff’s response to shockwave therapy was proving a little less impactful than I had hoped. So I decided to use some mechanical vacuum cups on those unusually tender areas over his deltoid muscle. With regular frozen shoulders, cups often help increase blood flow around the joint capsule and reduce pain. For a small percentage of frozen shoulders, they can make a big difference.
Once the deltoid muscle cups were on, I left Geoff and his wife to their good-natured bickering and went to tend to another patient. Unaware that the two previous decades of using cups to treat pain had left me totally unprepared for what I would find when I returned.
On returning to the room, Geoff was smiling broadly, but his wife, on the other hand, looked quite pale and shaken. The 3 cups on Geoff’s shoulder were full to the brim with Geoff’s skin which had expanded and turned so black that you would think it was frostbitten. Somewhat shocked, I carefully removed the cups immediately.
Where each cup had been, there was a golf ball-sized swelling. Each golf ball was dark blue, almost black. I was very concerned that I was seeing a once-in-a-lifetime serious negative side effect to cupping. Geoff, on the other hand, had already deduced it was a good thing. And he was grinning ear to ear.
After the cups had been off for a moment, still smiling as if in a state of bliss, Geoff gently rotated the shoulder a couple of times as if to check something. Then he promptly lifted the shoulder right up to his ear as if it had never hurt a day in its life. His wife’s jaw dropped. And so did mine.
In the following days, Geoff’s wife experienced a good deal of embarrassment on multiple occasions because Geoff kept stopping on busy streets to shadow boxes with his reflection in shop windows.
The emotional impact of that week was like witnessing a person’s sight suddenly return after three years of unexplained partial blindness. To say Geoff was happy would be a huge understatement. In fact, it wasn’t apparent how unhappy he had been about his shoulder until one saw how jubilant he was about its miraculous recovery.
Naturally, I was happy too and somewhat amazed. Moments like this force me to re-evaluate my perception of how the body works.
Geoff’s said that during the 10 minutes the cups were on, it literally felt like all the pain and stiffness was being pulled out of him, which is why he was smiling so broadly when I returned. In the weeks following the cupping session, Geoff’s entire upper arm turned bright yellow, like you might see after a very serious injury.
It appears that Geoff had a severe build-up of congested inflammation in his deltoid muscle. Perhaps equivalent to the swelling found in a severely sprained ankle. And no meaningful use of the shoulder joint. Then once that swelling was drawn to the surface, his body could finally disperse the inflammation. This theory is supported by the fact that when we repeated the procedure two months later, his shoulder (which had continued a 95% improvement) only generated a very mild bluish reaction to the cups, which passed within 24 hours. And the remaining 5% of his symptoms resolved with that session.
There is a question of how Geoff’s deltoid got so congested. Most likely overuse. But perhaps the biggest mystery is that the muscle had not appeared at all swollen; it was just tender to touch.
We understand very well that our bodies are subject to inflammation. Cases like Geoffs heavily insinuate that there are aspects of inflammation we currently have little understanding of. Although by way of circumstantial evidence, MRI scans often do reveal ‘fluid build-ups’ in chronically painful tissues. Especially in Geoff’s age group.
It is worth noting that the really unusual thing about Geoff’s case wasn’t so much the results. Done properly, cupping frequently attains similar levels of success over time. The unusual things were the speed of recovery and the visual intensity of the reaction.
Josh’s shoulder cupping story also has ties to life at sea. And the dangers of pushing through too much pain. It also reveals a great deal about how some pains get stored in the body, particularly after serious injuries.
Josh’s area of expertise is the use of concrete in strengthening office buildings. It’s incredibly harsh physical work done by some of life’s unsung heroes. Un-strengthened buildings in countries like Haiti and Turkey have crushed thousands of people in recent years. And those of us who are lucky enough to live in countries where this is not tolerated owe a great debt to men like Josh.
In his former professional life, Josh didn’t learn anything about reinforced steel and concrete. But he did learn about the physical resilience needed to do the work he does now.
At 17 years of age, Josh signed up to work on a trawler—fishing for Patagonian Tooth Fish in the depths of the arctic ocean. Working on a trawler on the southern ocean involves a level of physical toughness most of us are barely aware exists -let alone have personal experience of. It also involves working alongside some very tough characters.
On the second day of his very first jolly fishing trip, Josh was on deck and got hit by a wave, which knocked him completely unconscious. As he fell, already unconscious, the tip of his right shoulder hit the metal deck very hard.
When Josh had recovered from the blow to the head, it became apparent that the shoulder was badly injured. All he could do with the arm was hold it at his side as if it was in a sling. He felt searing pain in the bone with any movement of the shoulder, and the whole arm felt incredibly weak. Less than ideal for working on a fishing trawler in ferocious seas.
Under normal working conditions, this injury meant a trip to the hospital and probable weeks of sick leave. But hunting Tooth Fish in the depth of a freezing maelstrom is not a normal working condition. And the work culture is very different to most work cultures, thankfully for the rest of us.
Josh’s injury put him in a very awkward position. He basically had three options. The first was to stop working. This would mean three weeks of being treated with all the warmth a police informant would receive from a boat full of career criminals. The second option was requesting an airlift at great cost to his employer, which would have been provided, along with harsh criticism, shaming and permanent dismissal. The third option was to keep working. Josh took option three.
To cut a long story short, Josh spent three weeks sorting fish and performing the role of a general ‘dog’s body’ with one arm. During which, he lost count of how many times the point of his shoulder bounced off metal walls; as he was thrown around in rough conditions. His workmates renamed him ‘Squeak’ after the unusual noise he would make every time the point of his shoulder hit something hard. But he pushed through the whole ordeal. Making it to the end of the trip without missing a single shift.
Once back at port Josh went to the hospital. X Rays confirmed that he had cracked the end of his acromion process (the hard pointy bone on top of the shoulder). There was no procedure to repair it.
Afterwards, his workmates learned he had worked through a broken bone, which secured their respect. They even stopped calling him Squeak. But he had paid a heavy price.
As a result of re-traumatising the fracture so many times, it didn’t heal properly.
So Josh ended up on a disability benefit for 15 months before he was able to work again.
Josh’s shoulder also never fully recovered. Twenty years later, he still found it would ache for days if he pushed himself on a concrete job. He also permanently lost the ability to sleep on the injured side.
But I didn’t know about any of this the first time Josh came to me about his shoulder. We had never spoken about it. He would come to me periodically with acute episodes of lower back pain. Which I would help settle down so he could return to work. Usually far faster than I recommended.
On the day of Josh’s memorable cupping session, he called me to ask if I could take a look at his shoulder. And I could hear from his voice on the phone that it wasn’t good. Then when he showed up, it was apparent he couldn’t move the arm – due to pain around his AC (acromioclavicular) joint on top of his shoulder.
The AC joint is a little fibrous joint on top of the shoulder. An inch away from where Josh’s fracture had occurred. It is susceptible to sprains and dislocations. Very heavy lifts can dislocate the AC joint, and sports tackles have a track record for doing the same. But Josh had done none of the above that week. Thus it appeared to be a mystery AC sprain.
Josh was in a terrible state. He was very pale and sweating from the pain. He is durable, obviously, so I was concerned. It even occurred to me that he might have an infection, but there were no other signs of that. I tried some gentle mobilisation of his AC joint, but it was too painful. So, fatefully, I thought I would try a vacuum cup to draw some of the inflammation to the surface.
The rest of that session was exactly like Geoff’s cupping session. When I returned, there was a golf ball-sized black swelling right over the top of Josh’s shoulder. Right next to where I would later learn he’d been injured all those years before. He, too, experienced a complete resolution of his symptoms on the spot. The movement of the arm returned instantly. His colour returned. And he was back to his normal manly self in less than 20 minutes. The relief, as they say, was palpable.
Then after the session, Josh found he could sleep on that side for the first time in 20 years. His old injury appeared to have spontaneously healed itself. Like Geoff, he, too, had a large yellow bruise-like stain down his arm after the session.
It had been so long since the fishing incident that Josh barely recalled it was the cause of his niggly shoulder. It wasn’t until the shock and mystery of how much inflammation had been released, and seeing how confused I was, that it occurred to him that there may be a connection. That is when he recounted the trawler fishing story.
Josh’s shoulder had been harbouring an unhealed AC joint sprain (adjacent to the original fracture) for 20 years. Over time the joint and surrounding tissue had become deeply congested with chronic inflammation. Then, for whatever reason, on that particular week, Josh’s nervous system decided to activate his pain pathway, bringing the old issue into very sharp focus.
Cases like Geoff and Josh (and countless others) teach us that there are times when the body starts its healing processes but simply can’t finish them without assistance. And that this is a major cause of chronic pain in our society.
This ‘unhealing’ tends to happen most often in areas of repetitive use, like shoulders. So presumably, it is a repetitive strain that leads healing to pause, sometimes for decades. It happens a lot after bad injuries, it happens a lot after surgeries, it happens a lot in people who push their bodies to extremes, and it is very easy to treat with cupping.
We are accustomed to the idea of ‘anti-inflammatories’, which use chemicals to ‘neutralise’ inflammation in painful tissues. Cupping is the same but different.
It uses mechanical pressure to draw inflammation away from painful tissues so the body can disperse it.
Cupping inflamed tissue is as logical as using mechanical pressure to remove a splinter from a child’s finger.
Using mechanical pressure to remove splinters from fingers is basic common sense. And so well established that there’s clearly no need for a triple-blinded randomised control trial to assess if it is valid. Cupping is a lot like that. It is so safe, so logical, so effective, and so well established that it should not need to be supported by any scientific evidence. But it is.
If you type ‘cupping therapy for pain‘ into Google Scholar, it comes up with over 44 thousand results. I cannot claim to have read all 44 thousand papers. But I have read many, and all the ones related to ‘effectiveness’ concluded basically the same thing.
