Orthopaedic complaints in kyudo: Tomizawa 1971 study

In 1971 four Japanese orthopaedic surgeons sent a questionnaire to 122 kyudo practitioners from the national federation, aged 18 to 78, mean age 43. About 75% reported at least one complaint. The sites, in order of frequency: shoulder 62 cases, lower back 59, hand and fingers 53, elbow 46, neck 44. Many named more than one at the same time.

The thirty with the most marked picture had a clinical examination and radiographs. At the shoulder, involved in roughly half the cases, there was pain at the glenoid tubercle in 9, at the coracoid process in 6, at the supraspinatus tendon in 3, joint crepitus in 3, restricted movement in 4, one case of deltoid atrophy and one of mild atrophy of supraspinatus and infraspinatus; the left side was slightly more affected than the right (4 to 3). At the elbow, pain at the lateral epicondyle, at the origin of the forearm extensors, dominates with 12 cases, then the medial epicondyle in 6, the olecranon in 6, the radio-ulnar joint in 2 and restricted movement in 4; here the right side is more affected than the left (3 to 2). At the neck, a third of all cases reported shoulder stiffness, with trapezius pain in 8. At the hand, almost everyone had a callus running from the inner side of the left thumb's metacarpophalangeal joint towards the space between the fingers. At the lower back, pain from overload of the erector muscles in 10 cases and pain with nerve root irritation in 5; no lumbar or cervical scoliosis.

Radiographs of the most severe cases show osteoarthritis and osteochondromatosis of the elbow (four cases), calcification of the supraspinatus tendon and a picture of shoulder periarthritis, with osteophytes and disc degeneration at cervical and lumbar level in the older athletes. Two findings about behaviour: only 25% did any warm-up or supplementary exercise, and only 25% had consulted a doctor.

The sample was drawn from members of the Japan Kyudo Federation, selected arbitrarily among university clubs and adult practitioners; the 122 who answered the orthopaedic questionnaire were analysed. From their answers, the thirty with the clearest complaints were selected and given a clinical examination, measurement of shoulder and elbow range of motion, and radiographs of the neck, shoulder, elbow and lumbar spine.

The paper documents three cases in full. A man of 77 with fifty years of kyudo, left shoulder range reduced to 70 degrees forward, 70 degrees out and 30 degrees back, right elbow between 150 and 34 degrees, positive Lasègue sign, sensory disturbance in the territory of the fourth and fifth lumbar roots and reduced Achilles and patellar reflexes; on radiographs, calcification of the supraspinatus tendon and osteochondromatosis of the right elbow. A man of 61 with forty years of practice, bilateral coracoid process pain and left elbow pain, atrophy of the interossei of the right hand with claw hand and ulnar nerve palsy. A man of 34 with twelve years of practice and an average of five to six hours of training a day, right elbow pain with osteochondromatosis and osteophytes of the coronoid process.

In the discussion the authors list what they believe favours these pictures: prolonged repetition of a single movement, scant warm-up and supplementary exercise, training with a tired body, and continued use of a bow too strong for the archer. They propose periodic check-ups from ten years of practice onwards.

The proportions apply to those who answered. The questionnaire was orthopaedic and said so: an archer in pain had one more reason to send it back, and the 75% reporting complaints should be read with that selection in mind. There is no comparison group without kyudo, and a mean age of 43 with cases up to 78 makes it impossible to separate the shooting action from the osteoarthritis that comes with the years: the most striking radiographs belong to a man of 77 and a man of 61.

Radiographs were taken only of the thirty with the most marked complaints, selected for exactly that reason, so how widespread those changes were among the 122 is unknown. Attributing them to kyudo is the authors' clinical judgement, not the result of a comparison. There is no measure of exposure, no shooting score, no breakdown between men and women, and the figures are given as counts out of 122 with no confidence intervals.

The context is 1971, with the equipment, the training volumes and the medical habits of the time, in a traditional discipline whose action differs from that of Olympic target archery. The four cases of elbow osteochondromatosis are few, and the mechanism the authors propose, chronic irritation of the synovial membrane, remains a hypothesis of 1971 resting on the literature of the day. The text is in Japanese, with an English abstract.

This is the oldest source in the registry on an archer's aches, and its value lies in the shape of the problem rather than in the percentages. Half a century ago, in a traditional discipline, the sites named most often were the ones that keep coming back in today's studies: the shoulder first, then the lower back, then the elbow and the hand. The hands say something precise: the callus on the left thumb, the one that holds the bow, was there in almost everybody.

For someone shooting today, the numbers do not transfer: kyudo has its own action, its own equipment and its own training volumes, and these are figures from people who answered a questionnaire about pain. What stays readable is the outline: most complaints were from overuse and grew with years of practice, a quarter of the sample did any warm-up and a quarter had seen a doctor. The authors were already saying that the problem is not the accident but the repetition, and that check-ups make sense once practice is measured in decades.