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?
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).
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).
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.
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.
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