Japanese Massage: Shiatsu, Anma and Seitai Explained

Shiatsu, anma and seitai are often grouped together, but they have different histories and rules, and this guide explains how to choose a treatment with confidence.

Published October 19, 2026 at 11:17 PM JST | By Tokyo Paul

Quick answer: Anma is traditional Japanese massage, shiatsu is a related finger-pressure bodywork that developed from it, and seitai is a general word for body-balancing treatments. Anma massage and shiatsu are regulated professions in Japan, and licensed providers hold a national license issued under the Ministry of Health, Labour and Welfare. Sessions are for relaxation and general wellness, not medical treatment.

Three terms, one family of traditions

Anma, shiatsu and seitai are words visitors meet on shop signs and clinic doors. Anma means traditional Japanese massage, using kneading, rubbing, tapping and pressing. Shiatsu means "finger pressure," a bodywork style that grew out of anma and is also practiced abroad. Seitai is a broader word, often translated as body adjustment or body balancing, and it covers a variety of approaches.

All three share the idea that working on the muscles and joints can bring comfort and ease. Shops and clinics differ in atmosphere, qualifications and what they offer, so reading signs and descriptions carefully helps. Choosing between them is partly a matter of taste, partly a matter of goals, and partly a matter of checking that the provider is qualified for the services offered. Asking a hotel front desk or a local tourist office for a recommendation is a sensible way to begin.

Anma

Anma is thought to have reached Japan from China during the Nara period and became a distinct system in 1320, according to the Wikipedia article on anma. It was popularized in the 17th century by Sugiyama Waichi, who was blind and founded schools for blind practitioners. Edicts of the Tokugawa period reportedly restricted the practice to blind practitioners, and the image of the blind anma master became part of Japanese culture.

Today, anma is still practiced independently of shiatsu, and many blind and visually impaired Japanese people continue to work in the profession. A session typically uses kneading, rubbing and pressing techniques over the shoulders, back, arms and legs. The pace is often gentle and steady, and many people enjoy it as a restful break from sitting at a desk or from a long day of sightseeing on foot.

Shiatsu

Shiatsu is a form of Japanese bodywork based on finger pressure. The Wikipedia article says the Japanese health ministry defines it as manipulation by thumbs, fingers and palms without the use of instruments. It derives from anma, and the term itself appeared in the early twentieth century, with a professional association founded in 1925 to set shiatsu apart from anma.

Tokujiro Namikoshi, who founded a shiatsu college in the 1940s, is often credited with developing modern shiatsu, and other teachers later added frameworks drawn from traditional East Asian medicine. A session usually takes place on a mat or a treatment table, and the practitioner applies steady pressure with the hands, elbows or palms. Recipients commonly remain clothed in loose, comfortable clothing, and oil is usually not used.

Seitai

Seitai literally means something like "adjusting the body." The term is used by a wide range of practitioners, and the style of treatment varies, from gentle stretching and alignment to hands-on manipulation. Because the word describes an approach rather than one regulated qualification, the background and training of practitioners can differ widely, and a title on a sign does not say by itself which qualifications a person holds.

For that reason, it is sensible to read the clinic's description, ask about the practitioner's training and look for any posted licenses. Some seitai practitioners also hold national licenses in related fields, and others do not. Advertising for licensed treatments is subject to legal limits, so descriptions are often modest and focus on relaxation rather than on specific results.

Licensing in Japan

Japanese law regulates certain hands-on treatments. In general, anma massage, shiatsu, acupuncture, moxibustion and judo reduction therapy may be offered as a business only by a doctor or by a person who holds the relevant national license issued under the Ministry of Health, Labour and Welfare. Licensed providers are also expected to follow rules on facilities, reporting and advertising.

Anyone planning to receive these treatments can choose a qualified provider and ask the local health office or a municipal information desk about specific treatment centers. For visitors, this means that a sign with a license notice, a clearly displayed provider name or a clinic affiliated with a school is a helpful signal. Rules change, so the official pages are the best place to confirm details.

Clinics, relaxation shops and judo therapists

Several kinds of places offer hands-on care. Clinics for licensed providers focus on treatments such as anma, shiatsu, acupuncture and moxibustion. Relaxation shops offer lighter services, such as foot massage or oil treatments, in a spa-like setting. Judo therapists, called judo seifukushi, run clinics for bone, muscle and joint injuries, and the national license requires at least three years at a designated school or four years at an approved university, followed by a national exam (check the Ministry of Health, Labour and Welfare for the current requirements).

Judo therapists are also widely known as bonesetters, and bonesetter clinics are commonly called sekkotsuin. For relaxation, a spa or a shop may be the right choice. For a particular concern, such as an injury, the right first step is a conversation with a doctor. This guide shares general cultural information and published research, not professional advice; for a health concern, talk with a doctor or a local clinic.

What a session is like and what to expect

A first visit often begins with a short conversation about the areas of concern, then a treatment of roughly 30 to 90 minutes, depending on the menu. Staff may give a simple form to fill out, and communication is often through gestures, pointing at a diagram and simple words such as "itai" (it hurts) and "kimochi ii" (it feels good). Telling the practitioner if the pressure is too strong is welcome.

On the evidence, the Wikipedia article on shiatsu reports that some studies suggest improved relaxation and sleep, and that there is no scientific evidence that it prevents or cures any disease. For that reason, it is best viewed as a pleasant wellness practice. Tell the practitioner about pregnancy, injuries or medical conditions beforehand, and skip a session when unwell. Check the current rates and the booking method on the provider's official page.

Frequently Asked Questions

What is the difference between shiatsu and anma?

Anma is traditional Japanese massage using kneading, rubbing and pressing. Shiatsu grew out of anma and uses finger, palm and thumb pressure, usually on a mat while the recipient is clothed. Shiatsu developed as a distinct practice in the early twentieth century, and both are regulated in Japan.

Do massage therapists in Japan need a license?

For anma massage, shiatsu, acupuncture, moxibustion and judo reduction therapy, generally yes. These may be offered as a business only by a doctor or a person with the relevant national license, so confirm current rules with the Ministry of Health, Labour and Welfare or a local health office. Relaxation services are described differently, so ask the shop what it offers and what qualifications its staff hold.

Is seitai the same as shiatsu?

No. Seitai is a broad term for body-balancing approaches, while shiatsu is a specific style of finger-pressure bodywork. Qualifications can differ, so it helps to ask about the practitioner's training. Both are best viewed as wellness practices rather than medical treatment, and a doctor is the right person to consult about a health concern.

Want to go deeper? Tokyo Paul's book Unlocking Ikigai is available on Amazon.

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