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

The side effects of Shiatsu in the mirror of the contribution by Edzard Ernst

What about the risks of Shiatsu? In order to answer this question, since it is even more difficult to find reliable information about this than about the effectiveness of Shiatsu, Edzard Ernst quotes the warnings given on the verywellhealth website:

„Safety and Side Effects

While shiatsu is generally considered safe when done by a qualified professional, 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. People with leg stents should avoid abdominal massage.

Shiatsu should also be avoided immediately after surgery, and by people with infectious skin disease, rash, or open wounds.“¹

And what about adverse reactions and complications from Shiatsu? Here Edzard Ernst refers to shiatsu-london.net („Professional Shiatsu School“²) and quotes that Shiatsu, if done properly, does not lead to side effects. Individual patients may experience slight discomfort, but this usually ends during treatment („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“).³

Whether Shiatsu is without side effects, Edzard Ernst says, can unfortunately be answered in the negative. But for that one has to dig deeper to get a preliminary answer at all… and he then refers to the 2009 published work by A.F. Long et al. (A typology of negative responses: a case study of shiatsu⁴) on the evaluation of „negative“ reactions.

The basis of this work is a prospective cohort study lasting six months, which was carried out in three countries (Austria, Spain and Great Britain) with a response rate of 67%. Here, Edzard Ernst continues, the answers of the participants show a prevalence rate of 12 to 22 % (in the three countries) for „negative“ reactions.

This means that in 12 to 22 % of all treatments there were „negative“ reactions. This sounds a lot, but has to be put into perspective, because certain „negative“ reactions (e.g. feeling cold, fatigue, muscle aches like „sore muscles“ …) are regarded as side effects of regeneration and healing (and in this sense not as „negative“).

82% of these „negative reactions“, Ernst continues, were temporary „negative effects“ and a total of nine subjects (1.4%) described „a potentially negative event or effect“ that could pose a risk to client safety.

The 82% of all „negative“ reactions mentioned by Edzard Ernst are classified by A.F. Long et al.⁵ as transitional effects of type 2 and 3. They are in accordance with theory (thus no undesirable side effects, rather „expected“, „normal reactions“) and change from originally „negatively“ experienced to „positively“. They do not burden the client, only last for a short time and do not hinder their normal activities.

The difference between type 2 and type 3 reactions is that clients initially experience type 2 reactions as „negative“, but over the next few days as positive (e.g. fatigue after treatment, so that the treated person has to rest for a short time and feels much better afterwards). In contrast to this, type 3 reactions also change from „negative“ to „positive“, but are not explicitly perceived by the client in this form (e.g. greater exhaustion on the day of treatment).

The type 5 responses (those „potentially negative events or effects“ reported by Edzard Ernst), on the other hand, describe effects and reactions that limit and disturb the participants in their daily lives, such as pain in the back, knees (after stretching) and neck, strong emotional reaction or even burns (after moxa treatment).⁶

A.F. Long et al. evaluate the type 5 responses based on the work of H. Yamashita (Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan, 1999⁷), whereby first of all a distinction is made between negligence on the part of the practitioner (e.g. non-execution or incorrect execution of a necessary procedure, as in the above enumeration the burns after a moxa treatment) and proper treatment. The non-negligently induced events, in turn, are then divided into „definite“, „probable“, „possible“ or „doubtful“. Assessment criteria are the time of occurrence after treatment and recurrence after further treatment.⁸

If one applies this definition to type 5 responses, then the repeated back pain („many times“) turns out to be a definitely undesirable but not negligent event (and „undesirable effect“): the pain occurred in a temporarily appropriate context and was repeated during renewed Shiatsu treatments.

In contrast, complaints that got stronger after the first treatment (spine) were classified as a „possible“ adverse event (but not as a „possible“ adverse effect). Complaints that become stronger when used (?) again would be a „probably“ adverse event (or „probably“ adverse effect).⁹

In contrast to Edzard Ernst, A.F. Long et al. in their study, after a detailed discussion of the „negative“ reactions, come to the conclusion that Shiatsu is a safe form of treatment, at least when in the hands of a competent practitioner: „… shiatsu being inherently a safe modality, at least when in the hands of a competent (and, in the current context, experienced and accredited) practitioner“.¹⁰

Anmerkungen/Fußnoten

1
Cathy Wong: What You Can Expect From a Shiatsu Massage. Can Shiatsu Soothe Pain? https://www.verywellhealth.com/shiatsu-what-should-i-know-about-it-89743. Access: 28/6/19.
2
http://shiatsu-london.net/contraindications.html.
3
In the meantime this page might have been changed, because now you can find there unde „Contraindications“: „Although shiatsu is a very safe massage, with no side effects, there are certain cases when it is better to avoid receiving it“. And then circumstances are mentioned on the page under which Shiatsu should be avoided (http://shiatsu-london.net/contraindications.html). Access: 28/6/19.
4
Long AF, Esmonde L, Connolly S: A typology of negative responses: a case study of shiatsu. Complement Ther Med. 2009 Jun;17(3):168-75. Doi: 10.1016/j.ctim.2008.09.004. Epub 2008 Nov 17. https://www.ncbi.nlm.nih.gov/pubmed/19398071. Access: 28/6/19. Siehe auch die deutsche Zusammenfassung der Studie unter Info-Pool – Studien.
5
Ibid.
6
For the sake of completeness: Type 1 responses are not related to the treatment („unconnected responses“, e.g. the outbreak of influenza). Type 4 responses are „undesired, but not unsafe events or effects“: which are presented by the client as negative, disturb her and interfere with her activities (e.g. „feeling of depression“ for two days after treatment).
7
Yamashita H, Tsukayama H, Tanno Y, Nishijo K.: Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. J Alternative Complement Med 1999;5:229—36.
8
For example a „clearly“ undesirable event occurs after a reasonable period of time and during any further treatment, a „likely“ undesirable event occurs after a reasonable period of time and occasionally during further treatment, a „possible“ undesirable event occurs after a reasonable period of time and not again, and a „dubious“ undesirable event occurs at a later time and then no longer.
9
According to A.F. Long et al., however, the final classification would require more information, especially regarding the interaction between the practitioner and the client.
10
Long AF, Esmonde L, Connolly S: A typology of negative responses: a case study of shiatsu. Complement Ther Med. 2009 Jun;17(3):168-75. Doi: 10.1016/j.ctim.2008.09.004. Epub 2008 Nov 17.

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