With the New England Patriots headed to the Super Bowl yet again, attention will inevitably turn to star quarterback Tom Brady, his TB12 method, and the ensuing tensions between his coach and his personal trainer/nutritionist. It’s easy to be skeptical and yet still in awe of Brady’s strict wellness regimen. But he is hardly alone in the field of professional sports when it comes to advocating for performance enhancement and greater overall health using everything from unconventional therapies to a whole food approach.

Indeed, one could make several comparisons between new Phillies manager Gabe Kapler’s personal wellness blog and the Brady’s strict regimen. Kaplifestyle.com purports to address all things fitness- and health-related as they pertain to the modern athlete. However, this is where they diverge; Kapler prides himself on using an evidence-based approach, while Brady’s methods are more akin to those of Gwyneth Paltrow’s Goop. Brady is certainly not the first athlete to subscribe to pseudoscientific methods, and he most certainly will not be the last.

Everyone–from the sedentary desk jockey to the professional athlete–is attracted to quick and easy ways to improve one’s fitness and overall health. Professional athletes are human, just like the rest of us, but with additional incentives to try anything to stay healthy and gain a competitive advantage, no matter how slight. It’s no surprise pseudoscientific training techniques are rife throughout sport, and baseball is no exception.

However, many of these practices, which purport to provide improved healing and performance enhancing effects, are not supported by scientific evidence. At best, some these alternative therapies are a waste of money; at worst, there are significant, potentially fatal, risks associated with the adoption of alternative therapies.

Before we can discuss the use of alternative therapies or unconventional medical treatments, let’s turn to the National Institutes of Health, a mainstay of biomedical and public health research. The NIH’s National Center for Complementary and Integrative Health focuses solely on health practices and products that do not fall within the scope of conventional medicine, also known as “Complementary and Alternative Medicine.”

CAM encompasses a number of treatments and interventions, such as homeopathic medicine, herbal remedies, diet regimens, energy healing therapies like Reiki, acupuncture, yoga and chiropractic manipulation. This is a broad list, including a number of diverging practices, each with varying amounts of evidence to support–or refute–their efficacy. Certain alternative practices are more visible, and have been more thoroughly studied, than others. Some are regularly used by health practitioners in conjunction with more traditional treatments. Remember, this list includes everything from your neighborhood yoga studio to homeopathic remedies, so you may not be aware of just how pervasive alternative therapies have become.

According to a 2007 National Health Interview Survey conducted by NIH, 38 percent of American adults have used some form of complementary or alternative medicine, and their use continues to increase. That means it’s very likely that you, someone you know, or someone on your favorite baseball team has used some form of alternative therapy.

One example readily visible to anyone watching a major league game on television is the use of magnetic jewelry, such as copper bracelets and titanium necklaces. While Phiten necklaces and copper jewelry appear to have fallen out of favor with professional baseball players, this metal jewelry was glaringly visible evidence of a player’s willingness to adopt anything that might provide him with any advantage, no matter how slight.

Magnetic therapy purports to improve blood flow, alleviate discomfort, reduce stress, increase oxygenation, and stabilize energy flow. Phiten contends its necklaces amplify the body’s energy, “increasing the efficiency of each and every single cell.” Magnetic jewelry is easy to spot. This visibility accounts for the thorough debunking it received from a number of scientific outlets, but it is also responsible for the quick adoption and spread of these baubles.

Perhaps due to criticism, or perhaps simply due to the appeal of other emergent alternative therapies, baseball players have moved beyond magnetic jewelry and have embraced magnetic chairs, such as the Magnesphere. The Magnesphere chair deems itself a magnetic resonance therapy system that uses extremely low-level magnetic fields to balance the body’s autonomic nervous system. The manufacturer proudly states that it has FDA approval to claim the Magnesphere chair provides “Enhancing Relaxation,” although it is not clear if this allegedly enhanced relaxation was evaluated against a folding chair or a plush La-Z-Boy.

The pseudoscience behind energy manipulation as a performance enhancer isn’t limited to jewelry and furniture. Reiki and acupuncture allegedly operate through energy manipulation, based on the idea that one’s body is composed of vital energy. Diseases and physical conditions are thought to be caused by a disturbance or blockage in the flow of energy. Reiki and acupuncture purport to remedy said conditions by restoring the flow of energy.

Reiki practitioners will use their hands to manipulate patients’ energy fields, such as in a massage, while acupuncture relies on needles inserted into the patient’s skin to assist with energy flow. Acupuncture has become fairly well integrated into the mainstream health consciousness. During Jason Giambi’s tenure, the Indians had an in-house acupuncturist who made regular visits to the clubhouse and also assisted the team with yoga and Reiki massage. Massage certainly has psychological and physiological benefits. However, anytime a needle is involved —

such as in acupuncture — there is the chance of a wound or infection developing. That brings us to our next subject, cupping.

Cupping ostensibly restores proper flow of qi, or energy, by removing blockages and realigning one’s life energy. The NIH specifically notes that cupping has received renewed attention as of late due to its practice by world-class athletes. The most famous example is now-retired Olympic swimmer Michael Phelps, but a number of baseball players also have made cupping a part of their training room routines.

While most of us outgrow the practice of giving ourselves hickeys, it seems many baseball players have not. Francisco Cervelli of the Pirates has been a vocal advocate of the practice and reportedly sports spherical bruises from cupping across his lower back, a phenomena which has since become popular with other players in the clubhouse.

A Hardball Times Update by Rachael McDaniel Goodbye for now.

This is how these practices spread. Gerrit Cole has adopted the practice. Reliever Matt Belisle learned about cupping from a Korean teammate and saw it in practice with both the Rockies and Nationals.

Indeed, Bryce Harper, Stephen Strasburg, Jayson Werth, Tanner Roark and Sammy Solis all have been spotted with the telltale splotches on their necks, shoulders, and elbows. Ian Kennedy was first introduced to cupping during his time with the Diamondbacks, and has continued to use the therapy while with the Royals, where there are several players who range from casual users to devotees.

Some players believe cupping improves blood flow, reduces inflammation, and promotes healing, but cupping is generally regarded as ineffective by medical practitioners. In one study comparing cupping and exercise as rehabilitation for patients with a lumbar muscle strain, it was found that exercise provided a more significant benefit in rehabilitation.

In the face of insufficient evidence demonstrating efficacy, and with a nod to the psychological power of the placebo effect, it is easy to say that cupping is fairly innocuous. If it makes the players feel better, what’s the harm? But this line of thinking fails to recognize that while the risk of injury is minimal, it isn’t non-existent, and in the case of improperly administered treatments, could land someone a spot on the disabled list.

As noted by a former sideline physician for the New York Jets, the heated glass cups used to create suction easily could burn someone. Beyond the risk of severe burns, there is resulting tissue damage from routine cupping, and in extreme cases, repeated cupping can open gaping wounds. The typical clubhouse training room is hardly a sterile environment, and there is a nonzero risk of introducing bacteria and causing an infection, which should be considered in any treatment that may involve abrasions and needles.

Like cupping, cold therapy has gained increasingly popularity among major leaguers. Although cold therapy is considered part of conventional medical treatments, it is not without its detractors. Cold temperatures have long been thought to provide an anti-inflammatory effect, and alternating between cooling and warming has long been used as a treatment following injury. However, there is a distinction between icing that can be achieved with cold packs and ice in the dugout and more intensive procedures.

In a study of college pitchers, researchers found that icing a pitcher’s shoulder and arm between innings can help a pitcher maintain velocity over multiple innings while decreasing perceived exertion and facilitating recovery between innings. In longer-term recovery, the combination of short-term icing and light exercise between starts was found to be beneficial. Ice pack usage remains controversial, however, and some researchers feel that it may actually hinder recovery when used inappropriately.

Cold water immersion therapy is thought to have a slight edge over ice packs and cryotherapy chambers in performance recovery. Water immersion therapy can be used for individual areas, as demonstrated by iconic images of Sandy Koufax’s elbow in a bathroom sink, but many baseball players immerse their entire bodies in a water tank.

The Rays players use this both before and after games, alternating between a hot-water tank at 106 F and a cold-water tank at 55 F. As an added benefit, the pressure of the water provides a light massaging feel. There is inconclusive evidence supporting water immersion therapy as a viable recovery technique, but this is a situation where the psychological benefits and low risk of injury would not discourage one from continuing therapy.

In a more extreme example, players are turning to cryotherapy. Ryan Braun reportedly used it after a thumb injury; C.J. Wilson was an avid user of whole-body cryotherapy. Both the Royals and the Marlins have purchased whole-body cryotherapy chambers, which enclose all but a player’s head and exposes his body to a temperature range of -120 C to -140 C, temporarily lowering the temperature of the skin for three minutes.

Not only is there a lack of evidence regarding the use of whole-body cryotherapy in treatment and recovery, but it’s downright dangerous. The Food and Drug Administration issued a warning as its practice became more widespread. Potential risks include frostbite, burns, and the more serious asphyxiation, which was implicated in one woman’s death in a cryotherapy chamber in 2015. While one hopes cryotherapy chambers are being used under the guidance of a trained professional, accidents do happen, and the consequences can be dire.

While a number of treatments falling under the umbrella of “Complementary and Alternative Medicine” have little to no scientific foundation, we would be remiss to dismiss the NIH’s entire list. For example, yoga often is associated with Reiki and acupuncture, since it also has roots in energy healing therapy and breath control. Studies of yoga’s efficacy as a complementary treatment for disease have been largely inconclusive, but practitioners do seem to derive physical and psychological benefits from its blend of physical activity and mindfulness. Similarly, while a number of fad diets purportedly result in increased immunity and anti-inflammatory effects, there is much to be said about the benefits of eating a well-balanced diet made up of minimally processed foods.

Much of this discussion focuses on whether or not “alternative” medicine is truly medicine; but we mustn’t forget the term “complementary.” As noted by the NIH, “Complementary and Alternative Medicine” includes a group of practices and products which are not considered part of conventional medicine, but may be used in conjunction with conventional medicine. Under the supervision of a medical doctor, a patient may benefit from the use of alternative practices when used to complement standard care. However, unsupervised or lackadaisical use of practices can lead to more harm than benefit. The key is to remember that a professional should supervise any medical intervention.

Before trying any new and alternative training or recovery technique, the professional athlete would be wise to consult with athletic trainers, medical professionals and sports scientists. There may be safer and more effective strategies to aid in recovery or enhance overall health. That said, if a placebo provides a psychological advantage with minimal physical or psychological risk, we typically overlook the use of these complementary and alternative practices.

However, professional athletes have a responsibility to the public not to oversell practices that do not work, aren’t undergirded by peer-reviewed research, could potentially cause harm, or could just be a waste of money. Fans are impressionable; fads become habits. As noted by NIH, cupping has become more common now that world-renowned athletes have attested to its non-existent benefits. The issues to consider go beyond the scope of whether a treatment is efficacious; we must consider whether they are harmful in themselves. While we haven’t seen as many Phiten necklaces on the field lately, or baseball’s answer to the TB12 method, the next speculative alternative therapy is just around the corner, and it is incumbent upon players, trainers and field staff to view these new fads with a skeptical eye.

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