Written by: 
Richard Thomas, medical writer

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What is shiatsu?

'Shiatsu' - sometimes 'zen shiatsu' - is a Japanese word meaning 'finger pressure', and this reveals its origin in the ancient art of acupressure, the traditional Chinese practice from which it evolved. It is also related to acupuncture and tuinaA form of Chinese massage that aims to regulate energy and blood flow., as well as to modern American and European derivatives of all these practices, such as osteopathyA therapeutic system that centres around the concept that many conditions are related to musculoskeletal disorders. and reflexology.

The theory of shiatsu is that particular ailments and conditions can be helped by the application of controlled pressure to specific parts of the body, usually by fingers or thumbs but also by other means, such as knees, elbows and even feet.

The pressure is applied to those areas or 'points' that practitioners believe link to the same 'energy pathways' that are the basis of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points.. In traditional Chinese medical philosophy this 'energy' is referred to as chi (qi in Japanese) and the pathways are called 'meridians'.

It is widely believed in many forms of Oriental medicine, including shiatsu, that physical problems in the human body can be caused by some interruption or irregularity in the flow of chi. Applying pressure to very specific points is said to 'release' or 'unblock' the correct flow of chi and thus to help correct the problem or ailment complained of by 're-balancing' the body.

Treatment can involve stretching, rotating and manipulating, or 'palpating', limbs and soft tissue, as well as applying pressure to them.

Shiatsu can be used to a limited degree for self-help - it has been shown to be effective for the relief of nausea, headaches and migraine, for example - but for the greatest benefit it is recommended that the therapy should be carried out by a trained practitioner, since in shiatsu it is considered that the interaction of the therapist with the patient is as significant as the treatment itself.

What to expect from a shiatsu practitioner

The European Federation of Shiatsu defines the practice as occurring 'within the energetic relationship between the practitioner and the client, intuitive in its nature, and broad in its guiding philosophy and scope of application'. An important saying in shiatsu is 'diagnosisThe process of determining which condition a patient may have. is treatment and treatment is diagnosisThe process of determining which condition a patient may have.'. Practitioners consider there is no distinction between the two processes.


Practice varies, particularly between those trained in the differing Eastern and Western traditions, but by and large a trained therapist, in common with most trained complementary medical practitioners, will take some time to compile a history of your problem.

That means putting questions to you about non-medical aspects of your life such as eating and social habits, and going through a process of getting as much information about you as the therapist considers appropriate to get a full understanding of you as a 'whole person'. Other methods of diagnosisThe process of determining which condition a patient may have. include Oriental pulse-taking and feeling the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs..

Sensitivity to pressure in certain areas provides the practitioner with the clues to what is wrong and what to treat.


Shiatsu treatment is usually carried out on a soft mat on the floor, Oriental-style, and can last for anything from an hour to 90 minutes. Pressure is generally applied through light clothing, so there is no need to undress further than this, unless the therapist asks you to do so in order to treat you better, and you are willing to do so.

Treatment is most often carried out with you lying on your back but you may also be asked to lie on your front or side, depending on what the therapist thinks is required.

Pressure in shiatsu is characteristically applied in a sustained and constant way, rather than in the vigorous action of, for example, some forms of massage. Sometimes the touch is little more than holding and supporting the area being treated.

The practitioner may also use body stretches, special breathing techniques and gentle manipulation of joints to encourage muscles and tissues to relax and recover. Again, this approach seems to have been the inspiration for any number of modern Western derivatives, such as many of the techniques used in osteopathyA therapeutic system that centres around the concept that many conditions are related to musculoskeletal disorders. and more recent therapies from the Alexander Technique to the Rosen Method and Bowen Technique.

What is shiatsu used for?

Shiatsu is widely used in Japan for the treatment of a variety of common ailments. It is used to relieve:

  • Nausea
  • Lower back and neck pain
  • Digestive and menstrual pain
  • Depression
  • Headaches
  • Colds and fluA viral infection affecting the respiratory system..

It is also used to improve:

  • Stamina
  • Libido
  • Sleep
  • Concentration and mental alertness.

In Western countries, it is most commonly applied against stressRelating to injury or concern. and for relaxation, but some practitioners will sometimes claim they are treating the more serious underlying problem of a physical, mental or emotional disorder, even when the patient is not fully aware of it.

How safe and effective is shiatsu?


Safety is not normally a serious issue with shiatsu because most practitioners will usually carry out treatment only on patients who are relatively well. For example, they will generally not treat someone who is obviously infectious or has a fever or high temperature, nor will they treat areas that are inflamed or where there is wounding or scar tissueA type of connective tissue that forms after a wound heals..

They are also cautious about handling the frail and elderly and those with serious conditions, such as cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. or heart disease. As a result, shiatsu is generally regarded as a very safe technique in the hands of a properly trained practitioner.


Anecdotal evidence abounds in support of the efficacy of shiatsu, particularly in Japan, where it has been an officially recognised paramedical practice since 1952. However, conventional randomised clinical trials that demonstrate efficacy in a scientific sense are few and far between, mainly because of the highly individual and intimate, and therefore subjective, nature of the relationship between therapist and patient.

A Europe-wide study published in December 2007 by the University of Leeds in England found that chief among the health problems for which people sought the help of a shiatsu practitioner were stressRelating to injury or concern. reduction, alleviation of the symptoms of particular conditions, and of uncomfortable symptoms in general, and emotional help and support.

Benefits reported included favourable physical and emotional changes, or feeling 'energy moving or blockages being released', 'relaxed or calmer', 'more energised', 'more able to cope with things' or 'more balanced'.

Physical benefits, confirmed by a handful of trials in America and Europe, were mainly in preventing and alleviating nausea, headaches, fatigue, stressRelating to injury or concern. and musculoskeletal pain of various kinds and from various causes. However, the report concluded that there was a need for much more research.