Shiatsu: the best thing since sliced bread, or total flimflam?

Alternative medicine comprises a myriad of treatments which have little in common other than not being accepted by conventional medicine. Someone once counted more than 400 different modalities! These are 400 therapies that either have not been proven to work or have been proven not to work. Regardless of this fact, these interventions are often promoted as the best thing since sliced bread.

Take shiatsu, for instance.

According to the UK Shiatsu Society:

Shiatsu is a physical therapy that supports and strengthens the body’s natural ability to heal and balance itself. It works on the whole person — not just with the physical body, but also with the psychological, emotional and spiritual aspects of being.

Shiatsu is currently popular in the UK and elsewhere. It originates from Japan and has its roots in Traditional Chinese Medicine. In Japanese, the term ‘shiatsu’ means ‘finger pressure’ but practitioners also employ at times forceful pressure applied by an elbow or other parts of the therapist’s anatomy, as well as manipulative techniques to adjust the patient’s body. Shiatsu practitioners believe that these techniques stimulate our body’s ‘energy flow’.

If that sounds a bit like vague flimflam to you, let me assure you that you are not alone.

But what conditions do shiatsu practitioners claim to treat effectively?

If we go on the internet, we are spoiled for choice about information relating to this question. On one of these websites, a practitioner states that ‘in addition to the more common conditions treated, I have also helped people with ME, MS, candida, terminal and post-operative cancer, and frozen shoulders.’

Another source is even more explicit and claims ‘shiatsu can be used in the treatment of a wide range of internal, musculoskeletal, and emotional conditions. It is thought to reduce muscle stiffness, stimulate the skin, aid digestion, and influence the nervous system. Shiatsu is used to treat a wide range of chronic conditions, such as headaches, PMS, digestive disorders, fatigue, insomnia, fibromyalgia, stress, anxiety, and musculoskeletal pain, including low back, neck, and joint pain.’

Personally, I find such claims confusing, if not irritating, because they are way out of line with reality. The last time my team reviewed the evidence, we were far less optimistic about the proven benefits of this therapy. In fact, after carefully studying all the published articles, we concluded there was no convincing data are available to suggest that shiatsu is effective for any condition.

Since then, a systematic review has emerged but the shiatsu studies found comprised just one single randomised controlled trial, three controlled non-randomised, one within-subjects study, one observational study and three uncontrolled studies. The authors of this paper are well known for their advocacy of alternative therapies; yet even they concluded that ‘more research is needed… for shiatsu, where evidence is poor’. A more factual conclusion might have been that there is almost no good evidence to support any of the therapeutic claims that are currently being made for shiatsu.

And what about the risks?

Here it is even harder to find reliable information. One website, for instance, warns that ‘certain individuals should take caution and consult a physician before receiving shiatsu. For example, there’s some concern that shiatsu may have harmful effects in pregnant women, patients who have recently undergone chemotherapy or radiation, and people with such conditions as osteoporosis, heart disease, and blood clotting disorders. Additionally, shiatsu should not be performed directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures. Shiatsu should also be avoided immediately after surgery, and by people with infectious skin disease, rash, or open wounds.’

Another website tells us that, ‘when performed properly, shiatsu is not associated with any significant side effects. Some people may experience mild discomfort, which usually disappears during the course of the treatment session.’

So, is shiatsu without side effects?

The answer, I am afraid, is a clear and simple no — but one has to dig deep to find even a tentative answer to this question.

A prospective cohort study of the effects and experience of shiatsu within three countries (Austria, Spain and the UK) was published in 2009. Data were collected via postal questionnaires, and 633 clients provided full follow-up data, which corresponds to a response rate of 67 per cent. A prevalence rate of 12 to 22 out of 100 of client-perceived ‘negative responses’ was found across the three countries. Nine clients (1.4 per cent of the total), relating to 10 sets of written comments, reported a negative response that was classified as ‘a potentially adverse event’ that might represent a risk to client safety.

In addition, there are much more serious complications such as strokes. These might be extreme rarities — but who knows? Nobody!

Why? Because, as with almost all other alternative therapies, there is no reporting or monitoring system for such events — and if we don’t look, we don’t see. The true prevalence of side effects after shiatsu is anyone’s guess.

The conclusion from all this is one which is all too familiar in the realm of alternative medicine: there is no good evidence for effectiveness and some evidence of risk. And this can only mean one thing: the proven benefits do not outweigh the potential harm.

Edzard Ernst, emeritus professor at the University of Exeter, is the author of A Scientist in Wonderland and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.