Volume 2, Number 3 | Fall 2007

Japanese Acupuncture - Current Research
Effects of Press Tack Needle in the Sports Field
Toshikazu Miyamoto
Doctoral Program in Sports Medicine,no pricking sensation. This paper will present
studies on PTN in the field of sports as well as
double blind randomized, controlled studies on
which the author would make comments.

Graduate School of Comprehensive Human Science,
University of Tsukuba

Introduction
In recent years, treatment with acupuncture for
sports injuries is drawing increasing attention. The
majority of sports injuries such as tennis elbow orbaseball shoulder are caused by repeatedmovements of a portion of the body during sports
activities. In these sports injuries caused by therepetition, acupuncture, moxibustion and massage
are applied in Japan. The first systematic literatureon acupuncture treatments in the field of sports waspublished in 1949 by Honma in the journal of“Ido-no Nihon”, which carried six articles in series.
The literature describes that acupuncture wasextensively applied, beyond the general notion ofacupuncture practice, to even enhancing athletic
performance and recovering from muscle fatigue, inaddition to the treatments of sports injuries. Since
the publication of the report, only case reports on
acupuncture treatments in the field of sports havebeen reported sporadically. It is only after 1980 thatstudies in this field have begun to be actively
undertaken.
Meanwhile, the press tack needle (PTN), often
called the thumbtack-type needle (empishin), which
was devised in Japan in around 1980, is like a small
0.5 – 1mm long thumbtack. The press tack needle isan acupuncture technique that the needle is stuckin the skin and attached to the site with a piece ofadhesive tape. The PTM is employed in the field ofsports since it does not cause pain while in use,making it possible for athletes to continue sports
activities with the needle in place. Since around1990 basic studies on PTN involving humansubjects have been carried out with the muscle
fatigue models to examine its effects on fatigue
dissipation. PTN has been used for double blind
clinical trials since around 2000 as it gives virtually

2Studies on PTN in the field of sports
Most studies on PTN in the field of sports focus
on the process of acute muscle fatigue recovery. The
experimental protocols were with indwelling PTN(1) to investigate muscle output by voluntarily
applying isometric exercise stress with themaximum muscle strength mainly to biceps muscle
of arm1-4), quadriceps muscle7), hamstrings5,6), andtriceps muscle of calf8,9); (2) to investigate the index
for the number of movements for the knees andelbows to be able to carry out isotonic exercise until
all-out muscular failure14,15); and (3) to observe an
decrease in the total work and the maximum muscle
strength by applying isokinetic exercise stressloading11,12,13).
The results of these studies are summarized asfollows:
1) The PTN showed the ability of suppressing the
reducing process of muscle output compared tonon-treated.
2) In comparison between non-treated and placebo,some cases showed differences in the maximum
muscle output but some cases did not.
3) PTN was effective when it was used 1cm lateral
to the spinous process of the vertebra where thecutaneous branches of the posterior branches ofthe spinal nerves that control muscles are
distributed, whereas almost no effects wereobserved when it was used on any otherdermatome areas.
4) A correlation between the levels of lactic acid andmuscle output were suggested. However, thePTN did not affect the level of lactic acid.
5) In regard to isokinetic exercise of knee joints,
PTN suppressed the declining rate of the total
work in extension movements, whereas nosuppression was observed in flexion movements
in many cases.
6) Buffering the blood lactic acid was accelerated
under low stress and high rotation.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 3 | Fall 2007

7) No influences on hemoglobin dynamics wereobserved.
These results showed that PTN was effective forsuppressing transient decreases in muscle strengthand muscle fatigue. The mechanisms, however, arenot known. Many of these studies have several
issues that (1) bias factors of the study subjects
might have caused influences on developing themodels of muscle fatigue, (2) the relationshipbetween subjective fatigue perceptions and themuscle strength was not examined, (3) theconnection with matters of biochemistry was not
examined, and (4) comparisons with otherinterventions than PTN were not made. Now theseissues have progressively been improved, leading to
the enhanced quality of studies.

practitioners who manipulate needles; and (2) theskin and muscles of the subjects are stimulated,which also makes it difficult to blind them.
Thus, double blind studies on acupuncture
treatments have focused on the effects of needlingdifferent points – meridian points and non-meridian
points and on the effects of shallow needling anddeep needling. These are comparisons of needlingpoints or needling depths and are not double blindin the strict sense. There are studies in which thesubjects were blinded under general anesthesia in
operation and also randomized studies in whichsham needles were used. However, practitioners inthe study system were not blind. In short, no clinicalstudies were conducted under the condition of which
both subjects and practitioners were unaware.

There are few studies in which comparisons weremade between PTN and other interventions. Izumi
et al.16) reported that for muscle fatigue of boxing
players, comparisons were made based on theM-Test (meridian test) between the results of PTN
and those of self-stretching performed with a ballfor stretching. The results indicate that PTN
improved the number of positive movements
assessed by the M-Test.

PTN is the acupuncture needle most suitable fordouble blind trials because (1) its needling does notgive pain, which allows blind testing of the subjects;and (2) practitioners are able to needle without
checking the presence of the needle tip and afterneedling, a plaster is affixed so that the needle
inserted cannot be viewed.

Randomized, clinical trial in the field of sports
Documents of such placebo, sham-controlled
studies as pointed out by “Acupuncture-NIH
Consensus Statement” in the sports field have been
published by Brattgerg et al.17) for tennis elbow, by
Julia Kleinhenz et al.18) for rotator cuff tendinitis,and by Vrehota et al.19) for plantar fasciitis. Thesestudies did not satisfy the criteria for double blind
and were invalid as double blind tests since bothtest subjects and practitioners were not “blind.”

In order to make double blind trails in the true
sense, Miyamaoto20) has developed placebo
acupuncture needles that have no needle tip, packed
in the package liked ones (Fig. 1). And he has
conducted
arandomized,double
blind,
placebo-controlled study to examine whether or not“acupuncture treatments have positive effects on
conditioning of long-distance athletes of track andfield” and reported investigation results. (The study
was subsidized by the scientific research fund of theMinistry of Education, Science, Sports, andCulture.)

Randomized, double blind method is used as aclinical study of the highest level of evidence.
Double blind is the technique to conduct a clinicaltest under the condition in which biases of thesubjects and practitioners are eliminated. Applying
the double blind method for acupuncture treatments
is difficult due to the reasons that (1) unlike
medication therapy, it is unfeasible to blind

Papers of randomized, clinical trials with thesubjects of athletes
Introduced hereunder are two representative
clinical studies on PTN in the field of sports inwhich placebo needles were used.
Miyamoto21) has conducted a randomized, double
blind study using placebo needles to investigate theeffects of PTN on muscle soreness and muscle

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 2, Number 3 | Fall 2007

stiffness that resulted from running a marathon
race.
The subjects were 15 university students who
were to experience a marathon for the first time.
They were randomly divided into two groups: thePTN group of 8 persons (6 male, 2 female) who were
not involved in the acupuncture practice,examination, and data analysis; and the placebogroup of 7 people (6 male, 1 female) who wereassigned to placebo having no needle that wasuniquely developed with the same package
appearance as the one for the PTN (Fig 1). Before
the marathon run either PTN or placebo was affixedaccording to the assignment list to the 8 acupointsof Zusanli (ST36), Sanyinjiao (SP6), Xuehai (SP10),and Liangqiu (ST34) on both legs. Needles wereremoved after 5 days. Measuring items were Visual
Analogue Scale（VAS）for muscle soreness, serum
CK activity, LDH isozyme, forward flexion from astanding position, and muscle hardness, andmeasurements were evaluated three times-before
the start of the run after the finish and 5 days after
the marathon run. The results showed following.
Press needle

1. The PTN reduced muscle soreness caused after
the marathon run (p<0.01) (Fig. 2). 2. Although thelevels of CK activity and LDH 4-5 isozyme increased
after reaching the goal line (p<0.01), no effects ofthe PTN were observed. 3. No differences in a
forward flexion from a standing position wereobserved in both groups. 4. The level of muscle
hardness increased in the vastus lateralis muscle
and vastus medialis muscle (p<0.05). However, noeffects of the PTN were observed. 5. The marathon
time of the PTN group was shorter. 6. The subjects
were not aware of the difference between the PTN
and placebo needle. It was reported from theseresults that the PTN was effective for relievingmuscle soreness after a marathon race.
Miyamoto et al. confirmed that their study wasvalid as a double blind study by means of directly
asking the practitioners and the subjects whether
they recognized that needles used for the subjects
had a tip or not and found that they did notunderstand the difference between the PTN andplacebo needle. Although there is an issue about thestudy that the number of the subjects is limited, thisPlacebo needle

is the first research to which the indexes were added
needleneedleplasterplaster

about muscles including muscle soreness, muscle
stiffness, muscle flexibility and CK activity.
Kaneko22) has investigated the effects of the PTN

plaster 12mm

plaster 12mm

on muscle soreness after a triathlon race in aplacebo-controlled study.

needle tip (length 0.7mm)

needle tip (length 0mm)

Ｆｉｇ. 1. Press needle and placebo needle

The subjects were 149 of males and females who
participated in a triathlon event. They wererandomly divided into two groups: a group of 79 (67male, 12 female) who were assigned to PTN and agroup of 70 (56 male, 14 female) who were assignedto placebo. The placebo needle used in the study was
the same as the one used by Miyamoto. Stimulus
sites for both groups were Shenshu (BL23), Qihashu(BL24), Dachangshu (BL25), and Ciliao (BL32) ofright and left sides with leaving the needles
indwelled only during the race. Measuring item was
VAS (visual analog scale) values for muscle soreness

4The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 3 | Fall 2007

in 6 regions of the lower extremity (anterior thigh,The study by Kaneko et al. is an excellent study

posterior thigh, anterior lower legs, posterior lower

that was properly designed as a randomized, doublelegs, lower back, and buttocks), and measurements

blind study with an adequate number of subjects

were made before the race (PRE) and immediatelyinvolved. Although variations with time for each

after the race (POST1) and on the following daygroup(POST2). The results showed the following (Table 1).

between the two groups were not made. Moreover,

Each VAS score was increased on POST1

muscle soreness was reviewed as DOMS (delayedcompared to that on PRE (p<0.01) for both groups.

onset muscle soreness). It is, however, not clear if

With PTM treatment, VAS score were decreased on

the soreness was the type of DOMS or not since it

POST2 compared to those on POST1 on except for

was more intense immediately after the race thanGluteus (p<0.01, p<0.05), and had recovered to theon the following day (next day) and the intensitycondition before the race. In the P group, VAS score ofwas not measured continually on the days following

the hamstrings was decreased on POST2 compared

the next day after the race.

werestatisticallytreated,comparisons

to that on POST1, while VAS score were significantly
higher than those on PRE for Quad, Hamstrings, andFrom the studies by Miyamoto and Kaneko,

Calves. It was reported that these results suggested

it is becoming clear that a placebo-controlled

suppression of delayed onset muscle soreness by thestudy using a needle without a tip packed in theuse of the PTN during the race.

same package as the one for PTN is suitable for

Table.1

a double blind study since both subjects andChanges of muscle pain(VAS）

practitioners are unaware of which needle ispress needle （N=79)

assigned to and that the PTN is able to relieve
muscle soreness caused by marathon run,

before start

after finish

af.1dayQuads

32.1±24.2

48.4±22.0 **36.0±24.9 ＃＃Hamstrings

32.2±23.6

47.0±20.6 **30.9±22.5 ＃＃Calves

25.8±18.940.4±23.5 **30.5±22.4 ＃＃Tibialis

32.7±23.1

49.0±24.2 **35.1±24.6 ＃＃Glutes

37.8±24.5

46.8±24.1 **37.5±24.2 ＃＃40.3±22.4 **＃＃lower back

31.4±22.6

32.8±22.4

triathlon

race,

orlongdistancerunning.

Sedative mechanism of the PTN, which has notbeen investigated, is a subject for futurestudies.
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