What do we really know about acupressure?

Acupressure is one of the Complementary and Alternative Medicine (CAM) techniques. It is simple, safe and practical technique to manage symptoms such as nausea, vomiting, anxiety and pain. Let’s dive deeper into what acupressure is, where does it come from, how does it work, and when it works best according to research. Lastly, we will discuss what acupressure can do for athletes, as this was the topic of my PhD thesis.

What is acupressure?

Acupressure is a therapeutic technique which uses pressure applied to certain points on the body. The therapist applies pressure with the thumb, other finger or elbow. Acupressure can also be applied with the use of devices, such as a bead or a band. Acupressure is quite safe as it does not cause many side effects. It can be as gentle as touch. If acupressure is applied to the ear, it is called auricular acupressure.

Where acupressure comes from?

Acupressure comes from Traditional Chinese Medicine dating as early as the second century BCE (Unschuld, 1999). Acupressure is closely related to acupuncture, as they both work with points on the body arranged in meridians. Meridians are thought to be channels through which energy flows throughout the body (look at the photo). The blockage of energy flow along meridians causes imbalances that can lead to diseases.

There are 14 standard meridians running throughout the body with around 360 acupuncture points (World Health Organization, 2008). Most of acupuncture points can be used as acupressure points (Zhao-Pu, 1991b), but in practice, the ones with easy access are the most commonly used.

As acupuncture is slowly building acceptance of its usefulness in western medicine, so is acupressure, its non-invasive analogue. The crucial difference between the two is in their method of application. Acupuncture uses needles to apply stimulation to the points, whereas acupressure uses pressure. This difference becomes crucial when working with children and youth, people who fear or dislike needles or in environments where keeping skin clean may be an issue (e.g., road accident, sports field).

How does acupressure work?

The mechanism of acupressure from the Western medicine viewpoint is not fully understood and multiple mechanisms have been proposed in the literature (Felhendler & Lisander, 1999; Gao et al., 2012; A. D. Lee & Hsu, 2014). The main mechanisms suggest that acupressure influences nervous system (McFadden & Hernández, 2010). Other theories include stimulation resulting in the release of hormones known as endorphins, and changes in circulation of local bioactive substances such as cytokines (Selfridge, 2012).

Some researchers suggest that acupressure influences the autonomic nervous system. This influence is based on activation of the parasympathetic, and reduction in activity of the sympathetic nervous system (McFadden & Hernández, 2010).

The sympathetic nervous system is responsible for a mobilisation of the body and the fight-and-flight response (Jansen, Van Nguyen, Karpitskiy, Mettenleiter, & Loewy, 1995). This change is reflected by changes in various physiological parameters, mainly in the cardiorespiratory system (Matsubara et al., 2011).

However, research on the exact mechanisms underpinning acupressure still leaves some questions unanswered.

What are the benefits of acupressure?

Blood pressure

The evidence available in the literature is consistent in showing that acupressure and auricular acupressure decreases heart rate in healthy individuals (Felhendler & Lisander, 1999; Gao et al., 2012; Litscher, 2004; Sugiura et al., 2007), individuals with musculoskeletal injuries (Barker et al., 2006; Lang et al., 2007) and patients recovering from a stroke (McFadden & Hernández, 2010).

Pain

Acupressure has been successfully used to manage pain in a range of conditions including headaches (Hsieh, Liou, Lee, Chen, & Yen, 2010), painful menstruation (Cho & Hwang, 2010), cancer (Spross & Wolff Burke, 1995), or during labour (U.-L. Chung et al., 2003; E. J. Lee & Frazier, 2011; M. K. Lee, Chang, & Kang, 2004). One of the settings where acupressure has been effectively used as a pain management tool was during transport to hospital (Barker et al., 2006; Kober et al., 2002; Lang et al., 2007).

Acupressure has shown to be effective in chronic musculoskeletal conditions such as chronic low back pain (Hsieh et al., 2006; Hsieh et al., 2004).

Anxiety

Acupressure has been found to decrease the reactivity of the sympathetic nervous system through decreasing the heart rate. Inhibition of the sympathetic nervous system shifts autonomic activity more to the parasympathetic system with the increased expression of rest-and-digest response. The “calming down” effect of acupressure may be an origin for the effect of reducing an anxiety attributed to this therapy.

Anxiety was reduced in patients with minor contusions and fractures (Barker et al., 2006; Kober et al., 2002; Lang et al., 2007). Additionally, (Agarwal et al., 2005; Valiee, Bassampour, Nasrabadi, Pouresmaeil, & Mehran, 2012) acupressure and auricular acupressure was effective in reducing anxiety in pre-operative patients, and auricular acupressure (Kober et al., 2003; Mora et al., 2007) has been successful in reducing anxiety in patients transported by ambulance to undergo surgical procedures. Moreover, acupressure (Wang, Gaal, Maranets, Caldwell-Andrews, & Kain, 2005) was effective in reducing anxiety in parents whose children were undergoing surgery.

Other symptoms

Acupressure has been shown to be effective in decreasing symptoms such as nausea, vomiting (Norheim, Pedersen, Fønnebø, & Berge, 2001; Shin, Song, & Seo, 2007; Werntoft & Dykes, 2001), fatigue (Molassiotis, Sylt, & Diggins, 2007), and pain.

During childbirth, acupressure has been shown to decrease pain intensity and shorten the delivery time (Hjelmstedt et al., 2010; Kashanian & Shahali, 2010; M. K. Lee et al., 2004; C. A. Smith, Collins, Crowther, & Levett, 2011). Acupressure can also be effective in reducing nausea and vomiting in cancer patients receiving chemotherapy (Jang & Park, 2011).

What acupressure can do for athletes?

Unfortunately, athletes are a group that is at high risk of sustaining an injury. These injuries will result in pain and possibly some other negative consequences like decrease or loss of function. Acupressure has a potential to be applied in various sports injuries by a range of sports medicine personnel.

Acupressure has not been extensively studied in the context of sports medicine. Auricular acupressure was investigated during treadmill training in healthy individuals for its positive influences on lactic acid levels and oxygen uptake (Jaung-Geng, Salahin, & Jung-Charng, 1995), and investigating pain thresholds during exercising (Tekeoglu, Adak, & Ercan, 1998). Further two articles provided an overview of positive influence of acupressure use in sports fatigue (Ma, 2003), and an opinion on reducing menstrual pain in athletes using acupressure (Martin, 1993).

Finally, acupressure has been effective in reducing acute pain in athletes suffering from various musculoskeletal injuries (Mącznik, 2013, Mącznik, 2017). This was an easy 3-minute application to one acupressure point. This was the main topic of my PhD thesis. I will write more about it soon, so stay tuned.

Alex

Academic readings:

Agarwal, A., Ranjan, R., Dhiraaj, S., Lakra, A., Kumar, M., & Singh, U. (2005). Acupressure for prevention of pre‐operative anxiety: A prospective, randomised, placebo controlled study. Anaesthesia, 60(10), 978-981.

Barker, R., Kober, A., Hoerauf, K., Latzke, D., Adel, S., Kain, Z. N., & Wang, S.-M. (2006). Out-of-hospital auricular acupressure in elder patients with hip fracture: A randomized double-blinded trial. Academic Emergency Medicine, 13(1), 19-23. doi: 10.1197/j.aem.2005.07.014

Cho, S.-H., & Hwang, E.-W. (2010). Acupressure for primary dysmenorrhoea: A systematic review. Complementary Therapies in Medicine, 18(1), 49-56.

Chung, U.-L., Hung, L.-C., Kuo, S.-C., & Huang, C.-L. (2003). Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor. Journal of Nursing Research, 11(4), 251-260.

Felhendler, D., & Lisander, B. (1999). Effects of non-invasive stimulation of acupoints on the cardiovascular system. Complementary Therapies in Medicine, 7(4), 231-234.

Gao, X.-Y., Wang, L., Gaischek, I., Michenthaler, Y., Zhu, B., & Litscher, G. (2012). Brain-modulated effects of auricular acupressure on the regulation of autonomic function in healthy volunteers. Evidence-Based Complementary and Alternative Medicine, 2012(Article ID 714391), 1-8.

Hjelmstedt, A., Shenoy, S. T., Stener‐Victorin, E., Lekander, M., Bhat, M., Balakumaran, L., & Waldenström, U. (2010). Acupressure to reduce labor pain: A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 89(11), 1453-1459.

Hsieh, L. L.-C., Liou, H.-H., Lee, L.-H., Chen, T. H.-H., & Yen, A. M.-F. (2010). Effect of acupressure and trigger points in treating headache: A randomized controlled trial. The American Journal of Chinese Medicine, 38(01), 1-14.

Hsieh, L. L.-C., Kuo, C.-H., Lee, L. H., Yen, A. M.-F., Chien, K.-L., & Chen, T. H.-H. (2006). Treatment of low back pain by acupressure and physical therapy: Randomised controlled trial. BMJ, 332(7543), 696-700.

Hsieh, L. L.-C., Kuo, C.-H., Yen, M.-F., & Chen, T. H.-H. (2004). A randomized controlled clinical trial for low back pain treated by acupressure and physical therapy. Preventive Medicine, 39(1), 168-176.

Jang, S. Y., & Park, J. S. (2011). The meta-analysis of the effect of acupressure for nausea and vomiting in cancer patients receiving chemotherapy. Journal of Korean Oncology Nursing, 11(2), 116-126.

Jansen, A. S., Van Nguyen, X., Karpitskiy, V., Mettenleiter, T. C., & Loewy, A. D. (1995). Central command neurons of the sympathetic nervous system: Basis of the fight-or-flight response. Science, 270(5236), 644-646.

Jaung-Geng, L., Salahin, H. S., & Jung-Charng, L. (1995). Investigation on the effects of ear acupressure on exercise-induced lactic acid levels and the implications for athletic training. American Journal of Acupuncture, 23(4), 309-313.

Kashanian, M., & Shahali, S. (2010). Effects of acupressure at the Sanyinjiao point (SP6) on the process of active phase of labor in nulliparas women. Journal of Maternal-Fetal and Neonatal Medicine, 23(7), 638-641.

Kober, A., Scheck, T., Greher, M., Lieba, F., Fleischhackl, R., Fleischhackl, S., . . . Hoerauf, K. (2002). Prehospital analgesia with acupressure in victims of minor trauma: A prospective, randomized, double-blinded trial. 95(3), 723-727. doi: 10.1213/01.ANE.0000025704.39845.61

Lang, T., Hager, H., Funovits, V., Barker, R., Steinlechner, B., Hoerauf, K., & Kober, A. (2007). Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: A prospective, randomized, double-blind trial. American Journal of Emergency Medicine, 25(8), 887-893.

Lee, A. D., & Hsu, E. S.-Z. (2014). Mechanisms of acupuncture analgesia. In Y.-C. Lin & E. S.-Z. Hsu (Eds.), Acupuncture for pain management (pp. 73-85). New York: Springer.

Lee, E. J., & Frazier, S. K. (2011). The efficacy of acupressure for symptom management: A systematic review. Journal of Pain and Symptom Management, 42(4), 589-603.

Lee, M. K., Chang, S. B., & Kang, D.-H. (2004). Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. Journal of Alternative and Complementary Medicine, 10(6), 959-965.

Litscher, G. (2004). Effects of acupressure, manual acupuncture and Laserneedle® acupuncture on EEG bispectral index and spectral edge frequency in healthy volunteers. European Journal of Anaesthesiology, 21(01), 13-19.

Ma, Y. N. (2003). Application of acupoint therapeutic efficacy screening in the recovery from sports fatigue. Chinese Journal of Clinical Rehabilitation, 7(21), 3006-3007.

Macznik, A. K., Schneiders, A. G., Athens, J., & Sullivan, S. J. (2017). Does acupressure hit the Mark? A three-arm randomized placebo-controlled trial of acupressure for pain and anxiety relief in athletes with acute musculoskeletal sports injuries. Clinical Journal of Sport Medicine, 27(4), 338-343.

Macznik, A., Schneiders, A., Sullivan, J., & Athens, J. (2013). Management of pain associated with acute sports injuries—Is acupressure a way to go?. Journal of Science and Medicine in Sport, 16, e8.

Martin, M. (1993). Acupressure technique: Menstrual pain in athletes. Int J Alternat Complement Med, 11(5), 23-24.

Matsubara, T., Arai, Y.-C. P., Shiro, Y., Shimo, K., Nishihara, M., Sato, J., & Ushida, T. (2011). Comparative effects of acupressure at local and distal acupuncture points on pain conditions and autonomic function in females with chronic neck pain. Evidence-Based Complementary and Alternative Medicine, 2011(Article ID 543291), 1-6.

McFadden, K. L., & Hernández, T. D. (2010). Cardiovascular benefits of acupressure (Jin Shin) following stroke. Complementary Therapies in Medicine, 18(1), 42-48.

Molassiotis, A., Sylt, P., & Diggins, H. (2007). The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: A randomised controlled trial. Complementary Therapies in Medicine, 15(4), 228-237.

Mora, B., Iannuzzi, M., Lang, T., Steinlechner, B., Barker, R., Dobrovits, M., . . . Kober, A. (2007). Auricular acupressure as a treatment for anxiety before extracorporeal shock wave lithotripsy in the elderly. The Journal of urology, 178(1), 160-164.

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Wang, S.-M., Gaal, D., Maranets, I., Caldwell-Andrews, A., & Kain, Z. N. (2005). Acupressure and preoperative parental anxiety: A pilot study. Anesthesia & Analgesia, 101(3), 666-669.

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