A Client Asks About Reflexology

Posted on: Sat, 03/05/2011 - 12:43am By: Alice

I got put into an awkward position today. A client asked, "Does reflexology work?"

Had I been in my own office, I would not have hesitated to answer freely. However, I was not in my office. I have recently taken a part time position in a spa and the spa offers reflexology treatments. I have twice been called upon to do reflexology treatments and even though I do not believe in reflexology as it is defined by most practitioners, I think a nice foot massage is pleasant and see no harm in it. In both cases, the clients had no expectations other than an extended foot massage and I am quite capable of that. But today I was asked a direct question and I definitely felt put on the spot.

What is Reflexology?

Reflexology is a type of massage using direct pressure on points on the feet and sometimes the hands. Reflexologists believe that certain points on the feet correspond to different organs and areas of the body and that one can affect these organs by applying pressure to their corresponding points. Reflexology was devised as a system in the 1930s by a physical therapist named Eunice Ingham. She worked with a physician, Dr. Riley, who was a practitioner of Zone Therapy. He believed that by applying pressure to various points on the hands, the tongue, the nose, and other areas, that one could relieve pain and cure the causes of the pain.

During a reflexology treatment, the therapist will systematically apply pressure, usually with their thumbs, to various points on the feet. For reasons I do not understand, they often apply very hard pressure to the point that it is painful. Both therapists and clients seem to think reflexology is supposed to hurt and if it does not, it will not be beneficial. Perhaps part of the attraction is that it feels good when they stop. I don't know.

Of course, the reality is that there is no map of the body on the feet or the hands. There is no evidence that one can affect any dysfunction of any particular organ by applying pressure to any particular point on the feet. Why do massage therapists persist in believing this and selling it to their clients? I have no idea. It seems so obviously silly, especially in this day and age, but people believe all sorts of peculiar ideas.

Does Reflexology Work?

When my client asked, "Does reflexology work?" I felt very put on the spot. As an ethical massage therapist devoted to evidence based massage therapy, I am compelled to be honest with my clients. I also, at that moment, feared that if I plainly admitted that reflexology is just nonsense that the client might get upset and tell the management and they would be very angry with me and punish me and/or fire me. I really did not want to lose my job at that moment. What to do?

"Massaging the feet can feel very good," I told my client, evading the question. "Yes, but does it work?" she asked. "In what way?" "Does it cure anything?" she asked. "There is no evidence that reflexology cures any disease," I told my client. "I didn't think so," she responded, and she sounded relieved. I think she was happy that she had a therapist who would talk sense.

I was relieved, too, that I could speak freely and not worry about any repercussions.

I told her that I was a minority in the field of massage therapy, that my goal was to practice evidence based massage therapy. I told her about the history of reflexology and she pointed out that it came about during a time when there was an explosion in natural therapies, such as those popularized by John Kellogg, most of which turned out to be of dubious value.

Lack of evidence

I am aware of a very few poorly constructed "studies" which purport to show that reflexology has therapeutic value. Although reflexologists shun scientific evidence, they will sometimes point to these studies. One which I read a number of years ago had a small sample of five or ten people. The subjects had tension headaches. They were given a half hour reflexology treatment while lying down and when they got up they felt better. Now, I am not a research scientist but immediately I saw how this "study" was obviously flawed. First of all, reflexologists do not concentrate only on the area of dysfunction. If you have gall bladder disease, they will still work on your entire foot. If reflexology worked, you should be able to improve your gall bladder disease by applying pressure to its corresponding point on the foot. You should not need to "treat" other areas. However, the most obvious flaw is that there was no control group to compare to. Most people will find lying down for half an hour and having their feet massaged to be a pleasant and relaxing experience. One would not have to exert pressure on any specific points. A general, nonspecific foot massage might be just as relaxing and effective. Lying down for half an hour and relaxing or having another part of the body massaged might be just as effective. In no way does this demonstrate any curative effect from reflexology itself. But this does not deter reflexologists from claiming therapeutic benefit from their treatment.

Maintaining Integrity

Fortunately, I was able to have an open and honest conversation with my client. I am not a particularly confrontational person and I do not aggressively challenge my colleagues who reject evidence to the contrary and subscribe to reflexology. I know I will be put in this position again. If the client wants an extended foot massage, I will be happy to oblige. If they ask me if reflexology works, though, I will have to diplomatically tell them there is no evidence to suggest that it has any therapeutic value beyond the placebo effect or relaxation.

I appreciate the honesty and thoroughness of your response. Extremely well written, completely plausible, and well argued. Brava! Cheers, Michael Dobson

The first time I experienced Reflexology, I had a stiff neck and could hardly turn my head. The Reflexologist only worked on the point that corresponds to the neck, on the back of the big toe. She did not touch my neck. After the session I had no pain and complete mobility in my neck and shoulders. I could have just "laid down and relaxed" at home and had tried that to no effect. The Reflexology worked. Also, having done Reflexology on hundred's of people, I often hear people say their sinuses suddenly opened up and they could breathe better. I do agree with you on one point, foot massage feels good. Reflexology should not be painful. But if I can suggest to your scientific left brain thinking...open your mind!! Love ya.

I recently discovered a well-written article on the subject of foot reflexology at the blog Science Based Medicine.  Mark Crislip, MD, critically examines the history, theory, and claims of reflexology and writes:

Monkeys, and other animals, groom each other often with a marked reduction in stress. Touch is good, and one doesn’t need to wrap it up in pseudoscientific nonsense for it to beneficial.

You can read the entire article here: Reflexology. Insert Nancy Sinatra Reference Here.

My own opinion is that if massage of the feet feels good, that's enough reason to do it, but the specific claims of reflexologists cannot be supported and make no sense whatsoever.

I certainly agree that there is a lack of good research on reflexology. I have found it to be extremely effective in relieving symptoms for various complaints. I am recently certified in reflexology. It was a 200 hour course solely for reflexology, not vaguely offered as part of a massage curriculum. One goal of mine is to add to the body of research in reflexology. I've not done formal research before so I am taking my time in mapping out my course of action!
Maybe I'll publish or at least share my findings here! I think it is good to question and study and remain open minded but descerning.
When someone asks me if reflexology works I say that I have witnessed very specific results to very specific reflexology treatments and that I find that it works for me.
Thanks for the stimulation!

I think there's no doubt that many people enjoy having their feet massaged. However, reflexologists have not yet begun to ask the most fundamental questions. What evidence is there that there is a map of the body on the feet? How would one establish this? By what mechanism would pressure on any particular point on the foot affect a particular organ of the body?

The "research" that I've encountered so far has been weak and full of holes. Some people with headaches are given a reflexology treatment and get up feeling better. No control group. This does not mean that reflexology itself had a uniquely direct effect on the headache. We know that laying down for half an hour, being touched, and being attended to can all make people feel better and headaches are self-limiting conditions. So, something much more specific than that would need to be done to demonstrate that it is reflexology as a unique method that is creating the effect.

I also notice that reflexologists invariably treat the entire foot in a session. If a specific point on the foot had an effect on a specific organ, why treat the entire foot?

However, I will volunteer to be a subject for a good foot massage any day!

Pam, I hope you'll check out the post on POEM, the Project for Open Education in Massage. Part of its purpose is to start educating massage therapists in how to conduct valid research, how to formulate questions, evaluate studies, etc. I think you'll like it.

Thanks for your comment!

Hi Alice!
I know this is an older post, but my eyes have recently been opened to evidence based massage and thus, I have been doing a lot of reading in my excitement to finally see in black and white what I've been suspecting for years. Through your writings and that of Diane Jacobs, etc. everything has changed for me lately, although my work won't really look that much different. What will change the most is the way I talk to clients, and that is so freeing! I won't have to feel like I am duping my clients with some wacky magical treatment trying to over-sell the pure and simple benefits of relaxation, stress relief, and calming the nervous system. Thank you for being so vocal and instrumental in this movement. It's amazing and it's about time. Thanks also for the belly laugh I got while reading this post about reflexology. I always felt like such a traitor for not really believing in reflexology, and basically put a disclaimer about the effects of it on my web site because I always felt a twinge of guilt when clients asked if it works. With evidence based massage I can look my clients in the eye when answering questions about benefits because the benefits are real, but maybe not reached exactly as they previously thought. (I actually removed cranio sacral therapy from my offerings altogether- what's your take on cst?)
As you said, "people believe all sorts of peculiar ideas" but it is a good start when we, as therapists, aren't the ones responsible for spreading those ideas.
Vickie Jenny

 Thank you, Vickie Jenny! We love hearing from readers and one of the beautiful things about the internet and blogs is that we aren't limited by space and time. You're welcome to comment whenever you want. 

I'm glad that you've found a way to think about what you are doing with your clients that you can feel good about. One of the things I love about being an independent therapist is that I can communicate openly and honestly with clients and not have to worry about someone else interfering in the client/therapist relationship. This can sometimes be a problem when we are working for others and it takes a bit of diplomacy to figure out how to navigate it successfully. However, in the end, we really must communicate with integrity and always think of the best interest of the client. Our understanding of what we are doing may change, as you've discovered, but we have to maintain clean communication with our clients. 

I was never a believer when it came to reflexology but I've still had to adjust my thinking over the years. That's okay. We do the best we can with the information available at the time. I'm glad you've discovered evidence-based massage therapy. There are wonderful resources out there and I've developed an awesome online community of science-oriented therapists. I, too, have been greatly inspired and influenced by Diane Jacobs. If you have an opportunity to study with her, I recommend it.

I had a little instruction in cranial work with John Barnes and Paul St. John and a little experience receiving it. While I found its gentle handling of the head very soothing and relaxing to receive, as a practitioner I never could feel the "pulses" they spoke of, though I'd feel my own pulse or the client's breathing. I often wondered if people weren't mistaking these for this "pulse" of cerebralspinal fluid. 

Research has not been able to detect these pulses and has not shown any evidence that we can move cranial bones. There is poor inter-rater reliability - that is, when two different practitioners are presented with the same client, they will come up with different diagnoses, thus casting doubt on the validity of the diagnoses. I think that, in the end, the gentle handling is very soothing and can be beneficial but the claims made are unsupportable and implausible. That being the case, people sure pay a lot of money and spend a lot of time learning to gently handle people's heads.

Paul Ingraham of SaveYourself.ca wrote a very thorough article about CST that goes into detail about the claims, research, etc. I recommend it if you are interested in knowing more.

Thanks for stopping by and feel free to comment any time!