Key Points
• Understanding the motor points of the neuromuscular system and their corollary—tonic acupressure points—increases efficiency in helping clients relax and deepen into a sense of calmness and well-being.
• A motor point is a specific location where the motor nerve enters the muscle and where visible contraction can be elicited with minimal stimulation.
Consider this metaphor. Imagine sitting in a well-lit room. Maybe it’s too bright and stimulating for your comfort, so you want to turn down the light. In the absence of a dimmer switch, you have two options: Get a ladder and unscrew all the light bulbs in the room, or flip the light switches to turn off the lights.
Sometimes I observe a massage therapist expending a great deal of energy massaging the shoulders to help a client relax. Perhaps the therapist is working very hard, kneading all the adjacent muscles associated with a given painful area. But I have experienced that some well-placed pressure in exactly the right place brings relaxation extremely fast. What makes the difference?
An understanding of the significance of the motor points of the neuromuscular system and their corollary—tonic acupressure points—can greatly increase a bodyworker’s efficiency in helping a client relax and deepen into a sense of calmness and well-being.
Conversely, if that metaphorical room is too dark, and lacks light and energy, what can be done to make a difference? How can a therapist flip the switch to stimulate the neuromuscular system when that is needed?
“That’s it! You just found the spot where I hold all my tension,” is a statement I’ve heard many times over the years of my massage practice. Often, while receiving on-site bodywork or during a full-body session, clients are impressed that I’ve found and alleviated their particular area of pain or discomfort. “It’s those magic hands of yours!” they say. I simply smile.
What may feel like magic to the client is actually the process of addressing the motor points—the most electrically charged areas of the muscles, located where the motor nerve enters and enervates the muscle. Let's look at these motor points, and how they relate to the tonic points of acupressure for delivering our most effective and efficient bodywork.
East Meets West: Paradigms of Healing in Bodywork
First, let me explain how I came to this awareness. As a massage therapy student in 1984, I was excited to learn techniques that would support my desire to participate in the growing holistic health movement. I was enthusiastic about studying the techniques of Swedish and integrative massage and fascinated to learn about the anatomy and physiology of the body. Understanding the anatomy of muscles was key to using techniques that could help relax those muscles.
Looking back, I realize how fortunate I was to attend a school that also included the study of shiatsu as part of the core curriculum. In the 1980s, the Boulder School of Massage Therapy was pioneering in its inclusion of barefoot shiatsu, a Japanese form of bodywork, and tui na, a form of traditional Chinese bodywork. There was a growing interest across the country in what we called “Eastern medicine.” A different paradigm was influencing health practices as evidenced by the burgeoning interest in tai chi, yoga, and meditation.
Little did I know at the time how important this introduction to Asian bodywork would be to my later development of Comfort Touch, the nurturing form of acupressure that is practiced internationally in medical settings and elder care.
Barefoot shiatsu was developed in Japan in the early 20th century, having evolved from ancient Asian bodywork practices. This form of bodywork was based on a different conceptual framework—the understanding of meridians and the flow of chi, the subtle energy in the body. Because the techniques are primarily compression-based and do not rely on gliding or kneading strokes, no oil or lotion is used. Traditionally, it was practiced in the home with the recipient fully clothed and lying or sitting on a 1–2-inch-thick futon, which rested on the clean floor.
After completing massage school, I continued to practice Swedish/integrative massage, as well as barefoot shiatsu. To inform my practice of massage, I was keen to continue my study of anatomy and physiology (see “Exploring Inner Space” Massage & Bodywork, August/September 2004, regarding my exploration of the human body via the study of cadavers). I also continued to study Asian bodywork, with its language of meridians, acupressure points, and chi.
These approaches have different explanations for why and how they influence the health and well-being of the client. They seem to operate in different cultural paradigms. In massage school, they had been taught as different approaches to healing. Neuromuscular bodyworkers were stressing the importance of origins, attachments, and actions of muscles, along with the location of trigger points (a hyperirritable, palpable nodule in the taut bands of the skeletal muscles’ fascia) in the treatment of physical complaints.
Asian bodywork emphasizes the importance of meridians—pathways of energy in the body—that were punctuated with tsubos. These tsubos, also called acupressure points, are located along 14 major meridians or pathways of chi, in the body (Image 1). Shiatsu involves pressure, both general and specific, that is applied to these meridians and points. Asian bodywork, including acupuncture and acupressure, has evolved over millennia and was based on empirical evidence long before modern scientific-based anatomical awareness.
I wondered, “Where is the commonality in the differing approaches to bodywork? We all have the same anatomy. Do acupressure points have a physiological basis?”
I was particularly interested in a set of acupressure points called “great points.” As I studied them, I realized several of them did indeed correlate with the motor points of the muscles where they were located. While awareness of motor points is a significant aspect of physical therapy education, the knowledge of motor points is mostly neglected in massage therapy education. But here, I realized, was the key to the integration of Eastern and Western anatomy.
The Significance of Motor Points
A motor point is a specific location where the motor nerve enters the muscle and where visible contraction can be elicited with minimal stimulation. It is used in physical therapy to either stimulate a muscle that needs rehabilitation or to sedate a muscle that is hypertonic. Physical therapists use palpation, massage, electrical stimulation, and exercise to work with the muscles, incorporating understanding of motor points.
Where are the motor points located? Because they stimulate the muscle—causing movement—it makes sense that they are generally located in the thickest part, i.e., the belly of the muscle. I think of them as the on/off switches of the muscles. Could it be that we massage therapists have spent so much time learning the origins and insertions of muscles that we’ve neglected learning the location of motor points? I think so.
By definition, every muscle has a motor point (sometimes more), and it isn’t difficult to find them if we know our basic anatomy. There are several hundred muscles, or muscle groups, in the body, but fortunately we need only look at the largest muscles that we are able to palpate. These include the large muscles of the shoulders, arms, back, buttocks, and legs.
According to A Proposed Standard International Acupuncture Nomenclature Report, published by the World Health Organization in 1991, there are 361 acupuncture points, located along the various meridians. For our purposes as bodyworkers practicing massage and acupressure, we do not need to know all of these to be successful. In fact, we can be effective in our work if we focus on just a few of them. But which ones do we need to know? This is where the understanding of motor points helps.
Clinical Applications and Communication with the Client
Various approaches to Asian bodywork acknowledge that specific points along meridian pathways have particular value in helping relieve muscular tension and pain, contribute to relaxation, and promote a sense of well-being in the client. These are called great points or tonic points. Many of them correspond to motor points, though they are named for their placement along the meridians outlined by traditional Chinese medicine. Following are some examples with detailed descriptions and clinical applications.
When applying pressure to a point, always begin slowly. Initially, use broad contact, placing the palm of your hand over the point. Use specific pressure only after using broad pressure to warm the area surrounding the point. Your pressure should be perpendicular to the surface of the skin (Image 2), so it can most efficiently access the layers of body tissues and act on the motor point where it activates the muscle. Remember that the motor point is beneath layers of skin and fascia. It can be up to an inch below the surface but can still be affected with pressure applied directly into it.
Use the client’s feedback to ensure you are directly on the point. You need only use the least amount of pressure necessary to elicit the relaxation response. A client might say, “Oh, that is it” or “That feels good.” Be mindful that if you are not directly on the point at the correct angle of pressure (perpendicular to the skin and underlying layers of fascia), you can easily cause pain or irritation to the client. Palpation and treatment of tonic points should not be painful.
Tonic Acupressure Points
Following are descriptions of the tonic acupressure points, along with their locations and indications for their use.
Gallbladder 21
Traditionally referred to as “shoulder well,” this point is in the belly of the trapezius muscle at the top of the shoulder, straight down from the ear (Images 3–5).
Pressure on this point brings welcome relief for people of all ages and levels of physical condition. Always begin with broad contact pressure to warm the area, followed by specific contact pressure. For many people, especially the elderly and people who are more sensitive, broad contact pressure will be sufficient.
The importance of this tonic point cannot be overemphasized. By stimulating it, you are helping tonify the entire upper body. The area of “shoulder well” is the crossover point for the energy meridians and the myofascial network of the head, neck, and shoulders. Broad contact pressure on Gallbladder 21 has a relaxing and calming effect on the whole body.
Pressure exerted here, along with pressure on the tonic points of the occipital ridge (Bladder 10 and Gallbladder 20; see Image 8), is effective in relieving neck pain. It is usually not necessary or safe to apply specific pressure into the neck itself.
Large Intestine 4
This point is located proximal to the web between the thumb and index finger of the hand on the motor point of the adductor pollicis muscle (Image 6).
Specific contact pressure is applied to relieve tension in the shoulder, arm, and hand. It is also known to relieve headaches, constipation, and menstrual cramps. This point is often used, alternately, in conjunction with Large Intestine 10, as they have some similar effects.
Large Intestine 10
Located in the belly of the brachioradialis muscle, this point, along with Large Intestine 4, is used to relieve tension in the shoulder, arm, and hand (Image 7).
Because of its location in this major muscle of the forearm, both broad and specific contact pressure can help alleviate the pain and tension in the arm involved in lifting objects. It is also known to alleviate headaches, constipation, and menstrual cramps.
Stomach 36
Located in the belly of the tibialis anterior muscle of the lower leg, contact pressure and contact circling on and around this point helps relieve pain, tension, and/or fatigue in the legs (Image 8).
Pressure on this point can be useful to stimulate the muscles of the lower legs before exercise, such as walking. Stimulation to this point is also tonifying for the digestive system, as well as the female reproductive system.
Bladder 10 and Gallbladder 20
These points are located along the occipital ridge at the base of the skull. The Bladder 10 points are lateral to the midline of the skull, approximately 1½ inches apart (Image 9).
Pressure applied here is effective in alleviating eyestrain, tension headaches, and neck pain.
The Gallbladder 20 points are also located along the occipital ridge, approximately 3 inches apart. They are useful in relieving head, neck, and shoulder pain, and general myofascial tension in the body.
Generally, use specific contact pressure on these points. Work very slowly and ask the client for feedback. Be sure you’re on the ligamentous tissue of the occipital ridge—not exerting pressure into the neck itself. This tissue includes the attachments of the galea aponeurotica (the tendinous sheath that covers the top of the head), the horizontal nuchal ligaments, and the attachments of the superficial muscles of the neck.
Pericardium 6
Sometimes referred as “inner frontier gate,” this point is located approximately 2 inches below the palmar side of the wrist on the inner forearm. It is found between the two tendons.
Apply specific contact pressure with the pad of your thumb to this point and hold for a few seconds. Pressure on this point is commonly used to alleviate nausea, upset stomach, and dizziness. It helps bring cohesiveness to the nervous system.
Special medical devices (e.g., Relief Band) keep sustained pressure or intermittent electrical stimulation on this point to mitigate motion sickness, alleviate nausea from chemotherapy, lessen morning sickness in pregnancy, and help treat or prevent postoperative nausea.
Pericardium 6 can be treated on either side or both sides. If using a device, usually pressure or stimulation is only applied to one side. The length of dosage is highly variable. Communication with the client is important. Usually, it will feel irritable if pressure is held too long.
Triple Heater 5
Referred to as “outer frontier gate,” this point is located approximately 2 inches proximal to the dorsal wrist crease between the radius and ulna bone. It is on the opposite side of the forearm from Pericardium 6.
Specific contact pressure applied to Triple Heater 5 helps balance metabolic processes and hormonal regulation in the body. Triple Heater 5 acts as a link to the hypothalamus in the brain, which is the thermostat of the body. Pressure to this point is helpful in alleviating cold hands, fever and chills, and pain in the fingers and hands. This point is also associated with emotional balance, hence the “outer frontier gate” that regulates social and emotional
energetic boundaries.
Kidney 1
Traditionally referred to as “bubbling spring,” this point is located on the sole of the foot, in a slight depression in the ball area of the foot. It is on the center line of the foot about one-third of the distance between the tips of the toes and the heel (Image 10).
Kidney 1 is the lowest of the acupressure points on the body. In traditional Asian bodywork, it is considered the point where the vital energy or chi of the Earth bubbles up into the body.
Specific contact pressure applied to Kidney 1 can help the client feel grounded and supported by the energy of the Earth. It can easily be incorporated into massage of the foot. It can also be useful to hold this point on both feet, at the end of the sequence of touch in the supine position. It is very calming and balancing.
Conception Vessel 6
Located approximately 2 inches below the navel in the center of the abdomen (Image 11), this point is also called the “sea of chi” or “sea of energy.”
Anatomically, it relates to the organs of the lower digestive tract and its rich network of nerve plexuses. It is the gravitational center of the body.
Broad contact pressure over this point is very comforting to the individual, allowing release of deeply held physical and emotional tension. Attention to this point helps facilitate deep, easy, and full breathing. Metaphorically, it corresponds to nurturance and assimilation of experience in the body. It can be thought of as the reservoir of creative energy in the body.
Governing Vessel 20
This point is at the top of the head, in the soft spot (anterior fontanel) along the midline of the skull (Image 12).
Traditionally called the point of “one hundred meetings,” Governing Vessel 20 is thought to be the point of connection to the outer world of the individual, or to the world of spirit. Also called the “all forgiving point,” attention to this point helps balance the right and left sides of the body. Very light touching of this point can be used to close a session.
Self-Care Using the Tonic Acupressure Points
Tonic points can also be used to treat oneself as part of a self-care regimen. Use specific contact pressure on the point, holding for a few seconds or through one respiratory cycle of inhalation and exhalation before release. Repeat as needed. Begin with GB 21, L 4, L 10, and ST 36, and enjoy their benefits.
Incorporating Use of Tonic Acupressure Points into a Bodywork Session
Awareness and use of tonic acupressure points is traditionally an integral aspect of Asian bodywork practice, which makes primary use of compression-based techniques. Stimulation with contact pressure of specific acupressure points is done when working on a particular part of the body. This may be unfamiliar to you if you practice conventional Swedish massage, with its gliding and kneading strokes. But with this newfound awareness and understanding of motor points and tonic points, you can begin to incorporate these specific techniques into your practice.
Work with a practice partner. Ask for feedback as you learn. And, of course, communication is key as you begin to incorporate this awareness into your client session. Enjoy the feeling of satisfaction as you begin to deepen the effectiveness of your bodywork practice.
Resources
Bowden, Bradley, and Joan Bowden. An Illustrated Atlas of the Skeletal Muscles, 2nd ed. Englewood, CO: Morton Publishing Company, 2005.
Gach, Michael. Acupressure’s Potent Points: A Guide to Self-Care for Common Ailments. New York: Bantam Books, 1990.
Lee, Anna, and Lawrence Ty Fan. “Stimulation of the Wrist Acupuncture Point P6 for Preventing Postoperative Nausea and Vomiting.” The Cochrane Database of Systematic Reviews. April 15, 2009. https://doi.org/10.1002/14651858.CD003281.pub3.
Lombardi, Anthony. “Understanding Motor Muscle Inhibition in Musculoskeletal Injury.” Chiropractic + Naturopathic Doctor. July 26, 2018. www.cndoctor.ca/december-2013-2749.
Lundberg, Paul. The Book of Shiatsu: A Complete Guide to Using Hand Pressure and Gentle Manipulation to Improve Your Health, Vitality and Stamina. New York: Simon and Schuster, 2003.
Rose, Mary Kathleen. Comfort Touch: Nurturing Acupressure: For the Elderly, the Ill & Anyone in Need of a Caring Touch. Longmont, CO: Wild Rose, 2020.
Rose, Mary Kathleen. Playlist of Barefoot Shiatsu/Acupressure videos: youtube.com/playlist?list=PL1ZcIHQDD7-CYsC_cPAL9wHTTfIG1L78M.
Serizawa, Katsusuke. Effective Tsubo Therapy: Simple and Natural Relief Without Drugs. Tokyo: Japan Publications, 1984.
Thompson, Gerry. Shiatsu: A Complete Step-by-Step Guide. New York: Sterling Publishing Company, 1994.
Vandergriendt, Carly. “What’s the Difference Between TENS and EMS Units?” Healthline.com. January 15, 2021. www.healthline.com/health/tens-vs-ems.
Warfel, John. The Extremities: Muscles and Motor Points. Baltimore: Lippincott Williams and Wilkins, 1993.
Warfel, John. The Head, Neck and Trunk. Baltimore: Lippincott Williams & Wilkins, 1993.
Werntoft, E. and A. K. Dykes. “Effect of Acupressure on Nausea and Vomiting During Pregnancy. A Randomized, Placebo-Controlled, Pilot Study.” Journal of Reproductive Medicine 46, no. 9 (September 2001): 835–9. https://pubmed.ncbi.nlm.nih.gov/11584487.
Yamamoto, Shizuko. Barefoot Shiatsu. New York: Avery, 2002.
Yin, Jieyun, and Jiande Chen. “Gastrointestinal Motility Disorder and Acupuncture.” Autonomic Neuroscience 157, no. 1–2 (October 28, 2010): 31–7. https://doi.org/10.1016/j.autneu.2010.03.007.
Mary Kathleen Rose, LMT, has been actively involved in the holistic health field since the 1970s. A pioneer in the field of touch therapies for the elderly and the ill, she is an ardent advocate for the needs of special populations. She is the developer of Comfort Touch and is internationally known for her work in bringing safe, appropriate, and effective touch to hospice, hospital, and home-care settings. Rose is the author of Comfort Touch: Nurturing Acupressure for the Elderly, the IllandAnyone in Need of a Caring Touch (Wild Rose, 2020); Comfort Touch of the Hands & Feet: A Guide for Family Caregivers (Wild Rose, 2015), and producer of the videos Comfort Touch: Massage for the Elderly & the Ill (Wild Rose, 2004) and Bereavement: Dealing with Grief & Loss (Wild Rose, 2022). She can be reached at rosevine@comforttouch.com; comforttouch.com.