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Acupressure is a form of alternative medicine that is a part of Traditional Chinese Medicine (TCM) and is often used in conjunction with acupuncture, to which it is closely related. While some regard acupressure and acupuncture as pseudoscience, varying degrees of scientific evidence exists of beneficial effects of both. Research has proven benefits and improvement in the outcome of ailments treated with add on acupressure therapy. The original philosophy behind both acupressure and acupuncture in the olden times was based on the principle of “Qi'' (pronounced as “chee”), which was believed to be fluid and animated life energy source present inside a human. Well functioning, or well flowing, Qi was believed to be needed for mental and physical well being; any obstruction to said the flow was thought to result in ailments. Qi is thought to flow in predetermined pathways, or meridians, that connect different organs in the body. The points where these meridians intersect are regarded as special pressure points, stimulation of which can unblock and align the flow of the Qi of one’s body. The modern-day principle of acupressure can be described as stimulation of nerve-rich areas of the skin to influence the underlying tissues, glands, organs and overall functioning of the body, in a minimally invasive manner, by strategic application and modulation of pressure. Although acupressure can be administered by trained specialists and physiotherapists, self-acupressure practices, after proper training, can help patients manage their health concerns on their own as well. While acupuncture entails the placement of specialised needles in the skin, acupressure relies on the application of appropriate pressure on pressure points, usually by hand. Besides manipulation with fingers, thumbs and knuckles, a wide range of portable acupressure devices like elastic or inelastic bands and mats with protruding plastic points are available. These devices are easy to use and take patient comfort into account. Two types of portable and easy-to-use acupressure devices are available - devices that can either exert a constant level of pressure at specific pressure points or automatically modulate. Some examples of common acupressure devices include, but are not limited to:

  • Acupressure footboard
  • Massage footwear
  • Acupressure mat
  • Opto-mechatronic acupressure pen
  • Various handheld acupressure applicator devices, etc.
  1. Types of acupressure
  2. Some acupressure points
  3. Indications for acupressure
  4. Preparation for acupressure
  5. Procedure of acupressure
  6. Contraindications of acupressure
  7. Complications of 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:
  • 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 
  • 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

References

  1. Mehta P, Dhapte V, Kadam S, Dhapte V. Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments. J Tradit Complement Med. 2016;7(2):251-263. PMID: 28417094.
  2. Murphy SL, Harris RE, Keshavarzi NR, Zick SM. Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial. Pain Med. 2019 Dec 1;20(12):2588-2597. PMID: 31237610.
  3. Waits A, Tang YR, Cheng HM, Tai CJ, Chien LY. Acupressure effect on sleep quality: A systematic review and meta-analysis. Sleep Med Rev. 2018 Feb;37:24-34. PMID: 28089414.
  4. He Y, Guo X, May BH, Zhang AL, Liu Y, Lu C, et al. Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis. JAMA Oncol. 2020 Feb 1;6(2):271-278. PMID: 31855257.
  5. Schlaeger JM, Gabzdyl EM, Bussell JL, Takakura N, Yajima H, Takayama M, et al. Acupuncture and Acupressure in Labor. J Midwifery Womens Health. 2017 Jan;62(1):12-28. PMID: 28002621.
  6. Au DW, Tsang HW, Ling PP, Leung CH, Ip PK, Cheung WM. Effects of acupressure on anxiety: a systematic review and meta-analysis. Acupunct Med. 2015 Oct;33(5):353-9. PMID: 26002571.
  7. Li LW, Harris RE, Tsodikov A, Struble L, Murphy SL. Self-Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2018 Feb;70(2):221-229 PMID: 28437570.
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