Shiatsu Massage: Procedure, Effects, and What Makes It Unique

Shiatsu is a Japanese form of bodywork. It is performed clothed, without oil, using sustained pressure from thumbs, palms, and elbows. A session typically lasts 45 to 90 minutes and usually takes place on a mat on the floor. Here you will find what happens during this time, how the pressure feels, what a treatment costs, the difference from Thai massage, and what devices can simulate it.

What Shiatsu means

The word simply means finger pressure: shi for finger, atsu for pressure. The form originated in Japan in the early twentieth century from the older Anma massage, supplemented by elements of Western anatomy. Since 1964, Shiatsu has been recognized as an independent practice in Japan.

The underlying model comes from traditional East Asian medicine: The body is traversed by pathways, called meridians, along which life energy flows. If this flow is blocked, discomfort arises. This is a cultural explanatory model and not an anatomical description. You don't have to believe in it to benefit from the treatment.

How a session proceeds

Work is performed on a firm mat on the floor, less commonly on a treatment table. The floor is not arbitrary: Only this way can the therapist apply her own body weight vertically over the pressure point, instead of pressing with her arm. This is why Shiatsu works deeply without appearing forceful.

• Beginning. A short conversation, then you usually lie on your stomach. The therapist first just places her hands and works with gentle, broad pressure.
• Back and buttocks. Pressure along the pathways to the left and right of the spine, with thumbs or heels of the hands. Each point is held for a few seconds, not kneaded.
• Legs and feet. Moving downwards, often using forearms or elbows on the strong muscle groups.
• Side-lying and supine position. Arms, hands, abdomen, neck, and head. This is accompanied by gentle rotations of the shoulders and hips.
• Conclusion. A few minutes of resting afterwards, without touch.

How the pressure feels

Different from a kneading massage. The pressure comes slowly, pauses, and slowly releases. It is clearly noticeable in tense areas, and barely perceptible in relaxed ones. It is pleasant when you can continue to breathe calmly. As soon as you hold your breath or resist, it's too much, and you should say so.

A slight soreness the day after is possible, similar to mild muscle soreness. Fatigue immediately after the session is common, so many people don't plan anything demanding afterwards.

Shiatsu, Thai or classic massage

• Clothing. Shiatsu and Thai are performed clothed, classic massage with oil on the skin.
• Technique. Shiatsu holds pressure. Thai holds pressure and also stretches vigorously. Classic massage kneads and strokes.
• Pace. Shiatsu is the calmest of the three. Thai is significantly more dynamic, as you are passively guided into positions.
• Surface. Shiatsu and Thai on a mat, classic on a treatment table.

If you're looking for a detailed comparison to Thai massage: traditional Thai massage. All forms side by side can be found in the overview of massage types.

What a treatment costs

Guide values for privately paid sessions in Germany, not a fixed price:

• 45 to 60 minutes: around 60 to 90 Euros.
• 90 minutes: around 90 to 140 Euros.
• Ten-session passes significantly reduce the per-session price at most practices.

In large cities, prices are at the higher end. Statutory health insurance does not cover Shiatsu, as it is not considered a recognized therapeutic agent. Some private supplementary insurance plans may contribute; it's worth checking beforehand. How this compares to other types of massage can be found here: what a massage costs.

How often is beneficial

For acute tension, many practices recommend several appointments in quick succession, followed by longer intervals. For most, one appointment a month is sufficient for everyday balance. More frequent sessions are not harmful, but can quickly amount to a four-figure sum per year. The general assessment on this: how often one should get a massage.

Precisely this calculation often decides the question of a device for many. Someone who goes every two weeks for 80 Euros pays around 2,000 Euros per year. A mid-range massage chair thus pays for itself after one to two years, after which each application costs nothing more. What it cannot do, however, is explained below.

What to wear

Comfortable, loose clothing made of thin fabric, in which you can sit and bend your legs. Long trousers and a long-sleeved shirt are better than short items, as otherwise the therapist works directly on the skin and the pressure is felt differently there. Socks stay on. Jewelry, watch, and belt are removed. Do not eat immediately before, as the abdomen will be worked on.

When Shiatsu is not suitable

Consult a doctor beforehand if pregnant, with thrombosis or suspected thrombosis, osteoporosis, acute inflammation and fever, recent injuries and surgeries, or when taking blood-thinning medication. Work is not performed over open wounds, fresh bruises, and inflamed areas.

Shiatsu in devices

The term also appears in retail, and there it means something different. A Shiatsu massage cushion mimics circular movements with rotating massage heads, while a massage chair moves them along a track up the back. Both are based on the technique but are not identical to it: A device does not hold pressure for seconds at a single point and does not respond to anything it feels under the rollers.

What it can do, however, is provide the same area every evening, for ten minutes, without an appointment. Those who want to try this can find massage cushions for individual zones and massage chairs for the entire back. Test sitting is free at over 40 locations.

Brief summary

• Shiatsu means finger pressure and is performed clothed, without oil, on a mat on the floor.
• Pressure is held rather than kneaded; the therapist's body weight replaces force.
• A session typically lasts 45 to 90 minutes.
• The pressure is pleasant as long as you can continue to breathe calmly.
• A privately paid session usually costs 60 to 140 Euros; health insurance does not cover it.
• Shiatsu devices mimic the movement but do not hold pressure at one point.