Japanese Massage

Chinese roots and development in Japan

A 2010 report on anma in the Journal of Bodywork and Movement Therapies describes it as a traditional style of Japanese massage that was brought from China in the 6th century. According to the authors, it is based on the theory of Chinese medicine, developed in Japan according to Japanese preference, and has recently come to include theories of Western medicine. This is a one-sentence summary in the introduction of a clinical pilot study, not a historical analysis, and the sources reviewed for this page do not include primary-source scholarship that would confirm the date or the route of transmission.

A systematic review of shiatsu makes a related but separate statement, saying that shiatsu primarily developed in Japan and shares roots with Chinese medicine. Shared roots do not make the practices identical, and the sources reviewed here do not trace how individual techniques moved between China and Japan.

Edo period practice

A shiatsu association history, written by a former instructor, says anma evolved in Japan during the Edo period (given there as 1602 to 1868) and was mainly performed by blind practitioners. The same account says their medical knowledge fell behind that of doctors and herbalists and that anma came to be seen mainly as useful for relaxation. This is an association's narrative, and the evaluation it contains is the author's own.

The association history is the only source reviewed that places anma in the Edo period, and it does not cite its own sources for the statement. No open scholarly account of the period could be opened during this research. The role of the blind in anma is therefore reported here as the association states it, and the organization, dates and legal standing of that role are left to specialist sources.

Relationship to the emergence of shiatsu

The same association history credits Tamai Tempaku with developing shiatsu and dates his book Shiatsu Ho (finger pressure method) to 1919. It says the book combined anma, ampuku (abdominal massage), and do-in (therapeutic exercises) with Western anatomy and physiology. It then gives 1925 for the opening of Tokujiro Namikoshi's Shiatsu Institute of Therapy in Hokkaido and 1933 for his move to Tokyo. On this account shiatsu drew on anma rather than replacing it, and anma has continued as a distinct term, as the clinical studies under Research and Evidence show.

Anma and Japanese massage

Published clinical reports use the phrases anma therapy and Japanese massage together, and several abbreviate the intervention as AMT. In these papers anma means a specific style of manual therapy delivered in a defined way, rather than any massage that happens to take place in Japan. This page uses Japanese massage as a heading for that style and for the neighboring Japanese manual therapies, and says so where a statement applies only to anma. The sources reviewed do not define a single formal family called Japanese massage.

Anma, shiatsu and survey categories

Shiatsu means finger pressure, and a systematic review separates it from acupressure, which applies pressure for longer at specific points. National health surveys in Japan group the practices differently again. A study of survey data from 1995 to 2013 counted people who used acupuncture, moxibustion, anma-massage-shiatsu, or judo therapy as one set of complementary users, so figures from that source cannot be split between anma and shiatsu. Judo therapy appears there as a separate category, and the sources reviewed do not describe it further. Similar names are not evidence that two practices are equivalent.

Session format in published trials

The protocol of a randomized trial in gynecologic cancer survivors describes anma as mainly kneading, with smaller amounts of stroking and pressing. Sessions were given through clothing at a comfortable intensity, on a massage table, as a full-body treatment that left out the face, head and abdomen, with extra attention to areas the participant wanted addressed. Each session lasted 40 minutes, and the protocol specified one weekly session for 8 weeks, all delivered by one licensed massage practitioner with more than 20 years of experience.

Variation between studies

Other studies used different schedules. A pilot study from 2005 gave three clients five 40-minute sessions over about two and a half weeks. A before-after study in outpatients with Parkinson's disease used a single 40-minute session that included upper and lower limb exercises, and some participants went on to seven weekly sessions. A study in care facilities used sessions of 30 to 40 minutes. These are research protocols, and everyday practice may differ in length, setting and content.

What the reviewed sources do not describe

None of the sources reviewed sets out an intake process, consent procedure, hygiene standard or the content of professional training for anma practitioners. One trial report does not state who delivered the sessions, and another protocol mentions a single licensed massage practitioner without describing the training route. Professional registers and codes of conduct for anma were not found among open sources during this research, so they are not summarized here.

Uses reported in the literature

Authors of anma trials describe it as one of the most popular complementary therapies in Japan and as a practice used to relieve physical and psychological complaints, including in people with cancer-related symptoms. The studies themselves examined neck and shoulder stiffness, anxiety, general physical complaints, quality of life, movement-related symptoms in Parkinson's disease, and range of motion of the shoulder. Their stated rationale is that anma is a long-used practice, which is a description of use and not a finding about benefit.

Wider claims about massage in Japan

Japanese survey research on complementary users shows that people seek these practices for the symptom that troubles them most, and that many also use conventional medical care for the same symptom. Older users in that data were more likely to combine the two. The association history cited above says anma came to be seen mainly as useful for relaxation. For general massage, the U.S. National Center for Complementary and Integrative Health states that it is used to manage a health condition or support wellness.

Scope of the literature

PubMed searches for anma and Japanese massage, including a search on the name of the most frequent author, returned a small set of clinical papers, and most of the controlled studies come from one group at Tsukuba University of Technology. No systematic review specific to anma was found in these searches. The nearest review covers shiatsu and acupressure and included only 9 shiatsu studies among 80, with its authors concluding that very little shiatsu research exists. Its findings should not be carried over to anma.

Randomized trial in gynecologic cancer survivors

In this trial 40 survivors of gynecologic cancer were randomly allocated, 20 to each group, to eight weekly 40-minute anma sessions or to no anma. On the primary measure, a 100 mm visual analogue scale for subjective physical complaints, the estimated improvement over 8 weeks was 21.5 points in the anma group and 0.8 points in the control group, a between-group difference of 22.2 points (95% confidence interval 10.1 to 34.4). The report also described immediate effects of a single session, including a fall in urinary epinephrine, which the authors interpret as possible inhibition of the sympathetic nervous system.

Quality of life and the limits of the trial

A companion report on the 40 participants found that global health status and quality of life improved more in the anma group at 8 weeks, with an estimated mean difference of 10.4 points (95% confidence interval 1.2 to 19.6). Fatigue and insomnia scores also improved, while anxiety and depression scales did not differ significantly between groups. The study was open-label, relied mostly on subjective outcomes, and used a no-anma control that received one chat session, so expectation and attention effects are not separated from touch. The authors list recruitment difficulty, long-term survivors with few symptoms, and the need for multicenter confirmation as limits.

Smaller and uncontrolled studies

A crossover pilot of 15 women with chronic neck and shoulder stiffness compared 40 minutes of anma with 40 minutes of rest and reported lower stiffness and state anxiety scores after anma. An earlier pilot with three clients and three control volunteers was described by its authors as too small for statistical analysis. Two studies in Parkinson's disease reported improvements in symptom scores, gait measures and shoulder range of motion after anma, but they enrolled 6 to 21 people and used before-after or non-randomized comparisons.

Broader massage evidence

For massage in general, the National Center for Complementary and Integrative Health summarizes the evidence as weak for low-back pain, possibly short-lived for neck and shoulder pain, and limited or inconsistent for several other conditions. These statements concern mainly Swedish and other massage styles. They are context only, and they do not show that anma produces the same effects.

Reported harms

The anma trial reports reviewed here did not describe adverse events in the text examined. For massage generally, the National Center for Complementary and Integrative Health says the risk of harmful effects appears low but that rare serious problems have been reported, including blood clots, nerve injury and bone fracture. A shiatsu review identified four single case reports of adverse events and excluded them because it focused on efficacy, and it suggested that professional bodies consider an adverse-event reporting system.

One published case report describes balloon-expandable stents in both common iliac arteries that collapsed in a 76-year-old man who had received daily shiatsu in the umbilical region. The patient remained asymptomatic, and the authors advise avoiding abdominal wall compression after iliac stent implantation. It is a single report about shiatsu, not anma, and it does not establish how often such events occur.

Suitability and care boundaries

The National Center for Complementary and Integrative Health advises particular caution with vigorous methods and for people at higher risk of injury, such as older adults, and notes that people with cancer may need lighter pressure in sensitive areas. It also states that massage should not be used to delay seeing a health care provider about a medical problem. The anma trials enrolled long-term cancer survivors, people with Parkinson's disease in clinics and facilities, or healthy volunteers, so their results and any harms reported there cannot be assumed to apply to people in active treatment or with other conditions. This page is educational and is not individualized medical advice.