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Eastern massage systems have been an integral part of the cultures where they are practiced. Systems for evaluation, diagnosis, and treatment generally are not grounded in conventional Western neurophysiology. Eastern massage includes, among other approaches, Shiatsu, a Japanese system based on traditional Chinese meridian theory with principles of Western science. The theory of Shiatsu is based upon the system of the 12 traditional Chinese meridians (ie, major channels) of the body in which the energy, life force, or Chi, circulates. Acupressure pressure points, situated along the course of channels, allow access to these channels. Acupressure applies massage forces, largely through digital pressure, to the same points treated with acupuncture needles. Imbalances of energy along the meridians are believed to cause disease and can be rectified by localized finger pressure. A therapeutic effect derived from massage is muscle relaxation. Massage appears to reduce tone and enhance circulation to the area. Muscle relaxation also may result from increased sensory stimulation caused directly by massage. This increased sensory input to the spinal cord may result in changes in reflex pathways, leading to central modulatory decreases of muscle tone.
Manipulation procedures are used in many ways by a variety of practitioners. The most common goal of a manipulative treatment is to increase the mobility of a particular area or region of the musculoskeletal system where restrictions are encountered. While some practitioners focus on pain relief as a main outcome measure, others seek enhanced mobility or reduction in restriction of vascular or lymphatic congestion as it relates to the rest of the body. Soft-tissue technique uses mechanical stretch of skin, muscle, and fascia to increase motion. Lateral and linear stretch and deep inhibitory pressure are the most common procedures used. Soft-tissue techniques are useful in virtually all patients and may function as the first step in manipulative treatment involving multiple techniques. Soft-tissue techniques are very valuable in encouraging circulation and enhancing venous and lymphatic flow. The overall purpose of soft-tissue techniques is to relieve fascial and superficial muscle tension.

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