People sometimes ask me whether shiatsu is simply Japanese massage. It’s a fair question. Both use the hands, both tend to leave you calmer than you arrived, and both have long histories. Lie down for each, though, and you soon notice that they start from different ideas about the body and about what touch is for.
I think of them as two different conversations. A Swedish massage speaks mainly to muscle and soft tissue. Shiatsu speaks to the channels of Chinese medicine, and through them to the whole person. This article explains what that means in practice, what research has and hasn’t shown, and how to choose between them.
Where Western massage comes from
Much of what people in the UK call massage builds on Swedish massage. Its history usually begins with Per Henrik Ling, who developed his system in Sweden in the early nineteenth century. Later in that century the Dutch physician Johann Mezger presented massage to his colleagues as a medical treatment and gave the strokes names that therapists still use, such as effleurage and pétrissage. Deep tissue and sports massage grew from the same roots.
In a typical session you lie on a couch, undressed to whatever level feels comfortable and covered with towels. The therapist works on bare skin with oil or lotion, using gliding, kneading and compressing strokes. The goals are largely physical: to ease tight muscles, warm the tissues and help you relax. A skilled therapist feels for tension under their hands and adjusts the pressure as they go.
Where shiatsu comes from
Shiatsu means “finger pressure” in Japanese. It developed in Japan and shares its map with acupuncture: the meridians, or channels, along which Chinese medicine describes Qi as flowing. An acupuncturist works on points along those channels with fine needles. A shiatsu practitioner works along them with sustained pressure from the thumbs, palms, elbows and sometimes knees.
You stay fully clothed, ideally in something loose and soft, and lie on a futon on the floor. Working at floor level lets the practitioner lean in with their body weight rather than muscle strength, so the pressure can feel deep without feeling sharp. Much of the session consists of held, still contact, with gentle stretches and rotations of the limbs and joints in between.
The reasoning behind the treatment differs too. A shiatsu practitioner assesses which channels feel full and which feel depleted, often by touch on the abdomen, and works to bring them back into balance. That assessment draws on the same diagnostic thinking I use in acupuncture.
In shiatsu, a sore shoulder prompts a question about which channel runs through it, and what else along that channel needs attention.
How the two feel
Rhythm is the first difference most people notice. Swedish massage keeps moving, with long flowing strokes that work through the back, legs and arms in turn. Shiatsu feels slower and more spacious: pressure sinks in, holds, and then releases. If you expect a rub, the stillness can surprise you at first, and some people come to value it for exactly that reason.
The second difference is practical. With shiatsu you keep your clothes on and leave without oil on your skin, which suits people who feel self-conscious about undressing, find oil massage overstimulating, or want to go straight back to work afterwards. Swedish massage offers the particular comfort of warm oil and skin contact, which many people find hard to beat.
What the research shows
Western massage has the larger body of research. In 2004, Moyer, Rounds and Hannum published a meta-analysis in Psychological Bulletin that pooled 37 randomised studies. A single session reduced anxiety in the moment, blood pressure and heart rate. A course of sessions reduced longer-term anxiety and depression, and these turned out to be massage’s largest effects. For low back pain, NICE guidance says clinicians can consider manual therapy, including soft tissue techniques such as massage, but only as part of a treatment package that includes exercise.
Shiatsu has much less behind it. A 2011 systematic review in BMC Complementary and Alternative Medicine, by Robinson, Lorenc and Liao, found only nine shiatsu studies of mixed design and judged the evidence insufficient in both quantity and quality. The same review found more support for acupressure, which applies similar pressure to acupuncture points. The strongest acupressure evidence concerned some types of pain (period pain, lower back pain and labour) and nausea and vomiting after surgery, and the authors also found good-quality evidence of better sleep in older people living in care homes.
You may read that shiatsu affects the nervous system in ways that are measurably different from Western massage. It’s an appealing idea, but I haven’t found good-quality trials that compare the two directly, so nobody can yet say it with confidence. A fair summary is that massage has reasonable evidence for short-term calming effects, shiatsu has very little research in either direction, and the differences people feel between them are real experiences that science hasn’t yet measured well.
Choosing between them
Neither one is better in general. The right choice depends on what you want from the hour.
- A Swedish or deep tissue massage suits you if you want work on particular tight muscles, or simply want a classic relaxing massage.
- Shiatsu suits you if you prefer a slower, stiller treatment, or feel drawn to the Chinese medicine view of health behind acupuncture.
- Either works well if your main aim is to switch off for an hour.
Because shiatsu and acupuncture draw on the same channels and the same diagnosis, the two sit comfortably together in one treatment plan. Shiatsu can also suit people who like the Chinese medicine approach but feel uneasy about needles.
Before either treatment, tell your practitioner if you’re pregnant, or if you have osteoporosis, a blood clotting problem, or a recent injury or operation, so they can adapt the pressure or suggest something else.
If you can’t decide, try each once and notice how you feel that evening and the following morning. That comparison will tell you more than any description.