OVERVIEW.

Shiatsu is a Japanese finger pressure technique used primarily for musculoskeletal (neck, shoulder, low back, arthritic) and psychological (depression, stress, anxiety) problems. The belief is that during illness, qi energy is either excessive, deficient, or in a state of imbalance. The goal is to stimulate the free flow of qi energy through the meridians or energy channels. In shiatsu, the practitioner’s body weight is used to apply bilateral finger pressure along the client’s meridians and acupuncture points in order to access qi energy.^1,2

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Two sources cited a total of 30 concerns for shiatsu. Battermann¹ cited 24 concerns, whereas Bereford-Cooke² cited 14. The largest proportion of concerns was related to circulation (26%) and pregnancy (16%). Modification of technique (lighter pressure) was recommended over lymphatic tissue,¹ during pregnancy,¹ and in people with hypertension.² Remarkably, no pressure-related concerns were mentioned for work over superficial nerves (see Herskovitz et al³ and Mumm et al⁴ below).

OTHER ISSUES: OVERLY AGGRESSIVE TECHNIQUE.

In a 1992 case report, Herskovitz et al³ reported a 61-year-old who sustained an adductor pollicis brevus nerve compression following strong digital shiatsu pressure of the palm and thenar muscle. In 1993, Mumm et al⁴ reported a 64-year-old woman with a prior history of severe varicella as a child and who presented with vesicular zoster over the 8th cervical dermatome following very vigorous shiatsu massage.

Note: In 2002, Elliott and Taylor⁵ reported a case of an ICA dissection associated with a “shiatsu massager.” Note that this injury was machine-induced and not attributed to a practitioner’s manual technique of shiatsu.