Background: Although shiatsu has been taught in specialized schools in Japan since 1940, there is a limited amount of research for its practice. As a result, authors substitute shiatsu with acupressure to use available research on acupressure. It is the position of the authors that, while the two share common aspects, they are substantively different. This project was undertaken to describe technical differences and advocate for a clear distinction, especially in research studies and academic discussions.Methods: To understand whether it is appropriate to include acupressure studies in the evidence for shiatsu an analysis of the references included in a frequently cited systematic review was conducted to collect information about the protocols. In addition, a preliminary exploration of shiatsu practitioners’ perceptions about the differences between shiatsu and acupressure is described. This exploration used videos of shiatsu and acupressure techniques and asked practitioners to comment on their perception of similarity.Discussion: The results identified several key technical differences between the two, including type of pressure applied, the positioning of the thumb, and the way in which body weight is used. Researchers should separate shiatsu and acupressure in their designs and purposively choose one or the other. To facilitate such clarification, we have proposed a definition for shiatsu that may facilitate the differentiation between these two techniques.Conclusion: The authors hope to stimulate discussion about the differences between shiatsu and acupressure, and to question the appropriateness of using acupressure studies as evidence of the efficacy of shiatsu. A true understanding of the efficacy of shiatsu cannot be determined until studies use a common definition of shiatsu and discontinue substituting acupressure research for evidence of shiatsu efficacy. When this happens, it is proposed that a clearer picture of the safety, efficacy, and mechanism of action of both shiatsu and acupressure will emerge.

Several manual bodywork therapies that originated in Asia are related to the theory and practice of acupuncture and Traditional Chinese Medicine (TCM). One of the aims of these therapies is to stimulate specific points on the body called acupoints which are the same points in which needles are inserted in acupuncture. These manual therapies, however, vary in their interpretation and explanation of the theories of TCM, and even more so, in the practical way the stimulation is applied. The aim of this paper is to clarify these differences and show how future research can benefit from specifying the actual techniques used. This paper analyses and compares research papers, textbooks, articles, official definitions and demonstrations of the techniques to highlight the similarities and differences, and examines instances in research in which the techniques were not clearly differentiated. There are many instances in the research literature in which references from one of these practices, or from acupuncture itself, has been used as evidence for other manual therapies conflating the evidence. As far as it is known, nobody has proved that inserting a needle or applying electric stimulation on a specific point on the body has the same physiological effects as pressing with a finger. Nobody has proved that applying stationary pressure has the same

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