What is Shiatsu?
Shiatsu is a form of manipulation by thumbs, fingers, and palms to apply pressure to the human skin, incorporating techniques such as stretching, holding, and leaning body weight into various points along key channels. The practice is a form of Japanese bodywork based on concepts in traditional Chinese medicine such as qi meridians. Practitioners use sustained pressure, stretches, and joint mobilizations on clients who remain fully clothed, typically lying on a floor mat. Despite the fact that many practitioners use concepts of qi and meridians in explaining shiatsu, neither exist as observable phenomena.
Origins & Lineage
Shiatsu evolved from anma, a Japanese style of massage developed in 1320 by Akashi Kan Ichi, which was popularized in the seventeenth century by acupuncturist Sugiyama Waichi. Tui Na, shiatsu’s ancestor, was introduced to Japan around the 6th century AD, along with other aspects of Chinese culture.
The term shiatsu was already in use in 1919, when a book called Shiatsu Ho (“finger pressure method”) was published by Tamai Tempaku. Tokujiro Namikoshi (1905–2000) founded his shiatsu college in the 1940s and is often credited with inventing modern shiatsu, with his legacy being the state recognition of shiatsu as an independent method of treatment in Japan. In 1964 the Ministry of Health of the Japanese National Government recognized Shiatsu as a uniquely Japanese therapeutic treatment.
Namikoshi’s school taught shiatsu within a framework of western medical science. A student and teacher of Namikoshi’s school, Shizuto Masunaga, brought to shiatsu a traditional eastern medicine and philosophic framework, founding Zen Shiatsu and the Iokai Shiatsu Center school. In the 1970s, Masunaga proposed Shiatsu as a way (‘do’) for the personal development of both giver and receiver. Shiatsu was officially recognized by the Japanese government with a series of laws passed during the period 1955-1964.
How It’s Practiced
Shiatsu techniques include massages with fingers, thumbs, elbows, knuckles, feet and palms, acupressure, assisted stretching, and joint manipulation and mobilization. Sessions typically begin with an assessment through observation and palpation, followed by a full-body treatment lasting 60 to 90 minutes. Shiatsu uses gentle manipulations, stretches and pressure using fingers, thumbs, elbows, knees and feet.
Practitioners work primarily on floor mats, allowing them to use body weight rather than muscular force. Zen Shiatsu is administered by thumbs, fingers, palms and elbows, feet and knees, and depends for its success on a meditative activity of the practitioner, aimed especially at detecting the body responses to the treatment. Different styles exist: Namikoshi Shiatsu emphasizes Western anatomical frameworks, Zen Shiatsu incorporates meridian theory and Five Element diagnosis, and other variants include Macrobiotic, Healing, and Movement Shiatsu.
Shiatsu diagnosis is primarily through touch, rather than traditional Chinese medicine which primarily uses pulse diagnosis and inspection of the tongue, with practitioners trained in the anatomical location, functions and uses of over 150 pressure points on the body.
Shiatsu Today
Shiatsu is practiced globally, particularly in Japan, Europe, and North America. Professional training programs, such as 715-hour diploma programs endorsed by the Commission on Massage Therapy Accreditation (COMTA), represent one of only two Asian Bodywork Therapy programs in the nation to be awarded such credentials. 500-hour certification programs meet national standards for the profession and enable graduates to apply for membership with the AOBTA (American Organization for Bodywork Therapies of Asia).
Practitioners typically work in private practice, wellness centers, spas, and integrative health clinics. Some specialize in particular populations or combine shiatsu with other modalities. No special certification requirements exist for Shiatsu massage therapists beyond a current massage therapy license in order to practice.
Common Misconceptions
Shiatsu is not acupuncture without needles, though both reference meridian systems. There is no evidence that shiatsu is of any benefit in treating cancer or any other disease, though some evidence suggests it might help people feel more relaxed. In 2015, the Australian Government’s review found no clear evidence of effectiveness for shiatsu among 17 alternative therapies evaluated, and one recent systematic review did not find shiatsu to be effective for any particular health condition.
Shiatsu is not purely spiritual work; most contemporary practitioners integrate anatomical knowledge with energetic concepts. It is not painful by design, though appropriate therapeutic pressure may occasionally produce discomfort. The practice is not passive; recipients actively participate through breathing and body awareness.
How to Begin
Prospective recipients should seek practitioners certified by recognized organizations such as the American Organization for Bodywork Therapies of Asia (AOBTA). Sessions typically cost $80–150 and last 60–90 minutes. Wear comfortable, loose clothing; no oils or lotions are used.
For those interested in training, introductory weekend workshops (12–20 hours) provide foundational exposure. Professional certification requires 500-hour programs that meet national standards for the profession. Shizuto Masunaga’s Zen Shiatsu (1977) remains the foundational English-language text for self-study, though hands-on instruction is essential for developing proper technique and sensitivity.