Shiatsu in Spain

Professional Practice of Shiatsu in Spain

In Spain, Shiatsu may be practised professionally, but it is not currently recognised as a regulated healthcare profession, and there is no official qualification specifically required to practise it.

Background and attempts at regulation

In 2007, the Health and Consumer Affairs Committee of the Spanish Parliament approved the creation of a working group to examine the situation of natural therapies and consider their possible future regulation.

The working group began its activity in 2008 and included representatives from the Ministry of Health, the Carlos III Health Institute, the Ministry of Education and fourteen regional governments. Scientific societies, professional bodies, associations and organisations representing different disciplines were also invited to contribute

This process resulted in the official report Analysis of the Situation of Natural Therapies, published by the Spanish Ministry of Health in December 2011. The report examined 139 techniques, including Shiatsu, and addressed matters such as education, safety, scientific evidence, professional practice and possible future regulation.

At the time, this appeared to offer a genuine opportunity to create a regulatory framework protecting both the public and qualified practitioners. However, the process did not result in regulation. In subsequent years, the institutional debate changed direction and became increasingly focused on the concept of so-called “pseudotherapies”.

For many people within the sector, this was deeply disappointing. A considerable amount of work carried out by practitioners, associations and specialists from different disciplines did not receive the expected institutional continuity. There was also a perception that some assessments were being made without sufficient knowledge of the education, professional practice and quality standards of each individual discipline.

Current situation

Shiatsu is still not a regulated profession in Spain. There is no compulsory official qualification and no specific public register of Shiatsu practitioners.

To work legally on a self-employed basis, a practitioner must:

  • Register their professional activity with the Spanish Tax Agency.
  • Register under the Special Social Security Scheme for Self-Employed Workers.
  • Declare their income and submit the required tax returns.
  • Comply with general invoicing, data protection, consumer information and business-premises requirements.
  • Charge VAT where applicable, as Shiatsu does not generally benefit from the exemption granted to certain healthcare services provided by officially recognised healthcare professionals.

In previous years, many practitioners registered under general categories connected with naturopathy or other health-related activities. The CNAE-2009 classification already expressly included the activities of Shiatsu practitioners under category 86.90, “Other human health activities”.

The new CNAE-2025 classification provides clearer identification and expressly placesShiatsu, together with Thai massage, Watsu, Tui Na and Qigong, under code 86.99, “Other human health activities not elsewhere classified”. However, this administrative and statistical classification does not amount to official professional recognition and does not establish compulsory educational requirements.

Education and professional standards

In practice, the public authorities do not systematically verify whether a person offering Shiatsu has completed appropriate professional education. It is therefore possible to comply with the fiscal and administrative requirements for self-employment without having to demonstrate a specific Shiatsu qualification.

This creates a paradox: the training, experience and professional conduct requirements for membership of the Spanish Association of Shiatsu Practitioners—APSE—are more demanding than the legal requirements for offering Shiatsu services to the public.

APSE therefore plays an important role in professional self-regulation. It establishes membership, education and ethical standards intended to support high-quality practice and protect the public. However, these are voluntary association standards rather than requirements imposed by the Spanish State.

Difficulties faced by self-employed practitioners

Most Shiatsu practitioners in Spain work on a self-employed basis. This involves monthly Social Security contributions, accounting and administrative obligations, periodic tax returns and, in most cases, VAT.

Although contributions have been linked to estimated net income since 2023 and certain reductions are available to newly registered self-employed workers, the financial andadministrative burden remains particularly difficult for practitioners whose income is low, irregular or seasonal.

This pressure can contribute to informal or undeclared work. This does not justify such activity, but it is important to recognise that the present system can make it difficult for new or part-time practitioners to enter the legal economy. Proportionate regulation, clear educational requirements and fiscal conditions better adapted to small professional activities would help improve transparency, public safety and the professional development of the sector.

Conclusion

Shiatsu can be practised professionally in Spain as a self-employed activity, but it remains unregulated as a distinct profession. There is no compulsory official qualification and no public system ensuring that every person offering Shiatsu has received adequate training.

APSE believes that an appropriate regulatory framework should:

  • Recognise the specific identity and characteristics of Shiatsu.
  • Establish minimum educational and professional standards.
  • Protect the public from inadequately trained practitioners.
  • Recognise practitioners who have completed comprehensive professional training.
  • Clearly distinguish responsible professional practice from activities without adequate standards.
  • Provide a viable administrative and fiscal framework for small self-employed practitioners.