How dangerous is Shiatsu? Science and polemics (Dr. Eduard Tripp)

The study by K. Faull (A pilot study of the comparative effectiveness of two water-based treatments for fibromyalgia syndrome: Watsu and Aix massage)¹ compares Watsu („Water Shiatsu“)² with Aix massage in a within-subject design³. There is a significant improvement in fibromyalgia patients (compared to Aix massage).

The studies by M. Iida et al. (Effects of shiatsu massage on relief of anxiety and side effect symptoms of patients receiving cancer chemotherapy⁴), L.H. Brady et al. (The effects of shiatsu on lower back pain⁵) and P. Lichtenberg (Shiatsu as an adjuvant therapy for schizophrenia: An open-label pilot study⁶) have no control group and used only a simple before-after design, which limits the validity of their results.

The study by Ieda et al. shows the relaxing effects of shiatsu treatments on anxiety and other side effects in nine patients receiving chemotherapy. The small size of the experimental group, the selection of participants and the lack of a control group, however, significantly limited the study’s findings.

Brady et al. can show in their study on lower back pain that pain and anxiety improved significantly in 66 participants after Shiatsu treatments. This effect was also observed when demographic variables were controlled. The statement of the study is limited by the fact that 13 subjects had already received Shiatsu before.

In their study, Lichtenberg et al. show significant improvements in values such as psychopathy, anxiety and depression through Shiatsu as a supportive treatment method for schizophrenia.

A.F. Long (The effectiveness of shiatsu: findings from a cross-European, prospective observational study, 2008⁷) conducted a prospective observational study (cohort study) with 948 participants in three different countries, demonstrating significant improvements in existing symptoms. Although the study for a longitudinal cohort study had a good response rate (67%), considered confounders and recorded the changes accurately, the study suffers from so-called „response bias“ because the data of those participants who did not participate or did not complete all required questionnaires were not recorded.⁸

Referring to the weak evidence of the efficacy of Shiatsu, also recorded by Robinson et al., Edzard Ernst views his assessment in the Oxford Handbook of Complementary Medicine 2008 as being confirmed („this seems to indicate that our verdict of 2008 is still not far off the mark“).

This picture of Shiatsu in science (weak evidence) has not changed fundamentally until today, even though some work on Shiatsu has been done in the meantime.

For example, there is Natural Medicines⁹, a website that is dedicated to science in dealing with traditional methods of treatment. Since many aspects of medicine, especially in the field of naturopathy, are influenced by traditions and beliefs, the goal of Natural Medicines, the website informs us, is to take an objective look at these methods and to use verified scientific research for their evaluation.¹⁰ In the monographs produced by Natural Medicines, it is explained in particular what the respective method is (traditionally) used for, whether it is safe and what side effects can be expected.

With regard to Shiatsu, according to Natural Medicines (the last review took place on 7 July 2015¹¹), there is too little reliable scientific evidence for a rating of efficacy. In this context, four studies are cited: the study by L.H. Brady et al. (mprovement of pain and anxiety in lower back pain¹²), the study by J. Ingram et al. (faster and less induced births¹³), the study by H. Saito (efficacy against intestinal obstruction and intestinal sluggishness after abdominal laparotomic surgeries¹⁴) and the study by S. Cheesman et al. (improvements of quality of life in patients with advanced diseases in palliative care¹⁵). But here too, according to Natural Medines, more research data are needed to evaluate these effects („more evidence is needed to rate Shiatsu for these uses„).

Anmerkungen/Fußnoten

1
Faull K: A pilot study of the comparative effectiveness of two waterbased treatments for fibromyalgia syndrome: Watsu and Aix massage. Journal of Bodywork and Movement Therapies 2005, 9:202-210.
2
Watsu is developed by Harold Dull and used in warm water. Watsu is not evaluated as Shiatsu in Austria. The Aix massage goes back to a form of massage used in the French Spa Aix-les-Bains, which also includes a massage under the jets with thermal water (see https://teara.govt.nz/en/photograph/6584/the-aix-massage). In this respect, this study makes no statement about Shiatsu.
3
Within-Subject-Design: the same person will successively complete all experimental conditions.
4
Iida M, Chiba A, Yoshida Y, Shimizu K, Kanda K: Effects of shiatsu massage on relief of anxiety and side effect symptoms of patients receiving cancer chemotherapy. Kitakanto Medical Journal 2000, 227-232.
5
Brady LH, Henry K, Luth JF, Casper-Bruett KK: The effects of shiatsu on lower back pain. J Holist Nurs 2001, 19:57-70.
6
Lichtenberg P: Shiatsu as an adjuvant therapy for schizophrenia: An open-label pilot study. Alternative Therapies in Health and Medicine 2009, 15:44-46.
7
Long AF: The effectiveness of shiatsu: findings from a cross-European, prospective observational study. J Altern Complement Med. 2008 Oct;14(8):921-30. https://www.ncbi.nlm.nih.gov/pubmed/18990043.
8
Robinson et al. also note that the studies by Sundberg et al. and Ballegaard et al. follow a „pragmatic“ approach, namely that of Shiatsu as part of a healthcare setting or in conjunction with other „interventions“ such as acupuncture or lifestyle changes. Thus, in the eyes of the authors, these studies reflected the usual practice, but the specific effects of Shiatsu could not be filtered out.
9
https://naturalmedicines.therapeuticresearch.com is a payed service.
10
„Natural Medicines approaches the subject of natural medicines from a completely objective and unbiased perspective. It seeks to answer questions about natural medicines by systematically identifying, evaluating, and applying scientific information. As a result, it curtails perpetuation of myths and age-old beliefs and replaces them with reliable scientific data“ (https://naturalmedicines.therapeuticresearch.com/about-us/editorial-principles-and-process.aspx). Access: 28/6/19.
11
https://naturalmedicines.therapeuticresearch.com/databases/health-wellness/professional.aspx?productid=1178. Access: 28/6/19.
12
Brady LH, Henry K, Luth JF, Casper-Bruett KK: The effects of shiatsu on lower back pain. J Holist Nurs 2001, 19:57-70. http://www.ncbi.nlm.nih.gov/pubmed/11847714?dopt=Abstract.
13
Ingram J, Domagala C, Yates S: The effects of shiatsu on post-term pregnancy. Complement Ther Med 2005, 13:11-15. https://www.ncbi.nlm.nih.gov/pubmed/15907673?dopt=Abstract.
14
Saito H: Preventing and resolving post-laparotomy intestinal obstruction: an effective shiatsu method. Am J Chin Med. 2000;28(1):141-5. https://www.ncbi.nlm.nih.gov/pubmed/10794126?dopt=Abstract.
15
Cheesman, S et al.: Exploring the value of shiatsu in palliative care day services. Int J Palliat Nurs. 2001 May;7(5):234-9. 2. https://www.ncbi.nlm.nih.gov/pubmed/12148974.

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