Acupressure

Even though the principle of acupressure therapy remains the same, there exist variations in the way it is practised. Following are examples of different types of acupressure therapies used by practitioners:

• Shiatsu (Japanese acupressure): Shiatsu originated in China before making its way to Japan where it first gained notoriety and developed further. The shiatsu practitioner identifies the problems faced by the patient by touching the body gently and applying pressure across the complete body. Shiatsu is performed by applying pressure using the thumb, elbow, knee, palms of hands or soles of feet perpendicularly to the skin at acupoints along with passively stretching and rotating the joints. Finger pressure (tsubos) and finger massage are also used to stimulate specific points along the meridians of the body. In some cases (Watsu Shiatsu) warm water is also incorporated in acupressure therapy to enhance blood circulation and alleviate pain. Different types of shiatsu practised across the globe, especially in the West, include: 
  • Zen Shiatsu
  • Macrobiotic Shiatsu
  • Healing Shiatsu
  • Tao Shiatsu
  • Seiki
  • Namikoshi Shiatsu
  • Hara Shiatsu
  • Watsu Shiatsu
• Jin Shin Do's (Body mind acupressure): Taking a holistic approach to treatment, Jin Shin Do combines western psychology with Japanese acupressure, Chinese acupuncture theory and Taoist philosophy technique. Acupressure is applied alongside the management of mental health, combining the body and the mind in the healing process.
• Auricular acupressure (AA): Recognised by the World Health Organisation (WHO) as a form of micro acupuncture, it was devised by a French neurosurgeon. The principle is based on the theory that specific points on the auricles (outer cartilage part of ears) correspond to major organs of the body and thus, therapeutic effects on the corresponding target organ can be achieved by manipulating the auricular acupoints of the ears.
• Tapas acupressure technique (TAT): Better known as Power Therapy, it is a type of acupressure in which the patient is asked to conjure and hold on to mental imagery while acupressure is performed.

In theory, special pressure points at the intersection of various meridians of the flow of Qi are called acupoints. An acupoint is the point closest to the surface of the skin and activation of the acupoint is the prime step in acupressure. In reality, acupoints are areas of high electrical conductance in nerves. While special needs are placed at acupoints in acupuncture, pressure by elbows, fingers, feet, knuckles, palms, thumb or special acupressure devices is used to activate these acupoints. Acupoints are located in terms of distance measured along specific meridians. One acupressure unit of measurement (AUM) is defined as a Body Inch (BI) or Cun, which equals the width of a thumb until the base of the fingernail. Various categories of acupoints include:

• Local points (LP)
• Distal Points (DP)
• Tender Pointe (TP)

Activation of different categories of acupoints have different physiological results; for example, some affect the autonomic nervous system whereas others influence the perception of pain. Acupoints are named on the basis of their location in the body and the organ systems they influence.

Research has proven the adjunct use of acupressure in addition to allopathic medicine can improve outcomes and patient quality of life. Some instances where acupressure therapy is advocated for add on use include:

• Anxiety: Most notably pre-procedural anxiety in patients undergoing surgery can be addressed better with the addition of acupressure therapy. 
• Constipation: Self-acupressure, applied after proper instruction, by patients to acupoints in the perineal region along with medication has shown to relieve constipation sooner.
• Insomnia: Auricular Acupressure (AA) has shown to prolong sleep duration and improve sleep latency in patients suffering from insomnia.
• Pain: By activating the correctly corresponding acupoint in the body, various causes of pain can be ameliorated. Some clinical conditions where acupressure is advisable as additional therapy to manage pain include:
  • Headaches
  • Back pain
  • Osteoarthritis of the knee
  • Labour pain management
  • Dysmenorrhea
• Nausea, vomiting and fatigue: Adverse effects of anesthesia or chemotherapy can lead to nausea, vomiting and fatigue. In addition to routine pharmacological management, add on acupressure therapy has shown to improve patient satisfaction in cases of: 
  • Postoperative nausea and vomiting
  • Chemotherapy-related nausea and vomiting
  • Cancer-related fatigue

When considering acupressure therapy, it is important to discuss it with one’s treating doctor before proceeding. Upon sound medical advice, one must seek out a trained and licensed acupuncturist who practices acupressure to proceed. The patient should disclose their entire medical history to the acupressure therapist. Along with a routine medical history and examination, the acupressure therapist may assess the patient in unique ways through touch to gauge the pressure points, or acupoints, which will need to be activated. The acupressure therapist will provide the patient with options of approaches that can be taken. In some cases, the acupressure therapist may even guide the patient with instructions and teach them how to self-administer acupressure. Although no specific measures need to be taken before an acupressure session, some steps can be taken to have the most fruitful experience.

• Arriving 15 minutes before the session time to avoid being stressed or uneasy when the treatment begins. Dizzy spells can thus be avoided during acupressure therapy.
• Eating an appropriate amount before the session: Not eating too much or too little will help patients remain comfortable throughout the session and not feel faint or nauseous.
• Avoid caffeine: Caffeinated beverages, or caffeine in other forms, should be avoided before the acupressure session as the stimulant action of caffeine can aggravate dizziness or cause heart palpitations in susceptible patients.
• Wearing loose comfortable clothing: Not only does this help the patient feel more relaxed but also helps the acupressure therapist access the acupoints accurately and apply adequate pressure.
• Avoid alcohol or any other intoxicant before the session. 

Depending on the type of acupressure therapy being performed the procedure may vary slightly. However, the basic therapy remains the same. Acupressure is usually performed with the patient sitting or lying down on a massage table. The acupuncturist identifies the pressure points in the individual's body by touch and, after correctly identifying them, stimulates them. Pressure applied to active acupoints can be through the fingers, knuckles, palms, elbows or soles of the practitioner. Special devices like bands or hand-held applicators that modulate pressure automatically can also be used. The pressure is often increased for about 30 seconds, held steady for 30 seconds to two minutes and then gradually decreased for 30 seconds. This is typically repeated three to five times. The entire acupressure therapy session roughly lasts one hour. Following the session, the acupuncturist assesses the patient’s physical response to the therapy. The acupressure specialist and the patient then exchange feedback to evaluate any changes to be made for the next session. Acupressure techniques are also taught to the patient to self administer in cases treating conditions like constipation and insomnia.

Although a benign and harmless therapy with relatively few complications, the presence of certain factors can either make the use of acupressure entirely imprudent or may warrant caution. Some such contraindications to acupressure therapy include:

• Pregnancy: The application of acupressure therapy to certain lumbar and sacral points in the body while pregnant can stimulate labour pains and labour. This can even result in premature delivery or other adverse events.
• Pre-existing heart disease: Alterations in blood circulation brought about by stimulation of acupoints can lead to a drop in blood pressure.
• Previous stroke or cerebrovascular accident (CVA) 
• Bruised, broken, inflamed, injured or scarred skin over the area to be treated 
• Fractured bone in the area to be treated
• A ruptured tendon in the area to be treated 
• A sprain in the area to be treated 
• Known cancer or tumour in the area to be treated 
• Bone diseases like rheumatoid arthritis or spinal injury
• Varicose veins

When performed correctly and at the appropriate acupoint, acupressure is virtually free of complications. The most common temporary side effects patients may experience after acupressure include:

• Exhaustion
• Slight pain, discomfort or tenderness in area treated
• Soreness
• Lightheadedness
• Bruising due to excessive pressure
• Indentations from acupressure devices
• Redness in the area treated