Massage Therapy Journal Winter 2025

Winter 2025

New CE Tech Neck II: The Lower Body Connection Creative Focus in Client Care How to Approach Precision Neuromuscular Therapy (PNMT) New Technology Massage Professionals React to AI and Robots

JOURNAL

From Ancient Techniques to Modern Balance

Exploring Japanese Massage Techniques From Ashiatsu to Zen Shiatsu and Everything In-between

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Massage Therapy Journal Vol. 64 No. 4 Contents

FEATURES

16 FROM ASHIATSU TO ZEN SHIATSU AND EVERYTHING IN-BETWEEN: EXPLORING JAPANESE MASSAGE TECHNIQUES Japanese massage techniques

26 MASSAGE THERAPISTS REACT AND EXPERTS RESPOND: WHAT DOES ROBOT MASSAGE MEAN FOR THE FUTURE

34 TECH NECK II: THE LOWER BODY CONNECTION New CE Taking a more holistic approach to help clients who are managing tech

68 CREATIVE FOCUS IN CLIENT CARE Precision neuromuscular therapy relies on creativity to help massage therapists get to the root of a client's issues.

OF MASSAGE THERAPISTS?

take into consideration mind, body and spirit to help clients with a wide variety of complaints. By David Malone

neck symptoms. By Jessica Crow

AI and robots have entered the massage therapy industry.

Photo courtesy of Stan Shimizu

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How does Visceral & Neural Manipulation help your clients? Visceral Manipulation

N eural Manipulation Neural Manipulation (NM) enhances the free movement of nerves in relation to surrounding muscles, fascia, organs, and bones. Mobilizing nerve fixations can restore proper signaling, improving function in compromised structures like muscles, organs, and fascia.

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JOURNAL

DEPARTMENTS

Massage Therapy Journal® | Official Publication of the American Massage Therapy Association® Winter 2025 Vol. 64 No. 4 ISSN: 0895-0814 USPS 0010-218 Cover credit: Photo courtesy of China Facchini Michelle Vallet Senior Publications Manager AMTA BOARD OF DIRECTORS (effective March 1, 2025) Cindy E. Farrar President Rick Greely President-Elect Kimberly Kane Santos Immediate Past President

6

LETTER FROM THE PRESIDENT My AMTA Touchstones

9

SHAREABLE RESEARCH Updates in Research: Pain + Acupressure

12

Jaime Bernardo, Jr. Director Heber J. Blackner Director Matthew Fecteau Director Donald Goodale Director Jane Horton Johnson Director Deb Kilty Director Cheryl L. Siniakin, Ph.D. Director Lee Stang Director

ADVOCACY Advancing Massage Therapy Through Research and Advocacy

74 RESEARCH

Massage Therapy Utilization in the Military Health System

EDITORIAL REVIEW OPERATIONAL COMMITTEE Jacqueline Herbach, LMSW, LMT President, Momentum Massage, Jane Neumann, BS, LMT, NCTMB Private Practice

Fitness, & Mind New York City Steve Jurch, MA, ATC, LMT Director of Allied Health Training at the Community College of Baltimore County

AMTA Illinois Chapter Communication Chair

Jessica Libero, LMT, NCTMB Connecticut and New York Licensed Reiki Practitioner Martha Brown Menard, Ph.D., CMT

Publication Management SPARK Publications sparkpublications.com

Project Manager: Jaclyn Yepsen Creative Director: Larry Preslar

Massage Therapy Journal is published quarterly by the American Massage Therapy Association (address below). Periodicals postage paid at Evanston, Illinois, and additional mailing offices. POSTMASTER: Send address changes to Massage Therapy Journal , 500 Davis St., Suite 900, Evanston, IL 60201-4695. SUBSCRIPTIONS: All subscription matters and notice of change of address should be sent to: Massage Therapy Journal Subscriptions, AMTA, 500 Davis St., Suite 900, Evanston, IL 60201-4695 (877-905-2700). Subscription rates: U.S. and Canada, $25 for one year (four issues); $45 for two years (eight issues). Foreign, $70 for one year; $120 for two years; available on a limited basis. Contact AMTA Member Experience, 500 Davis St., Suite 900, Evanston, IL 60201-4695. Phone: 847-864-0123 info@amtamassage.org EDITORIAL COPY: Queries should be sent to Michelle Vallet via email: mtj@amtamassage.org . Visit amtamassage.org/mtj for writer guidelines. Information contained in Massage Therapy Journal does not necessarily reflect the opinions or beliefs of AMTA and/or the staff of Massage Therapy Journal . ADVERTISING: Contact the AMTA sales team at Smithbucklin to learn more about advertising and exhibitor opportunities: (301) 215-6710 Ext.130 or hbrown@smithbucklin.com. Copyright © 2025 American Massage Therapy Association MTJ-024

80 SOOTHE

Winter Self-Care Regimens: Easy Ways to Boost Physical and Mental Well-Being

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84 TOOLS OF THE TRADE

Three Simple, Effective Strategies to Help Keep Your Business Booming in the Winter Months

86 THE POWER OF VOLUNTEERING Inspire and Uplift your Professional Community

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6 • Massage Therapy Journal

Letter from the

President

My AMTA Touchstones Hello my friends, I have found that along our journeys it is

years ago, the feelings of being included and valued stirred up by that recollection are as strong as they were then. While typing, wearing my AMTA-GA Chapter T-shirt, I pause to reach for my Tampa tea tumbler that I received at one of my first board meetings as a national director. It may be my imagination, but I swear my tea tastes better accompanied by the specific memory of camaraderie (chapter and board) and pirate boat fun (a story for another time). As I contemplate both my presidency and my time on the National Board winding down, childhood days of playing tag come to mind. There was always one predetermined place we called “home base.” It was essential home base be easy to reach, like a porch step or tree trunk. As long as some part of you was touching it, you could not be tagged. You were safe and could catch your breath before getting back in the game. It was our tag touchstone. This is what AMTA has been to me: A home base. A safe place of respite and renewal while in volunteer service to our association and profession. While my contribution may take on a new yet undetermined change, rest assure I won’t be far. With gratitude I will take my touchstones and leave my seat to the those who will come after. Rick Greely — AMTA National President Elect—“Tag you’re it!” I am because WE are! A safe place of respite and renewal while in volunteer service to our association and profession. This is what AMTA has been to me: A home base.

important to collect what I call “touchstones”. Different than the conventional definition, I use it to refer to those things that we can “touch”— either figuratively or literally—that call us to be present, make us feel comforted or safe and serve as a point of grounding. These things can also put us in “touch” with the associated feelings from the previous experiences. For me, touchstones can come in many different forms. They may hold spiritual, religious or cultural significance, like a crystal, cross or totem. They can also be a designation of something or someplace special, like traveling back to our childhood home, a trinket we keep nearby or maybe that small shell found on the beach. Perhaps it is a random item that just “speaks” to us. As I write this, my last President’s letter, despite having a few months left of my term, my mind is flooded with a myriad of memories from my year thus far, as well as my many years of volunteering. I am also surrounded by an array of physical reminders. These are my AMTA touchstones. Sustaining Memories and the Spirit of Community One of the most recent memories is the special moment at our 2025 convention in Dallas, when all of the attendees in the opening session raised and waved their arms to “Reach Out and Touch Somebody’s Hand.” Many even joined hands. It was one of the most heart-touching experiences of felt community and belonging that I recall having, and to this day continues to warm my heart and may even cause my eyes to leak. Another touchstone, though not as recent, is when I was first invited to volunteer with AMTA. Despite it being 23

ENGAGE WITH AMTA AMTA’S local chapters are a great place to start getting involved. Find yours at amtamassage.org/ chapters.

Cindy E. Farrar AMTA President

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Winter 2025 • 9

Shareable Research

Updates in Research: Pain + Acupressure For years, people have been increasingly interested in finding nonpharmacological strategies to better manage pain. Integrative health care approaches like massage therapy have shown promise, which in some cases has led to more research that strengthens the foundation of the profession.

READ MORE! Learn more about integrative techniques like acupressure in this issue’s exploration on Japanese massage—“From Ashiatsu to Zen Shiatsu and Everything In-between: Exploring Japanese Massage Techniques.” Read now on page 16.

javi_indy / Shutterstock.com

Share this research with clients and colleagues by visiting amtamassage.org/mtj.

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10 • Massage Therapy Journal

Acupressure + Labor Pain

Auricular Acupressure + Chronic Musculoskeletal Pain This 2025 systemic review and meta-analysis of randomized controlled trials explored the effectiveness of auricular acupressure on chronic musculoskeletal pain. The study. Researchers performed a systematic search on six electronic databases from the databases inception to May 7, 2023, to identify relevant randomized controlled trials. Abstracts, full texts and data were assessed for risk of bias by two independent reviewers using the Risk of Bias 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. A random-effects model was used for meta analyses. Primary outcomes were pain intensity and disability, and secondary outcomes comprised pain pressure thresholds, pain catastrophizing level and fear avoidance beliefs. The results. Six studies with a total of 496 participants met inclusion criteria. All included studies compared the effectiveness of auricular acupressure with a sham control for management of chronic musculoskeletal pain. Researchers found moderate-quality evidence supporting a large effect size of auricular acupressure for enhancing post intervention pressure pain threshold, and low-quality evidence suggesting the effectiveness of auricular acupressure for reducing pain and disability. “Our systematic review revealed that auricular acupressure significantly improved pain, pressure pain thresholds and disability in individuals with various chronic musculoskeletal pain conditions immediately post treatment compared with sham treatment,” researchers noted. “Auricular acupressure has immediate post treatment benefits for chronic musculoskeletal pain, whereas its effects at the 1- or 6-month follow-up remain uncertain.” Researchers also noted more randomized controlled trials were needed at a longer follow up with more detailed protocols.

Researchers wanted to know what effect, if any, acupressure on the eighth point of the extra back meridian (EX-B8) would have on pain during childbirth for primiparous women (women giving birth for the first time). The study. This randomized, single-blind, sham-controlled study included a total of 90 primiparous women in the active phase of the first stage of labor who were randomly divided into three groups: acupressure, sham and a control. The acupressure groups received treatment for 20 minutes during their uterine contractions at three different points in labor: 4–5 centimeters dilated, 6–7 centimeters dilated and 8–10 centimeters dilated. The control group received standard labor care. A Numerical Rating Scale was used to assess pain before, and 10 and 20 minutes after the start of the intervention. The results. Researchers found that pain was significantly decreased in the EX-B8 acupressure group when compared with the sham and control groups at all three time intervals. In the EX-B8 group, the greatest amount of pain relief was achieved when patients were 8–10 centimeters dilated. “Acupressure on this point can be recommended as an effective, low-cost and accessible pain relieving technique, especially at the end of the active phase of the first stage of labor,” researchers concluded. “Further studies are needed to determine why acupressure on the point is more effective at the end of the active phase of labor.”

References 1. Azadeh H, Heshmat R, Nasiri M, Azarkish F, Mobarakabadi SS. “The effect of EX-B8 acupressure on labor pain: A randomized, single-blind, sham controlled trial.” Pain Res Manag. 2025 Feb 24:2025:7873155. 2. Kwok Wing Lee T, Chang JR, Hao D, Fu SN, Yu Lok Wong A. “The effectiveness of auricular acupressure on chronic musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials.” J Integr Complement Med. 2025 Jan;31(1):25–35.

WANT MORE INFORMATION? For more information on some of the research being done on the benefits of massage therapy, browse the Research section of AMTA’s website at amtamassage.org/research.

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12 • Massage Therapy Journal

Advocacy Advancing the Massage Therapy Profession y

Advancing Massage Therapy Through Research and Advocacy

R esearch is the foundation for progress in the massage therapy profession. By establishing strong evidence and elevating practice standards, research not only validates the bene fi ts of massage but also fuels policy changes that expand access to care. At AMTA, we are deeply committed to advancing this work by advocating for federal research funding and supporting innovative studies in partnership with the Massage Therapy Foundation (MTF). Together, these research initiatives are helping shape the future of the massage profession. AMTA Advocates for Federal Funding of NCCIH: A Leader in Research Earlier this year, AMTA submitted a statement to the U.S. Senate Appropriations Subcommittee, urging for continued federal funding for the National Center for Complementary and Integrative Health (NCCIH): an agency uniquely positioned to lead research for integrative treatments for chronic pain and other health issues. We also strongly opposed the Administration’s proposal to eliminate the Center.

AMTA’s advocacy, together with that of our health care partners, has kept this issue at the forefront—through policy engagement, public statements and direct conversations with lawmakers. Both the House and Senate Appropriations Committees approved Fiscal Year 2026 bills maintaining NCCIH’s current funding. Had the initial proposal succeeded, it would have stripped critical federal support for safe, cost effective, non ‐ pharmaceutical approaches to care and been a major setback for massage therapy and other integrative health professions. While this progress is encouraging, the process is not fi nished as fi nal legislation must still be passed. Importantly, the Senate’s report highlights the value of integrative care, calling for expanded research on pain management, ongoing investment in the National Institute of Health Helping to End Addiction Long-term ® Initiative and broader access to non-pharmacologic treatments. These efforts align closely with AMTA’s advocacy priorities and vision for advancing massage therapy research.

Irina Strelnikova / Shutterstock.com /

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Winter 2025 • 13

AMTA’s Partnership with the MTF: An Investment in Research Through our partnership with the MTF, AMTA has invested more than $16 million in massage therapy research since the foundation’s inception 35 years ago, and our commitment continues to grow. In January of this year, DŽĘɯƍŔĘđıĘđɯíşɯíđđĽƤĽŪşíŔɯɸǭȿǰɯ ŝĽŔŔĽŪşɯŪǃĘƐɯƤĸĘɯşĘljƤɯǰɯNJĘíƐƘɀ an unprecedented level of support for research projects that strengthen the evidence base for massage as an effective integrative health treatment, while empowering massage therapists with the knowledge and credibility to deliver safe, effective patient-centered care. Below are some of the ĊƬƐƐĘşƤɯíşđɯƐĘĊĘşƤŔNJɯ ĊŪŝƍŔĘƤĘđɯƐĘƘĘíƐĊĸɯĽşĽƤĽíƤĽǃĘƘɯ p¸ ɯĽƘɯİƬşđĽşıɯ ƤĸƐŪƬıĸɯƤĸĘɰDŪƬşđíƤĽŪşɁ • pNJŪİíƘĊĽíŔɯ£ĘŔĘíƘĘɯ¸ĸĘƐíƍNJɯİŪƐɯ ĘđĽíƤƐĽĊɯ QƐƐĽƤíĉŔĘɯ ŪDŽĘŔɯ«NJşđƐŪŝĘɯɐQ «ɑɯ ($299,465 grant in 2025): This randomized controlled study

evaluates abdominal myofascial release (MFR) for improving symptoms, quality of life and bowel function in adolescents with constipation predominant IBS, while using a Wireless Patch System to track gastrointestinal activity. By combining patient-reported outcomes with physiological data, it aims to reveal MFR’s therapeutic bene fi ts and mechanisms, advancing safer, developmentally-appropriate treatments for pediatric IBS. • píƘƘíıĘɯQŝƍíĊƤɯŪşɯ«ŔĘĘƍɯĽşɯLŪƘƍĽƤíŔĽǔíƤĽŪşɯ İŪƐɯ ĘđĽíƤƐĽĊɯ}şĊŪŔŪıNJɯíşđɯ«ƤĘŝɯ ĘŔŔɯ ¸ƐíşƘƍŔíşƤɯ íƤĽĘşƤƘ ($294,822 grant in 2024): This three-year study at Children’s Hospital of Philadelphia and Children’s National Hospital is evaluating massage as a non-pharmaceutical intervention for pediatric oncology patients. The research aims to show that routine massage therapy can improve sleep quality and

Learn more about the Massage Therapy Foundation’s current research projects:

SCAN HERE

Massage Therapy’s Expanding Role in Health Care

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14 • Massage Therapy Journal

duration for children undergoing intensive chemotherapy or stem cell transplants, ultimately supporting their overall well-being. • Trauma-Informed and Culturally Responsive Integrated Massage Therapy ($300,000 grant in 2023): Center for Victims of Torture has recognized the urgent need for trauma-informed massage therapy interventions for adult survivors of torture and war, highlighting a critical lack of research on culturally responsive practices and integration of language services. This gap is especially concerning given that over 1.3 million survivors live in the U.S., with millions more worldwide requiring similar support. • Massage Therapy as a Preventative for Post-Irradiation Fibrosis and Neuropathy ($187,012 grant in 2023): This foundational study investigated whether manual therapy

techniques, such as massage and mobilization, can prevent radiation-induced fibrosis and related complications. Using an animal model, the research aimed to provide evidence that massage therapy may reduce the harmful effects of life-extending radiation treatment for cancer. This study was completed on April 30, 2025. • Massage Service Integration in a Military Primary Care Clinic ($209,050 grant in 2019–2025): This study examined the high prevalence of acute and chronic pain within the Department of Defense (DoD) and Veterans Administration (VA), where opioid use mirrors the civilian epidemic. It explored massage therapy as a promising, evidence based strategy to help reduce the burden of chronic pain in these populations. This study was completed on September 15, 2025.

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16 • Massage Therapy Journal

Photo courtesy of China Facchini

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Winter 2025 • 17

From Ashiatsu to Zen Shiatsu and Everything In-between: Exploring Japanese Massage Techniques Japanese massage techniques take into consideration mind, body and spirit to help clients with a wide variety of complaints.

By David Malone

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18 • Massage Therapy Journal

W ith some techniques dating back centuries and others that are more recent, Japanese massage techniques are varied in both style and the types of clients they can help. Shiatsu is probably the most well-known, at least in name, while others, such as Kobido or Seitai, are lesser known but can still provide a wealth of benefits.

sometimes, with the use of parallel bars to assist with balance and leverage. Because of the more intense pressure, a variety of contraindications exist. “There are many contraindications and precautions,” Facchini explains. “It’s important to do a thorough intake prior to the first session. Some are case by case and depend on the severity of the condition. In some instances, a doctor’s clearance may be required.” Contraindications and special considerations include: • People of advanced age • People who are pregnant • Clients with osteo conditions • Clients managing blood disorders • Armpits and popliteal areas, which are always contraindicated for deep pressure Ashiatsu provides many benefits for clients, but the technique is also helpful for massage therapists who need to give their hands and body a break. “Ashiatsu doesn’t put as much wear and tear on my body as deep tissue and Swedish massage does,” Rose says. “Ashiatsu practitioners can provide the same amount of energy to the first and last clients of the day without feeling drained.” Massage therapists who are interested in adding ashiatsu to their list of services need to remember the importance of proper hygiene and care for their feet, including: • Monthly pedicures • Keeping callouses and toenails trimmed and filed • Wearing socks to keep feet soft • Stretching to keep feet malleable “Before putting my feet on a client every session, I make sure that my feet are warmed up using a heating pad and cleaned using antibacterial wipes,” says Rose.

Here, you’ll get a brief overview of a few of the most popular types of Japanese massage.

Ashiatsu: Using Your Feet Despite the difference of only a single letter, ashiatsu did not directly evolove

from shiatsu or vice versa. While shiatsu directly translates to “finger pressure,” ashiatsu translates to “foot pressure.” Ashiatsu is a Western adaptation that has evolved from and blended with many ancient massage techniques found throughout Asia, including in places such as Japan, India and China. “Ashiatsu is a form of barefoot massage dating back to the 12th century in Kerala, India,” notes Sherlyn Rose, an LMT who practices ashiatsu. “The practitioner would balance themselves by holding onto a rope overhead while they slide their foot from one end of the body to the other. This Hindu and Ayurvedic tradition of using the feet along the energy lines of the body spread to China and other parts of the Oceana continents, including Hawaii.” Ashiatsu is especially beneficial for clients who may be seeking a deeper pressure massage, such as athletes or those with an active lifestyle. This technique can feel akin to deep tissue massage and Swedish massage. “Ashiatsu is like deep tissue. It can be very deep and therapeutic. It’s broader, as the foot conforms to the muscle groups,” says China Facchini, LMT, South Carolina DeepFeet Bar Therapy Instructor and Sarga Bodywork Instructor. “Ashiatsu is also like Swedish massage in that it can utilize various pressures and focus on luxurious flow. We practice effleurage, petrissage, vibration and friction with our feet.” During a massage, a therapist controls the amount of pressure with their body position and,

Ashiatsu provides many benefits for clients, but the technique is also helpful for massage therapists who need to give their hands and body a break.

Kobido: Focus on the Face Kobido, which is sometimes referred to as the Japanese facelift and directly

translates to “ancient way of beauty,” is a Japanese facial massage that uses fast, rhythmic movements to stimulate and sculpt the face, according to Renata’s Organic Skincare Spa.

ksenvitaln / Shutterstock.com

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to the lifting and tightening effects of the facial massage. According to Renata’s, prior to a Kobido massage, the massage therapist may cleanse the face before applying a noncomedogenic oil. The massage might begin in a sitting position with stretching movements to the neck area before clients lie down and receive a stimulating massage to the face and neck with fingertips, focusing on the muscles in the face. Massages typically last anywhere between 60 and 90 minutes, but are also offered in shorter sessions between 30 and 45 minutes. Seitai: Teaching the Body to Restore Itself Seitai, which translates to “balanced body,” is a Japanese bodywork practice developed by Haruchika Noguchi in the mid-20th century. Noguchi believed that when humans adapt the environment to their needs, as opposed to

The purported benefits of Kobido include anti-aging properties, improved skin hydration, improved circulation and lymphatic lifting effect, and relaxed muscular tension and stress release. Facial oils and creams can be used to help enhance the benefits. drainage, a natural

Photo courtesy of Stan Shimizu

Stan Shimizu practicing Shiatsu massage on a client.

The purported benefits of Kobido include anti-aging properties, improved skin hydration, improved circulation and lymphatic drainage, a natural lifting effect, and relaxed muscular tension and stress release. Facial oils and creams can be used to help enhance the benefits. Although not specific to Kobido massage, a pilot study 1 using computed tomographic (CT) technology explored the effectiveness of facial massages in relation to morphological changes, such as improvements in facial sagging. Five healthy adults performed a self-massage twice daily for two weeks. Before and after the massages, they were given CT examinations, which were then analyzed by two radiologists on a high-accuracy imaging analysis system for massage-induced changes in the cheeks and the superficial musculoaponeurotic system (SMAS). The radiologists found that after the facial massage, the malar top thinned and shifted cranially and horizontally while the SMAS height increased. The change in the rate in cheek thickness and SMAS height showed a significant correlation, with these changes being attributed

Photo courtesy of China Facchini

China Facchini practicing ashiatsu on a client.

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Shiatsu: Restoring Balance to the Body Shiatsu is a form of traditional

Common Shiatsu Assessment Tools

Japanese bodywork that is based on restoring balance to the body. Directly translated, shiatsu means “finger pressure.” Despite being a Japanese technique, shiatsu’s roots are tied to ancient Chinese intellectual and philosophical ideas, which were introduced to Japan during the 6th and 7th centuries. “Illness and disease are thought to result from imbalances in the natural internal flow of energy, known as Ki in Japanese or Qi in Chinese, through the body,” explains Stan Shimizu, owner of Shiatsu Sennin-so. “Shiatsu uses finger and palm pressure to restore and improve the continuity of this flow, thereby harmonizing the body, mind and spirit.” Harmonizing this Ki or Qi is at the core of shiatsu work. A shiatsu practitioner will push, rub and stimulate specific acupressure points (called Tsubos) and energy meridians to influence the flow of Ki.

ksenvitaln / Shutterstock.com Photo courtesy of Stan Shimizu

Assessment helps massage therapists better understand their clients, and with shiatsu, assessment is often approached from a more holistic perspective. Some common assessment tools used by practitioners of shiatsu include: Bo Shin (Seeing or Observing): The process of examining a client’s inner being and opening up the practitioner to the client’s Ki/Qi. Mon Shin (Questioning/Obtaining Information): Involves paying attention to body language, facial expressions and other nonverbal gestures. Setsu Shin (Touching): A shiatsu therapist’s hands and fingers act as their eyes to help better understand their clients, not just on a physical level, but on an emotional and spiritual level, as well.

adapting themselves to the environment, they become weaker. Seitai focuses on restoring the body’s natural ability to rebalance and self-regulate. This restoration of balance and self-regulation is accomplished via pressure points, gentle manipulation and Japanese taiso stretches. Seitai can help relieve pain, reduce stress and promote relaxation, improve mobility and enhance body posture. As is the case with virtually all types of massage, Seitai begins with a thorough intake where massage therapists talk to clients about their specific concerns, areas of discomfort and goals. The massage session integrates Seitai pressure points, gentle manipulations, and Japanese taiso stretches meant to address areas of tension, misalignment or stagnation while also inducing relaxation. All versions of Seitai include some version of these elements, but some slight differences between practitioners may exist, depending on how they’re trained. The Seitai stretches can be performed by clients on their own between sessions to enhance the treatment’s benefits.

What sets shiatsu apart from other bodywork therapies is its focus on stimulating specific Tsubos and energy meridians.

Shiatsu massage being performed on a client.

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Watsu: The Power of Water While not directly a Japanese massage technique, Watsu has evolved from the principles of shiatsu and Zen shiatsu. However, Watsu differs from both shiatsu and

Zen shiatsu in that it is performed with a client’s body immersed in warm water that has been heated to a temperature range of 95 F to 98 F. A client will never be fully underwater during a Watsu session. “Watsu is based on being with another person and stretching, which oxygenates the muscles and increases flexibility and range of motion. Warm water, and the continuous support it provides, is ideal for freeing the spine,” says Teresa Piddington M.Ed., LMT, and Watsu practitioner and instructor. “It takes the weight off the vertebrae and relaxes the muscles. Gentle, gradual twists and pulls relieve the pressure a rigid spine places on the nerves. The Watsu receiver experiences greater flexibility and freedom during and after a session.”

Despite taking from ancient Japanese techniques, Watsu is a relatively new technique that has its roots in California in the 1970s. “Harold Dull laid the foundational vision for aquatic bodywork and Watsu during the 1970s based in his personal studies with Zen shiatsu master Shizuto Masunaga in Japan,” says Ahara Vatter, senior worldwide aquatic bodywork instructor. “Other practitioners, skilled in varied forms of shiatsu, energy understandings, breathwork and bodywork also contributed.” By 1980, Dull had officially developed Watsu at the School of Shiatsu and Massage at Harbin Hot Springs in Middleton, California. Piddington lists both immediate and long-term benefits for Watsu clients.

Long-term benefits include: • Improved sleep patterns • Improved digestion • Improved healing and immune system response. • Decreased anxiety

Immediate benefits include: • Increased range of motion • Increased muscle relaxation • Decreased muscle spasm • Decreased spasticity • Decreased pain

• Greater decreases in pain • Decreased depression • Decreased chronic tight muscles

“Watsu facilitates freeing the spine and body and promotes deep systemic relaxation and stress relief by balancing the nervous and energetic systems,” Vatter says. “Though Watsu has beneficial effects for most people, it is used to address trauma, both physical and psycho-emotional, with therapeutic applications that include but are not limited to neuromuscular injuries, stress and pain, nervous system and orthopedic disorders, closed head injuries, discomfort during pregnancy and other special needs.” Over the years, many Watsu imitators have emerged, but for both Piddington and Vatter, none have reached the heights of Watsu. “Watsu is the original aquatic shiatsu therapy. It specifically focuses on breath-timed moves and shiatsu pressure point and meridian channel work,” Piddington says. Vatter agrees, “There are many imitations of the Watsu modality throughout the world, but not necessarily offered with the same ethical, scientifically based or professional bodywork standards.”

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What sets shiatsu apart from other bodywork therapies is its focus on stimulating specific Tsubos and energy meridians. Shiatsu centers a holistic view of a client’s health and seeks to identify the root cause of their imbalances, Shimizu notes. It can be performed over clothing and without oils while the client is standing, sitting or lying down. “There are variations on how pressure is applied during a shiatsu treatment,” Shimizu says. “Various kinds of pressure can be utilized, depending on the situation, the part of the body being treated and the quality of Ki/Qi present in the body. Variations include standard direct pressure, interrupted pressure, suction pressure, vibrational pressure and fluid pressure.” During a shiatsu massage, fingers and palms are used, but the thumbs most commonly deliver the pressure. According to Shimizu, this is because: • They are more sensitive in detecting temperature, tissue quality and Ki/Qi in different parts of the body. • They are ideal for targeting and applying pressure to specific acupressure points. • They can sustain and leverage the shiatsu therapist’s body weight, which can be channeled through the thumb. The primary benefits of shiatsu include pain relief, improved flexibility, reduced stress and increased overall energy. However, despite reduced stress being a benefit, shiatsu is not a type of relaxation treatment. “It is a therapeutic treatment and more medically and holistically focused. Another misconception is that shiatsu must be very painful to be effective,” Shimizu says. A study 2 conducted on 80 nulliparous pregnant women examined the impact of shiatsu massage on labor pain and anxiety. The study split the women into two groups (control and intervention) of 40. The intervention group received shiatsu massages from certified midwives. Their pain was then assessed using the Numeric Rating Scale, and anxiety was assessed using the Hamilton Anxiety Rating Score. The study found that the intervention group showed significant reduction in labor pain scores

while the control group showed an increase. Anxiety scores in the intervention group also decreased compared to the increase seen in the control group. Researchers concluded that shiatsu massage was effective and safe for relieving pain and reducing anxiety during childbirth, suggesting that shiatsu massage can be used as an effective alternative method to relieve pain and anxiety during labor in low-risk pregnancies. Zen Shiatsu: Integrating Mind and Body Shizuto Masunaga developed Zen shiatsu in the 1970s. Zen shiatsu incorporates Zen Buddhist principles and psychology, and is a direct evolution from shiatsu. “Masunaga graduated with a degree in psychology and also became a professor of psychology,” says Shimizu. “He also studied Zen Buddhism, which influenced his belief in the interconnections between body, mind and spirit.

ksenvitaln / Shutterstock.com Photo courtesy of Stan Shimizu

Zen shiatsu is especially beneficial and effective in helping with conditions where emotional diturbance or stress is an underlying factor.

A client receiving shiatsu massage.

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More traditional shiatsu focuses specifically on the anatomical and physiological aspects of the body and does not consider the mind or spirit.” Zen shiatsu shares many of the same benefits as shiatsu, but due to the added emphasis on mind and spirit, Zen shiatsu is especially beneficial and effective in helping with conditions where emotional disturbance or stress is an underlying factor, according to Zen Shiatsu Chicago. The most common of these include: • Insomnia • Anxiety and depression • Muscular tension • Headaches • Digestive disturbances • Menstrual disturbances • Lower resistance to infection “Zen shiatsu is a hands-on method used to help with pain, injury and stress relief, like massage. Additionally, it is helpful for people’s internal health issues, such as problems with digestion, elimination, sleep, immunity or various chronic illnesses,” says Steve Rogne, director of Zen Shiatsu Chicago. A longitudinal case study 3 measured Zen shiatsu’s effect on stress reduction in a child with autism spectrum disorder. The seven-year old male was given a 20-minute Zen shiatsu massage weekly for six consecutive weeks. Stress was measured using a five-point stress scale designed for children with autism to indicate the client’s stress level before and after each session. The study found that based on the five-point pictorial stress scale, the child’s overall quality of life improved within the six weeks of receiving Zen shiatsu, offering preliminary evidence for the possibility of Zen shiatsu providing a viable integrative therapy for alleviating stress in children with autism. “The process of Zen shiatsu feels very affirming, in that it feels like it is directly responding to the unfolding needs of the individual. This makes it extremely well-suited to working with those with a history of trauma,” Rogne says. “Because our work has no preset

agenda and only works with the body’s inherent momentum, it does not set up any dynamic of force-on-force, or attempting to take the client’s body somewhere it is not ready to go. Instead, by concentrating our senses, we can follow and support the exact amount of healthy change the client is ready to make.” During a first session, extra time may be given to client intake to reaffirm their goals. The session will then comprise work directly on the muscles, alternated with relaxing stretches and movements applied to the client’s body to benefit joint health and fluid flow. “Both verbally and through our sense of touch, we determine the exact healthy change that the client’s body is trying to make, and we monitor the effectiveness of our treatment based on whether that change is happening or not” says Rogne. “We use our senses to feel for the most effective places to stop and stay, where the client’s body does the healing on its own. Zen shiatsu is as deep or light as needed for any individual, and our clients include those who can be easily overstimulated and need a relatively light depth of contact, as well as those whose bodies respond best at a deep level of contact. Our highly refined senses help us to exactly calibrate those needs.” References 1. Okuda I, Takeda M, Taira M, Kobayashi T, Inomata K, Yoshioka N. “Objective analysis of the effectiveness of facial massage using breakthrough computed tomographic technology: A preliminary pilot study.” Skin Res Technol. 2022 May;28(3):472-479. 2. Norhapifah H, Isa MR, Abdullah B, Mohamed S. “The impact of shiatsu massage on labour pain and anxiety: A randomized controlled trial.” Int J Community Based Nurs Midwifery. 2024 Oct 1;12(4):243-253. 3. Burke A. “Zen shiatsu: a longitudinal case study measuring stress reduction in a child with autism spectrum disorder.” Int J Ther Massage Bodywork. 2014 Dec 2;7(4):23-8.

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Massage Therapists React and Experts Respond

Photos courtesy of Aescape

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What Does Robot Massage Mean for the Future of Massage Therapists?

AI and robots have entered the massage therapy industry.

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A s the idea of AI and robots making their way into the massage therapy space becomes more of a reality, massage therapists are beginning to question the value these advancements may bring to both the profession and their own practices. Or, if they are advancements at all.

Massage Therapy Journal took some of the concerns we were hearing from massage therapists to company leaders. Here’s what they had to say. Eric Stephenson, LMBT, President at imassage Inc. , began to hear rumblings in 2020 from several colleagues about robotic massage. “It went in one ear and out the other until what can only be described as synchronicity happened in the Spring of 2022,” he says. “I met the Aescape team and learned about their mission and higher purpose in the world and realized it aligned with my own.” Candidly, Stephenson notes, he was a skeptic up until the day he received his first Aescape experience. “Not only was I pleasantly surprised, but it far exceeded the expectations I had,” he describes. “I have received many of the evolving massage protocols since then. My most recent 30-minute Aescape session was fantastic— relaxing me to the point of falling asleep twice. At one point after coming back awake, it felt as though human hands were touching me.” Paul Nunez, Director of Partnerships for Aescape , former massage therapist, has a career in the massage and spa space that spans 30 years. He was introduced to Eric Litman, founder and CEO of Aescape, in 2020 via a mutual friend who said: “You should talk to my buddy who is doing something with massage and robots.” Nunez was intrigued by Litman’s vision around how many opportunities in the spa industry could be supplemented by technology. “Before joining

Currently, the overarching feelings massage therapists seem to have around AI/robotic massage is a mixture of trepidation, distrust and apprehension. For example, we asked massage therapists about their thoughts on the oncoming wave of AI/ robotics in the massage profession and found nine of the 12 respondents had largely negative feelings about the potential of automated massage therapy. Admittedly, the sample size is small. But, the time is ripe to have meaningful conversations around how advancements in technology currently—and in the future—affect the profession. Aescape, a robotics company focused on the wellness space, is looking to change the narrative about robotics within the massage community.

Photos courtesy of Aescape

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