MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

In my never-ending search for novel so-called alternative medicines (SCAMs) I came across WATSU. If you had never heard of WATSU, you are in good company (for instance mine). WATSU (water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water. It was created in the early 1980s by the California-based Shiatsu teacher Harold Dull and combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is used to address physical and mental issues.

To me, this sounds as though an old physiotherapeutic approach has been re-vamped in order to seem more attractive to the affluent sections of the SCAM brigade. My suspicion seems to be confirmed by SCAM ueber-guru Dr Andrew Weil’s comments:

Dr. Weil has received the therapy many times and often recommends it.

While other bodywork modalities are based on touch in a stationary, two-dimensional world, Watsu offers a different experience. A three-dimensional environment, nearly free from gravity, within a warm and comforting fluid-space and the opportunity to connect with another person all have obvious therapeutic potential.

Achieving states of deep relaxation combined with the therapeutic benefits of good massage therapy can be of great benefit in controlling pain, relieving stress, and recovering from emotional and physical trauma.

But never mind the one-dimensional Dr Weil. The question is: does WATSU work? According to a recent paper, it is effective for a wide range of conditions.

The objective of this systematic review and meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies.

Literature searches for “WATSU OR watershiatsu OR (water AND shiatsu)” were conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design.

Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain, physical function, and mental issues.

The authors concluded that various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed.

Of the 27 studies included in this review, most were case-reports or case series, and only 5 were RCTs. Of these RCTs, none was robust. Some, for instance compared WATSU against no treatment at all, thus not controlling for placebo effects. All of these RCTs had small sample sizes, and all had been published in odd journals of dubious repute.

So, is it justified to categorically conclude that beneficial effects of WATSU were identified?

No, I don’t think so.

That physiotherapy in water can have positive effects on some symptoms would hardly be surprising. But, to convince people who think more critically than Dr Weil, better evidence would be needed.

3 Responses to WATSU … What’s it? … Weil knows

  • Wow!
    A Nobel prize is surely on its way:

    “…nearly free from gravity.”

    But how come the client is not floating free as in a plane’s parabolic loop, or in space etc?
    These clowns seem to need water to provide an equal and opposite force on their clients to that of gravity.

    Floating on water you cannot be anywhere near the effect of being “nearly free from gravity” – even the Moon has an effect on water – it’s called ‘tides’!
    If the dummies do not understand that, they know nothing.
    They are not even capable of being quacks.

  • I suppose that ought to be omizu-to-shiatsu to be consistent (お水と 指圧 ?)

    O-Watsu sounds more Californian.

    There is also something called “Japanese water therapy” that involves drinking several glasses of room-temperature water (not お冷) per day, perhaps along the lines of the classic “Your Body’s Many Cries For Water”, by F. Batmanghelidj M.D.

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