mind, and spirit. The Center for Disease Control (CDC) reports that 4% of the United States population uses prescription sleeping pills. While 4% seems like a small percentage of the population, it is actually around nine million individuals. Experts believe that there are millions more that simply buy over-the-counter sleep aids or try other home remedies (http://www.nydailynews.com/life-style/health/cdc-9-million-americanssleeping-pills-article-1.1441778). I believe that most of these could be prevented if people were able to be less stressed. If a person is constantly irritable, angry, or anxious, it could be impossible to get a restful night’s sleep. The American Psychological Association conducted a four year-long study on individuals experiencing chronic stress to determine what individuals personally felt originated their stress. On average, between 2007 and 2010, 73% of the participants felt stress due to money, and around 72% over the four year period claimed their stress was due to work. Forty-four percent of Americans claim that in the past five years, their stress levels have increased (American Psychological Association, 2011). One of the dangers of internal stress is that it begins to manifest itself physically over time if not treated. According to the same American Psychological Study, between the years 2007 and 2010 the largest symptom of chronic stress is irritability or anger. Next on the list is fatigue, lack of energy or interest, and fourt nervous or anxious (See Figure 2; symptoms The Effects of Shiatsu on Lower Back Pain Linda H. Brady, R.N., Ph.D. Drake University Kathryn Henry, Ph.D., L.M.T., O.B.T. James F. Luth, II, L.M.T., O.B.T., E.M.T. The Shiatsu Clinic and School Kimberly K. Casper-Bruett, M.S.N. Winterset Iowa Community School System Shiatsu, a specific type of massage, was used as an intervention in this study of 66 individuals complaining of lower back pain. Each individual was measured on state/trait anxiety and pain level before and after four shiatsu treatments. Each subject was then called 2 days following each treatment and asked to quantify the level of pain. Both pain and anxiety decreased significantly over time. Extraneous variables such as gender, age, gender of therapist, length of history with lower back pain, and medications taken for lower back pain did not alter the significant results. These subjects would recommend shiatsu massage for others suffering from lower back pain and indicated the treatments decreased the major inconveniences they experienced with their lower back pain. Lower back pain is at epidemic levels in the United States; up to 80% of all adults suffer at some time from this condition. Back pain is the leading reason for physician office visits, hospitalization and surgery, and work disability in the United States (Deyo, Cherkuin, Conrad, & Volinn, 1991). Despite the variety of treatments available for lower back pain, no clear choice of an effective treatment has been documented (Deyo, 1983). Sarno (1998) indicated that the annual cost of medical care and disability compensation related to back pain may 57 JOURNAL OF HOLISTIC NURSING, Vol. 19 No. 1, March 2001 57-70 © 2001 American Holistic Nurses’ Association Downloaded from jhn.sagepub.com at PENNSYLVANIA STATE UNIV on March 4, 2016 soon reach $50 billion in the United States. Because conventional medical practice is unable to cure a large percentage of adults complaining of lower back pain, it is understandable that those who suffer from back pain are looking for alternative or complementary therapies to help alleviate this condition (Deyo, 1998). Complementary and alternative care therapies include such measures as acupressure and massage (Astin, Marie, Pelletier, Hansen, & Haskell, 1998; Drivdahl & Miser, 1998; Eisenberg et al., 1998). The use of at least one of the complementary therapies in the United States increased from 33.8% in 1990 to 42.1% in 1997, with massage among the fastest growing of the therapies (Eisenberg et al., 1998). Ferrell-Torry and Glick (1993) investigated the use of therapeutic massage to modify anxiety and perceived pain in cancer patients. Spielberger’s (1983) State-Trait Anxiety Inventory was used to measure anxiety, and a visual analog scale was used to measure perceived pain. Therapeutic massage consisted of effleurage, petrissage, and myofascial trigger point therapy for 30 minutes on two consecutive evenings for nine clients. Anxiety and pain scores were measured before and after each of the two treatments. Massage therapy significantly reduced the levels of pain and anxiety. Shiatsu, which literally means finger pressure (Luth & Henry, 2000), is derived from an ancient form of holistic Chinese medicine that combines massage and acupressure and has been in existence for more than 2,000 years (Fields, 1995; Stevenson, 1995). Defined as the medicinal art of applying thumb and finger pressure to acupuncture points (Luth & Henry, 1999), shiatsu is based on finding and treating areas of heightened neurological activity or hypercontractivity of the muscles (Luth & Henry, 2000). Life force, or qi, encompasses the two opposing energy forces, yin and yang, that flow through all things and follow pathways through the body. It is thought that an imbalance, depletion, or blockage of this energy results in certain symptoms that are