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Acupressure for Athletes Lesson 1: The Foot and Ankle

Please note that this is the second part of an ongoing series, to read part one please click here: Acupressure for Athletes: Introduction

ballet-335496_640Let’s start from our base. Working upward from where our bodies first contact the ground.

We stand on our feet, we walk and run; when we swim we kick. And although all movements require coordinated motions of the entire body, it is our feet that do the initial work. They dig into the ground and drive us forward while also absorbing weight and shock to keep our bodies light or assist in deceleration. Our feet are our only contact sensors on the ground, they help us balance and alert us to changes in the pitch of where we’re standing or moving. All athletes must engage the capabilities of the ankle and foot design to improve performance and avoid injury. The runner who has healthy ankle and foot posture can avoid overuse and chronic injuries. Basketball, football, soccer, and all field sport athletes can make quicker pivots, stops, and starts. Gymnasts, traceurs, dancers, acrobats, and so on can improve balance and perform gentle landings. Swimmers can improve plantar flexion of the foot and avoid muscle cramps. In all activities, correct ankle/foot alignment and ground contact keeps our bodies in a good physical posture while sending sensory information to our nervous system which allows for adjustments in movement and positioning.

Improper foot and ankle alignment or lack of flexibility and strength can result in common injuries such as plantar fasciitis, heel pain, ankle sprains or dislocations, fractures and stress fractures, tendinitis, and so on. Additionally, improper alignment and lack of awareness may also increase the chances of injury in other joints and tissues of the body.

Let’s look at some acupressure points we can use to both prepare the body for exercise and help it to recover. These should be used supplemental to normal warm-up, cool-down, and stretching routines.

 

Pre-Exercise Acupressure

In general for pre-exercise acupressure we should apply direct increasing pressure to the point. In the post exercise routine we will learn massage techniques that relax the tissues, but in this pre-exercise routine the idea is to apply direct pressure at one specific point which will spread energy up and down the selected channel engaging the surrounding muscles, tendons, and ligaments. This can be done with the thumb or knuckles of the index or middle fingers, just try to find the way which allows for pressure to be direct and is comfortable for you. A sensation of soreness and tenderness should develop, just don’t bruise yourself. Very often this sensation may radiate locally or along the pathway of the channel. With experience you will develop technique for applying the correct amount of stimulation.

Engage the medial side muscles and tendons with the Spleen Channel

  1. GongSun(Sp-4): This point is located on the medial side of the foot just under the proximal end of the metatarsal bone. To find it place your finger on the inner side of the foot just at the joint of your big toe; trace along the arch towards your ankle only a short distance until you feel the end of the long bone, and you’ve got it. Try to apply pressure in the space between the underside of the bone and the muscle which runs along the arch.
  1. SanYinJiao(Sp-6): This point is located on the medial side of the leg slightly above the ankle and posterior to the tibia. To find it place four fingers on the inside of your leg starting at medial malleolus (the bone which protrudes out just above the ankle joint). Where the fourth finger touches the medial side of the leg—that is the point. To apply pressure use your opposing hand to hold your leg as if you are shaking hands (palm on the front of your leg), thus allowing your thumb to stimulate the point and the other fingers to support the leg. Notice that this point is slightly posterior to the tibia bone; try to find the small gap between the muscles and press.
  1. YinLingQuan(Sp-9): This point is located on the medial side of the leg slightly below the knee and posterior to the tibia. To find it move your hand along the inner side of your leg just below your knee, try to feel the tibia bone. Moving your hand along the curvature of the bone and locate where it straightens out—that is YinLingQuan. It is also approximately four fingers breadth below the knee. To stimulate, use your same-side hand and let your thumb fall on the point while the other four fingers grasp the lateral side of the leg.

With stimulation of these three points you should feel some sensation radiating through the medial side of the ankle, the arch, and sole of the foot.

Use of these points will both strengthen and increase flexibility of the medial arch. Thus preventing muscle cramps, improving shock absorption, and helping prevent plantar fasciitis and turf toe.

 

Strengthen and Stretch the Ventral Side with the Stomach Channel

  1. JieXi (St-41): This point is located on the front of the ankle between the two large extensor tendons. To find it place a finger on the front side of your ankle, flex your toes upwards to the ceiling; between the two largest tendons which protrude outwards that is where you will find JieXi. Now allow your ankle to relax and apply steady pressure to the point with your thumb or fingers.
  1. TiaoKou (St-38): This point is located on the lower leg half the distance from the knee to the ankle and between the anterior tibial muscle and long extensor muscle. To find this point, first estimate half the length of your lower leg; now starting from your knee slide your fingers down along the bone on the front of your leg until you reach the halfway mark, from here simply move your fingers laterally about an inch until you feel a small depression between the muscle tissues—and you’ve got it. Again you can use your thumb or fingers to apply steady strong pressure at this point.

With Stimulation of both JieXi and TiaoKou you should feel some sensation radiating down onto the top of the foot.

JieXi and TiaoKou both prepare the ankle joint for activity as well as encourage healthy dorsiflexion and plantar flexion. In addition to athletes who run a lot, these two points are also especially useful for swimmers, dancers, and gymnasts.

Activate the Lateral Side Muscles with the Gallbladder Channel

  1. XuanZhong(Gb-39): This point is located on the lateral side above the ankle directly opposite from SanYinJiao which we located on the medial side. To find XuanZhong place four fingers on the outside of your leg starting at lateral malleolus (the bone which protrudes out just above the ankle joint). Where the fourth finger touches the lateral side of the leg is the point. The best way to stimulate this point is to reach down with your same-side hand (palm on the back of your leg), letting your thumb extend downwards onto the point and grasping the inside of your calf with the rest of your fingers. In this way we can apply pressure simply by squeezing and rotating the pressure through the thumb.
  1. YangLingQuan(Gb-34): This point is located on the lateral side of the leg just below and centered between the head of the fibula and the tuberosity of the tibia. To find this point simply slide your hand down from your knee until you feel the two bones which protrude out—these are the heads of the fibula and tibia. Draw an imaginary equilateral triangle between these points with the third point pointing downwards. This third point is YangLingQuan. Again use your thumb to apply direct pressure on this point.

Sensation from these two points will often radiate down the lateral side of the ankle joint.

Use of these points helps engage the muscles and tendons which support the ankle and prevent it from rolling outwards. Use of this technique can help prevent ankle sprains and dislocations. Thus they are very important for athletes in any sport that requires quick pivots and turns, e.g. basketball, football, soccer, tennis, hockey…

Prepare the Calf and Heel with the Bladder Channel 

  1. KunLun(Ub-60): This point is located on the lateral side of the ankle directly posterior to the lateral malleolus and superior to the calcaneus. To find it simply place a finger on the bone which protrudes out on the lateral side of the ankle and slide it back towards the Achilles tendon until you feel a concave point—and you’ve found it. Apply direct pressure with your thumb or any of your fingers. To be most effective try to search around this small area for the point which feels most tender.
  1. ChengShan(Ub-57): This point is located between the lateral and medial heads of the gastrocnemius muscle half the distance from the knee to the heel. To find this point first estimate half the length of the lower leg, now search for an indentation on the center of the calf muscle; it may feel like an upside down V shape. Apply heavy direct pressure to this point with one or both of your thumbs. Again you can try to search around in this small area to find the point which is most tender and then apply direct consistent pressure.

With these points you will feel some sensation spreading through the calf muscle and down into the heel.

These points strengthen and prepare the Achilles tendon for activity, while also engaging the nerves and tissues which surround the heel. Thus they are extremely useful in preventing and improving symptoms of heel pain, as well as preventing tendinitis or rupture of the Achilles. These points are very helpful for runners or anyone troubled with heel pain.

 

All of the above techniques can be used at any point prior to or during regular warm-up, stretching, or breaks in activity. Try to feel how sensation radiates to the areas around the point. Adjust for your own needs and select the points which are most useful for you and your chosen activity.

 

Post-Exercise Acupressure

Post exercise acupressure focuses on relaxing the muscles and increasing circulation to the tissues. Build-up of metabolic wastes and prolonged ischemia result in muscle soreness and delayed recovery. By relaxing the muscles we can minimize some of the initial fatigue following a workout, and by improving circulation we accelerate recovery.

Whereas with the pre-exercise routine we were focused on direct strong pressure, for most of the post-exercise points we are generally trying to apply blunt pressure. Additionally we can use some massage techniques to help improve circulation to the surrounding tissues.

Start Muscle Recovery Off On the Right Foot

After your run or workout or game, your feet have definitely taken a beating. So let’s take care of them first. Here we are going to use three points on the top of the foot to relax the muscles of the feet and ankles. For these techniques you should sit on the ground or on a bench with your knee bent, placing your heel against your buttocks.

  1. TaiChong(Lv-3): This point is located between first and second metatarsal bones. To find it simply place a finger on the top of your foot between the joints of the first and second toe. Now slide your finger up towards your ankle, try to feel the gap between the bones and feel where the space ends and the small bones of the feet begin. To stimulate this point start at the point on the gap closest to the ankle and use your thumb or fingers to massage downwards towards the toes while applying pressure. Each time return to the most proximal point of the space between the toes. While applying pressure running down towards the toes you can also alternate in leaning more towards the big toe and the second toe. In this way the sensation should spread throughout the first three toes and into the arch of the foot.
  1. DiWuHui(Gb-42): This point is located between the fourth and fifth metatarsal bones. To find it place your finger on the top of your foot between the fourth and fifth toe joints. And just as above, slide your finger up towards your ankle, try to feel the gap between the bones and feel where the space ends and the small bones of the feet begin. Stimulation technique is identical to TaiChong; start with the fingers at the most proximal point on the gap between the metatarsal bones and run them downwards towards the toes while applying pressure. Sensation should spread to the toes and into the sole of the foot.
  1. JinMen(Ub-63): This point is located just proximal to the tuberosity of the fifth metatarsal bone. To find it place a finger on the side of your foot just above the joint of the fifth toe. Now slide your finger towards the heel along the side of the foot, about halfway towards your heel you will feel where the bone protrudes outward—this is the tuberosity of the metatarsal bone. JinMen is the soft spot just beyond the tuberosity. Once you’ve located the point we can stimulate it by applying pressure in a circular motion. Place a finger or thumb on the point and move it first in clockwise circles until you feel some tenderness develop and then switch to counterclockwise rotations. You can switch between the two as often as you like. You will feel some sensation spreading along the side of the foot, down into the sole and over to the medial arch.

Stimulation and massage of these three points will help relax the muscles of the sole of the feet and the tendons attaching to the five toes, while improving circulation to the area. This technique can help prevent wear and tear injuries such as plantar fasciitis, turf toe, and fallen arches.

 

Make Nice with Your Ankle

No matter your choice of activity, if you’re moving you’re likely stressing your ankles. So let’s use the following two points to relax the ankle joint and help move away any possible swelling and inflammation. Just as above please sit on the ground or on a bench with your knee bent and your heel placed against the buttocks.

  1. QiuXu(Gb-40): This point is located on the lateral side of the ankle joint. To find it flex your toes upwards and feel for the tendon that protrudes outward on the lateral side of the top of the foot. Qiuxiu is on the depression in the ankle joint just lateral to the tendon. Stimulate simultaneously with the following point, see below.
  1. ShangQiu(Sp-5): This point is located on the medial side of the ankle joint. To find it simply flex your big toe and look for the tendon which protrudes outward on the medial side of the top of the foot. ShangQiu is on the tender spot just medial to the tendon.

Note that you can locate these two points simultaneously by flexing the foot and all the toes upwards and feeling with the hands for the two tendons which run medially and laterally down the top of the foot. Also remember that we used these two tendons to locate the JieXi point in the pre-workout acupressure routine, so now we know points in the center of the tendons, to the left and to the right.

To stimulate these points place one finger or thumb on each of the points—it is easier if you use both hands. While applying pressure simultaneously move your fingers forward and backward in quick motions, stopping occasionally to apply direct firm pressure. Continue until you feel some tenderness and soreness spread throughout the entire ankle joint.

This technique will help relieve tension in the ankle joint. And by increasing circulation it can help move out any swelling or inflammation that may have developed during strenuous exercise. Used in addition to regular stretching and strengthening routines it will help keep the ankle joint strong and injury free.

Heel Yourself

Heel pain is a terribly common complaint of many athletes. Constant striking of the ground and abrasive forces often lead to pain and inflammation. Use the following techniques post-workout or at any time to relieve pain.

  1. KunLun(Ub-60): This point is located on the lateral side of the foot between the lateral malleolus and the Achilles tendon. To find it simply locate the bone protruding outward above the outer side of the ankle, from its’ center slide your fingers toward the Achilles tendon, try to find the most tender spot on the area between the bone and the tendon. Stimulate simultaneously with TaiXi, see below.
  1. TaiXi(Kd-3): This point is on the medial side of the foot between the medial malleolus and the Achilles tendon, opposite the point above. To find it simply locate the bone protruding outward above the inner side of the ankle, from its’ center slide your fingers toward the Achilles tendon, try to find the most tender spot on the soft area between the bone and the tendon.To stimulate use your same-side hand placing your thumb on the TaiXi point and the knuckle of your index finger on the KunLun point, thus pinching the tendon between the two. For more pressure you can use both hands, placing a thumb on each point. Massage in small circles, first counter-clockwise and then clockwise. Also stop occasionally to apply direct firm pressure. You should feel some sensation spread into the ankle joint and down into the heel.
  1. ChengShan(Ub-57): This point is located between the lateral and medial heads of the gastrocnemius muscle half the distance from the knee to the heel. To find this point first estimate half the length of the lower leg, now search for an indentation on the center of the calf muscle; it may feel like an upside down V shape. We used this point as one of our pre-workout techniques to prepare the Achilles for exercise. In this case we will use it to help the calf muscles and the attachments of the tendon to relax and to minimize muscle cramping.  To stimulate use one or both thumbs to apply heavy pressure at the point, now without releasing the pressure slide your thumbs down along your calf all the way to your heel. Repeat several times until you feel tenderness spread throughout the calf muscle and it begins to relax.

We can alternate between the KunLun/TaiXi massage and ChengShan massage. Combined they will help to relax the calf muscle and remove any metabolic waste build up around the heel and tendon. Thus these two techniques are very useful for anyone who suffers from heel pain or muscle cramps.

 

Massage Away Soreness Along the Spleen and Stomach Channels

For these two techniques please either sit on the ground with your leg stretched directly out in front of you or in a chair with feet flat on the floor.

  1. Spleen Channel: The spleen channel runs from the foot up into the torso, but here we are only concerned with the stretch between the ankle and knee. We will massage from the YinLingQuan point (from the pre-exercise techniques) down to the medial malleolus. First locate the YinLingQuan point (see “Engage the medial side muscles and tendons with the Spleen Channel” #3 above), now with your thumb or fingers while applying pressure slide your hand down along your leg to the ankle. Try to stay on the line between the tibia and the muscle. Repeat this several times until you feel some warmth and sensation spread along the inner side of the calf and down into the arch and sole of the foot. Try varying the speed and amount of pressure applied to see what works for you.
  1. Stomach Channel: The stomach channel runs from head to toe, but here we are only concerned with the stretch between the knee and ankle. The first point is just lateral to the head of the tibia where the curvature straightens out; we will massage from this point down to the front of the ankle. To find the starting point use your fingers to feel the head of the tibia just below the knee, now move to the lateral side of the bone and trace along the side of the bone until you feel the point where it begins to straighten out. This point is usually only a couple inches below the knee; the bone will feel sharper and less rounded. To massage use your thumb to apply pressure at this point and while maintaining pressure slide all the way down to the front of the ankle. Try not to let your hand get too far away from the bone, but keep the pressure directed onto the muscle. Repeat several times until you feel some warmth and sensation spread down into the top of your foot. Again you can vary the amount of pressure and speed until you find what works for you.

For both of these techniques you can use one or both hands depending on the amount of pressure you want to apply. It is most easily applied while sitting on the floor, but any position with the lower leg fully extended will work. Find what is comfortable and easy for you.

These two massage techniques will help to relax the muscles of the foot and ankle. Performed correctly, they will release muscle tension along the medial arch and top of the foot as well as promote circulation to the lower leg.

 

All of the post-exercise techniques are designed to help relieve tension in the muscles, move away build-up of metabolic waste, and promote circulation. These should all be performed in a relaxed comfortable manner—not requiring any excessive effort. Try to incorporate them into your regular cool down and stretching routines to help reduce post-workout fatigue and speed recovery.

 

Include these techniques as part of your regular warm-up, cool-down, and stretching routines

Use these sets of pre-exercise and post-exercise acupressure techniques to keep strong and flexible—ready to perform at your best in whatever your chosen sport.

The structure of the foot and ankle are quite complicated, so here we’ve provided several techniques as a comprehensive system to prepare for and manage any weaknesses or discomfort. Additionally, proper alignment of the ankle and foot and improved proprioception will set a foundation for correct posture in the rest of the body.

Continue on to Lesson 2: The Knee

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Acupressure for Athletes

runner pic artIt has been shown in research that stimulation of acupuncture points aligns with activation of specific brain regions. Thus one explanation for the mechanisms of acupuncture is that effects are resulting from stimulation of the central and peripheral nervous systems. In this way we connect our brain and spinal cord with our muscles, tendons, and joints—reminding the body of the mechanisms available to maintain proper posture and positioning during any athletic movement. Various protective reflexes, i.e. golgi tendon reflex or myotatic reflexes can also be engaged, accelerated, and maintained with acupuncture. Proper acupuncture treatment can affect these mechanisms which keep our bodies safe, prepared, and reactive during exercise. And simply by improving these functions we can make any exercise more efficient, enjoyable, and safe.

Any athlete has days when their body feels light, when movements are easy and smooth, perhaps following a good warm up or simply a lively mood or healthy meal and good sleep. When your body just feels strong and flexible while responding to your commands—this is the most pure example of aligning the nervous and skeletomuscular systems. Total alignment of these systems is what all athletes train and hope for on competition day.

Ancient Chinese medicine doctors often prescribed exercises to improve qi and blood circulation throughout the body, and early on in the history of Chinese medicine the channels (ata. meridians) were written down as one of the fundamental systems of anatomy. The Channels are pathways which show us how energy moves through the body, how all areas of the body connect. These connections may be direct and close-by, or they may be indirect and distant; nonetheless this is a network of how all tissues are interconnected. By stimulating areas on these channels we improve the flow of qi and blood, both removing blockages of feeder channels and increasing the flow to downstream channels.

Through our clinical experience and fundamental research, we now know that acupuncture at points on the channels sends signals to the central nervous system. This is essential for treatment to be effective. The patient should have a sensation of “DeQi” (soreness, numbness, tingling…), and the acupuncturist should feel a quick pull or grab on the needle at the time of “DeQi”. This is how we know that the points and channels have been activated.

There is often overlap between Chinese medicine theory and Chinese Kung Fu, especially QiGong and TaiChi exercises. From ancient times the goal of all Chinese Kung Fu was to create automatic responses in the body to external stimuli, to align physical movement with mental focus allowing for maximum efficiency and power. Thus many martial art forms are also designed in accordance with the channel theory of Chinese medicine. For modern day athletes and active people there is much to learn from this wisdom.

In the following posts we will discuss some simple acupressure points and stimulation techniques everyone can use to both prepare the body for exercise and assist in recovery.

Continue on to Lesson 1: The Foot and Ankle

Or skip to Lesson 2: The Knee

Walk daily to prevent limitations and pain of osteoarthritis

This recently published study shows that daily walking can help alleviate symptoms of knee osteoarthritis. This is something that we’ve always recommended clinically for patients to alleviate pain, and in this study Dr.White does a nice job of quantifying the results.

Walking an additional 1,000 steps each was associated with between a 16% to 18% reduction in incident functional limitation two years later. Walking less than 6,000 steps daily was the best threshold for identifying those who developed functional limitation.

By the way, 6000 steps is approximately equal to one hour of continuous walking.

From Chinese medical theory and our clinical experience we also know that it is important to keep the body warm.  Exposure to cold may decrease active circulation to the area resulting in decreased oxygen supply and buildup of metabolic waste. So during colder months it is important to wear an extra layer of clothing.

Walking daily is a healthy part of anyone’s daily routine—and by simply adding and increasing daily walks we have an easy, affordable, and enjoyable way of managing pain.

So walk, keep warm, and be pain free

 

 

http://onlinelibrary.wiley.com/doi/10.1002/acr.22362/abstract

http://www.sciencecodex.com/6000_steps_a_day_keeps_knee_oa_limitations_away-135520