Shiatsu: what it involves and what is known

Shiatsu is a form of Japanese finger pressure in which a practitioner presses and stretches your body while you stay clothed. People usually try it to relax and to ease tension, stress or aches. The research is limited: there are only a few small, mostly uncontrolled studies, so any benefit beyond relaxation is uncertain.

What it is

Shiatsu developed mainly in Japan, and the name means “finger pressure.” It grew out of Chinese medicine and draws on ideas such as yin and yang, meridians, the five elements and ki, often translated as energy. It was modernized in Japan during the 20th century and has spread internationally since the 1970s. Many styles exist today, including Zen, Macrobiotic and Namikoshi shiatsu.

Practitioners say ki flows along the meridians. In this tradition, pressure on the right areas frees blockages in that flow and restores balance.

People commonly seek shiatsu massage for muscle tension, stress and anxiety, low mood and poor sleep. Others go for back, neck and shoulder pain or headaches. Some book regular sessions as part of looking after their general wellbeing.

What a session is like

A shiatsu session usually starts with questions about your health, lifestyle, medical history, diet, sleep and emotional state. You stay fully clothed, so loose clothes such as a tracksuit work best, and no oils are used. You usually lie or sit on a futon mattress on the floor, though some practitioners use a treatment table or chair.

Many therapists begin by gently touching your abdomen, which they call the hara, to assess your energy. They then use their palms, thumbs, fingers, elbows, knees and sometimes feet to press, knead, tap and stretch. A session lasts about an hour. Afterward you may feel very relaxed, more energetic or a little tired. The practitioner may also suggest stretches or self-help practices to try at home.

Before booking, it is worth asking:

• How long did you train?
• How long have you been practicing?
• Are you on a professional register?

What research says

Shiatsu itself has been studied very little. A 2011 systematic review of Shiatsu and acupressure research found only nine shiatsu studies. Just one was a randomized trial, and most were of low quality. The reviewers judged the evidence too limited to support shiatsu for any specific condition or symptom.

That one randomized trial looked at back and neck pain, using integrated care that included shiatsu. It found no significant effect, and it was too small to be sure either way. The largest study was observational. People in it reported feeling better, especially with tension, stress and structural problems, but a study like that cannot show that shiatsu caused the change.

Acupressure, one technique used within shiatsu, has more research behind it. The review found fairly consistent results for some kinds of pain and for nausea after surgery. Those studies used set protocols, though, so the results may not apply directly to individualized shiatsu.

Cancer Research UK says there is no scientific evidence that shiatsu can prevent or treat any disease, including cancer, and that studies on symptom control are mostly small. Many people say they feel very relaxed after a session, and sometimes more energetic. Beyond that relaxation, any benefit is uncertain.

Who should be careful

Shiatsu is generally considered safe. Some people get a mild headache, muscle stiffness or tiredness afterward, which usually passes within a few hours. Contact the therapist if it lingers. A good therapist takes a full medical history and may check with your doctor. In rare cases they may advise against shiatsu.

Tell the therapist if you take medication, are pregnant or have cancer. In the first three months of pregnancy, certain points should be avoided because of a possible increased risk of miscarriage. Treatment may also be put off if you have a fever. A gentler approach is needed if you have a low platelet count or osteoporosis. Rare serious problems have been reported, particularly after vigorous neck work, so you can always ask for gentle pressure.

Shiatsu should sit alongside medical treatment, not replace it. If you have symptoms that are new, severe or not improving, see a doctor or other licensed clinician rather than relying on shiatsu alone.

How it fits with the pillars

Shiatsu belongs to the body pillar. It is whole-body pressure and stretching work done through your clothes, and its most consistently reported effect is relaxation and loosened tension. Practitioners describe it in terms of ki and balance. You can take that as the tradition’s own language and judge the experience by how your body feels afterward.

To keep some of that ease between sessions, a short morning stretch routine is a simple place to start.