As always we should follow the NO PAIN principle, and not touch the lower back except at the end of the

    treatment, and with a more superficial pressure. In the worst cases, we shouldn't touch the lower back at

    all.

    We could observe the posture and back movements of the patient. The patient should perform the

    movements with great care and stop before feeling any pain or discomfort.

    These movements inform us of which side is affected the most, and should be repeated at the end of the

    session to check the patient's improvement.

        Before applying any pressure, we should rotate the articulations of the toes, ankles and hips, being very

    careful with the latter, because sometimes they cause pain. In this case we either reduce the speed, or go

    to the next step.

    The lower part of the body heals the upper part, and the front frees the back. Therefore, it is important

    to treat longer, and with a stronger pressure, the thighs (the posterior lines of the legs), so as to work 

    on the biceps femoris, the semimembranosus, semitendinosus and gastrocnemius muscles  

    which release tension in the lower back muscles and ligament, and the buttocks including the Namikoshi

    point, to work especially on the gluteus maximus.

    The inside, front and outside of the legs are also important, but the stomach meridian along the leg relieves

    backache problems more than any of the other lines.

    The other two areas one should pay special attention to are the upper back as adjacent area, and the

    abdomen (rectus abdominis and transversus abdominis muscles), since the front will help relieve the back.

    All the points along the bladder meridian on the legs and feet are important, and we should press for a bit

    longer on Bl 60 in the external maleolus.

    If possible, we touch the area affected, always paying attention so as not to cause any pain. The pressure

    in this area should never be very deep.

    We should finish by applying pressure on the neck and on the occipital points where we should stay for at

    least one minute. If possible, we should also apply a manual cervical traction. Relaxing the neck muscles

    helps relax the back muscles too.

    Finally, we may recommend Sotai exercises one and two (SEE VIDEOS OF SOTAI EXERCISES

    BELOW) (or three if Sotai two hurts), for the patient to do at home. These exercises, if practised

    daily, will prevent any future recurrence of the back pain.

    Remember: if you receive a shiatsu treatment during the acute phase of the pain, you might feel a bit

    worse the day after. This is normal because shiatsu accelerates the healing process. If this is the case, just

    rest for a few hours and you will feel much relieved afterwards.

    In case of an attack of acute back pain, it is usually better to rest for one day in bed before receiving

    a shiatsu treatment the day after.

      References: Namikoshi, Toru: Touch and Stretch: Shiatsu for Everyone. Tokyo. 1985

                             Walker, Brad: The Anatomy of Stretching. Berkeley. 2011

                             Valenzuela, Arturo: Sotai: Reeducación Postural Integral. Madrid. 2006