ACUPUNCTURE PHYSICAL MODALITIES
Physical modalities
developed by ancient Chinese physicians including medical massage, suction
cupping, scraping therapy, therapeutic exercises, and breathing and relaxation
techniques. Physical modalities are employed to treat pain disorders,
for physical rehabilitation, and for health maintenance. Physical modalities
are most commonly employed to treat musculoskeletal conditions, and as
adjunctive therapies for paralysis and motor impairment.
Medical Massage and Manual Therapies (“tui na”)
Traditional Chinese Medicine includes a sophisticated system of manual
therapies known as “tui na” (literally “push-grasp”).
Tui na employs many manual therapy techniques also known in the West,
including:
- soft-tissue mobilization (compression, myofascial release, vibration, percussion, friction, stroking, kneading, deep pressure, etc.);
- joint mobilizations, glides, and traction;
- facilitated stretching;
Manual therapies are
typically directed at the nodes and vessels described in the acupuncture
system (hence the term “acupressure”). Manual therapies are
applied both locally and regionally to the affected areas, with particular
emphasis on the nodal sites and other sensitive areas (trigger points)
locally and distal or proximal along the nodal pathway(s) that traverse
the affected area(s). Topical applications may be used as lubricants for
medical massage, and to provide concurrent biochemical anti-inflammatory
and analgesic treatment to injured areas.
- Manual therapies are employed to:
- Relax and stretch tendons and muscles;
- Reduce restrictions and adhesions in connective tissue and joints;
- Restore normal joint lubrication, function, and range;
- Relieve neural or vascular compression;
- Normalize vascular flow;
- Reduce swelling and promote tissue drainage;
- Reduce pain or tenderness (at acupuncture nodes or trigger points);
- Promote systemic relaxation and stress reduction.
Manual therapies may be applied alone, or as supplementary modalities
to enhance the effects of needle therapy. For example, pressure along
a nodal pathway proximal or distal to a needling location lowers the threshold
for propagated needle sensation, and allows the practitioner to direct
the sensation towards the injured site. Research conducted in China indicates
that clinical outcomes improve when propagated needling sensation reaches
affected areas.
Soft-tissue mobilization and passive or active range-of-motion therapies
may also be enhanced by simultaneous needling at distal locations along
the affected vessels. For example, strong needling of node tiaokou Stomach
38 (located in m. tibialis anterior) is often combined with passive or
active shoulder ROM techniques to treat adhesive capsulitis. Nodes located
on the dorsal surface of the hands may be needled in combination with
AROM exercises to remobilize neck or low-back stiffness and reduce muscle
spasms in those areas.
Suction Cupping
Cupping involves creating a vacuum in a suction cup over various parts
of the body for therapeutic effects. By briefly heating the air in an
inverted cup, a vacuum is produced when the air cools after the cup is
quickly applied to the skin. Cups may also be mechanically evacuated using
small hand-operated pumps. The resultant low pressure under the cup causes
a localized expansion of tissue, which produces a profound vasodilatation
reaction.
Suction cupping is used therapeutically to draw blood flow to areas of
ischemic pain, thus flushing capillary beds and re-supplying vital nutrients.
Suction also mobilizes and stretches soft tissue by pulling it up and
away from underlying structures, thus loosening areas of adhesion or restriction
and activating muscle spindle reflexes that relax contractile tissue.
Cups of all sizes are employed to treat a wide range of disorders. Small
cups may be applied to the face to treat facial paralysis, whereas larger
cups placed in the lumbar region are used to treat lumbago. Cupping is
frequently applied over nodal sites, but can be used in non-nodal regions
as well. Suction cups are typically placed locally over disease/injury
sites, and retained or manipulated for 5-10 minutes. Topical application
of an oil-based lubricant to the skin just prior to cup application facilitates
a tight seal, and allows for sliding cups around in the treatment area
to further mobilize soft tissue.
Suction cupping may be used alone, or to enhance the effects of acupuncture.
Reduction of ambient pressure over the body surface lowers the threshold
for generation of propriospinal reflexes through needle stimulation of
muscle spindles. The activation of such reflexes is signaled through the
inducement of propagated sensation (see "Acupuncture Mechanisms of
Action"). Cups are sometimes applied over inserted needles to enhance
propagated needling sensation, and evoke the propriospinal responses that
facilitate muscle relaxation.
Scraping Therapy
Scraping therapy, known as guasha, is a technique that uses a smooth edged
object used to apply pressure to the skin, sub-cutaneous fascia, and superficial
muscle. The side of a typical Chinese porcelain spoon, the rim of a suction
cup, or other small, smooth-edged object is used to scrape along muscle
fiber orientation. Oils are applied as a lubricant that contain herbal
preparations that, along with the scraping action, enhance superficial
vasodilatation.
Scraping is used to remove blood and fluid stagnation from superficial
layers of fascia and muscle tissue. Resulting erythema may last from several
hours to a full day.
Exercise Therapy
Chinese physical rehabilitation modalities include a wide range of exercises.
Daoyin involves guided stretching of tendons and muscles to address specific
muscle groups or joints, similar to yoga and Western orthopedic rehabilitative
exercises.
Taijiquan, derived from Chinese martial arts practices, complements
orthopedic rehabilitative exercises by emphasizing smooth continuity,
balance, relaxation, and coordination in movement. The rhythmic relaxation
and integrated action of muscle groups required by taiji provides effective
neuromuscular re-training for the performance of activities of daily living,
as well as higher-level work, recreational and sports activities. The
effectiveness of taiji in preventing slips and falls in elderly populations
has been well-demonstrated. Taiji is a safe form of exercise to address
general health problems, such as generalized stiffness, poor conditioning,
chronic stress, or weakness and debility. Taiji is accurately described
as moving meditation, and promotes sympathetic/parasympathetic re-balancing
and stress reduction concurrent with its muskuloskeletal benefits.
Breathing Exercises (“qi gong”)
Qi means vital air or breath, and gong means practice or exercise. Qi
gong exercises are originally derived from ancient Daoist breathing, movement,
and stretching practices. Qi gong is noted in many ancient sources as
being fundamental to health preservation. There are various levels of
breathing exercise; some of the simplest techniques require learning to
breathe properly with the diaphragm, while others coordinate breathing
with movement and meditation or visualization to address specific problems
and diseases.
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Health Care Network 2003
Do not reproduce without written permission