CHAPTER 8 Working with Shiatsu 2

Basic techniques and tools

Contraindications

Before beginning to learn, we need to know when not to use Shiatsu.

There are few disorders which the experienced practitioner cannot treat with Shiatsu, but certain conditions should be approached cautiously. Because we need to relax in order to give a good session, anything that makes us feel nervous should be avoided, and beginners should not attempt to treat serious diseases.

Shiatsu is conventionally contraindicated for cancer, on the grounds that increased venous and lymphatic flow may cause the disease to spread. However, since physical exercise or deep breathing also increase the circulation and both these are considered beneficial, we may choose to treat nonetheless. There are many cases where appropriate Shiatsu has greatly helped the symptoms of cancer patients, but the decision on what is appropriate is best made by an experienced practitioner.

The first 3 months of pregnancy are also best treated by an experienced practitioner, or not at all, in our own interest as much as that of the receiver. Miscarriage during the first 3 months is relatively frequent, and although a gentle Shiatsu is unlikely to harm a baby if it is firmly established, the mother’s distress may lead her to blame the Shiatsu for her miscarriage even when she would have miscarried anyway. If you are an experienced practitioner and a regular client who knows and trusts you becomes pregnant and asks you to continue treating her through the first 3 months of her pregnancy, it is an agreement between you which should be made with the risks and possibilities discussed beforehand. From the third month, unless there are known problems with the pregnancy, it is fine to treat pregnant women as normal, except for the points in the note below.

Throughout pregnancy, direct pressure on the abdomen and certain points which move the Ki strongly (LI-4, SP-6, GB-21) are contraindicated.

Any kind of acute illness with fever is unsuitable for general Shiatsu treatment, since the fever is a sign that the body is already engaged in fighting off the infection, and should not be overloaded. Certain points, however, may help to speed recovery by eliminating the external pathogenic factor (see p. 140)

Shiatsu should be given with care in osteoporosis, for fear of damage to the bone. The same caution should be used in treating receivers who have had chemotherapy, for the same reason. High blood pressure is traditionally contraindicated, but this applies only to very hard and forceful pressure, which could damage the blood vessels. If only gentle Shiatsu techniques and relaxed penetration are used, Shiatsu can be soothing and beneficial in cases of high blood pressure.

Very weak or debilitated receivers, such as the elderly, the frail and many sufferers from ME (chronic fatigue syndrome) should also be treated very gently, if at all, with Shiatsu.

Other contraindications refer to localized conditions, where only the affected part should be avoided during the course of treatment. These include:

• varicose veins

• wounds

• fractures

• operation scars and adhesions

• inflamed joints (showing signs of heat or redness)

• areas of inflamed, red or raw skin.

In all these cases, while we should avoid working directly on the affected part we can give general Shiatsu to the rest of the body. In particular, holding relevant points above and below the contraindicated area, or treating the same area on the opposite side if the affected part is on a limb, can be extremely beneficial.

Practical Basics

Floor, bed or chair?

Shiatsu is traditionally performed on a mat on the floor. Working on the floor gives us maximum versatility, as we can apply pressure with our knees and feet as well as elbows and hands, and we can use a wide variety of stretches without constantly raising or lowering our working surface but simply changing our position and use of body weight.

Working on the floor also encourages us to work from the Hara, supported by leverage from our legs and feet. In the early stages of Shiatsu study we focus on posture and the relaxed application of body weight; gradually, as this becomes second nature and the body flows naturally into the most effective position, then a sense of Hara can develop and we begin to sense and work with Ki.

If a receiver cannot lie on the floor, we must choose another treatment position. For elderly people the techniques traditionally performed with the receiver in a kneeling or sitting position on the floor can be modified for use in a chair. For situations where neither floor nor chair are suitable, the solution is a treatment couch which is the right height to allow us to apply pressure through straight arms while leaning forward from the hips, or a couch which can be raised or lowered by a foot pedal (Fig. 8.1).

Fig. 8.1 Using a low table.

Standard fixed height treatment couches make it very hard to work from our Hara, and unless we mostly use our elbows, it is difficult to use relaxed body weight (Fig. 8.2).

Fig. 8.2 Working on a massage couch.

The worst option is a standard domestic bed, since, in addition to the disadvantages mentioned above, the height puts a strain on our back and the receiver’s unsupported body sinks into the mattress with each pressure.

Clothed or unclothed?

One of Shiatsu’s great advantages as a therapy is that it can be given through clothes. This is not only for reasons of modesty, traditional in the Far East and particularly necessary when Shiatsu techniques stretch the receiver’s limbs into revealing positions; it is also relevant to Shiatsu practice. On hot days or in a warm room, giver or receiver can sweat, making the receiver’s skin too slippery for stretches or pressure. It can also feel unpleasant to receive Shiatsu from sweaty hands, and for this reason many practitioners use a cloth when working on the face or other uncovered areas.

Note: Take care not to cover the receiver’s face completely with the cloth, so as to avoid possible feelings of claustrophobia.

More importantly, the focus of Shiatsu pressure is not the skin surface, but the deeper body structures and above all the Ki within the body. As students we are encouraged to feel the shape and tone of the receiver’s body through clothing, rather than uncovering areas ‘to feel them more easily’, since our sense of touch should not be distracted by the texture of the skin. Clothing can also be useful for observation diagnosis; to the eye of the experienced practitioner, the way clothing falls or creases can enhance rather than prevent her perception of the flow of the receiver’s Ki (see p. 323).

Some practitioners prefer to work on bare skin, however, and others use a combination of massage methods which include Shiatsu pressures but also include the use of oils, so that they uncover the receiver when using oils and cover her with towels when giving Shiatsu. We should work in the way we prefer, but a competent Shiatsu practitioner should be able to work as easily through clothes as on the naked body.

Shiatsu Techniques

We have established in the preceding chapters that Shiatsu, along with other forms of ‘energy medicine’, depends for its effect on the resonance between the fields of giver and receiver as well as upon the specific skills and techniques involved. We shall return to this theme towards the end of the chapter. Meanwhile, however, it is worth stating that there are basic skills in giving Shiatsu which make that resonance much easier to achieve. Of course we can give Shiatsu in any way we like and if we are natural healers we do not need skills. But the skills of Shiatsu help us to find our healing mode, and to work easily together with the natural flow of our own and the receiver’s Ki.

One of the most important skills we can bring to our Shiatsu is an awareness of our:

1 Posture

Relaxation and comfort

To give good Shiatsu our body must be free of tension and we need to avoid any sense of deliberately applying pressure to our receiver’s body. We could imagine the experience as a dance between two people, rather than a process in which an active therapist applies thumb pressure to a passive patient. When we abandon our ideas of ‘doing something to’ the receiver and allow ourselves to relax and become part of a process, Ki flows through us both as if through two circuits joined to make one.*

The basic movement: crawling

For most Shiatsu students at their first class, expecting to learn the use of thumbs on pressure points at once, it is a surprise to spend an hour crawling on the floor and each other. But many of them are giving the best Shiatsu they will give for a long time in this way; even after many years of professional practice, at the end of a tiring day they may find, as I do, that their best results are achieved by relaxing into the crawling technique.

Crawling is the transmission of body weight through straight but relaxed arms and relaxed hands, aided by support from legs, hips and Hara. If you practice crawling on the floor with full awareness of your body posture and how it changes, you can recognize some of the most basic principles of good Shiatsu technique – controlled use of body weight and relaxation. You can then apply a modified version of the technique and ‘crawl’ around the receiver with your hands only, not your knees, on the receiver’s back, shoulders and hips.

When crawling, keep your arms at right angles to the body surface, your hands relaxed, and only lean on areas of the receiver’s body that you feel will support your weight comfortably. If it feels wobbly, tense or insecure, move away from that area.

Controlled use of body weight occurs naturally in crawling, as we shift our body weight gradually on to each limb in turn, while allowing the other three limbs to support us. In giving Shiatsu, this is the correct way to change the strength of our pressure; not by using our muscles to press harder or more lightly, but by continuing to ‘crawl’ and use body weight, only keeping more weight invested in our supporting knees and less in our hands when we need to use a lighter touch (Figs 8.3 & 8.4).

Fig. 8.3 Use of body weight.

Fig. 8.4 Use of body weight.

When we abandon our body to the floor’s support we can relax. Tension disappears from our shoulders and hips as we crawl – our body weight is naturally supported by the floor. This depends largely on the vertical position of our arms and thighs; they are at right angles to the floor. When giving Shiatsu, we should remember this and keep our body at an appropriate distance from the receiver, so that our body weight can meet the receiver’s body surface at right angles.

Another aspect of relaxation is the molding of our hands to the surface which supports us. If, as we crawl on the floor, our hand lands on a cushion, or a pencil, or the edge of a thick rug, it automatically moulds itself around the new surface. The more relaxed our hands are, the more they contribute to our support, and the less we think about our hands, the more relaxed and accommodating they are.

This relaxation can bring great depth and sensitivity to our Shiatsu; instead of concentrating on the surface on which our hands rest, which would involve the hand–brain connection and analytical effort, we are relaxing into the support which the receiver’s body gives us, which involves the deeper sensing and balancing mechanisms of our own whole body. This means that we are not ‘doing something to’ the receiver; we are involved in the process on a deeper level.

As we relax into the support of the receiver’s body, we are also automatically aware of whether that contact is comfortable, so that we can stay there for a long time, or whether the receiver’s body is tense and uneasy in any particular area, and seems to want to throw us off. This is the central sensation in ‘feeling’ diagnosis, the sensing of parts of the receiver’s body which are empty of Ki or over-full.

From crawling to use of Hara

When we have learned to feel comfortable ‘crawling’ on the body of the receiver and are able to use body weight and stay relaxed, we are beginning to understand the use of the Hara. Now we can begin to use new techniques and working positions, but there are still certain basic ‘crawling’ guidelines which should be checked through constantly.

Are you feeling comfortable in what you are doing?

Good Shiatsu has to feel comfortable to both giver and receiver. If we are uncomfortable, the receiver will also be uncomfortable. We need to be able to lean in to the support of the receiver’s body, rather than expending effort in awkward positions. Only use techniques with which you feel comfortable. Only apply pressure to areas which you can reach comfortably.

Are your arms, hands, neck and shoulders relaxed?

If they are not, you are expending unnecessary effort. Take a deep abdominal breath and focus your attention in your Hara for a while, or go into a basic crawling technique until you feel more relaxed, keeping ‘weight underside’.

Can you feel your connection with the ground?

In classical Shiatsu, the giver works most of the time from a crawling position. The lower down she is, the more she can rely on stability and leverage from the ground. Even if you are doing a modified Shiatsu on a treatment couch, be aware of the ground, and your own and your receiver’s connection with it.

Is your base wide enough to support you?

You should be making full use of the ground’s support. Keep your knees a natural hips’ width apart as you crawl, and your hip area as open and relaxed as possible, to ensure maximum stability, support and Ki flow.

Is your Hara facing the area on which you are working?

If it is not, you are probably not making use of your body weight. As you progress in Ki awareness, it can help to imagine your Hara and Central Channel as giving out a spotlight beam which illuminates the part of the receiver’s body you are working on. The Hara and Central Channel can also direct Ki, so that you can position yourself with your Hara pointing in the direction in which you wish the receiver’s Ki to go.

Is your spine aligned ‘between Heaven and Earth’?

A sure way of remaining in the center of our Ki-field is to keep our spine aligned. The crown of the head and the tailbone should be in line with each other, and an awareness of this posture supports us in the crawling technique or any other, as if we are suspended from a ‘cosmic clothes-line’ (i.e. correctly aligned), allowing us to relax.

Taking care of our posture immediately puts us into our ‘felt sense’ of ourselves and is a pre-requisite for:

2 Awareness and expansion of our Ki-field

Many mentions have been made in the preceding chapters about awareness of our Ki-field and how to develop it through meditation, exercise and observation of our own sensations when we are treating. If we want our Shiatsu to be energy work as well as body work, this awareness and expansion is an essential technique. It enables us to gain a picture of our receiver’s energetic anatomy and to experience practically how we can best work with it in the session. Above all it involves us in the healing yuan connection which supports our receiver in healing herself.

Remind yourself of the importance of self-awareness and the expansion of your Ki-field as described on p. 43.

An example of an occasion when we can use our expanded field in the tradition of East Asian medicine is in the use of ‘distal’ points. Working with tsubos or acupoints at some distance from the seat of the problem, on a meridian which has some relevance to the condition, is an accepted and effective method of treatment. We can use distal points in Shiatsu (a simple example would be Liver 3 for drawing down excess Ki from the head) with the added emphasis of our awareness bubble around the receiver’s head and the relaxed intention extended from our Hara.

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