Introduction
The history of massage is important in the performance of the treatment and how it helps the profession to identify its strengths and weaknesses. Most of the concepts used today were written years ago. The history of massage is supportive and validating to the profession, and has stood the test of time to prove itself as a vital health enhancing and rehabilitative approach.
Origins and Evolution of Shiatsu
Shiatsu goes back to the 7th century AD, when a delegation of students was sent from Japan to China to study Chinese medicine and culture. Martial arts students, who frequently need to treat injuries or to revive an unconscious sparring partner, especially valued the knowledge they brought back.
Although Shiatsu traces its origins back to this earlier time, it acquired its unique characteristics only in the last century. It was during this time that Japan was more open to Western ideas than China, and there were two historical events in particular that shaped the development of Shiatsu.
The Japanese had been practicing their own style of Anma massage (similar to Tui Na) since the Edo Period (1602-1868). Around 1900, the government established licensing laws for practicing Anma. In part, this was a response to the increasing influence of scientifically based Western medicine, which the government hoped to encourage by these laws. There may also have been a desire to control Anma practitioners who had strayed into providing questionable forms of relaxation rather than therapeutic massage. In response to the new licensing laws, legitimate Anma practitioners began to call their work Shiatsu (which means “finger pressure”) and to emphasize the therapeutic benefits.
Following WWII, General Douglas MacArthur banned the practice of all traditional therapies in Japan, including acupuncture, moxibustion (burning mugwort on acupoints), and Shiatsu. Massage — including Shiatsu — was traditionally practiced by the blind in Japan, since it provided them with a livelihood, and their touch was considered especially sensitive. Shiatsu was eventually saved from the ban against traditional therapies when the Japanese Blind Association contacted Helen Keller. She petitioned President Truman, who overturned MacArther’s ban.
The threat to their livelihood motivated Shiatsu practitioners to downplay the origins of their work in traditional Chinese medicine. They increasingly described their work in Western medical terms and incorporated chiropractic and physical therapy techniques. These developments have led to the distinctive Shiatsu style we know today and also account for the variety of styles currently available.
There are three main styles or theoretical schools, each identified with an individual who provided the original distinctive focus: Namikoshi (Nippon style), Masunaga (Zen Shiatsu), and Serizawa (Acupressure Shiatsu).
Namikoshi’s style of Shiatsu is the one most often found in Japan. It places more emphasis on points than on energy channels, works the whole body (including stretches), and can be quite vigorous. Tokujiro Namikoshi established the Shiatsu Institute of Therapy in Hokkaido as early as 1925. He also founded the Japan Shiatsu Institute in 1940. He was concerned with the legal recognition of Shiatsu in Japan, which may account for his emphasis on Western medical theories. In addition to points, the emphasis of Nippon style Shiatsu is on the anatomical structure of the body — the muscles and bones — and the nervous system.
Shizuto Masunaga reintroduced the more traditional roots of Shiatsu, including energy meridians and Five Element theory. Masunaga, who was born into a family of Shiatsu practitioners, was interested in western psychology. He became a professor of psychology at Tokyo University and also taught psychology at Namikoshi’s Shiatsu school. In addition to valuing Chinese medicine, he was very interested in emotional, psychological, and spiritual development. This led to his creation of Zen Shiatsu.
Practitioners of Zen Shiatsu strive to maintain a meditative, intuitive state, allowing them to connect deeply with their clients and to detect changes in the body during the session. Zen Shiatsu practitioners see Shiatsu as a means of personal development, giving meaning and purpose to life, both for the client and the practitioner.
Katsusuke Serizawa, a student of physical therapy, Shiatsu, and Chinese medicine, was especially interested in a scientific explanation of the energy meridians. The focus of his studies was on acupoints or (as they’re called in Japanese) Tsubos. His research and extensive publications emphasize the change in electrical resistance of the skin over a tsubo point. He was especially interested in demonstrating the therapeutic benefits of Shiatsu in terms that were acceptable to modern scientific thinking. The western form of Serizawa’s Tsubo Therapy is called Acupressure Shiatsu and is not as widely known as Nippon and Zen styles.
Shiatsu first began to attract Western interest in the 1970’s, following President Nixon’s visit to China. Shiatsu is probably the most well-known style of Asian bodywork and is popular with all ages. One other difference between Shiatsu in Japan and in the West is that it’s become traditional in the West to practice Shiatsu on the floor, whereas this is rarely the case in Japan.
Shi and Ki
In Japanese, "shi" means finger and "atsu" means pressure. Shiatsu massage involves pressure application, gentle body manipulation and assisted stretching. Ki is the Japanese term for energy flow throughout the body. For thousands of years, Ki has represented the essence of life in Japanese culture (nourishment for the body, mind and spirit). Energy flows to organs through specific pathways or meridians. Shiatsu practice strives to eliminate energy imbalances within the organ systems, clearing the path for energy flow. Different pressure points, or tsubos, relate to different organs throughout the body. The practice focuses on these pressure points.
Five Elements
Chinese writings, dating back to the first century, name five elements that are active throughout the body (fire, earth, metal, water and wood). The elements represent the types of energy forces within the body. Fire imbalances create bitterness, earth imbalances create jealousy, and metal imbalances contribute to depression, according to certain Chinese beliefs. An imbalance in water creates fear, while wood imbalances create impatience. The five elements were introduced into Japanese culture during the sixth century and influenced the development and practice of shiatsu massage. Historical and traditional practices focus on finding elemental imbalances and returning energy to a stable state.
Lesson 2: Definition of Shiatsu
Objectives
At the end of the session, you will be able to:
Define what is Shiatsu
Apply the basic rules when practicing Shiatsu
Identify the benefits of Shiatsu
Identify the contraindications of Shiatsu
Perform the basic strokes of Shiatsu
Introduction
The success in the application of shiatsu relies on the therapist awareness and skills. The therapist must know the benefits of shiatsu to address particular client’s needs. There are instances wherein shiatsu should not be performed, thus the therapist awareness to contraindications is crucial.
Definition of Shiatsu
Shiatsu is a Japanese form of bodywork. The word shiatsu means "finger pressure", and shiatsu is sometimes described as a finger pressure massage. Like acupuncture, shiatsu is based on the holistic system of traditional Chinese medicine, where illness is thought to result from imbalances in the natural flow of energy, or qi (pronounced "chee") through the body.
Shiatsu therapists use finger and palm pressure to energetic pathways, called meridians to improve the flow of qi.
Basic Rules
The following are some of the basic rules that should be followed before the practice of shiatsu:
Wear comfortable, loose fitting clothes made of natural fibers. This will help with the flow of energy or qi.
The room should be warm, quiet, have adequate space and should be neat and clean. If not, this can have an adverse effect on the flow of qi.
The person receiving the therapy should ideally lie on a futon (a quilted Japanese mattress) or a similar floor mat. Pillows or cushions may be used to make the person comfortable.
Shiatsu should not be given or received by someone who has just eaten a large meal. Wait several hours before giving or receiving shiatsu.
No pressure should be exerted on varicose veins or injuries such as cuts or breaks in bones.
Although shiatsu can be of benefit to women while pregnant, there are four areas that should be avoided and these are the stomach, any part of the legs from the knees downwards, the fleshy web of skin between the forefinger and thumb, and an area on the shoulders at each side of the neck.
Ensure that the person is calm and relaxed.
It is generally not advisable to practice shiatsu on people who have serious illnesses such as heart disorders, multiple sclerosis or cancer. An experienced practitioner may be able to help, but a detailed and accurate diagnosis and course of treatment is essential.
Benefits of Shiatsu
Calming, grounding and deeply relaxing for body and mind
Helps to restore and rebalance energy levels
Creates a sense of well-being
Relieves stiffness and tension, improves posture
Helps clear toxins from the body
Improves immunity
Helps to prevent and relieve many conditions such as:
Headaches and migraines
Stress and anxiety
Backache
Neck and shoulder tension
Digestive problems
Menstrual problems
Joint pain and reduced mobility
Fatigue and insomnia
Contraindications
Shiatsu is often not recommended for those who have the following conditions:
Infectious skin disease, rash, or open wounds
Immediately after surgery
Immediately after chemotherapy or radiation, unless recommended by your doctor.
People with osteoporosis should consult their doctor before having shiatsu.
Prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having shiatsu.
Pregnant women should check with their doctor first if they are considering getting any type of massage or bodywork. Shiatsu in pregnant women should be done by massage therapists who are certified in pregnancy massage.
Shiatsu should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.
Basic Strokes in Shiatsu
Single thumb pressing – Apply single thumb pressing with the thumb of either the right or left hand. Be sure to apply pressure with the pad of the thumb and not the joint. The other fingers are held together and placed lightly on the patient’s body for support.
Double thumb pressing – Apply pressing with both thumbs simultaneously. Each thumb is open to about 30 degrees. The outer sides of the tips of both thumbs are held together, and the digital balls are pressed against the skin.
Thumb over thumb pressing – Apply pressing simultaneously with equal pressure from both thumbs. The other four fingers of each hand provide light support. This is used when strong pressure is desired.
Alternate thumb pressing – The thumbs are placed with their tips almost touching and pressed alternately as they progress along the line.
Single Palm Pressing – With all five fingers held together, apply pressure using the whole palm of one hand.
Double palm pressing – Pressure is applied with the palm of both hands, each held flat on the client’s body.
Palm over palm pressing – Pressure is applied using both hands with one hand over the other.
Stretching – Lean into the body or joint until you feel the point of resistance that stops the motion. Hold for five (5) seconds then release.
PERFORMING A SHIATSU MASSAGE
Lesson 1: Shiatsu Program
Introduction
The therapist will need to prepare a program outline designed for a particular client. The actual application of shiatsu will be done after the preparation of the program.
Shiatsu Program (60 minutes)
Position Body Parts Strokes Repetitions
Preparation - Stretching Back Rocking
Cross Stretching
Bilateral Stretching 2
1
1
Lower Extremities Stretching 2
Knee, Heel to Buttocks Stretching 2
Feet Thumb Pressing 5
Prone Left Foot to Thigh
Right Foot to Thigh Thumb Pressing
Alternate Palm Squeezing
Pounding
Jostling
Cupping
Quacking 2
2
3
1
1
1
Buttocks Thumb Pressing
Bilateral Compression
Ipsilateral Compression
Pounding
Cupping 1
3
3
3
3
Back Alternate Palm Compression
Bilateral Thumb Pressure
Single Thumb Pressing
Double Thumb Pressing 2
2
2
2
Shoulder, Nape and Head Alternate Thumb Pressing
Thumb Pressure
Alternate Thumb Kneading 3
2
2
Scapula, Arm and Head Thumb Kneading
Alternate Thumb Pressing
Alternate Palm Pressing
Cupping
Pounding 2
2
1
3
3
Supine Head Thumb Pressing
Thumb Kneading 2
2
Face Thumb Pressing
Finger Pressing
Palm Gliding
Fulling 2
2
3
3
Chest Thumb Pressing
Palm Circular
Alternate Palm Circular 2
3
3
Abdomen Palm Pressing
Alternate Effleurage 2
3
Left Arm and Hand
Right Arm and Hand Thumb Pressure
Wringing
Palm Squeezing
Finger Pressing
Wringing
Rolling
Cupping 2
3
2
2
2
2
3
Both Thigh Leg and Foot Alternate Palm Pressing
Thumb Pressing
Shaking 2
2
2
Left Foot to Thigh
Right Foot to Thigh Thumb Pressing
Cupping
Quacking
Bilateral Palm Squeezing
Quacking
Cupping
Pulling 2
1
1
2
2
2
2
Position your Client in Prone position
Warm your hand by touching the back of your client. One hand at the thoracic and the other hand on the lumbar area. Hold for five (5) seconds. Do this step for two (2) repetitions.
Apply Rocking.
Apply Cross Stretching on the back and hold for five (5) seconds. (4 points)
Apply Bilateral Stretching to the back for two (2) repetitions (4 points), and then apply Alternate Palm compression upward.
Apply Stretching to the lower extremities and hold for five (5) seconds.
Apply Stretching to the Hip hyperextended and hold for five (5) seconds. Do this step for two (2) repetitions. Then rotate clockwise & counterclockwise for two (2) repetitions. Repeat to the other side.
Apply Stretching to both knee and then heel to buttocks. Hold for five (5) seconds. Do this step for two (2) repetitions.
Apply thumb pressure to both feet (plantar surface center area) and hold for five (5) seconds. Then apply alternate thumb pressing for five (5) repetitions. Repeat the same procedure on the whole plantar surface.
Simultaneously apply thumb pressure to the center of both legs and thigh and hold for three (3) to five (5) seconds. Do this step with back and forth motion for two (2) repetitions.
Prone Position: Massaging the Buttocks
Apply bilateral compression to the buttocks and hold for five (5) seconds, and then knead clockwise and counterclockwise for three (3) repetitions.
Apply ipsilateral compression to the right and left buttock and hold for five (5) seconds, and then knead clockwise and counterclockwise for three (3) repetitions.
Apply thumb pressure to the medial, lateral, superior, inferior and center of the buttocks. Hold for three (3) seconds.
Apply bilateral compression to the buttock and hold for five (5) seconds. Then knead clockwise and counterclockwise for three (3) repetitions.
Apply pounding and cupping to the buttocks for three (3) repetitions.
Lesson 2: Massage Sequence - Prone Position
Prone Position: Massaging the Back
Position: The therapist in tripod position to the back of the client
Apply alternate palm compression to the lumbar up to the shoulder and then to the whole back with back and forth motion for two (2) repetitions.
Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply single thumb pressure to the lumbar up to the shoulder for two (2) repetitions. (Use left and right)
Apply double thumb pressure to the lumbar up to the shoulder and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply alternate palm compression to the lumbar up to the shoulder and then to the whole back with back and forth motion. Do this step for two (2) repetitions.
Position: The therapist in kneeling position to the buttocks of the client
Apply bilateral thumb pressure and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply unilateral thumb pressure (use left and right) to the lumbar up to the shoulder and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three (3) seconds. Do this step for (2) repetitions.
Apply alternate palm compression to the lumbar up to the shoulder and then to the whole back with back and forth motion. Do this step for two (2) repetitions.
Position: The therapist in sitting position to the feet of the client (flexed position)
Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply unilateral thumb pressure to the lumbar up to the shoulder and hold for three seconds. Do this step for two (2) repetitions.
Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three (3) seconds. Do this step for three (3) repetitions.
Back to tripod position
Apply alternate palm compression to the lumbar up to the shoulder and then to the whole back with back and forth motion. Do this step for two (2) repetitions.
Prone Position: Massaging the Shoulder, Nape and Head
Position: The therapist in the head area of the client
Apply alternate thumb pressure to the shoulder for three (3) repetitions. Then apply alternate thumb pressure to the left and right side of the shoulder using. Do this for three (3) repetitions.
Apply alternate thumb kneading to the shoulder. Do this step for two (2) repetitions.
Apply thumb pressure to the medial side of the spine from shoulder to lumbar simultaneously with back and forth motion. Do this step for two (2) repetitions.
Apply palm pressing to the whole back (from shoulder to lumbar) with back and forth motion. Do this step for two (2) repetitions.
Apply thumb pressure to the center of the nape and hold for five (5) seconds. Do this step for two (2) repetitions.
Apply thumb pressure to the center of the head for two (2) repetitions.
Apply scalp massage.
Prone Position: Massaging the Scapula, Arm and Hand
Position the arm of the client to his/her back exposing the scapula. Apply thumb kneading to the medial side of the scapula with back and forth motion for two (2) repetitions.
Assist the client back to the original position and apply alternate thumb pressure to the anterior side of the arm (upper to lower).
Apply alternate thumb pressure to the palmar surface of the hand for two (2) repetitions.
Apply alternate palm pressing from wrist to arm.
Repeat the steps to the other side of the arm.
Apply cupping and pounding to the back down to the leg for three (3) repetitions.
Then apply rocking.
Lesson 3: Massage Sequence - Supine Position
Supine Position: Massaging the Head
Position your Client in Supine position
Apply thumb pressure to the center of the head and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply thumb pressure to the lateral side of the head (left and right) and hold for three (3) seconds. Do this for two (2) repetitions.
Lateral flex the neck left: press the temporal side of the head and hold for three (3) seconds for two (2) repetitions. Then apply thumb kneading to the parietal and temporal side of the head for two (2) repetitions.
Repeat the steps to the other side.
Supine Position: Massaging the Face
Apply thumb pressure to the forehead and hold for three (3) seconds. Do this step for two (2) repetitions, and then knead.
Apply thumb pressure to the lateral side of the nose and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply finger pressure to the left and right side of the eye and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply finger pressure to the cheeks and hold for (three) 3 seconds. Do this step for two (2) repetitions, and then knead.
Simultaneously pinch the eyebrows and hold for five (5) seconds. Do this step for two (2) repetitions.
Warm the hand then touch the forehead and hold for five (5) seconds.
Apply Palm gliding to the forehead for three (3) repetitions.
Apply Fulling to the forehead with kneading to the temple of the head for three (3) repetitions.
Apply gliding to the forehead. Do this step for three (3) repetitions.
Supine Position: Massaging the Abdomen
Apply palm pressure to the abdomen and hold for five (5) seconds. Do this step for two (2) repetitions.
Apply alternate two handeffleurage to the abdomen following the pathway of large intestine for three (3) repetitions.
Supine Position: Massaging the Left Arm & Hand
Perform arm stretching by applying 90 degrees angle shoulder flexion then 180 degrees angle shoulder flexion and hold for five (5) seconds. Do this step for three (3) repetitions. Then apply abduction of 90 degrees angle followed by horizontal abduction of 90 degrees angle. Pull the arm downwards and hold for five (5) seconds for three (3) repetitions.
Apply wringing to the whole arm for three (3) repetitions.
Abduct the arm into 90 degree angle and apply thumb pressure to the medial and lateral side of the arm and forearm for three (3) seconds.
Apply palm squeezing to the whole arm with back and forth motion for two (2) repetitions.
Apply thumb pressure to the palmar and hold for three (3) seconds. Do this step for two (2) repetitions.
Apply finger pressure using thumb and index finger to the individual finger for two (2) repetitions, and then knead and pull.
Apply thumb pressure and gliding to the palmar and dorsal side of the hand for two (2) repetitions. Use the knuckles if necessary.
Apply wringing, rolling and cupping to the whole arm for two (2) repetitions.
Repeat to the other side.
Supine Position: Massaging both Thigh, Leg and Foot
Simultaneously apply alternate palm pressing to the foot up to the thigh with back and forth motion for two (2) repetitions.
Simultaneously apply thumb pressing to the medial side of the thigh with back and forth motion for two (2) repetitions.
Apply shaking for two (2) repetitions.
Supine Position: Massaging Left Thigh, Leg and Foot
Apply thumb pressure to the center of the thigh, then to the lateral and medial side of leg and foot. Do this step for two (2) repetitions. Knead and squeeze with back and forth motion.
Position the thigh in tree position, then apply palm pressing to the medial side of the thigh with back and forth motion for two (2) repetitions. Then apply thumb pressure for two (2) repetitions.
Position the thigh in reverse tree position, and then apply palm pressing to the lateral side of the thigh with back and forth motion for two (2) repetitions. Apply thumb pressure to the lateral side of the thigh for two (2) repetitions.
Back to the original position
Apply thumb pressure to the superior, medial, lateral and inferior sides of the knee and hold for three (3) seconds. Do this step for two (2) repetitions. Knead and glide with back and forth motion for two (2) repetitions.
Apply thumb pressure to the dorsal part of the foot and hold for three (3) seconds for two (2) repetitions. Then knead for two (2) repetitions.
Apply thumb pressure to the plantar side of the foot and hold for three (3) seconds for two (2) repetitions. Then knead for two (2) repetitions.
Apply flicking to the individual finger.
Apply ankle rotation clockwise and counterclockwise and stretched into plantar flexion and dorsiflexion. Hold for five (5) seconds. Do this step for two (2) repetitions.
Apply knee to chest stretching and hold for five (5) seconds for two (2) repetitions, and then pull and hold for five (5) seconds.
Apply cupping and quacking to the whole leg.
Repeat to the other side
Apply bilateral knee to chest stretching and hold for five (5) seconds. Do this step for two (2) repetitions.
Apply bilateral palm squeezing to the whole leg with back and forth motion. Do this step for two (2) repetitions.
Apply cupping and quacking. Do this step for two (2) repetitions.
Apply pulling for two (2) repetitions.
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