Shiatsu and Acupressure: Two Different and Distinct Techniques

RESEARCH Shiatsu and Acupressure: Two Different and Distinct Techniques Fernando Cabo, MSc,1* Amanda Baskwill, MSc,2 Isaac Aguaristi,3 Slava Christophe-Tchakaloff, LLM,1 Jean-Philippe Guichard1 1Shiatsu Research Institute, London, UK, 2School of Hospitality, Recreation and Tourism, Humber College, Toronto ON, Canada, 3Independent Mobile Massage Therapist, London, UK Background: Although shiatsu has been taught KEY WORDS: shiatsu; acupressure; bodywork in specialized schools in Japan since 1940, there is techniques; complementary therapies a limited amount of research for its practice. As a result, authors substitute shiatsu with acupressure to use available research on acupressure. It INTRODUCTION is the position of the authors that, while the two share common aspects, they are substantively dif- Shiatsu is a manual therapy of Japanese origin in ferent. This project was undertaken to describe which the practitioner applies pressure on certain technical differences and advocate for a clear points of the body in order to activate the body’s own distinction, especially in research studies and healing capacities. Its name in Japanese means “finger academic discussions. pressure”.(1) Although shiatsu has been taught in spe- Methods: To understand whether it is appropri- cialized schools since 1940, and recognized in 1964 ate to include acupressure studies in the evidence by the Ministry of Health of the Japanese National for shiatsu an analysis of the references included Government as a uniquely Japanese therapeutic treat- in a frequently cited systematic review was con- ment,(2) there is a relatively small body of evidence ducted to collect information about the protocols. for its practice.(3) As a result, authors and practitioners In addition, a preliminary exploration of shiatsu seem to conflate shiatsu with acupressure to make use practitioners’ perceptions about the differences of the available research evidence on acupressure. In between shiatsu and acupressure is described. This fact, a basic PubMed search for shiatsu as the sole exploration used videos of shiatsu and acupressure search term returns primarily acupressure studies, techniques and asked practitioners to comment on with the first mention of shiatsu outside the first their perception of similarity. 100 citations. In an attempt to improve the search, Discussion: The results identified several key the Medical Subject Heading (MeSH) database was technical differences between the two, including searched for shiatsu. Once again, acupressure was type of pressure applied, the positioning of the returned as the related MeSH term—as shiatsu is thumb, and the way in which body weight is used. considered to be a part of the ‘tree’ of acupressure.(3) Researchers should separate shiatsu and acupressure in their designs and purposively choose one or Similarities and Differences in the Literature the other. To facilitate such clarification, we have proposed a definition for shiatsu that may facilitate It should be noted that there are some similarities the differentiation between these two techniques. between shiatsu and acupressure. Both disciplines Conclusion: The authors hope to stimulate assess for imbalances in the body and use pressure to discussion about the differences between shiatsu restore balance and health.(4) Some shiatsu styles— and acupressure, and to question the appropri- but by no means all—use, in part, Traditional Chinese ateness of using acupressure studies as evidence Medicine meridians that coincide with acupressure.(2) of the efficacy of shiatsu. A true understanding of On a more technical level, both do not normally use the efficacy of shiatsu cannot be determined until oil or cream during the application of pressure, and studies use a common definition of shiatsu and some of the points pressed are the same. discontinue substituting acupressure research for While there are some similarities, there are more evidence of shiatsu efficacy. When this happens, substantive differences. First, shiatsu is a holistic it is proposed that a clearer picture of the safety, discipline that approaches treatment by considering efficacy, and mechanism of action of both shiatsu the whole body, whereas acupressure, in most cases, and acupressure will emerge. chooses to treat a few points only.(5,6) Second, the 4 International Journal of Therapeutic Massage and Bodywork—Volume 11, Number 2, June 2018 CABO: TECHNIQUES OF SHIATSU VS. ACUPRESSURE pressure used in shiatsu is always stationary and goes against two of the basic principles of shiatsu: sustained.(1) In acupressure, the pressure applied is the use of the weight of the body to apply pressure, often circular or may use a pumping action in which and sustained and static pressure. The movement is, the thumb repeatedly presses and releases pressure however, a common element in acupressure.(8,12-23) quickly.(6-8) Third, in shiatsu, the thumb is always in It is not clear why the authors have included shiatsu an extended position (see Figure 1), whereas, it is in the title and abstract, as this is clearly a case report more common to use the thumb flexed at the metacar- about acupressure. Their decision to do so contributes pophalangeal joint in acupressure(6,9) (see Figure 2). to confusion around these techniques. Finally, shiatsu uses the whole weight of one’s body One study that cites acupressure as a part of shi- to apply pressure, whereas acupressure uses, in part, atsu(4) cites Robinson et al.(3) as the source of this the strength of one’s arms or hands.(9-11) statement. Robinson and colleagues further claim The neglect to clearly differentiate between shiatsu that evidence of efficacy of acupressure may indi- and acupressure is illustrated in a case report by Yeh cate evidence of efficacy for shiatsu. Contradictory et al.(7) The intervention is titled “acupressure (shi- statements can be found within the same article: atsu)”. As one continues to read, the authors name the “Literature reviews indicated that the validity of technique used as “collateral meridian acupressure acupressure efficiency supports shiatsu technique therapy” and describe the procedure as “dynamic efficiency”, which is followed almost immediately pressure toward a caudal direction at the posterior by, “Sometimes, shiatsu is mistaken with “acupres- edge of the medial malleolus of [the] left foot at a sure”, whereas it is technically different from the frequency of 60 times per minute for 60 s., followed method”(12) (p. 178). And, there are others, including by a constant static force on the same point at cephalic the authors of this article, who echo the statement by direction for an additional 60 s.” (p. 485). Teimoori et al.(12) that the two techniques are differ- Although the second part of procedure, where a ent.(5) These examples are but a few that illustrate constant static force was applied, may be interpreted the need to explore the differences between shiatsu as part of a shiatsu treatment, the application of dy- and acupressure. namic pressure is not. The movement as described Need for Exploration of the Difference between Shiatsu and Acupressure It is the position of the authors that, while shiatsu and acupressure share some common aspects, they are substantially different in their philosophy and technique. As a result, this article analysis and preliminary exploration of practitioners’ perceptions was undertaken in an attempt to describe the technical differences and advocate for a clear distinction to be Figure 1. “Always use the thumb extended. … Do not bend made between them, especially in research studies the thumb at the first joint”. Images and text from The Book of and academic discussions. Shiatsu.(9) Reproduced with permission from Octopus Publishing In the literature, studies that equate both techniques Group Limited. oftentimes cite one review: “The Evidence for Shi- atsu: A Systematic Review of Shiatsu and Acupres- sure”.(3) However, it is our position that shiatsu and acupressure are different. As such, to understand whether or not it is appropriate to include acupressure studies in the evidence for shiatsu, a thorough review of the references included in the systematic review was undertaken. Each article, as described below, was reviewed for information about the protocol used. Building upon the analyses, a preliminary exploration of shiatsu practitioners’ perceptions of the differences of the two approaches is described. This exploration used videos that showed both shiatsu and acupressure techniques, and asked practitioners to comment on their perception of similarity. The purpose of this article is to stimulate discussion about Figure 2. Thumbs flexed at the metacarpophalangeal joint. From: the differences between shiatsu and acupressure, and Effects of SP6 Acupressure on Labor Pain and Length of Delivery to question the appropriateness of using the results Time in Women During Labor by Lee, et al.(6) Reproduced with of acupressure studies as evidence for the efficacy permission from Mary Ann Liebert, Inc. Publishers. of shiatsu. 5 International Journal of Therapeutic Massage and Bodywork—Volume 11, Number 2, June 2018 CABO: TECHNIQUES OF SHIATSU VS. ACUPRESSURE METHODS Article Analysis 80 references As there appears to be one review providing cre- dence to the argument that acupressure research can be used in the absence of shiatsu research about effi- 71 acupressure cacy, it is important to understand whether the studies 9 shiatsu studies studies included in the review sufficiently represent shiatsu

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