Reflexology

Related Terms

• Auricular reflexology, body reflexology, charka energy reflexology, foot acupressure, Laura Norman method, macroreflexology (acupressure and acupuncture), metamorphic technique, microrelfexology (ear, foot and hand reflexology), Original Ingham Method®, reflexology workout, reflextherapy, reflex zone therapy, Vita Flex, zone therapy.
• Note: The term "reflexotherapy" has been used to describe acupuncture in some countries.

Background

• Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Reflexology is often used with the intention to relieve stress or prevent/treat physical disorders. Pressure may also be applied to the hands or ears.
• Techniques similar to reflexology have existed for thousands of years, and were used by ancient Egyptians and early Chinese. In the early 20th Century, an American ear, nose, and throat physician, William Fitzgerald, MD, suggested that the foot could be "mapped" to other areas of the body in order to diagnose and treat medical conditions. He divided the body into 10 zones and labeled sections of the foot he believed to control each zone. Dr. Fitzgerald suggested that gentle pressure on a particular area of the foot could generate relief in the targeted zone. This process was originally named zone therapy.
• In the 1930s, Eunice Ingham, a nurse and physiotherapist, further developed these maps to include specific reflex points. At this time, the name zone therapy was changed to reflexology. Modern reflexologists in the United States often learn Ingham's method or a similar technique developed by the reflexologist Laura Norman.
• Reflexology charts consist of pictures of the soles of the feet on which diagrams of corresponding internal organs or parts of the body are drawn. For example, charts may display that the toes correspond to the head and neck, the ball of the foot to the chest and lungs, the arch of the foot to the internal organs, the heel to the sciatic nerve and pelvic area, and the bone along the arch of the foot to the spine. The right side of the body is believed to be reflected in the right foot, and the left side in the left foot.
• Although most reflexologists formally claim that these relationships are not used to diagnose disease, practicing reflexologists sometimes assert that tenderness or a gritty feeling of the feet represents current or past disease in the corresponding area of the body.
• Reflexology is sometimes combined with other techniques, and may be used by healthcare practitioners of various disciplines (such as massage therapists, chiropractors, podiatrists, physical therapists, or nurses).
• Reflexology is primarily based on Western physiological concepts of reflexes and the nervous system, rather than Oriental concepts of energy meridians or acupuncture points. Thus reflexology was not introduced as a form of energy medicine per se, but rather as a form of massage therapy and bodywork based on Western anatomical principles.
• Reflexology is sometimes confused with acupressure (shiatsu), which is based solely on Oriental energetic principles. While the two modalities are based on different theories of mechanisms of action, some modern reflexologists now incorporate some Oriental energetic principles in their understanding of the possible mechanisms of reflexology.
• Practitioners range from those who taught themselves from books to individuals who attended training courses and belong to professional associations. Techniques can be learned and self-administered. No widely accepted regulatory systems exist for reflexology, and there is currently no state licensure or training requirement in the United States.

Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Exactly how reflexology might work remains unclear, and several possible explanations have been put forward. One theory is that the body contains an invisible life force, or energy field, that when blocked can result in illness. It is proposed that stimulating nerve endings in the foot can unblock and increase the flow of vital energy to various parts of the body, and promote healing. This account is similar to theories behind other techniques in which mapped points are treated to affect corresponding remote body parts or conditions, such as acupuncture or acupressure.
• A different theory is that pressure exerted by reflexologists may release endorphins (compounds that alter pain sensations). Yet another explanation is that compression of specific points ("cutaneo-organ reflex points") stimulates nerves that form connections with other parts of the body, and may have distant effects as part of a reflex arc. Other theories include promotion of lymphatic flow or dissolving of accumulated uric acid crystals via direct stimulation of the feet. Reliable scientific research in these areas is limited.
• Reflexologists often take a full client history before examining the bare feet systematically, with the patient lying on a treatment table, couch, or reclining in a chair. During treatment, clients typically remain fully clothed, sitting with legs raised or lying on a treatment table. Unlike massage, which involves a generalized rubbing motion, reflexologists use their hands to apply pressure to specific points of the foot.
• Practitioners start by gently massaging the feet, and then begin to apply pressure to selected reflex points on the feet. The strength of pressure used often varies between practitioners, and from patient to patient. This therapy should never be painful.
• For lubrication, therapists may use lotion or oils (some which contain aromatherapy products). The reflexologist and client may converse throughout treatment or may remain silent, depending on client preference. Occasionally, practitioners will use instruments on the feet during therapy (for example, sticks of wood, clothespins, combs, rubber balls, rubber bands, tongue depressors, wire brushes, special massagers, hand probes, or clamps). Some reflexology instruction books state that clients may feel a tingling sensation in the part of the body corresponding to the reflex point being stimulated, although this has not been documented scientifically.
• Individual reflexology sessions often last from 30 to 60 minutes, and may be part of a 4 to 8 week course of therapy. Practitioners range from those who taught themselves from books to individuals who attended training courses and belong to professional associations. Techniques can be learned and self-administered. No widely accepted regulatory systems exist for reflexology, and there is currently no state licensure or training requirement in the United States.

Evidence

*Key to grades: 

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

• Reflexology is discouraged in patients with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Patients with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet, should seek a medical consultation prior to starting reflexology.
• In general, patients should inform their medical practitioners of any existing medical problems or medications. Some reflexology texts note specific conditions that theoretically may be negatively affected by this therapy, although scientific data is lacking in these areas. These conditions include diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones.
• Caution is advised in pregnant women, due to reports that rigorous stimulation of the feet may lead to uterine contractions.
• Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.

Authors

• This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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6. Carpenter JS, Neal JG. Other complementary and alternative medicine modalities: acupuncture, magnets, reflexology, and homeopathy. Am J Med 2005 Dec 19;118 Suppl 12B:109-17.
7. Ernst E, Koder K. An overview of reflexology. Eur J Gen Practice 1997; 3:52-57.
8. Gunnarsdottir TJ, Jonsdottir H. Does the experimental design capture the effects of complementary therapy? A study using reflexology for patients undergoing coronary artery bypass graft surgery. J Clin Nurs 2007 Apr;16(4):777-85.
9. Hayes J, Cox C. Immediate effects of a five-minute foot massage on patients in critical care. Intensive Crit Care Nurs 1999;15(2):77-82.
10. Hodgson H. Does reflexology impact on cancer patients' quality of life? Nurs Stand 2000;14(31):33-38.
11. Kohara H, Miyauchi T, Suehiro Y, et al. Combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer. J Palliat Med 2004 Dec;7(6):791-6.
12. Launso L, Brendstrup E, Arnberg S. An exploratory study of reflexological treatment for headache. Altern Ther Health Med 1999;5(3):57-65.
13. Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol 1993;82(6):906-911.
14. Siev-Ner I, Gamus D, Lerner-Geva L, et al. Reflexology treatment relieves symptoms of multiple sclerosis: a randomised controlled study (abstract). 4th Annual Symposium on Complementary Healthcare, Exeter England, December 10-12, 1997 (reprinted in: Focus Altern Complement Ther 1997;2:196).
15. Stephenson NL, Weinrich SP, Tavakoli AS. The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncol Nurs Forum 2000;27(1):67-72.