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Tuesday, April 11, 2006
Massage has its good and bad points
By TOMOKO OTAKE
In today's deadline-driven, high-stress society, it's no longer uncommon to experiences headaches, stiff shoulders and carpal-tunnel pain every now and then. While many people turn to painkillers for relief from minor complaints, which in some cases can snowball into a chronic condition, massage treatments can be highly effective.
The appetite for this type of alternative/preventive medicine seems to be growing, as seen by the proliferation of massage clinics and relaxation specialists all over Japan. While it may seem to be a profit-making boom, Japanese have used acupressure to ease pain for more than 1,000 years. And while domestic research on the scientific effects of acupressure is scarce, the proven effects of traditional Chinese and Japanese massage are being taken more seriously by those in mainstream medicine.
For instance, in February, a Taiwanese study that concluded acupressure was more effective than physical therapy in relieving pain and improving lives for people with lower back pain was published in the highly respected British Medical Journal.
The most well-known form of traditional Japanese massage is shiatsu, which literally means "finger pressure." Shiatsu is aimed at reducing pain by applying pressure to key pressure points on the body. According to the 2002 book "The Shiatsu Way to Health" (Kodansha International), such a treatment can strengthen internal organs (and thus prevent diseases), relieve migraines, hangovers, stomachaches, heartburn, insomnia -- you name it.
So why aren't we all regularly receiving massage treatment?
Perhaps the biggest reason is the mixed quality of practitioners. How can you tell from the signs outside the ubiquitous clinics/salons whether they are competent, average, unqualified -- or even part of the sex industry? It's not easy.
To help you navigate the changing landscape of traditional Japanese massage, here is some historical background, a run-down of issues currently surrounding the industry, and tips for picking good practitioners.
The origins of Japanese massage
The oldest reference to anma -- traditional massage therapists -- dates back to the Taiho Ritsuryo (Taiho Code) in the 8th century. Later, in the 1300s to 1400s, anma and acupuncture were taught in schools for the blind, as their sharp sensory perceptions made them good practitioners. In the Edo Period, one anma/acupuncturist Waichi Sugiyama, was given the title of kengyo, which originally meant "examine" but came to refer to the elite class of blind people, who worked as composers, academics and doctors. Sugiyama invented a type of acupuncture, while serving the shogun's family.
During Meiji Era Japan's embrace of all things Western, massage techniques were imported from France and became integrated with anma. In the 1920s, practitioner Tokujiro Namikoshi coined the word shiatsu to describe a therapeutic system he had established that integrated with modern anatomy and physiology with traditional methods.
Anma vs. shiatsu?
Both shiatsu and anma incorporate the principles of qi, an ancient Chinese therapeutic system of diagnosis and treatment, based on nearly 700 points on the body and the meridian lines of "energy flow" -- known as ki in Japan -- that connects them.
Present-day anma, which means "pressing and stroking," often involves rapid moves of the fingers. Practitioners try to relax tense muscles and improve blood circulation by applying pressure to tsubo points across one's body with the balls of the thumbs and fingers. Tsubo points are believed to accumulate fatigue and stress.
Shiatsu practitioners also apply pressure with their fingers, but use their elbows as well, and tend to apply slower, more constant pressure. In reality, unless practitioners tout themselves specifically as shiatsu experts, they probably use a combination of both.
Some practitioners say the line between shiatsu and anma is not that clear, as they both use a mix of pressing, pulling, rubbing and patting to stimulate the body.
The government-certified title for massage practitioners is "anma, massage and shiatsu-shi." To gain accreditation, students attend a three-year vocational school and take a qualifying exam. Many massage practitioners also study for licenses for acupuncture and moxibustion.
Another kind of state-licensed massage therapist is the judo seifukushi (judo therapists), who applies martial art techniques. They run clinics called sekkotsuin or seikotsuin, which service people who have suffered external injuries, like sprains, bone fractures and bruises, by using massage to accelerate the recovery of the muscles near the damaged area.
Despite these distinctions, not all massage therapists fall into one of these two categories. A growing number are not accredited by the government, due in part to decades-old regulations that protect the livelihoods of blind people by limiting the number of vocational training schools for people who are not visually impaired.
As a result, many of the massage clinics and salons that you see around town are not licensed by the government. Nor are there government qualifications for chiropractic and seitai (osteopathy).
Licensed vs. unlicensed
The 12,000-member association of licensed masseurs/acupuncturists/moxibustion specialists, called Zen-nihon Shinkyu Massaji-shi Kai (Zenshin), is stepping up action against private practitioners, which they say are engaged in "illegal activities."
"While the licensed practitioners have had at least three years of training at schools, I bet most other therapists are trained for less than a year," Zenshin director Hisao Sugita said. "And I hear there have been cases where serious damage has been inflicted by undertrained therapists."
When asked for a comment on the issue, Yasuhiro Sato of the Health, Labor and Welfare Ministry's health policy bureau said that while any "act that can potentially cause damage to one's body" can be termed illegal, it would be wrong to assume that all unlicensed practices are operating outside the law.
Sugita himself acknowledged that relaxation salons, which are generally fancier and more market-savvy than traditional clinics, "have filled a niche." It could even be said they and others without licenses have actually stimulated growth in the overall market.
"We can't possibly be beaten [in terms of technique], but many of us have lacked good management skills," Sugita said.
Susumu Kimura, a Tokyo-based shiatsu practitioner, was trained by the revered shiatsu master Shizuto Masunaga and has worked from his clinic-cum-home for 30 years. He says a certificate isn't everything.
"There are outstanding practitioners who don't have a government license," he said. "Even though I have a license, I don't publicize it."
How to judge?
Zenshin's Sugita said that licensed massage therapists are barred by government regulations from advertising the purported health benefits of massage -- which means anyone loudly touting them is probably not certified. Kimura, on the other hand, recommended that anyone interested in shiatsu should look for shiatsu specialists instead of ones that claim to offer all of the "anma, massage and shiatsu" services.
Kimura also recommends people to shop around and try a few different practitioners. "People who receive the care need to be sensitive, [because] they need to feel in charge of their health," he said.
National heath insurance accepted?
Insurance normally doesn't cover the treatment of chronic pain by massage therapists, regardless of whether they're state-licensed. The exceptions, if treated by a licensed massage therapist, are muscle paralysis and joint contracture. Certain treatments administered by judo seifukushi, such as those for fractures and other external injuries, can be covered, with a doctor's consent, but there is a gray zone between chronic and acute cases. Experts say that in some "semi-acute" cases, national health insurance can be used.
Zenshin says the standard price is 3,000-5,000 yen yen for a session, but fees vary from clinic to clinic, with some charging higher fees for the first visit. Kimura charges a flat fee of 5,000 yen per session, which generally lasts about 50 minutes. He recommends biweekly visits, but says people with chronic ailments often require weekly treatments.