Shiatsu Massage

Anma and early twentieth-century shiatsu

The Shiatsu Therapy Association, a Canadian professional body, places shiatsu within a longer East Asian story. Its history page says Chinese medical ideas reached Japan with Buddhist and Taoist teaching around the sixth century, and that during the Edo period (1602 to 1868) a massage form called anma was practiced mainly by blind practitioners. This is a professional body's narrative and not a peer-reviewed history, and the sources reviewed here do not give primary-source detail for these dates.

The same page credits Tamai Tempaku with creating modern shiatsu in the early 1900s, naming his 1919 book Shiatsu Ho and saying he combined anma, abdominal massage and exercise with Western anatomy and physiology. Other practitioner accounts credit Tokujiro Namikoshi as founder, so attribution of the term and the method differs between sources and was not resolved here.

Namikoshi, Masunaga and the main styles

A 2018 paper by shiatsu researchers states that shiatsu has been taught in specialized schools in Japan since 1940 and was recognized in 1964 by Japan's health ministry as a distinct Japanese therapy. It names Tokujiro Namikoshi, Shizuto Masunaga and Katsusuke Serizawa as the founders whose work underlies most modern styles, and calls the Namikoshi approach the most widely practiced style in Japan.

The Shiatsu Therapy Association describes Namikoshi as emphasizing neuromuscular points over meridian theory, Masunaga as creating Zen shiatsu by reintegrating Eastern meridian principles and a spiritual dimension, and Serizawa as focusing on tsubo points. A cross-European observational study likewise placed its data within a Zen, or Masunaga, model of shiatsu, which shows that the style is used as a research framework as well as a teaching label.

Spread and professional bodies

A systematic review in 2011 describes shiatsu as popular in Europe and lists schools practiced in Britain, among them Zen, Macrobiotic, Healing, Tao, Seiki, Namikoshi and Hara. The Shiatsu Society (UK) says it has operated since 1981 and sets professional standards. Beyond these descriptions, the sources reviewed give no dated history of how shiatsu moved from Japan to Europe or North America.

Name and meaning

Shiatsu is a Japanese word meaning finger pressure. The Shiatsu Society (UK) describes the practice as therapeutic bodywork using gentle pressure, manipulation and stretching to support the flow of vital energy, and says the term emerged in the early twentieth century. Practitioners describe the energy concept as ki, and the Society and the 2011 systematic review both link shiatsu to traditional Chinese medicine meridians. These are concepts of the tradition and have not been measured as biomedical entities in the sources reviewed.

Shiatsu compared with acupressure

Research papers often treat shiatsu and acupressure as one subject. Cabo and colleagues argue that they are different techniques and that acupressure trials should not stand in for shiatsu evidence. In their account shiatsu applies sustained, stationary pressure with the thumb extended and the practitioner's body weight, aims to treat most of the body in each session, and is not a rubbing, circling or pumping action. Of 101 shiatsu practitioners who viewed comparison videos, 95 percent judged the two techniques different.

This matters for reading the literature. The 2011 systematic review searched under the term acupressure and reported shiatsu and acupressure studies separately, and Cabo and colleagues found that only one of 80 references in that review met their shiatsu criteria. Statements that acupressure shows benefit for pain or nausea are therefore not carried over to shiatsu on this page.

Related terms

WATSU, a blend of water and shiatsu, is a passive hydrotherapy given in chest-deep warm water that combines stretching, joint mobilization and massage. A 2020 systematic review treated it as a stand-alone water therapy, so its findings relate to WATSU and not to floor-based shiatsu. Hand self-shiatsu, a standardized self-applied routine tested in Alberta, is another derived form.

A typical session

The Shiatsu Society (UK) says sessions last 45 to 90 minutes and are traditionally given at floor level on a futon or comfortable mattress, with the client fully clothed in loose clothing. It describes an initial conversation, hands-on bodywork, a closing sequence and aftercare guidance. The Society adds that shiatsu does not hurt, a statement from the professional body that is not independently verified in the sources reviewed.

Technique and explanatory models

Cabo and colleagues describe pressure applied by leaning body weight through the fingers, thumbs or palms and held without circling or rubbing. Explanations of why this might matter differ by style. The Namikoshi approach is described as organized around anatomy and neuromuscular points, while Zen shiatsu uses meridian-based assessment. None of the sources reviewed tested whether meridian-based assessment predicts outcomes, so these remain practitioner frameworks.

Training and professional standards

The Shiatsu Society (UK) lists a short introductory tier, a one-year wellbeing practitioner course and a Level 4 diploma of about 1,000 hours of learning and practice, preferably at schools it ratifies. Members follow its Code of Professional Conduct and Ethics, which it says has 23 pillars covering safe practice, consent and confidentiality. These are one UK body's standards. The sources reviewed do not describe standards in other countries, and no legal or regulatory material was sought.

Uses described by the professional body

The Shiatsu Society (UK) lists relief of pain and tension, stress reduction, improved circulation, flexibility, nervous system regulation, better sleep and balanced life force energy as reasons to receive shiatsu. These are claims by a professional body, and several, such as circulation and energy balance, are not tested in the trials reviewed on this page.

Reasons clients report

In a six-month observational study of 948 clients of 85 practitioners in Austria, Spain and the United Kingdom, the typical user was a woman in her 40s in paid work, and the most common reason on the day of the session was health maintenance. The most mentioned symptom groups were muscle, joint or body-structure problems, tension or stress, and low energy or fatigue.

A French qualitative study of ten shiatsu users found that pain, anxiety and sleep problems led them to try it, usually after conventional medicine had disappointed them, and that they were advised to try it by people around them and never by a physician. Ten interviews is a small sample and the findings describe those users, not shiatsu clients in general.

Systematic review evidence

The main systematic review, published in 2011, searched for shiatsu and acupressure trials published after January 1990 and found nine shiatsu studies: one randomized controlled trial, three controlled non-randomized studies, one within-subjects study, one observational study and three uncontrolled studies. The authors concluded that the shiatsu evidence was of insufficient quantity and quality, and that evidence for shiatsu was poor. Its search was limited to UK and US databases and it excluded qualitative work.

A 2026 systematic review of touch-based therapies in dementia care included only two reflexology or shiatsu studies among 33. It reported short-term calming, mainly for massage and acupressure, with mixed effects on other symptoms, low certainty and mixed risk of bias. It does not support conclusions about shiatsu specifically.

Randomized trials since 2011

A trial at a Tokyo hospital randomized 59 adults with chronic low back pain to weekly one-hour shiatsu for four weeks plus standard care, or standard care alone. The primary outcome, the Roland-Morris Disability Questionnaire, did not differ significantly at week 4, and at week 8 the difference was 1.7 points (p = 0.08). Some secondary measures favored shiatsu, including present pain, the Oswestry index and quality of life. The authors called it a limited sample trial, and it was open-label with standard care as the comparator.

A secondary analysis of the same trial reported better global sleep scores in the shiatsu group at weeks 4 and 8, though use of sleep medication worsened in some models. A trial in 68 ventilated intensive care patients reported lower agitation after three 5-minute shiatsu periods than after touch alone, and a trial in 80 first-time mothers in Indonesia reported lower labor pain and anxiety. Both authors call for larger studies, and these single-setting trials do not establish effects.

A single-blind pilot of shiatsu plus physical activity in Alzheimer's disease reported a larger fall in depression scores than activity alone, with the authors describing it as a pilot. Evidence across these studies is small, varies in comparator and is mostly short-term.

What the sources reviewed do not show

The sources reviewed contain no large trial with a sham comparator and long follow-up, and no source tested the meridian theory or the claims about energy. The WATSU meta-analysis found low to moderate certainty for water-based work, which should not be transferred to floor shiatsu. Observational client reports of improvement, such as those in the European cohort, cannot separate shiatsu from natural recovery, expectation or other care.

Reported harms and negative responses

In the European cohort, 633 clients gave full follow-up and 10 adverse events were reported by 9 clients (1.4 percent); none stopped shiatsu. A companion analysis found that 12 to 22 per 100 clients described a negative response, 82 percent of them classed as transitional effects, and that 9 clients reported a response classed as a potentially adverse event. The authors read this as supporting shiatsu as an inherently safe modality, an interpretation from client-reported data without an independent comparator.

The 2011 systematic review calls shiatsu inherently safe but identified four single case reports of adverse events that it excluded from analysis, and it recommends that professional bodies develop formal reporting systems. One published case describes collapse of balloon-expandable stents in both iliac arteries in a man who had daily shiatsu over the umbilical region, and the authors advise avoiding compression of the abdominal wall after such stent placement.

Avoidance and care boundaries

The Shiatsu Society (UK) says shiatsu should be avoided in infectious disease, internal bleeding or clots, and any acute feverish illness, and that clients should tell the practitioner about doctor-diagnosed conditions. It says shiatsu is safe and supportive in pregnancy; that is the Society's statement and it is not independently verified in the sources reviewed here. For massage in general, a US federal health agency page describes the risk of harm as low, with rare reports of blood clots, nerve injury and fractures linked to vigorous techniques and to older people.

The same agency page advises against using massage to delay medical evaluation of a health problem, which applies equally to shiatsu. Shiatsu is not a substitute for diagnosis or for necessary medical care. In the French interviews users described dismissive reactions from physicians, and the authors recommend that physicians be involved when patients use complementary therapies.