Volume 7, Number 4 | Winter 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (6) – Orthopedic
Disorders C Sports

Toshikazu Miyamoto
Professor,

Graduate School of Comprehensive Human Sciences,

University of Tsukuba

In our current society, the border between healthand disease is often unclear. Health care and its
focus now must aim to cure disease and include
promotion of life style choices that improve qualityof life and increase life expectancy, early detection of
disease and early treatment. In the field of sports
and athletic performance as well, beyond theofsportsinjuries,

treatmentforprevention of injuries or for physical disabilities andconditioning, health maintenance and athletic
performance have become important themes.
Oriental Medicine has characterized itself byaiming to “treat the unseen disease”, that is treating
the tendency to develop disease (root causes) before
the disease has a chance to disrupt essential
physiologicalopinions about Complementary and Alternative
Medicine (CAM); subjects were 309 University of
Hawaii athletes. Results showed that more than 46%
of respondents had received some form of alternative
or complimentary (CAM) treatment within theprevious 12 months, a percentage greater than thegeneral population. Contents of the CAM treatments

1. Introduction

treatment

acupuncture. Nichols et al 3) conducted a survey onprocesses

likeimmunefunction,

respiratory capacity, circulation, digestive processes
etc. In short, Acupuncture treatment starts withinformation about the athletes physical conditionand practice environment/routines and aims toestimate and repair impediments due to past
injuries, help prevent new injuries, fatigue and poor
performance due to over use by teaching the athlete
to maintain their optimally healthy condition.
Akimoto et al1) reported the results of questionnaires
regarding Acupuncture treatment answered byuniversity athletes (577 subjects). The percentage of
respondents who had experienced Acupuncture
treatment was 51.3%. The researchers also reported
that higher level athletes tended to have had moreexperience with acupuncture. Miyamoto et al2),queried 195 athletes (141 men, 54 women) from
Ibaraki prefecture, attending a national sports
event; 31.3% of these athletes had experienced

included 38% massage, 29% chiropractic, 14%
LomiLomi massage (unique to Hawaii) and 12%
acupuncture. Compared to earlier research, Sports
athletes who had tried acupuncture were moreprevalent than in the average population and as theathlete’s level of performance increased, the rate ofexperience with acupuncture increased as well.
Historic references for sports athletes receiving
acupuncture reach back to Homma’s research in1949 and include 6editions of “Ido no Nihon” Journal
as well as numerous international and domestic
reports4). Concerning acupuncture sports medicine,
Homma discussed 1) treatment prior to competition
to improve endurance, maximum strength andpower, dexterity and resistance to impact, 2)
methods for measuring fatigue related to sports andtreatment

methods

for

rapid

recovery,3)

Acupuncture and moxibustion for sports injuries anddysfunction,

4)

sportsmedicine

used

with

acupuncture and moxibustion treatment. Following
Homma’scontributions

toacupuncture

sportsmedicine, research until the mid-1980’s focused
mainly on case studies reported here and there.
In 1990, Miyamoto presented a series of 4 papers
on acupuncture and Physical Therapy for sports
injury5). The topics include research on acupuncture
treatment for sports and exercise, the current
situation of acupuncture treatment for sports
injuries and dysfunction and acupuncture treatment
for muscle fatigue as it relates to sports andmovement. Palham’s 2001 review article introduced
the study of acupuncture treatment on muscle
strength, cardio (aerobic) training, flexibility andsports performance, re-asserting the need for

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

3

Volume 7, Number 4 | Winter 2012

systematic guidelines for acupuncture in the field ofSportssports medicine6).

randomized control trials using embedded needles toSince 1980, the number of papers published

Medicine

Acupuncture

andintroduce

treat sports related injuries.

within the area of sports and acupuncture treatment
in major medical university journals (MEDICINA)(Number of articles)(keywords:

electro-acupuncture,600

embedded needles x sports injuries) has been

500

acupuncture,steadily increasing: 98 reports between 1980-89, 328
reports between 1990-99, 969 reports between 2000-(n=725)

PubMedIgaku Chuo Zasshi (n=1,395)

400

09 (See Figure 4). However, among the 1,395 papers

300

reviewed, most were transcribed minutes from200

meetings and only 332 were original papers.

100

Keywords from these research papers included 1)

0

Acupuncture x Sports (175) 2) Acupuncture x muscle

1980 ～84

1980 ～84

1980 ～84

1980 ～84 1980 ～84 1980 ～84(Year)

fatigue (47) 3) Acupuncture x muscle endurance (1)4) Acupuncture x delayed onset muscle soreness

Figure 4: Number of Published Articles
on Acupuncture for Sports Medicine(DOMS) (10) 5) Acupuncture x Sports injury/
dysfunction (88) 6) Acupuncture x Conditioning (5).
Similarly, of the Sports related acupuncture

2. Clinical Studies Abroad

articles published Internationally in Pub Med

Kleihenzet al.8), performed double blind RCTs on

between 1980 and 2009,there was a similar and52 sports athletes with shoulder tendinitis tomarkedinvestigate the efficacy of Acupuncture treatment.

upwardacupuncturex

trend:
sports(keywords

injury,DOMS,

included:
muscleThe

subjects

weredividedintotwogroups:endurance, muscle fatigue, movement, motion,acupuncture that penetrates the skin layer or shamexercise) between 1980-89, 59 reports, between

acupuncture that does not penetrate the skin layer

1990-99, 140 reports, between 2000-09, 526 reports

completely. The results showed 1)(See Figure 4). The frequency of relevant keywords

acupuncture group pain, function, ROM, muscle

was as follows: acupuncture x sports injury (17strength (as measured by the Constant-Mureley-reports),

reports),score all improved significantly more than the shamacupuncture x muscle endurance (12 reports),

acupuncture group 2) three months following theacupuncture x fatigue muscle (12 reports).

treatment

acupuncture

x

DOMS

(4

sessionsa

tracking

for thequestionnaire

Clearly, despite the overall increase in therevealed that, although at the time the sessions were

number of the internationally and domesticallycomplete there had been no distinction between

published papers, there is a distinctly small number

groups, the sham group reported distinctly differentof original reports from Japan in Japanese.

effects compared to the acupuncture group. Within

Concerning the field of acupuncture research forthe body of research using Acupuncture treatment

sports medicine, of particular interest is the 2010

forissued report on Clinical Sports Medicine, “Special

represents the highest quality research.

Report:forthe

Effectiveness

relatedinjuries,

thisinvestigationofBelow are the research results from Brattberget

Acupuncture Treatment for Sports Medicine”7).

al.9), they compared the effects of steroid injections

Within the field of Sports injury and dysfunction, thewith acupuncture treatment for tennis elbow. Theirresearchers present a picture of current trends infinding are as follows1) Compared to the control

4

Evidence

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

Volume 7, Number 4 | Winter 2012group, the acupuncture group reported significantly

recovery

protocols,

acupuncture

providedmore relief from pain. 2) Seventy percent of thesignificantly greater pain relief but also that,

acupuncture group had received steroid injections incompared to the other test groups, pressure pain was

the past, but had experienced little relief as a result.

not significantly improved in the acupuncture group.

3) Several subjects in the steroid injection groupexperienced a worsening of symptoms, but no such

3. Current Progress and Developments in Japanese

negative result or side effects of the treatment were

Clinical Researchexperienced by the acupuncture group. According to
the NIH and WHO, this research represents grounds

Effectiveness of Acupuncture for Sports Injuries
and Development

for establishing acupuncture as the treatment for

Takazawa et al.15) of the Japan Gymnastics

choice for Tennis Elbow. Further, Trinh et al.

Society presented Sports Medicine Research data on

conducted a systematic review of Acupuncture forthe percentages of athletes with specific injuries who

Tennis Elbow and Epicondylitis. However, many ofhad

the subjects for the study developed tennis elbow

conditions: of the 226 athletes with low back pain,from activities other than tennis. Concerning

13.3%, of the 97 athletes with Spondylolysis 6.2%,

domestic Japanese research, clinical studies ofand of the 140 athletes with disc herniation 15.0％

Tennis Elbow are not uncommon but comparative

were reported to have tried acupuncture. Further, it

studies examining the relative effectiveness of

was reported that at the Tsukuba University Sports

acupuncture have not yet been researched.

Medicine Hospital, low back pain was the mostZhang et al. 10) investigated previous cases ofankle joint sprains treated with acupuncture, andused

acupuncture

treatment

for

their

commonly treated complaint, 40% of all patients
receiving acupuncture.

found tension in the Peroneus and Tibialis Anterior

Miyamoto et al.15) investigated 163 university

muscles, local swelling, pain and feelings of anxiety

level athletes who sought acupuncture for theirwere all lessened.Hahm11) reported that in rats withspecificankle sprains, electro-acupuncture of 2 Hz frequency

compared to the first treatment, following the last

was effective for relieving pain and reducing edema

treatment

and 100Hz electro-acupuncture was effective for

improvements in their ability to practice for low backpain reduction alone. Park et al.12) found that

pain, disc herniation and Spondylolysis, but pain

electro-acupuncture stimulation of 2 Hz frequency

relief was felt most by those athletes complaining of

inhibited inflammation in injured ankle joints. Koo

low back pain and disc herniation. Izumi et al.16) also

et al.13) reported that a combination of 100Hz andcompared the results of 28 athletes following the

2Hz electro-acupuncture stimulation effectively

first and terminal treatment, reporting that training

increased the load bearing capacity in subjects withcondition, JOA score (Japan Orthopedic Society ofsprained ankles.

low back pain Treatment Performance Criteria)

injuries.

Theirathletes

results
reportedshowedthat,significant

Virchota et al.14) divided 48 athletes with plantar

significantly increased but the levels of pain andfasciitis into three groups; acupuncture, shamespecially pain while moving the torso and trunk did

acupuncture and general injury recovery treatments

not improve significantly.

includingstretching,icing,

aspirin-likepain

Ito et al 17) investigated 8 athletes with chronic

relievers and practice restrictions and then assessedlowdegreeacupuncture but had not achieved significantofsatisfaction.

pain,pressure

Researchpain

results

andtraining

showed

back

pain

who

had

been

treated

with

that,

improvement. Treatments were continued for 2

compared to sham acupuncture and general injury

weeks, 9 points on the lower limb were needled until

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

5

Volume 7, Number 4 | Winter 2012

the third session, thereafter, sessions included

research protocol is extremely complicated. However,retention needling at known trigger points for 10

because embedded needles are 1) depending on theminutes. Following the trigger point treatment, astimulation, usually painless so subjects unfamiliar

VAS score was obtained and reported to verify

with acupuncture are more easily “blinded” 2) can be

improvements in experienced pain. The authors

inserted with or without a needle tip so practitioners

reported positive changes in VAS scores but nocan be instructed to insert the needles withoutchanges in JOA scores.

examining the needle tip and to then fix them in the

Miyamoto et al 18) interviewed and investigateddesired location with tape, thereby “blinding” both

43 subjects with pulled hamstrings. These subjects

the subject and the practitioner. For these reasons,received electro-acupuncture treatments for 1-2

embedded needles are very useful for double blind

weeks with an average number of 7.6 treatments and,clinical acupuncture studies in general and, as willcompared to the first treatment, following the final

be discussed below, for sports athletes in particular.

treatment,

significant

Miyamoto et al.21) investigated the effectiveness ofimprovements in levels of pain and training

embedded needles for muscle pain and tension in

condition.

marathon runners using a randomized double blindthesubjects

reported

Yoshida et al. 19) investigated the efficacy of

protocol utilizing placebo needles as the control.

electro-acupuncture stimulation on rats with pulled

Subjects were 15 university students participatingmuscles (injured for the study). Compared with only

in a full marathon for the first time. Data andthe eccentric contraction group, researchers reported

materials were collected and analyzed by individuals

improvement of muscle tension and pain thresholds.

not involved in the needling or the marathon.

Further, Yoshida et al.20)treated model mice with

Subjects were divided into two groups, the firstmuscle injuries to investigate the effect of electro-

group included 8 athletes needled with regularacupuncture on degree and rate of recovery andembedded needles, and the second group included 7

found that, compared to the control group, theathletes needled with well-disguised “placebo”

electro acupuncture accelerated recovery rates.

embedded needles.

Overall, there are few high level evidence based

The embedded needles or the placebo devices

clinical research projects in Japan. However, awere placed bi-laterally on 8 acu-points on the lower

majority of these reports indicated that, regardlesslegs before the start of the scheduled race andof where the injured area is located, acupuncture

removed 5 days later. Data was recorded prior to thetreatments help reduce pain and improve athletic

race and 5 days following the race. Measurements

training condition during treatment. Unfortunately,

included VAS for muscle pain, creatine kinase (CK),

there are almost no double blind comparative tests

lactate dehydrogenase isozyme (LDH), trunk flexion

in the literature. However, within Japan, along withand muscle tension. The results of the research

an increase in clinical research, the response

findings

mechanism of acupuncture using animals for

significantly reduced following the marathon forexperiments is advancing.

those athletes with embedded needles (p>0.01) 2)

are

as

follows:1)

Musclepain

was

CK, LDH isozyme, LDH 4, LDH5 were allb Randomized control trials on Athletes and Sports

significantly elevated following the race (p>0.01) so

Medicine

it was concluded that embedded needles were

The difficulty regarding acupuncture research isineffective in moderating these cellular products. 3)

that, unlike pharmaceutical research, “blinding”

There was no change in trunk flexion between theboth the subjects and the practitioner from thetwo subject groups. 4) Increased muscle tension was

6

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

Volume 7, Number 4 | Winter 2012

andFrom Miyamoto and Kaneko’s research, we have

VastusMedialis muscles (p>0.05) indicating that thetwo comparative research studies demonstratingembedded needles were ineffective in reducingthat embedded needles and carefully crafted tip-lessmuscle tension. 5) Runners with embedded needles

placebo needles can be used to effectively blind thetended to have shorter race times. 6) Athletes were

subjects and the practitioners to the researchunable to determine if they had been needled with

protocol, as evidenced by the inability of the subjects

true needles or the control needles. Based on theseand practitioners to accurately determine which

results, it was concluded that embedded needles

needles had been used. Further, embedded needles

slightly reduced muscle pain following a marathon.

clearly reduced the muscle pain that commonly

observed

in

both

the

VastusLateralis

follows longer strenuous sporting events such as
Kaneko et al.22) investigated whether Triathletes

marathons and triathlons.

experienced less post-race pain following treatment
with embedded needles compared to placebo type

4. Summary

embedded needles. One hundred forty-nine male andWithin the field of acupuncture research forfemale triathletes were recruited and divided into

sports medicine and injuries, there has been a recent

two groups; the embedded needle group had 79

trend toward increased domestic and international

subjects and the placebo needle group had 70. The

research, however there are still few high level

placebo needle was the same item used by Miyamoto

evidence based reports available. The difficulties

et al. discussed above. Both groups were needledassociated with acupuncture treatment during

using the same points, bi-laterally: UB23, UB24,

clinical trials include1) the ethical difficulty of

UB25 and UB32. Needles were placed just before therequesting that serious athletes performing daily

start and removed as the athletes finished. Data wastraining programs participate in comparative trials

collected using a VAS score for 6 muscles in the lower

where the placebo control may offer no particularlimb before and after the race, as well as the day

benefit to them, 2) the reality that an integral partfollowing the race. Results were reported as follows:of acupuncture treatment involves stimulation with1)

needles, it is often difficult to mask these sensations

For

both

significantly

groups,followingmuscle
the

pain

race

increased(p>0.01).

2)during clinical trials.

Excluding the Gluteal muscles, muscle pain for the

For these reasons, a good deal of creativity isembedded needle group decreased significantly thenecessary to develop effective research models thatday following the race compared to immediately

maintain the integrity of acupuncture methods andfollowing

Athletes

techniques but also meet the necessary criteria forreported feeling their condition had returned to pre-double-blind comparative studies. Despite theserace levels. 3) For the placebo group, on the day

challenges, Japan is endeavoring to expand its role

following the race, athletes reported less hamstringin basic research projects that include acupuncture

pain compared to immediately following the race

treatment for sports related conditions such as(p>0.05) 4) Athletes in both groups were unable topromoting early recovery of post-exercise muscle

determine if they had been needled with true needles

weakness and repair, preventing muscle atrophyor the control needles. From these results, theduring injury recovery and speeding muscle repair

researchers
inhibited

the(p>0.01,

suggestedthecharacteristic

race

delayedinexercise in athletes.

p>0.05).

thatembeddedneedlesand development. Compared to foreign countries’

onset

musclesorenessclinical research, Japan has been conducting

following

strenuous

advanced research on fundamental areas of sports

athletes

medicine. However, none of these have been

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

7

Volume 7, Number 4 | Winter 2012published in English Journals, so from now there

Referencesmust be more active transmission of Japanese

1)

Takayuki Akimoto, Toshikazu Miyamoto, Ichiroreports abroad. There is a summary of these results

Kawano: Actual condition of Acupuncture

in Table 5.

Treatment for University Sports Athletes.
Clinical Sports Medicine 15(1): 87-93, 1998

Table 5: Summary of Acupuncture Treatment forSports Performance and Injuries

2) Miyamoto T, Kobayashi T, Meguriya S, et al.:The Actual Condition of acupuncture for1

Year by year we have seen an increase in Acupuncture

Athletes Entered the National Athletic Meet at

research for Sports Medicine, but advanced reports arelbaraki Prefecture. PROCEEDING FISU /still relatively uncommon.

2

CESU Conference The 18th universiade 1995

Concerning the topic of Sports Injury, compared to the

Fukuoka, 316─ 317, 1995

few available foreign research studies, Japanese3

research maintains higher quality methodology.

3) Nichols AW, Harrigan R: Complementary andDomestic (Japanese) research projects often examine

alternative medicine usage by intercollegiatetheathletes. Clin J Sport Med 16(3): 232─237, 2006

treatment

of

low

back

pain

in

athletes.

Acupuncture has often been shown to reduce pain and4)

improve ADL and athletic performance.

4The

responsemechanism

behindof Sports and Acupuncture I. Ido no Nihon 8(7):acupuncture

treatment for sports injuries such as ankle sprains andpulled muscles have been reported in papers both

2-3, 19495)3) : 3-8, 1990

animal research.
Japanese randomized double-blind clinical trials haveToshikazu Miyamoto: Acupuncture Treatment
for Sports Injuries (1). Physical Therapy 20(2・abroad and in Japan using both clinical trials and5

Yoshihiro Homma: An Introduction to the study

6)

Pelham TW, Holt LE, Stalker R : Acupuncture

been used to demonstrate the significant effectivenessin human performance. J Strength Cond Resof embedded needles in reducing post-exertion muscle

15(2): 266─271, 2001

pain for endurance sports such as marathons andtriathlons.

7)

Toshikazu Miyamoto, Akira Wada: Evidence for
Acupuncture Therapy in Sports Medicine.
Clinical Sports Medicine 27(6): 575-586, 2010

8)

Kleinhenz J, Streitberger K, Windeler J, et al :Randomized clinical trial comparing the effectsof acupuncture and a newly designed placebo
needle in rotator cuff tendinitis. Pain 83 : 235─
241, 1999

9)

Brattberg G: Acupuncture therapy for tennis
elbow. Pain 16 : 285─ 288, 1983

10) Zhang QG, Wang J, Gu KB, et al : Effects ofwrist ─ ankle acupuncture of functional statesof the vegetative nerve in the recruit. Zhongguo
Zhen Jiu 26(3): 203─204, 200611) Hahm TS: The effect of 2 Hz and 100 Hz
electrical stimulation of acupoint on ankle
sprain in rats. Journal of Korean Medical
Science 22 : 347─ 351, 2007

8

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

Volume 7, Number 4 | Winter 201212) Park IB, Ahn CB, Choi BT: Effects of20) Yukihiro, Yoshida, Tomoya Hayashi, T. Yanno:electroacupuncture with different frequencies

Effects

on the glycoconjugate alterations in articular

Muscles in in vivo Model Rats. Journal the

cartilage in the ankle joints of complete

Japanese Society of Balneology, Climatology

Freund’s adjuvant ─ injected rats. Am J Chin

and Physical Medicine 73(3): 177-190, 2010

Med 34(3): 417─426, 2006

ofElectro-AcupunctureforPulled21) Toshikazu Miyamoto, Atsushi Hamada, Akira

13) Koo ST, Park YI, Lim KS, et al.: Acupuncture

Wada et al.: Effectiveness of Embedded needles

analgesia in a new rat model of ankle sprain

for Post-Marathon Muscle Pain and Tension—

pain. Pain 99: 423─431, 2002

Investigation using Randomized Double-Blind

14) Virchota D, Belgrade M, Johnson R, et al : True
acupuncture

vs

sham

acupuncture

andconventional sports medicine therapy for

Trials. Japan Oriental Medicine Journal 54(5):939-944, 2003
22) Yasuhisa

Kaneko,Eiji

Furuya,Ayumi

plantar fasciitis. A controlled double ─ blind

Sakamoto: Effectiveness of Embedded Needles

study.

forInternational

JournalofClinicalAcupuncture 2(3): 247─253, 1991
Hosaka et al.: Limits and Responses to
TherapyforMusclePain—Placebo

Controlled Comparative Trial─. Journal of the15) Toshikazu Miyamoto, Ayumi Ishikawa, Riki
Acupuncture

Post-Triathlon

SportsNational

Japanese

Acupuncture

andMoxibustion Society 56(2): 58-165, 2006

Injuries:

Efficacy of Low Frequency Electro-Acupuncture
for Low back pain in University Sports Athletes.
Clinical Sports Medicine 17(9): 1073-1076, 2000
16) Shikegi Izumi, Toshikazu Miyamoto, Koboori
Takahiro, et al.: Low Frequency ElectroAcupuncture for Low back Pain, Training andConditioning, RDQ, JOA Score in Athletes: An
Investigation
Japaneseof

Efficacy.

National

JournalofAcupuncture

the
and

Moxibustion Society 58(5): 775-784, 200817) Kazunori Ito, Tomohiro Inoue, Yusuke Haneda
et al.: Trigger Point Acupuncture for Sports
Injury Induced Chronic Low back Pain: A
Survey Questionnaire for University Sports
AthletesontheEfficacyof

Acupuncture

Treatment. Journal of the National Japanese
Acupuncture and Moxibustion Society 55(2):142-149, 200518) Toshikazu Miyamoto, Kensuke Aoki, Sachiko
Ikemune et al.: Actual Condition of Acupuncture
Treatment for Athletes with Pulled Muscles. Ido
No Nihon 65(8): 44-48, 2006
19) Yoshida N : Muscle injury and acupuncture. Adv
Exerc Sports Physiol 15(4): 135─138, 2010

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

9