Shiatsu is a popular alternative therapy with a remarkable void of research. According to one of the rare reviews on the subject, Shiatsu is a form of Japanese massage, working on the meridian system of the body; the energetic pathways along which the acupuncture points are placed. The theory for shiatsu is based in the system of traditional Chinese medicine, understood in China for over 2000 years. Shiatsu can be valuable for reintegrating the body, mind and spirit, helping with the general energy level of the body as well as specific symptoms… Feelings of deep relaxation, support and increased vitality are common following a shiatsu treatment. The method, strength and frequency of treatment can be varied to suit individual need…
If this seems an optimistic evaluation to you, have a look on the Internet where bogus claims for Shiatsu abound. But such uncritical nonsense is, of course, neither informative nor responsible. In a previous post, I have been a little more critical about the value of Shiatsu and concluded that is an unproven therapy. I reached this conclusion mainly because, for our Oxford Handbook of Complementary Medicine (2008), we systematically researched the evidence and found very little of it. In fact, we concluded that NO CONVINCING DATA AVAILABLE TO SUGGEST THAT SHIATSU IS EFFECTIVE FOR ANY CONDITION.
Since then, a systematic review has been published. The Shiatsu studies found comprised just one single RCT, three controlled non-randomised, one within-subjects study, one observational study and 3 uncontrolled studies investigating mental and physical health issues. The authors, who usually are very much in favour of alternative therapies, concluded that more research is needed, particularly for Shiatsu, where evidence is poor.
This seems to indicate that our verdict of 2008 is still not far off the mark.
And what about the risks?
On this aspect of Shiatsu, it is even harder to find reliable information. One website, for instance, warns that certain individuals should take caution and consult a physician before receiving shiatsu. For example, there’s some concern that shiatsu may have harmful effects in pregnant women, patients who have recently undergone chemotherapy or radiation, and people with such conditions as osteoporosis, heart disease, and blood clotting disorders. Additionally, shiatsu should not be performed directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures. Shiatsu should also be avoided immediately after surgery, and by people with infectious skin disease, rash, or open wounds.
But what about adverse reactions and complications?
Another website, tells us that, when performed properly, shiatsu is not associated with any significant side effects. Some people may experience mild discomfort, which usually disappears during the course of the treatment session.
So, is Shiatsu without side-effects?
The answer, I am afraid, is NO – but has to dig deep to find even a tentative answer to this question.
A prospective, 6 months cohort, pragmatic study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK) has been published by UK authors in 2009 . Data were collected via postal questionnaires, including on client-perceived negative responses. Shiatsu was delivered by the practitioner in routine practice. 633 clients provided full follow-up data, a response rate of 67%. A prevalence rate of 12-22 per 100 of client-perceived ‘negative responses’ was found across the three countries. Transitional effects accounted for 82% of all the client-described ‘negative’ responses. Nine clients (1.4% of the total), relating to 10 sets of written comments, reported a negative response that was classified as ‘a potentially adverse event or effect’ that might represent a risk to client safety.
In addition there are much more serious complications such as strokes. These might be extreme rarities – but who knows? Nobody! Why? Because, as with most alternative therapies, there is no reporting or monitoring system for such events. Therefore the true prevalence is anyone’s guess.
The bottom line, I am afraid, is all too familiar: There is no good evidence for effectiveness and some evidence of risk – which can only mean one thing: the proven benefits do not outweigh the potential harm.