Table Of ContentThe Use of Acupressure Tapping, an Attractor Field Technique, for a 65-Year-Old Patient with Post-Operative
Cervical Pain: A Case Report
Aubrey Rohner
Background and Purpose. The implementation of Acupressure Tapping, an Attractor Field Technique, to
manage pain behaviors following a cervical surgical procedure has not been described in the literature. This
lack of data creates a gap between traditional physical therapy interventions that are implemented to manage
acute post-operative pain and alternative medicine. The purpose of this case report is to describe the use of
Acupressure Tapping to complement traditional interventions in managing pain behaviors following a cervical
laminoplasty and laminectomy in the skilled nursing facility setting.
Case Description. A 65-year-old man status post a cervical laminoplasty and laminectomy completed a 10-day
Acupressure Tapping (AFT) intervention. The patient reported neck pain, bilateral shoulder and upper arm
pain, tingling in the digits of the right hand, low back pain, and sciatica at baseline.
Outcomes. The patient completed 10, 10-15 minute treatment sessions in which Acupressure Tapping was
provided in conjunction with traditional physical therapy. Overall, the patient reported decreased cervical pain
and minimal to no change in bilateral shoulder, upper arm, low back, and sciatic pain following the
intervention. Reduced heart rate and respiratory rate were observed, as well, in addition to frequent
subjective reports indicating that the patient was in a more relaxed state post-intervention.
Discussion. The patient experienced decreased cervical pain immediately following the intervention. While the
mechanism of action of this intervention is theoretical, it is possible that Acupressure Tapping assisted in the
down regulation of the patient’s central nervous system, impacting his pain perception. Randomized clinical
trials are needed to evaluate the efficacy of Acupressure Tapping in patients with post-operative pain, as no
literature exists to support the use of this intervention in clinical practice.
Keywords: Acupressure Tapping, Attractor Field Technique, AFT
Background and Purpose
Research demonstrates that a cervical laminoplasty is an effective and safe method of treating multi-
level cervical spondylotic myelopathy, however, axial neck pain has been reported to be as great as 30-60% in
patients that have undergone this procedure.1,2 According to literature, psychological disorders, including
anxiety and depression, have been found to influence pain perception, whether acute or chronic.3,4
Approximately one out of every five primary care patients has at least one diagnosable anxiety or depressive
disorder.5 Physical therapists do not treat anxiety, however, treat patients’ musculoskeletal impairments that
may be heightened due to a phenomenon referred to as central sensitization, resulting in impaired pain
perception.3,4 Traditional physical therapy interventions that are implemented following a cervical surgical
procedure to reduce pain in the skilled nursing facility setting include cryotherapy, gentle active range of
motion, interferential current electrical stimulation, soft tissue mobilization to uninvolved musculature, and
patient education.6,7,8, Acupressure Tapping, an Attractor Field Technique, has been proposed to complement
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traditional physical rehabilitation in the management of post-operative cervical pain behaviors; however, there
is currently no literature to support the use of this intervention in the physical therapy setting.9
The Attractor Field Technique (AFT) is a manual technique referred to as Acupressure Tapping, which
was developed by Dr. David Hawkins in 1998.9 The underlying theoretical basis is founded in ancient Chinese
Medicine and resembles that of Acupuncture, as disease and distress result from disturbances in the mind-
body energy systems. It is theorized that each life stressor introduces “energetic errors in the body’s control
system,” resulting in disease and distress that starts in the mind and transforms into physical consequences.9
Hawkins describes AFT as a mechanism to tap into the meridian energy system, which serves as a “portal to
the energetic processes that direct our body’s development and control and coordinate the body’s
functioning.”9 The theory is that there are approximately 450 acupuncture points that comprise an energetic
signaling system, and when stimulated correctly, can “restore energetic functioning to distorted body energies
which underlie illness.”9 AFT involves tapping sequences of 23 meridian points that are located on the face,
head, and hands that compose over 100 physical and psychological condition-specific formulas including bone
pain, bone healing, joint pain, muscle spasms, nerve root irritation, anxiety, fear, grief, etc.9 Each point is to be
‘lightly tapped’ the designated number of times and double or triple tapped to increase the effectiveness by 10
to 50 times respectively, however the rate of tapping is insignificant. Dr. Hawkins' methodology explores the
use of meridian energy altering formulas for the elimination of energy fields and symptoms that result from
those energy fields, which are theorized to be the source of mental and physical disorders. The purpose of this
case report is to describe the use of Acupressure Tapping in managing pain behaviors following a cervical
surgical procedure.
Patient History and Review of Systems
The patient was examined and evaluated by the physical therapist prior to obtaining a written
informed consent to participate in this case report. The patient was a 65-year-old man who was admitted to
the skilled nursing facility five days after a C3-C6 cervical laminoplasty and C7 dome laminectomy due to
gradual, insidious multi-level cervical spondylotic myelopathy. He had received physical therapy during his
inpatient hospitalization. The patient was previously working full-time as a distributor for a retail store, but had
been off of work the last eight months due to extreme cervical and lumbar pain beginning in May 2014 and
generalized upper and lower extremity weakness. The patient lived alone in an apartment and was
independent prior to surgery, requiring a standard cane for ambulation due to weakness and impaired
balance. He had two adult daughters who lived nearby, but worked full-time and were unable to assist him at
home.
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The patient’s past medical history was remarkable for cervical stenosis, a herniated lumbar disc,
sciatica, depression, anxiety, insomnia, alcohol dependence, tobacco use disorder, addictive gambling, poor
eating habits, chronic pain, narcotic dependence, and smoking. The patient frequently stated that he had a lot
of anxiety about his current condition, socioeconomic status, returning home, and the loss of his wife in 2008
in the same facility. Additionally, the patient decided to quit smoking right before his surgery, and was
experiencing symptoms of nicotine withdrawal. He was referred for inpatient physical and occupational
therapy due to a progressive decline in upper and lower extremity strength, static and dynamic stability,
activity tolerance, and cervical pain and limited mobility. The patient’s chief complaint was constant 8-10/10
posterior neck pain and radiculopathy that increased with activity and reported intermittent tingling in the
digits of the right hand. The patient’s short-term goal for physical therapy was to return home without
cervical, lumbar, or bilateral leg pain with independence in his daily activities. The patient had hopes of
returning to fishing, exercising on a regular basis, and playing with his grandchildren in the long-term.
Examination
Objective measures were performed by the treating physical therapist at the patient’s initial physical
therapy visit and re-assessment was performed on a daily basis immediately following the intervention for the
2 ½ weeks that the patient was treated in the skilled nursing facility. During the patient’s initial physical
therapy visit, an ordinal self-report rating scale (Visual Analog Scale) was used to assess the intensity of the
patient’s pain at rest and with activity. The patient was asked to assign a score from 0-10 to describe his pain,
where 0 represented no pain and 10 represented the worst imaginable pain. Additional tests and measures
included vitals (heart rate and respiratory rate), and documenting negative or ‘catastrophizing’ thoughts
verbalized by the patient.
Clinical Impression
The patient consistently reported posterior neck pain greater than 5/10 on the visual analog scale that
radiated into his mid-upper back, bilateral shoulders, and upper arms. This pain increased with activity and
proved to be his primary limitation to returning home, as progression in physical and occupational therapy was
hindered. One-week post-operative, the patient reported low back pain and bilateral sciatica, as a result of the
herniated disc in his lumbar spine, which the patient had experienced prior to his operation. The patient also
demonstrated elevated heart rate and respiratory rate at rest and frequently spoke about his current condition
in a negative or ‘catastrophizing’ manner, which he attributed to his anxiety. The patient was receiving a
narcotic every four hours for pain management and anxiety medication two times a day, however, reported
that the effects of the medication were insignificant. Based on the patient’s widespread pain, consistently high
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pain ratings, and anxiety behaviors including elevated vital signs and frequent negative, ‘catastrophizing’
thoughts, he was determined to be an appropriate candidate for the Acupressure Tapping intervention. Table
1 demonstrates the patient’s comprehensive pain behaviors during his first week at the skilled nursing facility
(Post-operative day 5-11). The patient did not receive therapy services on the weekend.
Table 1.
Patient characteristics at baseline
Days Post- Pain Location Pain Rating Heart Rate (bpm)/ Negative/Catastrophizing
Operative (VAS scale) Respiratory Rate Thoughts
(0-10/10) (breaths/min)
Day 5 Posterior neck, radiates 10 92 / 18 “I don’t even know what the
into mid-upper back, surgeon did back there. He
bilateral shoulders, and better not have messed me up
upper arms more. Why is there pain in my
arms? There is just so much
pain. My wife died in this place
8 years ago. It just makes me
nervous.”
Day 6 Posterior neck, radiates 9-10 90 / 18 “I don’t think my pain
into mid-upper back, medication is working. Can you
bilateral shoulders, and check to make sure my nurse
upper arms is even giving them to me?”
Day 7 Posterior neck, radiates 8 Vitals not obtained “The surgeon told me I
into mid-upper back, shouldn’t have tingling
bilateral shoulders, and anymore. What if the surgery
upper arms; Tingling in failed?”
digits of right hand
Day 10 Posterior neck, radiates 9 Vitals not obtained “Why is this pain in my arms?
into mid-upper back, What if it’s bone cancer?”
bilateral shoulders, and
upper arms; Tingling in
digits of right hand
Day 11 Posterior neck, radiates 9 93 / 19 “Why is there so much pain in
into mid-upper back, my shoulders? It’s a deep pain,
bilateral shoulders, and deep in the joint. I think I tore
upper arms; Tingling in my rotator cuff. The doctor
digits of right hand; told me this surgery could fix
central low back and my sciatica and it is back. Now
bilateral posterior leg I will need surgery on that
pain too.”
Intervention
The patient’s pain was only temporarily relieved at rest with traditional physical therapy agents and
modalities including cryotherapy, pulsed diathermy, and electrical stimulation; therefore, indicating the
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implementation of Acupressure Tapping for long-term management of symptoms, both pain and anxiety
related. In addition, the patient reported that he was having a lot of anxiety, which was evidenced by his
elevated heart rate, respiratory rate, and frequent negative, ‘catastrophizing’ thoughts. The physical therapist
selected the following AFT formulas based on the patient’s physical and emotional symptoms and primary
complaints: Fear, Nerve Root Irritation, Back Pain: Cervical Muscle Spasms, Nerve Burning Pain: Sciatic, Back
Stiffness, Joint Pain: Upper Limb, and Arm Pain. Each diagnosis has an established energy field clearer and a
symptom remover formula that are both to be applied for maximum effectiveness per AFT [For detailed
meridian locations grid and condition-specific formulas refer to Appendix A].
On post-operative day 12, one-week after the patient’s admission to the skilled nursing facility, all of
the selected formulas were applied to determine his responsiveness to this intervention. The patient was
positioned in supine, with his neck supported by one pillow to maintain neutral spinal alignment. The physical
therapist educated the patient in the Acupressure Tapping technique and described the theorized effects. The
therapist began with the Fear formula and lightly tapped each meridian point in the sequence three times the
designated number (i.e.: 60 times) at the therapist’s selected pace. The patient was instructed to either rest
quietly or continue to vocalize his concerns. The physical therapist proceeded with each remaining formula
completing the energy field clearer formula first, followed by the symptom remover for each condition listed
above. The patient was most responsive to the Fear, Nerve Root Irritation, and Back Pain: Cervical Muscle
Spasms formulas as evidenced by the patient reporting decreased pain, thus indicating the continuation of
these formulas and discontinuing the remainder.
Acupressure tapping was implemented at the end of any treatment session in which the patient
reported cervical pain greater than or equal to 5/10, consuming 10-15 minutes of the patient’s 60-minute
treatment session, five days per week for the last week and a half of his stay. Acupressure tapping was used in
conjunction with therapeutic exercise to improve bilateral lower extremity strength and activity tolerance,
neuromuscular re-education to improve static and dynamic stability, therapeutic activity to improve
independence with stair negotiation, ambulation, and transfers, gait training to improve independence with
use of standard cane, and pulsed diathermy, cryotherapy, and interferential current electrical stimulation as
needed for pain control. The patient was also participating in occupational therapy for 45 minutes daily
consisting of bilateral upper extremity strengthening and scapular mobilizations.
Outcomes
Acupressure tapping was performed during 10 treatment sessions. The patient’s pain location, VAS
pain scale score, heart rate, and respiratory rate were obtained before and after the tapping formulas (Fear,
Nerve Root Irritation, Back Pain: Cervical Muscle Spasms) were performed. In addition, subjective comments
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were documented to track any change in mental state. Overall, the patient reported decreased pain at rest,
demonstrated reduced heart rate and respiratory rate, and frequently commented about his state of
relaxation following the Acupressure Tapping. Tables 2-4 demonstrate the patient’s comprehensive pain
behaviors before and after the implementation of the tapping intervention.
Table 2.
Visual Analog Scale (VAS) Scores (0-10/10) Pre and Post Intervention
Days Pain Location PRE POST
Post- Pain Rating Pain Rating
Operative (0-10/10) (0-10/10)
Day 12 Posterior neck, right of incision; mid-upper back 8 4
“Deep ache” left arm 4 2
Day 13 Posterior neck, right of incision; mid-upper back 8 0, “incision itches”
Left shoulder and upper arm 6-7 2-3
Low Back/Sciatica 4-5 2
Day 14 Posterior neck, right of incision; mid-upper back 9, “sharp, shooting” 1, “itches”
Left shoulder 3 3
Low Back/Sciatica 3 3
Day 17 Posterior neck, right of incision 7 4
Left shoulder 4 3
Day 18 Posterior neck, right of incision 8, “shooting” 3
Left shoulder 4-5 3
Low Back/Sciatica 3 1
Day 19 Posterior neck, right of incision; mid-upper back 6-7 2-3
Left shoulder and upper arm 5, “aching” 2
Day 20 Posterior neck, right of incision 6 0
Left shoulder 3 2
Low Back/Sciatica 3 0
Day 21 Posterior neck 6-7 2
Left Shoulder 2 2
Day 24 Posterior neck, mid-upper back 4-5 3
Day 25 Posterior neck, mid-upper back 5 2
Table 3.
Heart Rate (bpm) and Respiratory Rate (breaths/min) Pre and Post Intervention
Days Post- PRE POST
Operative HR / RR HR / RR
Day 12 87 / 17 76 / 15
Day 13 91 / 18 80 / 14
Day 14 84 / 15 77 / 14
Day 17 Vitals not obtained Vitals not obtained
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Day 18 86 / 16 78 / 13
Day 19 89 / 16 79 / 14
Day 20 Vitals not obtained Vitals not obtained
Day 21 Vitals not obtained Vitals not obtained
Day 24 85 / 14 73 / 12
Day 25 88 / 17 75 / 12
Table 4.
Patient’s Subjective Report Pre and Post Intervention
Days Post- PRE POST
Operative Subjective Report Subjective Report
Day 12 “When is this conference we are having? I cannot “I feel sleepy.”
go home. If I go home this surgery will have been
pointless. I will never be able to take care of
myself.”
Day 13 “The curve in my neck has never been right, “I feel relaxed. Seems like I’m breathing
which is why I have so much pain. Do you see my deeper.”
collarbone? The right one is bigger. Maybe that’s
why my neck hurts so bad.”
Day 14 “I will never be able to work again. My boss is “That seems to be very relaxing. I feel
going to fire me at the first opportunity.” calm.”
Day 17 No subjective report No subjective report
Day 18 “I think I have fibromyalgia. I can’t go home.” “I could take a nap right now.”
Day 19 “My grandson plays baseball. We won’t be able “I felt my eyelids getting heavier.”
to play together ever again.”
Day 20 “I never sleep anymore. My mind is always “My shoulders still hurt.”
racing.”
Day 21 “I’ll never be able to take care of myself. I’ll never “My pain is less. I’m scared it’s going to go
be able to work again.” up when I move.”
Day 24 No subjective report “My shoulders feel the same.”
Day 25 No subjective report “I’m not in as much pain when I’m more
relaxed.”
Discussion
The purpose of this case report is to describe the use of Acupressure Tapping in managing pain
behaviors following a cervical surgical procedure. This case report has shown how Acupressure Tapping, a
manual Attractor Field Technique, performed by a physical therapist was used in conjunction with traditional
physical therapy in the rehabilitation of a 65-year-old male status post a C3-C6 laminoplasty and a C7
laminectomy with complaints of significant cervical, bilateral shoulders, upper arms, low back, and sciatic pain.
The patient completed the intervention along with traditional physical therapy with no complications and was
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educated and instructed in how to perform the tapping intervention on himself for long-term management of
his symptoms.
This case suggests that it is possible for patients with post-operative pain and anxiety behaviors to
benefit from Acupressure Tapping, however, we are unable to determine the efficacy of this intervention due
to multiple confounding variables. The patient’s symptoms could have improved due to his medical condition
improving as a result of progressing through the stages of healing. Also, the patient requested a high dosage
of narcotics every four hours, used cryotherapy every four to six hours, and requested electrical stimulation or
pulsed diathermy as needed during physical and occupational therapy. It is important to acknowledge that the
intervention provided temporary pain relief and the patient’s pain intensity generally increased upon rising
from supine to sitting and with activity, therefore, the long-term effects of this intervention are unknown.
While the mechanism of action of this intervention is theoretical, it is possible that Acupressure
Tapping assisted in the down regulation of the patient’s central nervous system, impacting his pain perception.
There is no literature to support the use of Acupressure Tapping in managing acute post-operative cervical
pain and anxiety behaviors. Future randomized clinical trials are required to determine the efficacy of this
intervention in managing post-operative pain, as no literature exists to support the use of this manual
technique in the physical therapy setting.
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Appendix A. Figure 1.
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Appendix A. Figure 2.
Fear Formula
Cervical Nerve Root Irritation Formula
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Description:therapy visit and re-assessment was performed on a daily basis therapy visit, an ordinal self-report rating scale (Visual Analog Scale) was used to
