MASSAGE THERAPY

Shiatsu Massage
MODULE 1: INTRODUCTION TO SHIATSU MASSAGE
Lesson 1:

Origins and Evolution of Shiatsu

Session Objectives
At the end of the session, you will be able to:
Describe the history of Shiatsu
Define what is Shi and Ki in Shiatsu
Identify the Five Elements of Shiatsu

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 MacArthers 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).
Namikoshis 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 Namikoshis 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 theyre 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 Serizawas 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 1970s, following President
Nixons 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 its 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

Session 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 clients
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:
o Headaches and migraines
o Stress and anxiety
o Backache
o Neck and shoulder tension
o Digestive problems
o Menstrual problems
o Joint pain and reduced mobility
o 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 patients 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 clients 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.

MODULE 2: PERFORM SHIATSU MASSAGE

Lesson 1:

Shiatsu Program

Session Objectives
At the end of the session, you will be able to:
Perform Shiatsu massage sequence

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

Knee, Heel to Buttocks

Stretching

Feet

Thumb Pressing

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

Prone

Supine

Bilateral Compression
Ipsilateral Compression
Pounding
Cupping

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

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

Lesson 2:

Thumb Pressing
Cupping
Quacking
Bilateral Palm Squeezing
Quacking
Cupping
Pulling

2
1
1
2
2
2
2

Massage Sequence Prone Position

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 Left Foot

1. Apply thumb pressure to the plantar region (4 points) and hold for three (3) seconds
for two (2) repetitions
2. Apply thumb pressure to the medial, lateral & posterior side of the foot (3 points) and
hold for three (3) seconds. Do this step for two (2) repetitions.
3. Apply thumb pressure to the leg, thigh and buttocks (center, lateral, & medial side),
and hold for three (3) seconds. Do this step for two (2) repetitions. Then knead
(note: medial upward, lateral downward movement)
4. Position the leg and thigh in a frog position. Apply thumb pressure to the lateral side
of the foot, leg, thigh and buttocks for two (2) repetitions, and then knead.

5. Assist the client to the original position and apply alternate palm squeezing to the
whole leg for two (2) repetitions.
6. Flex the knee and apply ankle rotation clockwise & counterclockwise for three (3)
repetitions. Apply pounding to the plantar surface for three (3) repetitions. Then
stretch towards the buttocks and hold for five (5) seconds.
7. Apply jostling
8. Apply cupping, pounding and quacking.
9. Repeat to the other side.
10. Apply cross stretching and hold for five (5) seconds. Do this step for three (3)
repetitions.

Prone Position: Massaging the Buttocks

1. Apply bilateral compression to the buttocks and hold for five (5) seconds, and then
knead clockwise and counterclockwise for three (3) repetitions.
2. 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.
3. Apply thumb pressure to the medial, lateral, superior, inferior and center of the
buttocks. Hold for three (3) seconds.
4. Apply bilateral compression to the buttock and hold for five (5) seconds. Then knead
clockwise and counterclockwise for three (3) repetitions.
5. Apply pounding and cupping to the buttocks for three (3) repetitions.

Prone Position: Massaging the Back

Position: The therapist in tripod position to the back of the client
1. 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.
2. Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three
(3) seconds. Do this step for two (2) repetitions.
3. Apply single thumb pressure to the lumbar up to the shoulder for two (2) repetitions.
(Use left and right)
4. Apply double thumb pressure to the lumbar up to the shoulder and hold for three (3)
seconds. Do this step for two (2) repetitions.
5. 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
1. Apply bilateral thumb pressure and hold for three (3) seconds. Do this step for two
(2) repetitions.
2. 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.
3. Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three
(3) seconds. Do this step for (2) repetitions.

4. 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)
1. Apply bilateral thumb pressure to the lumbar up to the shoulder and hold for three
(3) seconds. Do this step for two (2) repetitions.
2. Apply unilateral thumb pressure to the lumbar up to the shoulder and hold for three
seconds. Do this step for two (2) repetitions.
3. 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
1. 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
1. 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.
2. Apply alternate thumb kneading to the shoulder. Do this step for two (2) repetitions.
3. 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.
4. Apply palm pressing to the whole back (from shoulder to lumbar) with back and forth
motion. Do this step for two (2) repetitions.
5. Apply thumb pressure to the center of the nape and hold for five (5) seconds. Do this
step for two (2) repetitions.
6. Apply thumb pressure to the center of the head for two (2) repetitions.
7. Apply scalp massage.

Prone Position: Massaging the Scapula, Arm and

Hand
1. 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.
2. Assist the client back to the original position and apply alternate thumb pressure to
the anterior side of the arm (upper to lower).
3. Apply alternate thumb pressure to the palmar surface of the hand for two (2)
repetitions.
4. Apply alternate palm pressing from wrist to arm.
5. Repeat the steps to the other side of the arm.

6. Apply cupping and pounding to the back down to the leg for three (3) repetitions.
7. Then apply rocking.
Lesson 3:

Massage Sequence Supine Position

Supine Position: Massaging the Head

Position your Client in Supine position
1. Apply thumb pressure to the center of the head and hold for three (3) seconds. Do
this step for two (2) repetitions.
2. 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.
3. 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.
4. Repeat the steps to the other side.

Supine Position: Massaging the Face

1. Apply thumb pressure to the forehead and hold for three (3) seconds. Do this step
for two (2) repetitions, and then knead.
2. Apply thumb pressure to the lateral side of the nose and hold for three (3) seconds.
Do this step for two (2) repetitions.
3. 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.
4. Apply finger pressure to the cheeks and hold for (three) 3 seconds. Do this step for
two (2) repetitions, and then knead.
5. Simultaneously pinch the eyebrows and hold for five (5) seconds. Do this step for
two (2) repetitions.
6. Warm the hand then touch the forehead and hold for five (5) seconds.
7. Apply Palm gliding to the forehead for three (3) repetitions.
8. Apply Fulling to the forehead with kneading to the temple of the head for three (3)
repetitions.
9. Apply gliding to the forehead. Do this step for three (3) repetitions.

Supine Position: Massaging the Abdomen

1. Apply palm pressure to the abdomen and hold for five (5) seconds. Do this step for
two (2) repetitions.
2. Apply alternate two handeffleurage to the abdomen following the pathway of large
intestine for three (3) repetitions.

Supine Position: Massaging the Left Arm & Hand

1. 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.
2. Apply wringing to the whole arm for three (3) repetitions.
3. 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.
4. Apply palm squeezing to the whole arm with back and forth motion for two (2)
repetitions.
5. Apply thumb pressure to the palmar and hold for three (3) seconds. Do this step for
two (2) repetitions.
6. Apply finger pressure using thumb and index finger to the individual finger for two (2)
repetitions, and then knead and pull.
7. Apply thumb pressure and gliding to the palmar and dorsal side of the hand for two
(2) repetitions. Use the knuckles if necessary.
8. Apply wringing, rolling and cupping to the whole arm for two (2) repetitions.
9. Repeat to the other side.

Supine Position: Massaging both Thigh, Leg and

Foot
1. Simultaneously apply alternate palm pressing to the foot up to the thigh with back
and forth motion for two (2) repetitions.
2. Simultaneously apply thumb pressing to the medial side of the thigh with back and
forth motion for two (2) repetitions.
3. Apply shaking for two (2) repetitions.

Supine Position: Massaging Left Thigh, Leg and

Foot
1. Apply palm squeezing to the whole thigh for two (2) repetitions including the medial
and lateral side.
2. 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.
3. 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.
4. 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.
Lesson 4:

Massage Sequence Original Position (Prone)

Back to the original position

1. 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.
2. 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.
3. 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.
4. Apply flicking to the individual finger.
5. 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.
6. Apply knee to chest stretching and hold for five (5) seconds for two (2) repetitions,
and then pull and hold for five (5) seconds.
7. Apply cupping and quacking to the whole leg.
8. Repeat to the other side
9. Apply bilateral knee to chest stretching and hold for five (5) seconds. Do this step for
two (2) repetitions.
10. Apply bilateral palm squeezing to the whole leg with back and forth motion. Do this
step for two (2) repetitions.
11. Apply cupping and quacking. Do this step for two (2) repetitions.
12. Apply pulling for two (2) repetitions.