Acupressure for the management of symptoms in acute sports injuries

Background The most common sport-related injuries are musculoskeletal injuries which are often painful. Using strategies that reduce pain, and decrease negative psychological symptoms, may optimise recovery. Acupressure is a therapy that involves targeted thumb pressure on designated points on the body identified in eastern medicine as therapeutic. Acupressure has many advantages including its non-pharmacological nature, lack of harmful side effects, and does not require equipment or special preparation (e.g. skin preparation). The effectiveness of acupressure for pain (and anxiety) relief in musculoskeletal injuries has been examined with encouraging results in several populations, however athletes have not been specifically studied. Aims The main aims of this thesis were: - to investigate the effect of acupressure on symptom management in acute musculoskeletal injures in athletes; - to apply knowledge translation principles to develop a video to train sports medicine personnel about acupressure and its safe use in pain management. Methods A sequential multistep approach was used to achieve these aims. Literature on manipulative and body-based therapies was systematically reviewed regarding the level of evidence for their use in sports and exercise medicine (SEM). This contextualised the use of acupressure technique in SEM. The effectiveness of acupressure in decreasing pain and anxiety in acutely injured athletes was then investigated using a three-arm randomised controlled trial (RCT) design. An instructional video was produced to facilitate the transfer of knowledge about the acupressure technique used in the RCT. The development of this video involved two stages of stakeholders consultations using focus groups and online survey design. The video was then trialled in a ‘real world’ sports medicine setting. Results The literature review revealed that the highest level of evidence is available for acupuncture, manipulation, massage and Pilates. The review identified four studies describing acupressure in SEM: two clinical trials, an overview, and an opinion. This gap in the literature was addressed with the RCT, which demonstrated that acupressure could effectively reduce pain in injured athletes without side effects. On average the acupressure group experienced a 19% reduction in pain (4.0% increase in sham group, and 0.5% decrease in non-acupressure group), but no significant effect was observed for anxiety. The successful acupressure procedure was then the subject an instructional video. Formal consultations with stakeholders provided recommendations about the production of the video including a focus on high quality content and production, and verbal presentation combined with manual demonstration. This video was very well-received by the targeted sports medicine personnel. Although the participants practiced acupressure after watching the video and felt ready to use it during the event, only two people did so. These participants felt confident applying acupressure and thought that this technique helped their athlete. Conclusions The evidence available on manipulative and body-based therapies in the context of SEM varies widely between therapies. Acupressure decreased the average pain scores in acutely injured athletes but did not affect anxiety levels. This technique is feasible to use in sports setting, and wherever access to medical care is limited. Translation of knowledge to the sports medicine personnel about the acupressure technique can be successfully carried out using an instructional video