Okinaka Miyono, et al.. Japanese Acupuncture and Moxibustion; 2022; Vol.16(1): 13-20

Original Research

Questionnaire on Physical Complaints of High School Esports Players-Potential Targets for AcupunctureOKINAKA Miyono1,2), KANEKO Yasuhisa3), WADA Tsunehiko1,2)
1） Doctoral Program in Sports Medicine, Degree Programs in Comprehensive Human Sciences,
Graduate School of Comprehensive Human Sciences, University of Tsukuba2）Acupuncture and Physical Therapy Teacher Training School, University of Tsukuba3）Kuretake Gakuen Clinical Research Institute of Oriental Medicine
Abstract[Introduction] Electronic sports (esports) are growing rapidly worldwide. Players can win millions of dollars in large
competitions. They often spend more than 10 hours a day for practicing. there are reports of physical complaints incollegiate and professional players. Recently, esports competitions is being held for high school students with thegovernment support. It is required for young, high school players to receive proper care as early as possible if they
have any complaint due to hard practice for the competitions. We clarify whether high school esports players haveany physical complaint and take care of their physical condition.
[Materials and Methods] We contacted the teachers of high schools that participated in the tournament or advanced to
the finals of the 2020 Esports High School Championship. If the teacher of high school agreed with the purpose of thestudy, the teacher informed his students about the questionnaire recruitment. The students participated in the surveyof their own free will. Data was collected anonymously using an unpaid, self-report electronic questionnaire
distributed, upon agreement.
[Results] Responses were received from 43 players (40 males and 3 females) who played world-famous esports games(e.g., League of Legends, Fortnite). The daily practice time was between 1 and 10 hours (average: 4.5 ± 2.3 hours);
22 of the players practiced 7 days a week, 6 practiced for 6 days a week, and 9 practiced for 5 days a week. 79% (34participants) had one or more complaints about their eyes, shoulders, neck, lower back, right wrist, right arm, or feetor had headaches. In total, 81% (35 participants) performed self-care, such as stretching, self-massage, and warm up.
Some players had received massage or osteopathic therapy, but no player received medical care or acupuncture.
[Discussion] 80% of high school players had physical complaints such as eye , neck, sholders, low back, arms. These
are symptoms that have been treated with acupuncture, and acupuncture may be useful. Although acupuncture
treatment tends to be received mostly by middle-aged and elderly people, acupuncture is widespread among athletes
in some sports, and some high school athletes receive acupuncture treatment. The number of players in esports is
expected to increase in the future, especially among the younger generation. Acupuncture could be considered as amodality which alleviate the complaints of esports players.
Key words: electronic sports, high school players, questionnaire, physical complaints, acupuncture

I. Introduction
In Japan, the annual rate of acupuncture therapy, which
includes “those who are currently undergoing therapy"
and “those who are not currently undergoing therapy but
have had it within the past year," was approximately 7.5%in the fiscal year (FY) 2002 to FY2012 and declined after
FY2013 to 4.6% in FY2017 and 4.0% in FY2018,according to a report by Yano et al. (2020)1). Most people
who undergo acupuncture therapy are middle-aged orolder adults. By contrast, the number of young people

tends to be small2). Interestingly, some high school
athletes have sought acupuncture therapy3-5), and the rate
is higher among top players 3,4). In this study, we focusedon esports, where the number of younger players isincreasing.
Over the last 20 years, video games have evolved fromplaying alone at home to competing with others via theInternet. This is called electronic sports or esports. Many
esports tournaments have been established worldwide
with large amounts of prizes. For example, an American
teenager won USD 3 million (approximately JPY 300

Corresponding author: Okinaka Miyono, Doctoral Program in Sports Medicine, Degree Programs in Comprehensive Human
ciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
3-29-1 Otsuka, Bunkyo, Tokyo JPN

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Okinaka Miyono, et al.. Japanese Acupuncture and Moxibustion; 2022; Vol.16(1): 13-20

million) 6). In 2021, the global esports market was valued
at over USD 1.08 billion7). Thus, the number of esports
competitors is expected to increase continuously.
In Japan, esports became popular since 2018. Esports
was listed as a new activity in the 2020 proposal“Evidence-based sports for diverse humankind’8). The
Ministry of Economy, Trade, and Industry (METI) and
Ministry of Education, Culture, Sports, Science, andTechnology (MEXT) have started supporting esports. An
esports tournament for high school students is held
annually with the support of MEXT. The 2020 Esports
High School Championship included participants from1,779 schools. There has been a movement to incorporate
esports into official school activities. Some schools
already have esports classes and esports clubs, whereas
others offer esports as part of science or computer clubs.
Undoubtedly, the number of high-school-aged esports
players is increasing.
Esports includes various games, and esports players
often manipulate their characters in the game using amouse and keyboard. In one game, esports players
collaborate with their team members to destroy the
opponent's home base, while in another game, they battle
to survive, and the last one standing wins.
Although esports are popular, there are also concerns
regarding the physical and psychological effects that they
may have on players. Esports requires only a few dynamic
physical movements, mostly in a sitting posture. Thesemainly involve extremely frequent repetitive finemovements of the fingers9).
Elite players require considerable practice to acquire
high-level skills. Takakura et al.10) reported that their
medical staff provided acupuncture to 12 Japanese
professional male esports players; in the study, esports
players were training for 10-16 h each day, and the authors
treated them with acupuncture, totaling 99 treatments that
addressed 358 complaints, including shoulder pain, neckpain, low back pain, arm/wrist pain, upper back pain,
lower leg and/or foot pain, and eye fatigue. Acupuncture
may be helpful for high school esports players with such
symptoms.
It is unknown whether esports affect the physicalcondition of high-school-aged players. Unlike adulthood,the growth period comprises a period of substantial
biomechanical growth, which affects the bones, muscles,
ligaments, and cartilage. Hence, improper loading may
impede healthy growth and affect subsequent quality oflife11).
If the players experience any discomfort or have any
complaints following exertion during competitions, theymust receive proper care to protect their health. In thisstudy, we surveyed high-school-aged esports players toinvestigate their esports situation, physical complaints,
and care routines.

II. Materials and Methods
The study protocol was approved by the University ofTsukuba Human Ethics Committee (East 2020-71, East
2020-83). In this study, the participants were high school
students (range: 15-18 years old). The questionnaire did
not contain any emotionally distressed items. We
contacted the teachers of high schools that participated in
the 2020 Esports High School Championship. If the highschool teacher agreed with the purpose of the study, theteacher provided his/her students with the study’s details,
including the questionnaire. The students were free tochoose whether to participate in the survey. The survey
was conducted from November to December 2020.
Data were collected anonymously using an unpaid selfreport electronic questionnaire that was distributed upon
agreement. The first page of the survey described the
purpose of the study and stated that the responses would
be anonymous, and that by sending the completed survey,
the respondent agreed that the responses could be used in
the study.
The questionnaire items were created by the authors withreference to previous research12,13) (Appendix 1). The
survey included questions about age, sex, sleep time,
major games played, weekly play schedule, daily play
duration, physical complaints and sites, self-care methods
for physical condition, and medical consultation and/or
treatment.
The results were collected, and the means and standard
deviations were calculated. A logistic regression analysis
was conducted as a sub-analysis to examine therelationship between the incidence of complaints andsleep or play duration. The complaint sites werecategorized and tabulated as headache/eye fatigue,
neck/shoulder, upper extremity, lower back, and lower
extremity fatigue.
To compare the trends between players from highranking schools (high schools that advanced to the finals)
and general schools, Wilcoxon's rank sum test was used toconsider age, sleep time, and play duration in the twogroups, and a chi-square test was used to consider
complaints and care status.
Statistical analysis was performed using SPSS Statistics
version 27 (IBM, Armonk, NY, USA), and thesignificance level was set at p < 0.05.
III. Results
Using opportunistic sampling, we requested theparticipation of 13 schools. Five schools consented toparticipate, and we received responses from 43 highschool students (mean age =16.2±1.0 years old,male:female 40:3).

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Okinaka Miyono, et al.. Japanese Acupuncture and Moxibustion; 2022; Vol.16(1): 13-20

Game
The students primarily played the League of Legends (25players), Fortnite (seven players), Rocket League (fourplayers), and other games (seven players).

Sleep durations varied from 5 h (seven players), 6 h (13players), 7 h (10 players), 8 h (eight players), 9 h (twoplayers), 10 h (one player), 11 h (one player), to indefinite(one player).

Play schedule
The mean play duration was 4.5±2.3 h/day and 5.8±1.7
days/week. The accumulated time spent on esports was
27.8±16.9 h/week. The play duration per day varied from1 h (three players), 2 h (five players), 3 h (seven players),
4 h (eight players), 5 h (seven players), 6 h (eight players),
7 h (one player), 8 h (one player), and 10 h (three players).
The most frequent duration was 4-6 h and the maximum
duration was 10 h.
The number of days devoted to esports per week was one(two players), two (two players), four (two players), five(nine players), six (six players), and seven days (22players). Half of the players played seven days a weekwith no breaks.
The cumulative duration spent on esports per week wasless than 10 h (eight players), 10-20 h (five players), 2030 h (15 players), 30-40 h (five players), 40-50 h (sixplayers), 50-60 h (one player), and 70 h (three players).

Physical complaints
The physical complaints by body parts are shown in
Figure 1.
Complaints (multiple answers permitted) included
headaches (9 players), eye fatigue (20 players), pain in theneck (17 players), shoulder (19 players), right arm (sixplayers), left arm (two players), right wrist (six players),
left wrist (one player), right thumb (two players), lower
back (13 players), and leg (three players).
The complaints were subsequently grouped as follows:
Headaches/eye strain (21 players), neck/shoulder pain (23players), upper limb pain (12 players), lower back pain (13players), and lower limb pain (three players).
The complaint sites were zero (nine players), one (nineplayers), two (14 players), three (nine players), and four
(two players). Overall, 34 players (79.0%) had at least one
complaint.

Sleep
Players reported sleeping before 0:00 (10 players), at
0:00 (14 players), 01:00 (nine players), 02:00 (eightplayers), or 03:00 (one player). One player responded thatthe bedtime was uncertain.

Figure.１

Sub-analysis of factors related to physical complaints
We analyzed the relationship between the occurrence ofeach complaint (one or more complaints: headaches/eye
fatigue, pain in the neck and shoulder, lower back, upper
limb, and lower limb) and sleep, duration of play per day,and number of days per week of esports. Neck andQuestionnaire results of Physical complaints by site of high school esports players(multiple answer:N=43)

Okinaka Miyono, et al.. Japanese Acupuncture and Moxibustion; 2022; Vol.16(1): 13-20

shoulder pain and sleep time (OR=2.3, CI: 1.0-5.3,
p=0.047) were the only significant associations.
We compared the high-ranking school players (n=21)
and general school players (n=20) and found that thefollowing factors were significantly different between thehigh-ranking and general schools: sleep duration 6.4±1.5
hours / 7.2±1.1 hours (p <0.05), daily esports duration
5.2±2.3 hours / 3.9±2.1 hours (no significant difference),
weekly esports duration 6.4±0.9 days / 5.2±2.0 days (p<0.05), and duration of play per week 34.1±17.2 hours /21.9±14.2 hours (p <0.05).
The complaint sites did not differ between players fromhigh-ranking schools and those from general schools. The
number of complaints was 19/15, headache 6/3, eye 10/10,
neck 6/10, shoulder 11/8, right arm 4/2, left arm 1/1, rightwrist 4/2, left wrist 0/1, right thumb 1/1, lower back 7/6,
and foot 2/1.
Self-care and medical treatments
Medical treatment and self-care are shown in Figure 2.
None of the players had attended any medical
consultations. Three players underwent Judo or massage
therapy. None of the patients had undergone acupuncture.
Thirty-three participants engaged in self-care routines toaddress complaints. The self-care routines consisted ofmultiple answers: stretching (22 players), self-massage(14 players), exercise (12 players), warm-up (nineplayers), cool-down (two players), and massage (twoplayers).

Figure.217

IV. Discussion
This survey targeted competitive high school-aged
esports players who engaged in school teams andtournaments.
Play schedule
The duration of play varied from to 21-30 hours a week
(15 players), 30-40 hours (five players), and 40-50 hours(six players). Three players engaged in esports for 70 h per
week. Research on general sports engagement among
middle and high school students (Kamada et al., 2016)14)
has shown that students spend an average of 16.9 hours
per week on extracurricular physical sports, and the top
5% spend more than 27 hours per week on these activities.
In 2018, the Sports Agency established guidelines forathletic activities and recommended15) that growing
middle and high-school students rest one or two days per
week and spend less than 16 hours per week in physicalsports. Although esports cannot be aptly compared tophysical sports, the duration of play among the esports
players in the current study was longer than that ofstudents who engaged in physical sports.
MEXT found that 47.0% of high school students go to
bed after midnight (12:00 a.m.) 16), but the percentage inthe present study was 74.4%. We did not investigate thetime of day or night when the players played esports, butthey tended to go to bed late. It has been reported that theaccess and use of media devices around bedtime weresignificantly associated with inadequate sleep quantity,

Questionnaire results of Self-care and Medical treatments by site of high school esports players(multiple answer:N=43)

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poor sleep quality, and excessive daytime sleepiness17).
Since esports participation can occur at any time
regardless of location (home or other venues), the playschedule may affect sleep.
Physical complaints
A survey of college students in the United States andCanada reported incidences of eye fatigue (55%), neckand back pain (42%), wrist pain (36%), and hand pain(32%)12). In a survey of Danish players, musculoskeletal
pain involving the back (31.3%), neck (11.3%), shoulders(11.3%), forearms (7.5%), wrists (6.3%), headache (3.7%),
and others were reported13). In this study, the players
reported headache/eye strain (48.8%), neck and shoulder
pain (53.5%), upper-limb pain (27.9%), lower-back pain
(30.2%), and lower-limb pain (7.0%). The results
demonstrated that high school-aged esports players
experienced physical complaints similar to thoseexperienced by sports players in previous studies.
Kamada et al. (2016)14) conducted a study on
musculoskeletal pain in 2,403 students (45.3%
participated in organized sports) from junior high and highschools in Shimane Prefecture. Students’ complaints wererelated to the neck (2.4%), lower back (8.5%), upper limbs(9.5%), and lower limbs (15.4%). A higher percentage ofthe students who participated in sports activities had lower
extremity symptoms. Compared to the general population,
esports players reported more upper-body complaints andfewer lower-extremity symptoms. This may be due toprolonged sitting and overuse of the hands in esports.
The characteristics of esports include: (i) “fast andsustained finger movement in a sitting position,” and (ii)“play until a late hour of the night,” (iii) “react to
unexpected actions from the opponent on screen.” Furuya
et al. (2006) 18) surveyed high school students majoring in
piano and found that 29 of 63 (46%) experienced hand or
finger pain. These data suggest that the frequent use of
fingers may cause physical symptoms, including pain.
Okinaka et al. (2021) 19) studied the effects of key-hitting
speed and static stretching, and noted that there werelimited data on the fingers. This aspect of competitive
esports should be examined in future studies.

Sub-analysis
We expected students who spent more time playing toexperience more complaints. However, the results did notindicate a relationship between these two factors.
Lindberg et al. (2020) 13) reported that esports players
who experienced symptoms took time off from playing,
which resulted in a shorter duration of play. From ourresults, it is unclear whether the complaints occurredbecause of the prolonged duration of play or if the durationof play was reduced because of the symptoms. It is also
unknown whether the duration of play was longer because

there were no physical complaints. In the future, a detailed
longitudinal study is warranted to clarify the relationshipbetween the occurrence of complaints and duration of play.
There was a difference in the amount of sleep and play
between the high-ranking schools and general schools, butthere was no difference in terms of physical complaints.
Esports competitions have a short history, and as they
develop into competitive sports, these results may not be
relevant.
The causal relationships and long-term effects of esports
are unknown. Therefore, further investigation is necessary.
Care for physical complaints among esports players
As with the collegiate esports players in a previous
study12), none of the high school-aged esports players in
the current study attended any medical consultation withorthopedics. However, 77% of players implemented atleast one self-care method. This finding suggests thatparticipants were highly interested in physical care.
However, it remains unknown whether self-care strategies
are effective, safe, or properly implemented. Healthcare
professionals, not only medical doctors, but also massage
and acupuncture therapists, should be engaged to assist
with the players’ self-care to implement appropriate
strategies.Professional-facilitated healthcare management
plans for the prevention of severe complaints or injuries
would also be useful.
Acupuncture and esports
Acupuncture therapy has long been used in conventional
sports to treat and prevent sports injuries and disabilities,
and to maintain conditions and fitness20). Acupuncture isalso recognized by high school athletes21).
Aoki et al.3) surveyed 952 track and field students. Of thestudents, 272 (32.7%) had undergone acupuncture
treatment. Furthermore, acupuncture was used more
frequently as the level of competition increased.
A survey by Hanaoka et al. (2013)5) indicated that 20(10.6%) of 189 high school swimmers underwent
acupuncture therapy. The primary purpose of treatment
was to assist swimmers with fatigue recovery andconditioning. In another study, Aoki et al. 4) conducted asurvey that indicated that 22 of 247 (8.9%) high school
wrestlers used acupuncture therapy.
Outside sports, Hasegawa et al.22) surveyed high school
brass band members and found that 45 members had
orthopedic complaints and 12 (7.5%) members attended
acupuncture and moxibustion/judo therapy clinics.
Symphonic band club members are similar to esports
players because both groups are less prone to trauma,
unlike sports. Furthermore, musicians and esports players
tend to practice for long hours to achieve various goals,
such as preparing for competition.
Although there may be differences depending on thenature of the competition and the environment, some highschool students utilize acupuncture treatment.

Okinaka Miyono, et al.. Japanese Acupuncture and Moxibustion; 2022; Vol.16(1): 13-20

The use of computer equipment tends to cause stiffshoulders by maintaining the same posture for a prolonged
time. This and the vicious cycle of poor posture due toexcessive tension in the neck and shoulders along with eyefatigue, may further aggravate the tension in neck andshoulders, causing stiffness23). Symptoms including stiffshoulders, lower back pain, eye strain, and headaches may
be improved by acupuncture24-27). Acupuncture therapy
was often used until now2, 28).
Takakura et al.10) reported that when acupuncture wasprovided to professional esports players, the players
experienced less pain and fatigue and felt more relaxed
after treatment.
Similar to traditional athletes, when symptoms arise due
to excessive practice, rest is the first-line therapy foresport players. However, to achieve success incompetitions or achieve their best performance record,
athletes and esports players may prioritize practice overrest. Thus, esports players may need coordinated care,similar to what athletes do.
Sports players, acupuncture schools and organizations,and schools for the blind have collaborated to promote theuse of acupuncture by providing support volunteers toassist in national sports competitions and high school
athletic activities29,30). Medical teams that support sports
players have also been proposed12). Currently,
acupuncture is not commonly utilized by high school-aged
sports players. In the future, acupuncturists may play animportant role in the healthcare of high-school esports
players.
Limitations
This survey was small and limited to players engaged inesports as high school activities. The style and duration ofplay differ greatly, depending on the characteristics ofeach game.
V. Conclusions
High-school-aged esports players experience eye fatigue,neck pain, shoulder pain, hip pain, and hand complaints.
They engage in esports for prolonged periods and tend tostay late into the night. None of the players in this study
used acupuncture therapy to address their physicalcomplaints. However, the symptoms they reported were
those for which acupuncture therapy was indicated.
Acupuncture may be considered as a potential modalitythat can assist in alleviating the physical complaints ofesports players.
Acknowledgments
We thank all the high school teachers and students fortheir participation in the study.
Conflict of interest
There is no conflict of interest.

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References
1) Yano T, Yasuno F, Fujii R, Nabeta T. Survey on
evaluation of recipients for Anma massage shiatsu
therapy and acupuncture and moxibustion therapy(Part 1). The Japanese Journal of Acupuncture &Manual Therapies. 2020;79(7):180-7. (in Japanese)
2) Kato R, Suzuki M, Fukuda F, Kato B, Itoh K, Ishizaki
N. A cross-sectional survey on utilization ofacupuncture and patient satisfaction in Japan. Journalof the Japan Society of Acupuncture and Moxibustion.
2017;67(4):297-306. (in Japanese)
3) Aoki K, Ikemune S, Matsubara Y, Mukai N,
Miyamoto T. A questionnaire survey on acupuncture
treatment of high school track and field athletes.
Eastern Medicine. 2013;29(1):49-55. (in Japanese)
4) Aoki K, Hanaoka Y, Hirose F, Miyamoto T. A
questionnaire survey on acupuncture treatment ofmale high school wrestlers. Eastern Medicine.
2013;29(1):41-7. (in Japanese)5) Hanaoka Y, Shimizu K, Sakuraba H, Sawazaki K,
Miyamoto T. Actual condition survey of acupuncture
and moxibustion among high school swimmers in Mie
prefecture, Japan. Eastern Medicine. 2013;29(2):2936. (in Japanese)6) Tidy J. US teenager wins $3m as Fortnite world
champion. BBC [Internet]. 2019 Jul 28 [cited 2021
Jun 17]; Available from:https://www.bbc.com/news/technology-49146644
7) eSports market revenue worldwide from 2019 to 2024
[Internet]. [cited 2021 Jun 17]. Available from:https://www.statista.com/statistics/490522/globalesports-market-revenue/
8) Science Council of Japan. Evidence Based Sports for
Diverse Humanity (EBS4DH). Science Council ofJapan. 2020. Available from:https://www.scj.go.jp/ja/info/kohyo/pdf/kohyo-24t290-5.pdf (in Japanese)9) Emara AK, Ng MK, Cruickshank JA, Kampert MW,
Piuzzi NS, Schaffer JL, et al. Gamer’s Health Guide:
Optimizing Performance, Recognizing Hazards, andPromoting Wellness in Esports. Curr Sports Med Rep.
2020 Dec;19(12):537-45.
10) Takakura N, Hiramatsu Y, Takanashi T, Takayama M,
Patil CL, Schlaeger JM, et al. Acupuncture for eSport
athletes. Acupuncture in Medicine. 2020;38(2):121-2.
11) Yamashita T. Children’s sports injury medical
handbook [in Japanese]. Tokyo: Chugai-Igakusha;
2020.
12) DiFrancisco-Donoghue J, Balentine J, Schmidt G,
Zwibel H. Managing the health of the eSport athlete:
an integrated health management model. BMJ OpenSport Exerc Med. 2019 Jan 10;5(1):e000467.
13) Lindberg L, Nielsen SB, Damgaard M, Sloth OR,
Rathleff MS, Straszek CL. Musculoskeletal pain iscommon in competitive gaming: a cross-sectional

20

Okinaka Miyono, et al.. Japanese Acupuncture and Moxibustion; 2022; Vol.16(1): 13-20

study among Danish esports athletes. BMJ Open Sport
Exerc Med. 2020 Aug 28;6(1):000799.
14) Kamada M, Abe T, Kitayuguchi J, Imamura F, Lee IM, Kadowaki M, et al. Dose-response relationshipbetween sports activity and musculoskeletal pain inadolescents. Pain. 2016 Jun;157(6):1339-45.
15) Japan Sports Agency. Comprehensive guidelines forthe state of athletic club activities Available from:https://www.mext.go.jp/sports/b_menu/shingi/013_in
dex/toushin/__icsFiles/afieldfile/2018/03/19/140262
4_1.pdf
16) Results of a survey on the relationship between
lifestyle-related lifestyles centered on sleep andchildren’s independence (Overview) . Ministry of
Education, Culture, Sports, Science and Technology.
[cited 2021 Aug 17]. Available from:https://www.mext.go.jp/a_menu/shougai/katei/__ics
Files/afieldfile/2015/04/30/1357460_01_1_1.pdf (inJapanese)17) Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar
MS. A meta-analysis of the effect of media devices on
sleep outcomes. JAMA Pediatr. 2016 Dec 1; 170(12):1202-8.
18) Furuya S, Nakahara H, Aoki T, Kinoshita H.
Prevalence and Causal Factors of Playing-Related
Musculoskeletal Disorders of the Upper Extremity
and Trunk among Japanese Pianists and Piano
Students. Med Probl Perform Art. 2006;21(3):112-7.
19) Okinaka M, Wada T. The efect of static stretching on
key hits and subjective fatigue in eSports. J Phys
Therapy Sci. 2021;33(12):891-7.
20) Kaneko Y. Current status and issues of sports
acupuncture and moxibustion, Exploring future
prospects Athletes’ conditioning and acupuncture
practice. Gendai shinkyu gaku. 2018;18(1):93-7. (inJapanese)21) Katayama K. Survey of acupuncture and moxibustion
treatment among high school athletes. Journal of
Kansai Clinical Sports Medicine and Science.
1995;5:33-5. (in Japanese)
22) Hasegawa M, Kawai H, Nishiwaki K, Mukai K,
Kitayama A, Mitani Y, et al. The outbreak situation of
the physical symptom in the musical instrument
exercise of the high school brass band club student About symptom properties by the performancemusical instrument distinction-. Annual Reports ofFaculty of Rehabilitation, Shijonawate Gakuen
University. 2010;(6):13-8. (in Japanese)23) Kikuchi T, Yamaguchi S, Igarashi H, Omata H,
Suzuki M, Araki N. The Efficacy of Acupuncture on
Tension Type Headache of Visual Display Terminal
Workers. Neurological Therapeutics. 2012; 29(6):753-60. (in Japanese)24) Tani M. Illustrations : Acupuncture and Moxibustion
Therapy Technical Guide Part 2 [stiff shoulders].

Tokyo: Bunkodo Co., Ltd.; 2012. 117-125 (inJapanese)25) Inoue M. Illustrations : Acupuncture and Moxibustion
Therapy Technical Guide Part 2 [Lower backpain/Lower back and leg pain]. Tokyo: Bunkodo Co.,
Ltd.; 2012. 105-116 (in Japanese)
26) Nishida A. Illustrations : Acupuncture andMoxibustion Therapy Technical Guide Part 2 [eyefatigue]. Tokyo: Bunkodo Co., Ltd.; 2012. 265-273(in Japanese)27) Yamaguchi S. Illustrations : Acupuncture andMoxibustion Therapy Technical Guide Part 2[headache]. Tokyo: Bunkodo Co., Ltd.; 2012. 365384 (in Japanese)28) Ishizaki N, Yano T, Kawakita K. Public status andprevalence of acupuncture in Japan. Evid BasedComplement Alternat Med. 2010 Dec;7(4):493-500.
29) Fukubayashi T, Miyamoto T. The practice of sports
acupuncture: the latest theory and practice.
Kanagawa: The Japanese Journal of Acupuncture &Manual Therapies; 2008. 12-25 . (in Japanese)30) Kondo H, Ikemune S, Izumi S, Kaneko Y, Sakuraba
H, Fujimoto H, et al. Introducing the Efforts of
Acupuncture and Moxibustion Committee of Sports Aiming for the Tokyo 2020 Olympic and Paralimpic
Games and further-. Journal of the Japan Society of
Acupuncture and Moxibustion. 2014;64(3):171-3. (inJapanese)