physiotherapy & exercise-based therapies) • There is a paucity of research for the optimal dosage of acupuncture treatment for treating shoulder, knee, neck and lower back pain • Studies comparing effective conservative treatments (including simple analgesics, physical therapy, exercise, heat & cold therapy) for (sub) acute and chronic nonspecific low back pain (LBP) have been largely inconclusive Lower back • The evidence for the use of acupuncture in (sub)acute LBP is inconclusive • There is limited evidence to support the use of acupuncture for pain relief in chronic LBP in the short term (up to 3 months) • The evidence is inconclusive for the use of acupuncture for long term (beyond 3 months) pain relief in chronic LBP • There is no evidence to recommend the use of acupuncture for lumbar disc herniation related radiculopathy (LDHR) Neck • There is good evidence that acupuncture is effective for short term pain relief in the treatment of chronic neck pain • There is moderate evidence that real acupuncture is more effective than sham acupuncture for the treatment of chronic neck pain • There is limited evidence that acupuncture has a long term effect on chronic neck pain Shoulder • There is good evidence from one pragmatic trial that acupuncture improves pain and mobility in chronic shoulder pain • There is limited evidence for the efficacy of acupuncture for frozen shoulder • There is contradictory evidence for the efficacy of acupuncture for subacromial impingement syndrome A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 2 Knee • There is no evidence to recommend the use of acupuncture for injury-related knee pain Ankle • There is no evidence to recommend the use of acupuncture for ankle pain A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 3 Background Acupuncture has roots in ancient Chinese philosophy. Traditional Chinese Medicine (TCM) acupuncture is based on a number of philosophical concepts, one of which is that any manifestation of pain/dysfunction is a sign of imbalance of energy flow within the body. It is in this context that the TCM acupuncturist uses a holistic treatment approach. TCM acupuncture involves inserting needles into traditional meridian points with the intention on influencing energy flow within that meridian1 . Acupuncture has been adopted into western medicine and treatments; many physicians currently practicing acupuncture reject such prescientific notions described above, using unnamed tender or trigger points to stimulate nerves or muscles1 . Further to this acupuncture is also now regularly practiced globally by a specialist sub-group of physiotherapists and some other health professionals. New Zealand physiotherapists have been practicing acupuncture since 19722 . As a technique acupuncture includes the invasive or non-invasive stimulation of specific anatomical locations by means of needles or other thermal, electrical, light, mechanical or manual methods3 . Acupuncture is most commonly used to treat chronic pain4 5 and is currently used for a variety of conditions, including; spinal cord injury6 , visceral dysfunction The other two studies compared 'traditional acupuncture' with suprascapular nerve block and acupuncture 'according to Jing Luo' respectively*6 , headaches4 , addictions6 emesis developing after surgery or chemotherapy in adults The other two studies compared 'traditional acupuncture' with suprascapular nerve block and acupuncture 'according to Jing Luo' respectively† , nausea associated with pregnancy6 and dental pain7 ; all of which fall outside the scope of this report. Acupuncture is also used to treat a number of musculoskeletal conditions, including shoulder6 , wrist, and lower back pain4 6 7 The other two studies compared 'traditional acupuncture' with suprascapular nerve block and acupuncture 'according to Jing Luo' respectively‡ , knee pain4 6, neck pain, tennis/golfers elbow and ankle pain6 . Modern acupuncture includes manual stimulation of needles that are inserted into the skin. Various adjuncts are often used including: electrical acupuncture (electrical stimulator connected to acupuncture needle), injection acupuncture (herbal extracts injected into acupuncture points), heat lamps, and moxibustion with acupuncture (the moxa herb, Artemesia vulgaris, is burned at the end of a needle). Dry needling is a technique used to treat myofascial pain in any part of the body8 , by definition trigger point dry needling (TDN) and Intramuscular manual therapy (IMT) are acupuncture techniques3 . Dry needling involves the insertion of a needle at specific trigger points, the needle being a solid acupuncture needle or a dry injection needle. 1. Methodology Comprehensive literature searching was carried out focused on the efficacy of acupuncture for spine, knee, shoulder and ankle pain. The databases accessed for the search were, Medline®, CINAHL, EMBASE, AMED, PsychINFO, PubMed and Medline-in-process and Google. These databases will capture most, if not all, of the more robust clinical studies that may have been reported in the TCM-specific databases. In addition, the databases used here are used routinely in evidence-based research for complementary and alternative medicines. Of note, the TCM-specific databases contain many case series studies and other study designs that would be excluded from this report. * see