Alternative medicine reflexology: Therapeutic foot manipulation

• Reflexology is a therapeutic practice involving the application of pressure to the feet in an attempt to alleviate symptoms elsewhere in the body.

• Few objective data support reflexology, but many patients report benefits including pain relief.

History of use. The ancient Egyptians, Chinese, and Native Americans all apparently practiced various types of therapeutic foot manipulation. The earliest record of foot massage is a wall painting in a tomb at Saqqara, Egypt, believed to date from approximately 2330 B.C. The contemporary practice of reflexology, in which manipulation of specific areas of the feet is thought to have therapeutic benefits on different areas of the body, is credited to one doctor of the ear, nose, and throat department of St. Francis Hospital in Hartford, Connecticut. He termed the practice "zone therapy", co-authoring a text of the same name that was published in 1917. He conceptualized, the body was divided into 10 vertical zones; organs within the different zones corresponded to analogous "reflex zones" on the feet. For example, the thoracic and abdominal organs and structures relate to the zones occupied by the five metatarsal bones.

For reasons that are unclear, reflexology is today the most popular form of alternative medicine in Denmark, and it is generally more popular in Europe than in the United States. Its practice is not regulated, although many professional organizations exist. The Reflexology Association of America has published standards of practice and a code of ethics. The association officially defines reflexology as "a science based on the premise that there are zones and reflex areas in the feet and hands which correspond to all glands, organs, parts, and systems of the body. The physical act of applying specific pressure using the thumb, finger, and hand techniques to these reflex areas results in the reduction of stress that promotes physiological changes in the body.

Clinical studies. Conditions treated by reflexologies range from asthma to back pain to cancer. Studies have shown mixed results, particularly when objective and subjective data are compared:

• Asthma. A randomized, double-blind, placebo-controlled study that included 40 adults with bronchial asthma found no significant differences in therapeutic effect between active and simulated reflexology.

The participants kept diary cards throughout the study, which included 10 treatments during a period of approximately 9-10 weeks. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were recorded at each visit. Patients were allowed to follow their normal regimen of inhaled corticosteriod ad B-agonists. There were no statistically significant changes in FEV1 or FVC during the course of the study between the active and placebo groups, nor were there measurables differences in FEVI before and after individual treatment sessions. On a quality of life questionnaire, however, almost all parameters, including physical functioning, lack of physical limitations, and vitality, improved in both groups. The authors concluded that their study failed to demonstrate a "relevant clinical effect" for reflexology in bronchial asthma.

• Low back pain. In a poster session at a conference on complementary medicine held in Exeter, England, in December 2001, one doctor of Liverpool John Moores University reported on a randomized controlled trial that included 243 patients with chronic low back pain treated with reflexology, relaxation, or usual physician care.

This means age of the study participants was 47 years; 59 percent were female. The mean duration of back pain was 121 months. Pain, functioning, depression, coping strategies, and perceived social support were assessed at baseline, before treatment, after treatment, and after six months.

There were no statistically significant differences in pain and functioning among the three groups at the end of the study, although a larger proportion of the reflexology group reported less pain. Pain scores decreased in all groups during the study.

• Cancer. A pilot study of reflexology, presented at the first congress of the research network of the European Association for Palliative Care in Berlin in December 2000, found no difference between reflexology and foot massage among 17 patients with advanced cancer. Patients were evaluated by the Hospital Anxiety and Depression Scale and a 10-point symptom distress scale at baseline and after each of six weekly sessions.

While reflexology had no objectively demonstrated benefits, patients with advanced cancer "may greatly appreciate touch therapies," the authors noted.

Controversies. The lead investigator of the cancer study, medical director of the Marie Curie Center, Edinburgh, Scotland, does not plan to employ reflexologists in his palliative care program. "As a medical manager with a responsibility to decide on the deployment of limited resources, I believe it is ethically and practically vital that the proponents of any new claim on those resources have evaluable evidence before time and money are spent.

The department of complementary medicine, University of Exeter (England), offered a different perspective. "The idea that organs are represented on the soles of the feet seems fanciful to orthodox trained scientists, since there is no known anatomical or physiological pathway for this representation. Of course, reflexology might have a useful clinical effect, even if its ‘representative zones’ basis is not correct: Massage of tender areas in the feet could have generalized health benefits. Patients report favorable effects of reflexology, and it must be a safe therapy. Further studies are certainly warranted.