Atlas›Domain X · Body, movement, breath & physical›Guide 057
Guide X-057

Japanese sekkotsu and jūdō seifuku

1920Japan
A 28 · L 60 · M 1214 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: jūdō seifuku (柔道整復) as defined by the Judo Therapist Act (柔道整復師法, Act No. 19 of 1970, as amended to Act No. 69 of 2014). The scope used here is the one set out by the Ministry of Health, Labour and Welfare (MHLW) and the Japan Judo Therapists Association (公益社団法人日本柔道整復師会, JJTA). It is written for a psychotherapist who refers clients to licensed practitioners. It is not a guide to delivering the method. All English renderings of Japanese text are the author's own translations and are marked "(own translation)".

What it is. Jūdō seifuku is Japan's nationally licensed form of bone-setting. It is known in everyday speech as honetsugi (ほねつぎ) or sekkotsu (接骨), and its clinics are called sekkotsu-in (接骨院) or seikotsu-in (整骨院). Under Article 2 of the Act, a jūdō seifuku-shi (柔道整復師, judo therapist) is a person licensed by the Minister of Health, Labour and Welfare who practises jūdō seifuku as a business. The licence follows a national examination (Art. 3). Under Article 15, only licensees and physicians may practise it as a business. [source: Judo Therapist Act via hourei.net]

Scope. The JJTA describes the practice as treating traumatic injuries of bones, joints, muscles, tendons and ligaments by "非観血的療法", non-surgical (literally "non-bloody") methods (own translation). Its main tools are reduction (整復) and immobilisation (固定), which support natural healing. The injuries covered are fractures, dislocations, contusions, sprains and strains. [source: JJTA presentation to MHLW council, 16 Nov 2020]

The legal limits are:

  • No surgery and no administering or directing drugs (Art. 16).
  • No treatment of a dislocated or fractured site without a physician's consent, except first aid (応急手当) (Art. 17). An MHLW briefing adds that this consent may be given verbally.
  • A duty of confidentiality that continues after practice ends (Art. 17-2).
  • Advertising limited to a list of permitted items. Even permitted advertisements may not describe skills, methods or career (Art. 24).

[source: Judo Therapist Act via hourei.net; MHLW 2016 briefing]

In its 2020 presentation to the MHLW council, the JJTA said that pelvic or spinal "correction" (骨盤矯正, 脊椎矯正), treatment of headache or cold-sensitivity, and plain massage fall outside jūdō seifuku. [source: JJTA 2020]

Roots. The JJTA traces the practice to bone-setting traditions linked to jūjutsu, including the resuscitation and healing techniques called kappō (活法). It says clinics were often built next to judo dojo, and that the practice gained official recognition in 1920. [source: JJTA 2020; JJTA English page] The legal instrument used in 1920 is described differently in different sources, and is left [uncertain: not verified].

Ebita (2012) argues that judo is important to how practitioners understand their professional identity. He also argues that the profession, unlike traditional bone-setting, does not prescribe drugs. [source: Ebita 2012, abstract]

How change happens, in its own terms. The injured structure is put back into alignment (reduction) and held still (fixation). Recovery is then supported by aftercare (後療法) using manual, exercise and physical-agent therapies, so that the body's own healing can work. [source: JJTA English page; Nippon Kogakuin syllabus 2024; 459.ac.jp clinic page]

Evidence status. No independent systematic review of jūdō seifuku outcomes was verified [uncertain: not verified]. Treat health claims beyond acute soft-tissue and bone-joint injury care as unestablished.

Scale. The JJTA's 2020 presentation reports 73,017 practising judo therapists and 50,077 clinics at the end of 2018. The JJTA has about 17,000 members, so most practitioners are not members. Training is at least three years at a prefecture-designated school, or four years at a university designated by the Ministry of Education (MEXT), followed by the national examination. [source: JJTA 2020]

The psychotherapist's role. Because Article 15 restricts the practice, a psychotherapist does not deliver jūdō seifuku. The role is:

  • understanding what the client is receiving and what it means to them, particularly for Japanese clients
  • referring appropriately and coordinating care
  • preparing trauma-affected clients for hands-on care
  • helping clients understand the insurance rules that affect them
  • recognising adverse effects and passing them on.

[synthesis]

2. Framework

This method has two parallel tracks: the clinical pathway the client follows at the clinic, and the psychotherapist's referral and integration track. Clinical session counts are not set by any manual. The figures below are published claim statistics, not recommendations.

A. The clinical pathway at a sekkotsu-in, as official and professional sources describe it

  1. Injury and presentation. Insurance covers acute or subacute traumatic injuries: fractures, dislocations, contusions, sprains and muscle tears (肉ばなれ). Conditions with an internal-medicine cause are excluded. Simple shoulder stiffness (肩こり) or muscle ache (筋肉痛) without injury is fully self-paid. [source: MHLW 2014 reference paper; MHLW 2016 briefing; Shimane Prefecture page]
  2. Assessment. Training includes palpation by body region and manual muscle testing. Students must learn to identify contraindications (禁忌事項) before applying techniques. [source: Nippon Kogakuin syllabus 2024] The structure of the intake interview is not described in the sources here [uncertain: not verified].
  3. First aid, reduction and fixation. Displaced bones or joints are realigned by hand and then held with tape, bandage or a metal splint. [source: JJTA English page; 459.ac.jp] For fractures and dislocations, physician consent is required beyond first aid (Art. 17).
  4. Aftercare (後療法). This combines manual therapy (手技療法: massage-type techniques and stretching), exercise therapy (運動療法) and physical-agent therapy (物理療法: for example ultrasound, electrical stimulation, heat, traction). [source: Nippon Kogakuin syllabus 2024; 459.ac.jp]
  5. Course and review. Published claim data for October 2014 show an average of 5.39 visits per month. About 90% of claims covered three months or less. Sprains and contusions make up most claims, and fractures, incomplete fractures and dislocations together are about 0.1%. [source: MHLW 2016 briefing] For contusions and sprains treated beyond three months, a written record of progress and the reason for frequent visits must be attached to the claim. Fees are reduced after five months, except for fractures. [source: MHLW 2014 reference paper]
  6. Billing. Patients usually pay only their co-payment, and the clinic bills the insurer directly under an arrangement called 受領委任 ("delegated receipt", own translation). This exception has existed since 1936. The general rule for these costs is that the patient pays in full and claims the money back (償還払い). The patient signs the claim form. [source: MHLW 2014; Shimane]

B. The psychotherapist's track [synthesis]

  1. Notice. Is there a body complaint, an injury, or an existing sekkotsu-in attendance?
  2. Screen for medical red flags and decide whether a physician comes first.
  3. Explore what the clinic means to the client.
  4. Refer or support the client's own choice.
  5. Prepare for touch, if relevant.
  6. Coordinate, with written consent.
  7. Integrate body experiences into therapy.
  8. Review benefit, harms, cost and insurance propriety.

Criteria for moving between steps:

  • Do not move from step 2 to step 4 until red flags are excluded or medically assessed.
  • Do not move from step 5 to attendance until the client can name how they will stop or pause touch.
  • Return to step 2 if symptoms change, worsen or persist.

3. Guiding principles

  • Stay within the law. Only licensees and physicians may practise jūdō seifuku as a business (Art. 15). In practice, the psychotherapist never performs reduction, fixation or aftercare manipulation, even if they have a martial-arts background. [source: Act]
  • Physicians come first for suspected fractures and dislocations. Outside first aid, the judo therapist needs a physician's consent (Art. 17). In practice, a suspected fracture goes to a physician; it does not become a reason to delay. [source: Act; MHLW 2016]
  • Know the scope. The covered conditions are acute or subacute traumatic injuries. Chronic stiffness, internal-medicine complaints and "correction" services fall outside insurance, and the JJTA places them outside jūdō seifuku. In practice, gently clarify what the client is getting and how it is paid for. [source: MHLW 2016; JJTA 2020; Shimane]
  • Manual treatments affect the body. The National Consumer Affairs Center of Japan (NCAC) says that manual quasi-medical practices "身体に影響を及ぼす", that is, they "affect the body" (own translation). In practice, take adverse effects seriously and do not dismiss them as "just tension". [source: NCAC 2012]
  • Check the licence. NCAC notes that most consumers cannot tell licensed from unlicensed practitioners. Seitai (整体) and chiropractic are not national licences in Japan. In practice, help the client confirm they are seeing a jūdō seifuku-shi when that is what they intend. [source: NCAC 2012; JJTA 2020]
  • Consent is ongoing. The USABP code requires informed consent before touch, periodic re-checking, and the client's right to refuse or end any touch at any time. The EABP asks that clients be told beforehand that physical techniques may be used. In practice, coach the client to give and withdraw consent at the clinic. [source: USABP Code; EABP 2020]
  • No sexual touch, ever. Every code consulted prohibits sexual contact with clients. The USABP adds that genital or other sexual touch is always inappropriate. In practice, any sexualised contact reported by a client is a safeguarding and reporting matter. [source: USABP; BACP; UKCP; APA; AAMFT]
  • Refer within competence. The UKCP, BPS, HCPC, AAMFT and BACP codes all require practising within competence and referring when appropriate. In practice, sekkotsu is a referral, not a technique the therapist adds. [source: codes as listed in Sources]
  • Avoid parallel-care confusion. The EABP asks the therapist to consider the implications when a client receives similar services elsewhere, and to discuss this with the client. In practice, clarify who does what and agree how information flows. [source: EABP 2020, 6.b]
  • Insurance propriety protects the client. Official sources document improper billing practices. Clients are asked to sign claim forms, and insurers may contact patients to check treatment dates. In practice, the client should sign only what is accurate and keep receipts. [source: MHLW 2016; MHLW 2018 reference paper]
  • Respect cultural meaning. Sekkotsu is familiar and judo-linked, and visiting is often a neighbourhood routine. In practice, ask about meaning before judging frequency or cost. [synthesis, informed by Ebita 2012 and JJTA]

4. Intervention inventory

Part A covers what the licensed jūdō seifuku-shi does. It is written so you can explain it to clients and prepare them, not so you can perform it. Article 15 of the Act restricts these procedures to licensees and physicians. Part B covers what the psychotherapist does. Example language is illustrative unless quoted. Japanese example phrasing is the author's own wording.

Part A. Clinic procedures (for referral and preparation)

A1. Reduction (整復, seifuku)

  • Purpose and when used: Restores a fractured bone or dislocated joint to alignment by hand, without surgery. [source: JJTA English page; JJTA 2020] Beyond first aid, the judo therapist may treat a fracture or dislocation only with a physician's consent. Published claim data show these cases are a very small share of clinic work. [source: Act Art. 17; MHLW 2016]
  • What the client experiences:
    1. The client's injured area is examined, including palpation. [source: syllabus 2024]
    2. The practitioner manipulates the part by hand to realign it.
    3. Fixation follows straight away (see A2).
    4. For anything beyond first aid, the client should expect a physician to be involved, usually through an X-ray and a consent decision. The X-ray step is [synthesis]: the sources here do not specify how consent is obtained.
  • Example language (illustrative): "If it might be broken or dislocated, a doctor needs to see it. The judo therapist is allowed to treat it only with a doctor's agreement, apart from first aid. Would you like to plan who you'll see first?" In Japanese (own wording): 「骨折や脱臼の可能性があるなら、まず医師に診てもらいましょう。」
  • Watch for:
    • Acute pain and a startle response during manipulation, especially in clients with trauma or medical-procedure fear.
    • A client being told that a fracture or dislocation was treated with no physician ever involved, beyond first aid.
    • Persistent deformity, numbness or loss of function afterwards.
    Any of these call for medical review. It is working when pain and function improve along the expected course and medical follow-up is in place. [synthesis]

A2. Fixation (固定, kotei)

  • Purpose and when used: Holds a reduced bone or an injured joint still so it can heal. Tape, bandage or a metal splint is used. Acute ankle or wrist sprains that need rest are typical. [source: JJTA English page; 459.ac.jp]
  • What the client experiences: The area is wrapped or splinted. The client is told how long to keep it on and when to return. The sources here do not give timings, and none are given here.
  • Example language (illustrative): "How did it feel to have that part strapped and held still? Some people feel relieved; others feel trapped."
  • Watch for:
    • Signs of restricted circulation, such as colour change, coldness, increasing numbness or rising pain under the strapping. These need prompt contact with the clinic or a physician. [synthesis]
    • For clients with restraint-related trauma, immobilisation can be activating, and this may be worth processing in therapy. [synthesis]

A3. Aftercare manual therapy (後療法: 手技療法)

  • Purpose and when used: The recovery phase after fixation. Massage-type techniques and stretching are adjusted to the injury and the state of the muscles, often for neck or lower-back sprains. [source: 459.ac.jp; syllabus 2024] Training covers manual work on the back, lumbar, gluteal, posterior thigh, lower-leg and foot regions. It includes identifying contraindications before treatment and building informed-consent skills by explaining procedures to patients. [source: Nippon Kogakuin syllabus 2024]
  • What the client experiences: Hands-on work, usually clothed or draped (the sources here do not describe the draping norm, so this is [uncertain: not verified]). The clinic page asks patients to tell the practitioner about pain during treatment. [source: 459.ac.jp]
  • Example language (illustrative): "The clinic actually asks patients to speak up about pain. What would make it easier for you to say something in the moment?"
  • Watch for:
    • Treatment drifting from injury aftercare into ongoing relaxation or "correction" visits without a new injury. This changes whether insurance applies (see B4).
    • Pain or neurological symptoms after neck or back work. In NCAC data, neck and lower-back harms were mostly nerve or spinal injuries. [source: NCAC 2012]
    • Any touch of the breasts, buttocks or groin that was not explained and agreed in advance.

A4. Exercise therapy and physical-agent therapy (運動療法, 物理療法)

  • Purpose and when used: Aftercare that restores movement and uses equipment such as ultrasound, electrical stimulation, heat and traction. [source: 459.ac.jp; syllabus 2024] No exercise doses, temperatures or durations are given here. Those belong to the treating practitioner.
  • What the client experiences: Guided movements at the clinic, and treatment on machines while lying or sitting.
  • Example language (illustrative): "What did they suggest you do between visits? How realistic does that feel, given everything else going on?"
  • Watch for:
    • Heat-related discomfort or burns.
    • Clients with implanted devices or reduced sensation who have not told the clinic. Raise device questions with the clinic or a physician. [synthesis]
    • Avoidance of prescribed movement driven by fear of pain. This can be addressed in therapy. [synthesis]

Part B. The psychotherapist's interventions [synthesis unless a source is tagged]

B1. Body-complaint and red-flag screening before suggesting sekkotsu

  • Purpose and when to use: Before suggesting or endorsing a sekkotsu-in visit, check that the problem is an injury within its scope and that a physician is not needed first.
  • Steps:
    1. Ask what happened. Is there a clear injury event, and when? Coverage applies to acute or subacute traumatic injuries, not internal-medicine causes. [source: MHLW 2016]
    2. Ask about suspected fracture or dislocation, such as deformity, inability to use or bear weight, or an injury from a fall or blow. If any are present, suggest a physician or emergency care first. [source: Act Art. 17 on physician consent]
    3. Ask about diagnosed conditions. NCAC advises consulting a doctor before manual treatment if you have an illness, and telling the practitioner the diagnosis. It cautions specifically about herniated disc, spinal stenosis and osteoporosis. [source: NCAC 2012]
    4. Screen for general red flags and refer to a physician if any are present: numbness or weakness, bladder or bowel changes, pain without an injury, night pain, fever, unexplained weight loss, head injury, neck injury with neurological symptoms, use of anticoagulants, or pregnancy. [synthesis: standard medical-referral practice, not taken from jūdō seifuku sources]
    5. Record what you asked and what you advised.
  • Example language (illustrative): "Before we think about the sekkotsu-in, I'd like to check a few things that would mean seeing a doctor first. Is that OK?" In Japanese (own wording): 「接骨院に行く前に、まず病院で診てもらった方がよい点がないか、少し確認させてください。」
  • Watch for:
    • Minimising or a reluctance to "bother" a doctor.
    • Somatic symptoms tied to stress being repeatedly treated as injuries.
    It is working when the client can say which professional handles which concern.

B2. Exploring the cultural meaning of sekkotsu with Japanese clients

  • Purpose and when to use: Sekkotsu is familiar, judo-linked and community-based. The JJTA describes clinics historically built beside dojo, judo therapists providing first aid and acting as trainers at sports events, and judo therapists working as functional-training instructors in long-term care. [source: JJTA English page] Ebita (2012) links practitioners' identity to judo. [source: Ebita 2012] Use this when attendance carries meaning: family tradition, a club or sports identity, an older relative's routine, or a sense of being cared for.
  • Steps:
    1. Ask how the client came to the clinic and who else in their life goes.
    2. Ask what the visits give them beyond treating the injury, for example routine, conversation, being touched, or permission to rest.
    3. Ask whether anything feels uncomfortable, including cost, pressure to keep coming, or forms.
    4. Reflect on the meaning without pathologising it. Link it to therapy goals only if the client wants that.
  • Example language (illustrative): "For many people in Japan, the sekkotsu-in is just part of the neighbourhood. What does going there mean for you?" In Japanese (own wording): 「接骨院に通うことは、あなたにとってどんな意味がありますか。」
  • Watch for:
    • Visits as the client's only source of physical care or social contact, which may point to isolation.
    • Shame about "weakness" in athletes or judo practitioners.
    • The therapist's own outsider assumptions, for example dismissing it as quackery or idealising it as tradition.

B3. Licence and scope check

  • Purpose and when to use: NCAC found most consumers cannot tell whether a practitioner holds a national licence. In its harm data, non-licensed categories (seitai, chiropractic, "correction") accounted for about 44% and sekkotsu-in or seikotsu-in for 13.6%. [source: NCAC 2012] Use this when a client describes "bone-setting", "correction" (矯正) or seitai.
  • Steps:
    1. Ask whether the practitioner is a jūdō seifuku-shi and whether the clinic is a notified 施術所. Clinics must notify the prefectural governor (Art. 19). [source: Act]
    2. Explain that judo therapists may not perform surgery or give drugs, and need a physician's consent for fractures and dislocations beyond first aid. [source: Act Arts. 16 to 17]
    3. Explain that the JJTA places pelvic and spinal "correction", headache and cold-sensitivity treatment, and plain massage outside jūdō seifuku. [source: JJTA 2020]
  • Example language (illustrative): "Is the person treating you a licensed judo therapist, or is this a seitai or 'correction' service? Both exist, and they're regulated differently."
  • Watch for:
    • Advertising that promises cures or describes techniques, which Article 24 restricts.
    • Pressure to buy a course of self-pay "correction" sessions. In a 2021 Tokyo survey, 75.3% of clinics mixed insurance and self-pay services. [source: Maruzawa & Kuboyama 2021, abstract]

B4. Insurance and billing literacy conversation

  • Purpose and when to use: Under the 受領委任 (delegated receipt) arrangement, the client signs claim forms that the clinic submits to the insurer. Official sources document a range of billing problems:
    • "部位転がし" ("rotating body sites", own translation): shifting the injured site between claims to avoid limits on how many sites can be billed.
    • Billing for many sites at once, over long periods, or for very frequent visits.
    • Fictitious claims (架空請求) and inflated claims (付増請求).
    • A case involving about ¥120 million and more than 100 insurers, which the MHLW notes was reported in the press.
    • Patients being paid a few thousand yen to sign pre-filled forms.
    [source: MHLW 2016; MHLW 2018 reference paper] Sanctions are in use. Regional bureaus recorded 15, 10 and 5 suspensions (or equivalent measures) of delegated receipt in FY2017, FY2018 and FY2019. A 2023 Nara case ended a practitioner's direct-billing arrangement after he added treatment days that never took place. [source: MHLW 2018 reference paper; Nara Prefecture 2023 release] Use this conversation when a client attends very often over long periods, has no clear injury, or mentions signing forms or receiving gifts.
  • Steps:
    1. Explain that insurance covers acute or subacute injuries. Simple shoulder stiffness or muscle ache is self-paid. [source: Shimane; MHLW 2016]
    2. Explain the client's rights and the clinic's duties. Practitioners must explain the billing rules, issue receipts and give itemised statements on request. Clinics may not induce patients with money or gifts. [source: MHLW 2016; MHLW 2014]
    3. Suggest the client checks what they sign. They should read the injured sites and causes listed, and keep their receipts. Insurers may contact patients to confirm treatment dates. [source: MHLW 2016]
    4. If the client is worried, point them to their insurer or the prefectural or regional health bureau. [synthesis]
  • Example language (illustrative): "It's your signature on those forms, so it's worth knowing what they say. Would it help to look at a receipt together, or to think about questions you could ask the clinic?"
  • Watch for:
    • Clients feeling obliged or indebted to the clinic.
    • Fear of getting the clinic into trouble.
    • Clients who are older or cognitively impaired.
    Avoid accusing a clinic yourself. Your role is information and support, not investigation. [synthesis]

B5. Preparing a trauma-affected client for hands-on care

  • Purpose and when to use: For clients with histories of abuse, assault, medical trauma or touch aversion who are about to receive manual care. The USABP code asks that touch be assessed for each client, that informed consent be obtained and periodically reviewed, and that the client may refuse or end touch at any time. [source: USABP Code VIII] The clinic page asks patients to report pain. [source: 459.ac.jp]
  • Steps:
    1. Ask what the client knows about what will happen (reduction, fixation, manual aftercare and machines), and fill gaps from Part A.
    2. Build a consent plan with the client:
      • which areas are acceptable to touch
      • what to say to pause or stop
      • whether to ask for explanations before each step
      • whether to bring a companion
      • whether to ask for a same-gender practitioner or another person in the room (a chaperone), where available.
      Chaperone and companion arrangements are [synthesis]. The sources here do not describe clinic policies on them.
    3. Rehearse one stop or pause phrase in the client's language.
    4. Agree grounding cues the client can use during treatment, such as eyes open, feet felt, or naming the room.
    5. Plan a debrief at your next session.
  • Example language (illustrative): "You're allowed to stop any treatment, even halfway through. What words would you feel able to say?" In Japanese (own wording): 「ちょっと止めてください」「始める前に説明してもらえますか」.
  • Watch for:
    • Freezing or compliance in place of consent. Saying no to someone in authority can be especially hard where deference is expected.
    • Dissociation after visits.
    It is working when the client reports using, or feeling able to use, the stop phrase.

B6. Referral and collaboration

  • Purpose and when to use: Use this when an injury is within scope and the client wants sekkotsu care, or is already receiving it. Clinic care and therapy run in parallel, and the EABP asks therapists to consider the implications of a client receiving related services elsewhere and to discuss them with the client. [source: EABP 2020, 6.b] Judo therapists have a statutory duty of confidentiality. [source: Act Art. 17-2] Referral fees are not acceptable. [source: EABP 5.d; MHLW 2018 notes proposals to exclude claims where clinics give money or gifts to referrers]
  • Steps:
    1. Confirm the client's choice of clinic, or suggest the client looks for a licensed jūdō seifuku-shi. Many practitioners are not JJTA members, so membership is not proof of a licence. [source: JJTA 2020]
    2. Obtain written consent before any contact, specifying what will be shared.
    3. Share only what is relevant to safe care, such as touch sensitivities or a startle response. Do not share trauma narrative.
    4. Agree that each professional stays in their own role: you do not advise on physical treatment, and they do not do psychotherapy.
    5. If a fracture or dislocation is involved, make sure a physician is part of the circuit. [source: Act Art. 17]
  • Example language (illustrative): "Would it help if I let the clinic know you prefer explanations before each step? I'd only share that, nothing about what we discuss here."
  • Watch for:
    • Splitting between professionals, for example one being idealised and the other blamed.
    • Accepting any gift or fee connected with referrals.

B7. Integrating body experience into therapy

  • Purpose and when to use: After clinic visits, a client may bring sensations, emotions or memories that surfaced during hands-on care. These can be integrated within the therapist's own competence, using verbal and awareness-based methods only. No hands-on work is involved.
  • Steps:
    1. Invite a description of what happened, what was felt and when.
    2. Track the body's response now, in the session, at a pace the client can tolerate.
    3. Separate present sensations from interpretations. Treat images or "memories" that emerged during bodywork cautiously. Do not suggest that they confirm past events, because bodily sensations can cue reconstruction.
    4. Link the experience to therapy themes only if the client wishes.
    5. Return to the consent plan (B5) and revise it.
  • Example language (illustrative): "You said your chest tightened when they worked on your back. Can we notice what's here now, without deciding yet what it means?"
  • Watch for:
    • Flooding or dissociation.
    • A rush to interpret.
    • Clients seeking more hands-on sessions mainly for emotional relief. If so, explore that need in therapy rather than through injury care.

B8. Recognising and passing on adverse effects

  • Purpose and when to use: NCAC recorded 825 harm complaints about manual quasi-medical treatments between FY2007 and June 2012:
    • About a third of cases where the harm level was recorded needed three weeks or more of treatment.
    • Nerve or spinal-cord injury: 21.6%.
    • Fractures, mostly of the ribs: 9.6%.
    • Contusions and bruising: 9.5%.
    • Muscle or tendon injury: 5.5%.
    • Dislocation or sprain: 2.0%.
    Most of these harms involved unlicensed practices, but 13.6% concerned sekkotsu-in or seikotsu-in. [source: NCAC 2012]
  • Steps:
    1. Ask routinely after visits about pain, new numbness or weakness, bruising and breathing pain.
    2. Advise prompt medical care for serious symptoms. If symptoms persist, worsen or do not improve over repeated visits, advise seeing a doctor. [source: NCAC 2012]
    3. Tell the client about reporting routes: a local consumer affairs centre (消費生活センター), a medical safety support centre or public health centre, and bar-association legal consultations for compensation. [source: NCAC 2012] Concerns about clinic standards can also go to the prefecture, which may inspect clinics and order improvements under Articles 21 to 22. [source: Act]
    4. Document the report and your advice.
  • Example language (illustrative): "That new tingling in your arm needs a doctor's opinion soon, today or tomorrow. Would you like to call from here?"
  • Watch for:
    • Clients attributing worsening symptoms to "the healing process".
    • Clients reluctant to complain because of the relationship with the clinic.

B9. Responding to reports of boundary violations or sexual touch

  • Purpose and when to use: A client reports sexualised comments, unexplained touch of intimate areas, or touch that continued after they asked to stop. Every code consulted prohibits sexual contact, and the USABP says genital or other sexual touch is always inappropriate. [source: USABP; BACP; UKCP; APA; AAMFT]
  • Steps:
    1. Believe and stabilise the client. Assess immediate safety.
    2. Explain the options: medical care, police, the prefecture, which notifies and inspects clinics, and the insurer. Do not pressure the client to choose one.
    3. Follow your own jurisdiction's safeguarding and mandatory-reporting duties, and consult supervision.
    4. Do not contact the clinic without the client's consent unless the law requires you to.
  • Example language (illustrative): "What happened was not part of treatment, and it was not your fault. Let's think together about what you want to do next."
  • Watch for:
    • Self-blame, and culturally shaped reluctance to accuse a respected local figure.
    • Your own urge to act faster than the client is ready to.

B10. Japanese clients living outside Japan

  • Purpose and when to use: Use this when a Japanese client abroad asks for "sekkotsu". The jūdō seifuku-shi licence is a Japanese national qualification. Whether it is recognised outside Japan is [uncertain: not verified].
  • Steps:
    1. Clarify what the client wants: injury care, familiar touch, or a link to home.
    2. For injuries, point the client to locally regulated clinicians, such as a physician or physiotherapist.
    3. Explore the cultural loss involved, if relevant. [synthesis]
  • Example language (illustrative): "It sounds like the sekkotsu-in was part of feeling looked after at home. What would help you feel looked after here?"
  • Watch for:
    • Use of unlicensed "bone-setting" services abroad without injury assessment.

5. Handling problems

The official sources here say little about psychological difficulties. Everything in this section is [synthesis] unless a source is tagged.

  • The client resists seeing a physician ("the sekkotsu-in is enough"). Explain that, beyond first aid, the judo therapist is legally allowed to treat a fracture or dislocation only with a physician's consent [source: Act Art. 17]. Seeing a doctor is therefore part of sekkotsu care, not a rejection of it. Explore what makes hospitals hard, such as waiting, cost, past experiences or fear of diagnosis.
  • Long-term, very frequent attendance with no clear injury. Review the meaning of the visits (B2) and the insurance rules (B4). Insurance covers acute or subacute injuries [source: MHLW 2016]. Fees reduce after five months, and long courses for sprains and contusions need documented reasons [source: MHLW 2014]. Consider whether the visits regulate distress, loneliness or chronic pain, and whether a medical assessment of the pain is due.
  • The client is asked to sign blank or inaccurate forms, or is offered gifts. Name the risk calmly: a clinic offering money or gifts to attract patients is prohibited, and fictitious or inflated claims are treated as fraud [source: MHLW 2014; Nara 2023]. Help the client plan how to decline, or how to ask for a receipt or an itemised statement [source: MHLW 2016]. Respect their pace.
  • Overwhelm or dissociation during or after hands-on care. Stabilise the client first. Revise the consent plan (B5), and consider pausing hands-on care until the client can use a stop signal. If the client has dissociated, check physical safety too, for example whether they were able to report pain.
  • The client could not say stop during treatment. Treat this as information, not failure. Rehearse the stop phrase again, or a non-verbal signal. Add a companion, or ask for explanations before each step. Explore deference to authority and what saying no means in the client's relational world.
  • Somatisation and "injury" framing. If emotional distress repeatedly shows up as new strains or pains treated at the clinic, keep asking about medical assessment. Gently open the link between stress and the body without dismissing the pain.
  • The client idealises the judo therapist, or prefers them to therapy. Explore what the hands-on relationship provides. Avoid competing with it. Coordinate with consent where splitting harms care (B6).
  • Rupture: the client feels judged for using sekkotsu. Acknowledge any cultural assumption you made. Return to curiosity (B2). Make clear you are not questioning their choice, only checking their safety and rights.
  • The therapist is tempted to "help" physically, for example to adjust a stiff neck or demonstrate a judo-style resuscitation or healing technique. Do not do it. Article 15 restricts practice to licensees and physicians [source: Act]. Mainstream psychotherapy codes require working within competence [source: UKCP; BPS; HCPC; AAMFT], and none of them contains a provision authorising touch. Body-psychotherapy codes regulate touch, and require specific training and consent [source: USABP; EABP].
  • New neurological symptoms after neck or back work. Treat this as urgent and refer for medical care. NCAC data link most neck and lower-back harms from manual treatments to nerve or spinal injury [source: NCAC 2012].
  • Reported sexual misconduct. See B9. Never minimise it, never investigate it yourself, and always use supervision.
  • Older or cognitively impaired clients signing claim forms. Consider whether a family member or advocate should be involved, with the client's consent. Insurers may contact patients to confirm visits, so the client may get calls they do not understand [source: MHLW 2016].

Sources

Web sources

Professional codes on touch, sexual contact and referral

Not verified

  • The exact promulgation date of the 1970 Act, the legal instrument behind the 1920 recognition, independent outcome reviews of jūdō seifuku, clinic chaperone and draping norms, and recognition of the licence outside Japan are all [uncertain: not verified].
  • No press report was verified directly. Billing controversies are given as official MHLW and prefectural documents report them.
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