What is It?
How Does It Work?
What You Can Expect

Health Benefits

How To Choose a Practitioner



Evidence Based Rating Scale

What Is It? 

Shiatsu is a hands-on bodywork method that originated in Japan from traditional Chinese medicine. The word shiatsu means "finger pressure" in Japanese. Advocates say the practice promotes health and healing by correcting energy imbalances in the body. 

Using touch and massage to enhance well-being is a tradition that dates back at least to ancient China, but probably to the origins of mankind. We have a natural tendency to hold or to rub areas of the body that have been injured. The practice of touching specific points on the body was originally called anmo (anma by the Japanese). Over time, anma was dropped as a medical treatment and was used purely for pleasure and relaxation. In the twentieth century, however, a group of practitioners recognized the value of anma in easing muscle tension and soothing various kinds of aches and pains. They began promoting the art as a way to treat illness and changed the name to shiatsu. It was officially recognized as a therapy by the Japanese Government in 1964 to distinguish it from anma and Western massage. (1) 

There are number of styles of shiatsu. Some practitioners use their fingers, thumbs, palms, elbows, knees, and feet to apply pressure to points along the body's main energy channels, known as Meridians. This is similar to acupressure where the goal is to release energy from areas that are out of balance and to bring energy into areas that are depleted. Other practitioners highlight diagnostic  or anatomical systems. In Britain the most common styles are Zen Shiatsu, Macrobiotic Shiatsu, Healing Shiatsu, Namikoshi Shiatsu, Movement Shiatsu and Hara Shiatsu. (1) The differences between them may be difficult to distinguish for the uninitiated. In general, Shiatsu emphasizes release of stress and the prevention of disease rather than treatment of specific ailments. 

How Does It Work? 

Shiatsu is based on some of the same principles as acupuncture, tai chi, and other forms of Traditional Chinese Medicine (TCM). According to TCM, illness is caused by imbalances in the flow of energy (qi in Chinese; ki in Japanese) in the body. Ki can accumulate and become trapped in points along the meridians known as tsubos, which correspond to Chinese acupressure points. Proponents believe that a shiatsu massage focused on these areas can clear disrupted energy flow and help to restore health by allowing energy to travel freely throughout the body.  

A more scientific explanation for shiatsu's pain-relieving ability is that it may initiate the release of endorphins, the body's natural painkillers. It may also lower the levels of adrenaline and other stress hormones in the body, stimulating a relaxation response. 

What You Can Expect 

A shiatsu session typically lasts about an hour. The number of sessions needed depends on the nature of the complaint. It may take four to eight treatments to resolve an acute problem, such as tension headaches, while long-term chronic conditions, such as low back pain, will probably require a more extensive regimen. Patients should bring or wear loose, warm, comfortable clothing, preferably cotton. Do not eat heavily in the two hours before a session and do not consume alcohol before or after treatment.  

The practitioner will begin treatment by taking a medical history, asking questions about lifestyle, past illnesses, diet, and exercise frequency. Physical and emotional characteristics will also be observed and assessed.  

During the treatment, the patient will most often lie fully clothed on a mat on the floor, but it is possible to receive shiatsu seated or on a treatment couch. The practitioner will touch certain areas of the body (often starting with the abdomen) to locate where tension resides. The treatment will then focus on these areas, to decrease the tension and restore energy flow. 

There are many different types of shiatsu massage, and the practitioner may use a combination of techniques, including pressing, holding, stretching, and rotating parts of the body. Practitioners of Zen shiatsu, for example, use their whole bodies as leverage to apply strong pressure, while barefoot shiatsu practitioners bring the feet into play, as well as the hands, to rub and press tsubos. Other techniques employ rubbing and kneading motions.  

While the treatment is generally relaxing, the client may experience seemingly odd reactions in the body, such as gurgling stomach noises or a shudder as the body releases tension. Or, if the therapist works on an area that has been storing tension caused by emotional upset, the client may feel like crying. This is not unusual. A good practitioner will act compassionately and be supportive.  

At the end of the session, the client will probably feel very relaxed and may wish to sleep. Some people, however, may feel invigorated and exuberant. This sense of well-being may last for a few days after a treatment. (1) 

Health Benefits 

Shiatsu is most often used to maintain general health and prevent illness. It can be especially useful for easing stress-related conditions. Proponents claim that the therapy can help relieve pain from arthritis as well as back, neck, and shoulder pain. People suffering from headaches, insomnia, muscle tension, and menstrual cramps have reported improvement with shiatsu.   

In one European observational study, 948 clients received shiatsu from 85 shiatsu practitioners over a six-month period. At the end of six months, 633 clients provided full follow-up information. They reported improvements in symptoms from musculoskeletal problems, tension, stress, low energy, and fatigue. Additionally, 77%-80% reported they had made lifestyle changes as a result of having had shiatsu: 16%-22% reduced the use of conventional medical treatments, and 15%-34% reduced the use of medication. Nine clients reported ten adverse events but none of them stopped receiving shiatsu. As a result of this study, shiatsu was determined to be inherently safe. (2-3)

Shiatsu is used as complementary treatment for breast cancer. The website states that women with breast cancer report shiatsu helps to relieve shoulder, neck, and back pain; stiffness; muscle tension; and headaches. However, the site also points out that no studies have been done to support these claims. (4) 

How To Choose a Practitioner 

There is no national body in the United States that specifically certifies shiatsu practitioners; however, there is national certification for massage therapy. Look for someone who has completed a course of study in massage therapy, is certified, and has a license to practice in the state along with having additional training in one of the forms of shiatsu. Because shiatsu involves touch, clients should feel comfortable with the practitioner. A word-of-mouth recommendation from a friend or coworker may be the best place to start. Having a short phone conversation with the therapist before a visit can help clients establish a comfort level. 


Clients should avoid shiatsu massage if they:

  • Have an open wound, a rash, or an infectious skin disease such as impetigo.  

  • Are prone to blood clots or have had recent surgery.

  • Have phlebitis, varicose veins, or other circulatory ailments.

  • Have had recent chemotherapy or radiation therapy: avoid massage in the area of a known tumor.

Clients should avoid massage specifically in the abdominal area if they:

  •  Are in the first three months of pregnancy. 

  •  Have an abdominal hernia.

  • Have eaten within the past two hours. 


1. The Shiatsu Society. Accessed July 31, 2011.
2. Long AF. The effectiveness of shiatsu: findings from a cross-European, prospective observational study. J Altern Complement Med. 2008 Oct;14(8):921-30.
3. Long, AF; Esmonde, L; Connolly, S, A typology of negative responses: a case study of shiatsu. Complement Ther Med, 17(3), pp168-175, 2009.
4. The Breast Cancer site. Accessed August 1, 2011.
5. Massage Certification. Accessed August 1, 2011.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.








Some women with breast cancer report relief from shoulder, neck, and back pain, stiffness, muscle tension, and headaches; studies are needed (4)

Observational study indicated improvements in symptoms; studies are needed (2-3)

Date Published: 04/19/2005
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