Is Shiatsu an effective therapy for menstrual pain? Probably not!

Dysmenorrhea affects 40–80% of women causing discomfort, pain and absenteeism. This study aimed to evaluate the effectiveness of shiatsu massage and abdominal stretching exercises in reducing primary dysmenorrhea among adolescent girls.

A quasi-experimental design with a pre-post test two-group comparison was employed. Sixty-six adolescent girls
with primary dysmenorrhea were purposively selected and divided into two groups: one received shiatsu massage therapy, and the other performed abdominal stretching exercises. Data were analyzed using the Wilcoxon and Mann-Whitney tests with a significance level set at p < 0.05.

The results showed that both interventions significantly reduced menstrual pain (p = 0.000). However, the shiatsu group experienced a greater average pain reduction (2.36 points) compared to the stretching group (1.55 points).

The authors concluded that their results of this study indicate that shiatsu massage therapy demonstrates a greater effectiveness in alleviating primary menstrual pain, commonly referred to as dysmenorrhea, when compared to abdominal stretching exercises, exhibiting a notable difference of 0.8 points in pain reduction between the two interventions.

The authors also offer the following suggestion: This intervention can be used in midwifery and healthcare settings, with Shiatsu materials serving as educational tools for adolescents on dysmenorrhea and reproductive health.

In my recent book, I reviewed the evidence on shiatsu (for references, see the original): It is a (mostly) manual therapy that was popularised by Japanese Tokujiro Namikoshi (1905–2000). It developed out of the Chinese massage therapy, ‘tui na’. The word shiatsu means finger pressure in Japanese; however, a range of devices is also being promoted for shiatsu. In 1940, Tokujiro Namikoshi established the Japan Shiatsu College in Tokyo. He taught many practitioners, some of whom subsequently developed their own version of shiatsu. Shiatsu follows the principles of Traditional Chinese Medicine based on chi, meridians, yin and yang, etc. These are philosophical concepts at best but lack scientific and biological plausibility. The amount of pressure used during treatment can be considerable and therefore, Shiatsu is experienced by some patients as (mildly) painful. Shiatsu is a treatment which includes not just the pressure applied by the therapist at specific points but also awareness of body posture, breathing and exercise. Shiatsu is claimed to stimulate the body’s vital energy. One observational study concluded that “clients receiving shiatsu reported improvements in symptom severity and changes in their health-related behaviour that they attributed to their treatment, suggestive of a role for shiatsu in maintaining and enhancing health.” A similar study observed a wide range of common, immediate and longer term effects. These included effects on initial symptoms, relaxation, sleeping, posture, and experiences of the body. There have been very few controlled clinical trials. One low-quality trial suggested that shiatsu massage seems to be effective in managing agitation in mechanically ventilated patients . A systematic review found no convincing data to suggest that shiatsu is effective for any specific health condition. Even though some patients experience the treatment as painful, Shiatsu is generally considered to be a safe therapy. It is, however, not totally free of risks. One observational study found that 12–22% “of patients reported ‘negative effects’ after shiatsu treatment,” and several case reports have associated Shiatsu also with serious complications (END OF QUOTE).

Because ther are so few studies of shiatsu, every new trial is potentially valuable. The present study, however, is a disappointment in this respect. It did not make the slightest attempt to control for any type of bias. Its findings are thus entirely meaningless. Most likely, they have little or nothing at all to do with the treatments administered but are due to placebo effects, natural history of the condition, selection bias, etc.

My suggestion, therefore, differs dramatically from that of the authors: if you suffer from dysmenorrhea – or, indeed, any other condition – you are well advised to avoid implausible and unproven treatments and opt for one of the many therapies thaat are supported by sound evidence.