Shiatsu and back pain

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The “modern” life

Today, the problem of back pain is extremely widespread. We can surely say that it is one of the “diseases” of our century. Hours and hours spent sitting on a chair, usually not a very comfortable one, at the desk in front of the PC, and the only movement we make is that of the arm that uses the mouse or the hands that type on the keyboard.

With the advent of globalization and the reduction of travel costs, more and more people travel for work and spend hours sitting in cars, on planes, on buses, in taxis. Others have the privilege of working at home, but always sitting in front of a PC.

Ultimately, we make less and less movement and spend most of our time in static positions that do not facilitate blood circulation, nor that of ki (or qi in Chinese), or the subtle energy that permeates everything. Our body was not designed to sit still but to move in space.

Excess of movement

On the other hand, there are people, like professional sportsmen, who instead “abuse” with the workout, bringing their bodies to extreme efforts and subjecting them to continuous traumas. Although the body is made to move, it is unable to withstand assiduous and exhausting efforts, especially after the age of thirty. This leads to muscular tears, herniated discs, lumbago, joint inflammation and so on.

The ideal would be to mix in a healthy way the movement with stillness, but unfortunately, in a society like ours, increasingly frantic and ultra-specialized due to capitalism, it is not always possible. Fortunately, there are people who care about the well-being of others and devote their lives to making people better and helping them solve their problems: Shiatsu is an optimal discipline for this type of discomfort, including back pain. For clarity, we specify that the techniques and remedies we will list are based on the style of Shiatsu devised by Master Masunaga, called Keiraku Shiatsu or Zen Shiatsu.

What is back pain?

When we talk about back pain, we include a series of disparate problems, with very different causes and consequences. The causes can be postural, traumatic, inflammatory, structural; due to environmental conditions (such as cold, humidity); to emotional or psychological blocks; they often manifest themselves with pain, which can be acute, dull, chronic, fluctuating, etc.

Back pain involves different problems depending on where it is located: one thing is an interscapular pain, another is at the level of the lumbar vertebrae. Zen Shiatsu treatments differ depending on whether the problem is in the upper back or in the lower part. To keep in mind that pain in an area does not necessarily imply that the cause is in the same area: a stiff neck can originate between the shoulder blades, as lumbago can arise at the dorsal level.

But back pain can also have different implications, caused by internal problems such as intestinal inflammation, cystitis, ovarian problems, for example. The diaphragm, a muscle responsible for respiratory activities, is another factor that can cause back pain. From the structural point of view, the legs can play a decisive role in the lumbar problems, just as the arms with the shoulders can do it for the upper part of the back.


Finally, we must say that emotional elements can greatly influence our health and create blocks and pains that cannot be explained by other reasons. Not only does our psyche affect posture (a closed, shy, reserved person, for example, will tend to have his/her shoulders bent forward, to protect the “heart”) but shocks and emotional traumas have the power to create bodily distress when they are not duly addressed.

The back is designed to support the body, through the spine and muscles. Thanks to it we overcome the force of gravity and we can stand in an erect position that allows us to move our arms freely and distinguishes us from most of the animal world. The back allows us to load weights and carry them around.

The burdens on our shoulders can also be emotional, psychological: to take on a difficult situation, for example, how it could be to take care of a sick loved one, perhaps beyond our real possibilities of being able to help him/her. Zen Shiatsu has the characteristic of being able to work not only at the osteomuscular level but also energetic, emotional, mental and therefore to face this type of situation.

The back according to Zen Shiatsu

Masunaga‘s Shiatsu is based on elements of Chinese medicine, in particular on claiming that the body is crossed by energy channels that carry ki throughout the body. Each meridian is connected to an internal organ, from which it takes its name. Unlike TCM (Traditional Chinese Medicine), Zen Shiatsu adds to the 12 extraordinary meridians extensions, so that each part of the body is crossed by the 12 channels mentioned above. Also on the back we find these meridians.

Along the column runs the extraordinary canal called Du Mai, or Governing Vessel. It regulates the yang of the whole body and has an important influence on the spine and the back in general. It is not treated with Shiatsu, as it is located inside the spine, but there are specific exercises that allow you to work with it.

Urinary Bladder

On the sides of the column, there are two channels of Urinary Bladder (in black in the figure on the right). It is one of the principal meridians for the treatment of back pain. Furthermore, according to the MTC, there are so-called Shu points along with it: these are diagnostic points of each meridian (and therefore of each connected organ) and through which the energy of the related channel can be directly contacted. This is why many types of internal problems can be solved through the treatment of the back. For Masunaga, among other things, the back (like the abdomen) is one of the diagnostic areas of the meridians. That is, each area of the back corresponds to one of the channels (as shown in the figure above on the left).


At the distance of a cun and a half from the Urinary Bladder canal (a cun is the width of the thumb, that of the receiver is used as a unit of measurement), there is Kidney (for the MTC it is the external canal of Urinary Bladder, but for Masunaga it is the meridian of Kidney, the other channel in black in the figure on the right). Like its “brother” Urinary Bladder (both are part of the Water phase), it is an extremely important meridian for back pain, especially the lumbar one. On it are the Shu points of the various Shens of each organ and meridian (these are points that deal with the most “spiritual” aspect of each channel).

Small Intestine

Moving further towards the outside of the back, we find the Small Intestine meridian (the red lines in the figure on the left). Here is the energy connection between back pain and intestinal inflammation. As can be seen from the map, Small Intestine passes through the scapula and the shoulder: in fact, it takes care of this articulation and an imbalance of SI can lead to shoulder problems.

Sanjao or Triple Heater

On the outer edge of the back, we find the Triple Heater. It is a particular meridian that it does not correspond to any organ, but deals with regulating body temperature and the immune system. This is why it is located at the edge of the body, as it is a “barrier” against external pathogens.

How Zen Shiatsu can solve back pain?

Going into the specifics of Shiatsu treatment, let’s see how problems regarding back pain can be solved. These are just examples of treatment, just to give an idea about the work that is usually done by competent Shiatsu Therapists. It is absolutely not intended to be an exhaustive explanation of the treatments used, as each therapist, however, uses and adapts his/her technical specifications depending on the person and the situation. In Shiatsu, in fact, there are no real protocols to follow to address the problems (although some schools teach indicative protocols).

Another question to clarify: in case of acute pain, serious pathologies (such as the lesion of the rotator cuff), hernias that have just come out and cause inflammation, it is advisable to contact a competent medical authority. We will address issues that are exempt from the medical-physiotherapeutic field, an area that does not concern the Shiatsu Operator (at least in many countries).

How does the therapist start work? After an interview, we move on to the observation phase: first of all the posture, especially standing, but also lying down. For example, checking if one of the two shoulders is higher, as well as the hips. If the pubic bone is rotated, if the legs are long equally. Finally, we proceed to the evaluation of the abdomen, energetic diagnosis of the meridians established by Masunaga. To deal with back work, we will divide back pain into two types:

  • pain in the upper back, including the neck and shoulders
  • problems in the lumbar area, including the hips
Shiatsu and back pain

Shoulders and scapular pain

Although there is a tendency to compartmentalize everything, and thus to divide the body into separate sectors, we must take into account that it is actually a whole. Problems at the shoulders can derive from tensions in the jaw or in the hips. This is why Shiatsu always works the whole body, even in the case of localized problems. That said, the first thing a Shiatsu Therapist will do is find the real root of the problem and focus on it. I clearly remember when a client of mine called me because her partner was three days that he could not get out of bed due to lower back pain; once the treatment started, it was evident that the cause was at the level of the dorsal area, although he felt pain in the lower part. Once that was treated, the lumbar area didn’t cause him any more problems.

Therefore, one of the first aspects to analyze for shoulder problems is the state of the jaw and its muscles, in addition to the hips. For example, if the person suffers from bruxism, it is already a clear indication of the possible cause of the problem. Pressures are made on the masseter muscle, to relax it, and the connected meridians, Stomach, Spleen, Small Intestine and Large Intestine, in particular, are processed.

Zen Shiatsu is a bimanual technique: a hand, called Child, works on points and on the meridian. The other, called Mother, listens and supports along the meridian worked by the Child. In this way, an energy bridge is created, like a circuit, which allows the ki to communicate, through the therapist, between the various affected parts. Then, pressing on the point of Stomach 6 with one hand, the other moves along the Large Intestine meridian (this is because the two channels are part of the same energetic level) in search of a point that loosens the tension of the masseter. Once the muscle tension is relaxed, creating a bridge through which the ki has started to flow again in a balanced way, relief will also be seen at shoulder level.

A Shiatsu therapist does not stop here, but will “clean” the channels concerned throughout their length with careful pressure. He/she also will continue to work on the shoulders, for example by treating the points of Small Intestine connected to them: from SI9 to SI15. Above all SI11 is very effective in unlocking the scapula.

Shoulder Blades

Another technique is the one called “cleaning the shoulder blades“. The Gall Bladder canal runs alongside them. With conscious manipulations, the therapist opens the scapula (for example by placing the recipient’s arm behind his/her back, if he/she has no impediments or pain in doing so), performs shoulder rotations and with precise pressures underneath and beside the scapula working on Gall Bladder. Many toxins lurk in this area and pressures help the body to expel them, thereby facilitating mobilization of the joint and relieving pain.

Finally, if the therapist is extremely experienced, he/she can make adjustments to the dorsal vertebrae with intense pressure on the area between the shoulder blades. This usually generates the typical sound of the clicking of the vertebrae. There is no need to be frightened, it is the noise created by some of the gases that are naturally dissolved in the synovial fluid: they come out of the solution creating a bubble or cavity that quickly collapses on itself, producing a “click”. According to a 1971 study, the content of the bubble is mainly nitrogen.

Other points used for shoulder problems are LI14-15, TH13-14, Lung1-2. I want to reiterate that, unlike acupuncture, Shiatsu is not limited to the stimulation of single points, but works on the entire meridian. So even the treatment of these points always falls within a holistic, complete body perspective. Often the problems of neck pain find resolution once the upper back is worked, as the root of the problem resided in that area. This is always due to the principle of the body as a whole, well explained by the concept of “tensegrity“.

Shiatsu and back pain

Lower back issues

The lower part of the back is governed by the Water meridians, ie Kidney and Urinary Bladder. The therapist, therefore, will manage to work effectively on these two channels, so as to relax the muscles connected to them (the paravertebral ones) and balance the energy that flows there. UB36, for example, although it is at the base of sitting bones, is an important point for low back pain. But also UB18, UB20 and UB52 are ideal for acute low back pain. In the case of acute lombalgia, UB23, UB24 and UB40 are used instead (the latter is behind the popliteal fossa of the knee).

Often, however, what is sought with Shiatsu is not a specific point, drawn on a map, but points that physically and energetically “call” us. Those are called Ashi points in Chinese medicine. These are points outside the maps that present imbalances. If we are dealing with hard, rigid points, we work with dispersion techniques, if they are empty, soft points, we try to tonify them. Paravertebral muscles are very long and strong muscles, but which, supporting the back, are often the site of tensions and contractures. Even a weak muscle creates pain, so it is necessary to reinforce it by tonifying it up, for example by using points UB23 and K10, perhaps with moxibustion.


The lumbar vertebrae are connected to the sacrum, which in turn is attached to the hips. Thus, working on them facilitates the possibility of solving problems such as sciatica, sciatalgia, and so on. In this case, we will treat meridians like Gall Bladder, above all GB30, but also Large Intestine, Kidney on the buttocks and Liver and Spleen in the groin area. Gall Bladder is generally connected with joint stiffness, so it’s always good to treat it in these cases. In addition to the aforementioned point, UB27 and UB31 can be used.

Since the diaphragm is a muscle that attaches to the vertebrae, it can be the root of a low back pain problem if the muscle is contracted. Therefore diaphragm releases are performed with intense and constant pressures. In general, we should work on the abdomen trying to relax it, as intestinal inflammation is one of the causes of lumbar back pain. Also, cystitis or ovarian problems can cause pain in the lower back. For example, it often happens to many women to have lower back pain during the cycle. In these cases, treatment is added for specific meridians: Large Intestine for colon inflammation, Small Intestine and Spleen for ovarian problems and Bladder for cystitis.

Then, manipulations are performed to help relax the back muscles, for example, passive twists performed by the therapist on the recipient. They too can generate clickings of the vertebrae, with a consequent sense of relief from the receiver. There is an infinite number of them and it makes no sense to list them all. These are mostly twists, but also movements that lengthen the lower back, such as bringing the legs bent towards the chest.

Conclusion of the treatment

Once finished, the therapist will check the situation again: the posture, the height of hips, shoulders, leg length and again will repeat the energy evaluation of the abdomen. It is rare that the problem is resolved after only one session, but surely, if the therapist has acted well, he will feel immediate relief after the first treatment. How many meetings depends on many factors: how long he/she has the problem, the age of the person, the reactivity and ability of the body to react, the trust in the therapist, the willingness to improve the lifestyle (posture, breathing, diet, exercise, mental attitude).

It is normal during a treatment that involves problems related to the back to experience pain during pressures and strains caused by manipulations. But usually, it is a “good pain“, as it is often described by the recipients. A pain that generates relief and relaxes tension. Always listen to what you feel during treatment and always warn the therapist if you experience extremely annoying pains.

We conclude this article on Shiatsu and back pain, inviting readers to gain direct experience (if they need it) with a qualified and well-trained Shiatsu therapist on this issue. There are other infinite techniques that can be used together with Shiatsu, such as cupping and moxibustion, which we will discuss in other articles. To learn more about Shiatsu, I refer to this short article. For its origins instead here.