Presently there are various methods of treatment for different types of diseases, such as cancer, asthma, and multiple sclerosis, and alternative medicine is becoming more prevalent among people despite the advanced technology. Many people nowadays try to avoid the use of medications because of the side effects. this is why people are attracted to alternative therapy techniques, because they want an effective treatment that is not costly and does not cause any harm.
– There are over a hundred different types of alternative medicine and the number is still growing. A few examples are: chiropractic, reflexology, hypnotherapy, reiki, ayurveda, kinesiology, homoeopathy, osteopathy, cranial therapy, various types of acupuncture, colour-therapy, massage, and sound therapy [1]. For example, Reflexology has been widely used in fields such as midwifery, orthopedics, neuroscience and palliative care [2].
1.1 What is Reflexology :
Reflexology is the physical act of applying pressure to the feet and hand with specific thumb, finger and hand techniques without the use of oil or lotion [3]. It is also called zone therapy, based on the notion that each body part is represented on the hands and feet and that pressing on specific areas on the hands or feet can have therapeutic effects on other parts of the body. The body is divided into 10 longitudinal zones-five on each side of the body. Each organ or part of the body is represented on the hands and feet; massaging or pressing each area can stimulate the flow of energy, blood, nutrients, and nerve impulses to the corresponding body zone and thereby relieve ailments in that zone[4].
– Each part of the foot represent a ‘” reflex area” that correspond to specific organ or part of the body, for example:
the tips of the toes reflect the head
the heart and chest are around the ball of the foot
the liver, pancreas and kidney are in the arch of the foot
low back and intestines are towards the heel
This concept was furthered by physiotherapist Eunice Ingham into the modern practice of reflexology. Dr. William H. Fitzgerald, an ear, nose, and throat doctor, introduced this concept of “zone therapy” in 1915. American physiotherapist Eunice Ingram further developed this zone theory in the 1930’s into what is now knows as reflexology. A scientific explanation is that the pressure may send signals that balance the nervous system or release chemicals such as endorphins that reduce pain and stress [11].
1.2 The difference between Reflexology and Foot Massage:
– Reflexology is different from foot massage in that it involves more superficial contact, deeper pressure on certain parts of the foot and resembles a caterpillar-like movement. It has been claimed that by pressing the ‘reflex zones’, energy blocks or disturbances such as calcium, lactate or uric acid crystals are reabsorbed and later eliminated – a process referred to as ‘detoxification'[2].
– In foot massage people typically use massage oil or lotion and use gentle gliding strokes all over the foot. Reflexology is quite different, while many people find reflexology relaxing. One of the reasons people often confuse the two is that some spas and salons advertise that they offer reflexology, but what people actually get is foot massage by a therapist who isn’t properly trained or certified in reflexology [12 ].
1.3 Reflexology Foot Chart:
1. Top of Head
2. Sinuses
3. Pituitary Gland
4. Temporal Area
5. Neck, Cervical
6. Upper Lymph Area
7. Parathyroid Gland
8. Ears
9. Eyes
10. Thyroid Glands
11. Shoulder
12. Lungs and Bronchi
13. Heart Area
14. Heart
15. Spine, Vertebra
16. Pancreas
17. Solar Plexus
18. Stomach & Duodenum
19. Liver
20. Spleen
21. Spleenic Fixture
22. Gall Bladder
23. Adrenal Glands
24. Hepatic Flexure
25. Kidneys
26. Transverse Colon
27. Waist
28. Ureters
29. Ascending Colon
30. Descending Colon
31. Lumbar
32. Small Intestines
33. Sacral
34. Bladder
35. Ileo-Caecal Valve
36. Appendix
37. Sigmoid Flexure
38. Hip & Lower Back
39. Coccyx
40. Sciatic Area
41. Rectum
42. Uterus
43. Prostate
44. Breast
45. Lymph Drainage
46. Fallopian Tubes
47. Lymph Nodes (Arm Pit)
48. Sacro Iliac Joint
49. Ovary or Testicle
50. Lymph Nodes (Groin)
51. Maxilla/Submaxilla (Jaw)
52. Tonsils
1.4 Reflexology Remedies:
– Some illness related to the:
Skin: ACNE can be treated by applying pressure on specific areas; liver(19), gall bladder(22), adrenal glands(23), ureters(28), bladder(34), kidneys(25). Also ECZEMA can be relieved by applying pressure on other areas; Parathyroid glands(7), adrenal glands(23), kidneys(25), ureters(28), bladder(34).
Digestive system: ANOREXIA can be treated by applying pressure on certain areas; Thyroid glands(10), stomach & duodenum(18), small intestines(32), transverse colon(26), descending colon(30), rectum(41). GINGIVITIS can be treated by applying pressure on other areas; maxilla & submaxilla(51), STOMACHACH can be relieved by applying pressure on this areas: stomach(18), and DIARRHEA & NAUSEA by applying pressure on areas; Stomach & duodenum(18), small intestine(32), ascending colon(29), transverse colon(26), descending colon(30), rectum(41), lymph areas(6).
Circulatory system: HYPERTENTION can be treated by applying pressure on these areas: Head(1), kidneys(25), ureters(28), bladder(34), ear(8). ANEMIA; Stomach & duodenum(18), liver(19), pancreas(16), small intestines(32), ascending colon(29), transverse colon(26), descending colon(30), spleen(20). HEART PROBLEMS can be treated by concentrating the applied pressure on these specific areas: Heart(14), stomach & duodenum(18), small intestine(32), ascending colon(29) and IRON DEFECINCY be treated by applying pressure onthis area in the chart: spleen(20).
Nervous system: ANEXIETY can be decreased by applying pressure on these areas as in the foot reflexology chart; Head(1), adrenal glands(23), kidneys(25), ureters(28), bladder(34), duodenum(18), small intestines(32), transverse colon(26), descending colon(30), rectum(41), EPELIPSY; Head(1), lymph areas(6). MIGRAINE can be relived by applying pressure on these areas: Head(1), frontal and temporal areas(4). BACKACH can be relieved by applying pressure on specific areas; Hip and lower back(38), spine(15).
Immune system: TUMOR (CANCER) can relieved it’s symptoms by applying pressure on specific areas; Spleen (20), lymph areas (6), tonsil (52) (also reflex areas relating to the cancerous regions).
Respiratory system: ASTHMA can be treated by applying continuous pressure on these areas: parathyroid(7), lungs and bronchi(12), kidneys(25), ureters(28), bladder(34), lymph areas(6). Also BRONCHITIS can be treated by applying pressure on certain areas such as parathyroid(7), lungs and bronchi(12), adrenal glands(23), lymph areas(6).
Joints: PAIN IN THE HIP JOINT can be relieved by applying pressure on certain areas such as adrenal glands(23), kidneys(25), ureters(28), bladder(34), neck(5), hip(38). INFLAMMATION OF THE HIP JOINT can be treated by applying pressure on certain areas such as stomach & duodenum(18), kidneys(25), ureters(28), bladder(34), hip(38), waist(27), vertebra and spine(15). And Parkinson’s Disease can be treated by applying pressure on certain areas such as Head(1), neck(5), parathyroid(7), adrenal glands(23), stomach & duodenum(18), pancreas(16), liver(19), small intestines(32), colon areas(26,29,30), kidneys(25), ureters(28), bladder(34), rectum(41) [14].
1.5 History of Reflexology:
– Around the world and throughout history reflexology has been rediscovered and reinstated as a health practice time and time again by peoples around the globe seeking to deal with health concerns. Archeological evidence in Egypt (2330 BCE), China (2704 BCE) and Japan (690 CE) points to ancient reflexology medical systems. In the West the concept of reflexology began to emerge in the 19th century, based on research into the nervous system and reflex. While no direct evidence of direct cross-fertilization from ancient times has been discovered, the practice of foot and hand work in a variety of cultures, belief systems and historical periods speaks to reflexology for health as a universal bridging concept [3].
– Reflexology was introduced into the United States in 1913 by William H. Fitzgerald, M.D. (1872-1942), an ear, nose, and throat specialist who called it “zone therapy.” He used vertical lines to divide the body into 10 zones. Eunice D. Ingham (1899-1974) further developed reflexology in the 1930s and 1940s, concentrating on the feet of Mildred Carter and a former student of Ingham subsequently promoted foot reflexology as a miraculous health method. A 1993 mailing from her publisher stated:
”Not only does new Body Reflexology let you cure the worst illnesses safely and permanently, it can even work to reverse the aging process, Carter says. Say goodbye to age lines, dry skin, brown spots, blemishes — with Body Reflexology you can actually give yourself an at-home facelift with no discomfort or disfiguring surgery”[4].
– Some reflexologists who deny that they diagnose or treat disease claim that the majority of health problems are stress-related and that they can help people by relieving the “stress” associated with various diseases or body organs. And this type of double-talk is similar to chiropractic claims that “subluxations” lower resistance to disease and that “adjusting” the spine to correct subluxations will improve health [4].
1.6 The benefits of reflexology:
– Our bodies are endowed with a wonderful self-healing potential. Sadly, this potential often remains unfulfilled because the vital energy pathways are blocked by illness, stress, congestion, injury, and toxicity. By applying a constant and alternating finger and thumb pressure to the feet and hands, the reflexologist induces a prolonged state of deep relaxation. Through relaxation, the body returns to a state of balance (known as homeostasis), as the energy flows freely from fingers and toes to the head, and only then can the body heal it [5].
– It has also been suggested that reflexology may help release stress and tension, improve blood flow of the body and promote homeostasis. Anecdotal evidence has shown that reflexology is beneficial in many conditions such as pre- and postnatal discomfort, pain, migraine and chronic obstructive pulmonary disease. Other therapeutic effects, such as strengthening the immune system, improving sleep quality and wound healing, have also been claimed [2].
– Reflexology like other forms of body work, can have a variety of benefits including [6]:
Structural benefits: assistance with physical problems such as pain and mobility
Emotional benefits: help in providing nurturing and holding
Energetic benefits: restoring and mobilizing energy for self-healing
– The benefits of reflexology in general include [3]:
Relaxation
Pain reduction
Amelioration of symptoms for health concerns
Rejuvenation of tired feet
Improvement in blood flow
Impact on physiological measures (e. g. blood pressure and cholesterol; measurements by ECG, EEG, and fMRI)
Beneficial for post-operative recovery and pain reduction
Enhancement of medical care (e. g. cancer, phantom limb pain, and hemodialysis patients)
Adjunct to mental health care (e. g. Depression, Anxiety, Post traumatic stress disorder)
Complement to cancer care (pain, nausea, vomiting, anxiety)
Easier birthing / delivery / post-partum recovery
1.7 The theories behind reflexology:
– The theory that reflexology definitely works with the central nervous system of the body is built on the studies done in the 1890s by Sir Charles Sherrington and Sir Henry Head, who showed that there is a neurological relationship between internal organs and the skin and the body’s nervous system can adjust to a stimulus. Therefore according to this theory, a pressure applied to the hands, feet or ears will send relaxing and calming messages to various parts of the body from peripheral nerves in the feet, hands and ears [7].
– “The Gate Theory” and “The Neuromatrix Theory” also explain why reflexology produces relief from pain and stress. The theories suggest that the brain creates pain which is a subjective experience in response to cognitive or emotional factors; therefore one’s moods and factors like stress and tension can affect our experiences of pain [7].
– Thus reflexology therapy reduces pain by improving the mood and reducing stress.
Another theory states that the human body has “vital energy” and there is congestion or choking of the energy flow which causes illness and disorders in the body [7].
– Surgical interventions and medical therapies continue to evolve and offer hope to people with acute and chronic diseases. However, both patients and healthcare staff aware that technology and aggressive treatments are not the only answer to providing care and improving wellbeing. Stone (2001:55) suggests that both UK and US there has been a significant shift towards integrated health care and greater tolerance towards the inclusion of complementary therapies by governments and the medical fraternity. There is evidence to suggest that an increasing number of hospital trusts are employing therapists or allowing volunteer practitioners to provide therapies such as massage, aromatherapy and reflexology. There are also a growing number of research projects reporting on the use and benefits of reflexology and foot massage in hospital wards, managing pain, reducing anxiety, improving perceptions of care [6].
– With the fast development of reflexology, now there is something called clinical reflexology, which is an advanced form of reflexology. It covers the application of reflexology within specific areas of clinical practice, including maternity care, and palliative care. Clinical reflexology is adapted to the client’s needs using the most effective techniques to help with the client’s problems and issues [15].
1.8 There is an arguing about the use of touch therapies such as reflexology in the hospital, and Ashcroft (1994) has highlighted the stresses of hospitalization with acute illness [6]:
The anxiety arising from being in an alien environment
Being disturbed constantly for clinical observations and the administration of often uncomfortable medical investigations and treatments.
Fear of dislodging intravenous and monitoring equipment
Being unable to drink and eat normally
Physical discomfort made worse by wounds, immobility, invasive catheters and sleep deprivation
Intrusion from noise, light and smells
Separation from friends and family
1.9 Where is Reflexology practiced nowadays, and for whom is used :
– Reflexology, although most commonly practiced in the community (Coxon 1998, Lett 2000) is now emerging as a choice for patients being cared for in mental health setting, maternity care and palliative care settings[6]. It has been suggested in the nursing literature that the introduction of reflexology and other complementary therapies in healthcare settings, could be an ideal non-pharmacological way of managing difficult symptoms, such as pain and nausea as well as reducing stress and limiting anxiety. Aside from the patient feeling the benefits, relatives too appear to gain satisfaction from the provision of reflexology [6].
– Identifying when and for whom it is appropriate to offer reflexology present challenges. Currently, provision of reflexology in acute hospital settings is largely on an ad hoc basis, delivered by existing healthcare staff or as part of a pilot or research project (Dryden et al 1999) [6]. Volunteer reflexologists may visit wards and departments supervised by clinical staff, providing only short treatments without any remuneration to selected patients deemed suitable for treatment. Finding a mutually convenient time is important, avoiding mealtimes, ward rounds and at peak visiting in the early evening. Dryden et al (1999) found that the best time to offer treatment was early afternoon, when the ward had a rest period and there were few visitors [6].
2. Many literature reviews about the studies that been conducted to see the effectiveness of reflexology technique on symptoms occurs in patients with chronic diseases such as cancer and osteoarthritis.
– A study done by Nancy L.N Stephenson et al. on the effects of Foot reflexology on anxiety and pain in cancer patients. It is a quasi-experimental, pre/post and crossover study. A sample of 23 inpatients from different medical/oncology units in hospitals of southeastern united states with breast or lung cancer were participants in this study. The majority of the sample were female, Caucasian and 65 years old or older who were receiving regularly scheduled opioids and adjuvant medications on the control and intervention day. The patients were divided into two groups randomly. Group A: receiving a foot reflexology to both feet for 30 minute total by a certified reflexologist in the first contacts and group B: receiving the same intervention in the second contact. The pain and anxiety were measured using two instruments; the VAS, the simpler one and the Short-Form McGill Pain Questionnaire (SF-MPQ) prior and post the intervention time. The VAS used to measure the anxiety, is a 10-cm line with verbal anchors at each end stating “not anxious at all” to “the most anxious I have ever been”(McGuire, 1988).
Following the foot reflexology intervention, patients with breast and lung cancer experienced a significant reduction in anxiety. Also one of three pain measures showed that patients with breast cancer experienced a significant decrease in pain. An additional study is required to determine the effects of foot reflexology on pain as measured by the intensity sections of the SF-MPQ, the VAS and IPP. There were no significant decreases in pain between the two groups because the crossover design allowed the 23 patients to be their own control; some of them were taking medications to manage their pain. Limitation of this study were the small sample size and the crossover design [8].
– When reflexology is provided in a palliative care setting it is essential that the patient is at the center of the treatment process because living and dying is ultimately a unique, intimate and personal journey. Reflexology can offer a means of relieving physical symptoms and of facilitating emotional and spiritual wellbeing, but requires the therapist to practice with awareness, sensitivity, intuition and adaptability. Reflexology cannot promise sustained improvements in physical health but can provide therapeutic touch and the space and attention to support patients in connecting their mind, body and spirit [2].
– Reflexology can also be invaluable in helping carers to cope both before and after the death of their loved ones. It is vital that reflexologists acknowledge their contribution within the team of health professionals involved in caring for the person and the family and the need for practice to be based on contemporary evidence-based knowledge. Sensitivity and humility enable the practitioner in reflexology to provide holistic, individualized and appropriate care for people at perhaps the most difficult time of their lives [2].
– Another study is done by Miss.Serawal Haera et al. about the effect of reflexology on joint pain in knee osteoarthritis patients on 21 May, 2003. A quasi-experimental research method was used, a sample of 30 knee osteoarthritis patients with pain were selected by purposive method at the orthopedic clinic, outpatient department of Phrae Hospital. Simple change-over design was used in this study to compare the difference of joint pain scores among patients before and after intervention. The subjects were randomly assigned to the experimental period first followed by the control period, and vice versa. In the experimental period patients received reflexology for 1 hour/day for 7 days, and in the control period patients didn’t receive reflexology for 7 days. The instrument for data collection were demographic data and information about knee osteoarthritis, the assessment of joint pain in patients with knee osteoarthritis, and a daily record of joint pain, medication used and daily activities. The data were analyzed by using frequency, mean, standard deviation and ANOVA for simple change-over design. The results of this study showed that the joint pain score in the experimental period after receiving reflexology was statistically significantly lower than during the control period. What this study revealed is that reflexology can be use as a complementary therapy to relieve joint pain and decrease drug used for pain relief [9].
– In the study by Siev-Ner et al. (2003) the reflexology group demonstrated statistically significant symptom relief in a study of patients with multiple sclerosis. Compared with no improvement in the massage group, scores for urinary symptoms, paresthesia and spasticity were statistically significantly improved, whereas muscle strength revealed only borderline improvement at the end of reflexology. The improvement in paresthesia remained statistically significant at the 3-month follow-up [2].
– Statistically significant reductions in the severity of hot flushes and night sweats, measured by a visual analogue scale (VAS), were reported after 6 weekly sessions of reflexology, but no statistically significant difference was found between the groups receiving reflexology and non-specific foot massage for menopausal symptoms in the study conducted by Williamson et al. (2002). In terms of general well-being, both the reflexology and non-specific foot massage groups demonstrated an improvement in the Women’s Health Questionnaire (WHQ) score.
However, the difference between the two groups was not statistically significant. Similarly, although improvements in the two sub scores (anxiety and depression) of the WHQ were detected, there was no statistically significant difference between the reflexology and foot massage groups [2].
– In the study by Brygge et al. (2001), the outcomes of lung function tests including peak expiratory flow (PEF) and the ratio between forced expiratory volume in 1s and forced vital capacity (FEV1/FVC) did not improve after reflexology in patients with bronchial asthma. In addition, the reflexology group was not superior to the sham foot massage group in lung function improvement [2].
– No statistically significant changes in patients with irritable bowel syndrome were observed either within or between the reflexology and sham foot massage groups in the study by Tovey (2002). Abdominal pain, constipation/diarrhea, and bloating remained unchanged after the reflexology treatment [2].
– Also about the edema of the feet in late pregnancy, women with oedema in late pregnancy perceived less swelling and tightness as compared with the pretest level in the reflexology treated group, according to Mollart (2003). However, there was no statistically significant improvement in mean ankle and foot circumference measurements after lymphatic reflexology. There were also no statistically significant differences among the lymphatic reflexology, relaxing reflexology and rest groups [2].
– These studies showed that reflexology is can be used as one of the effective techniques in physical therapy treatments, because it showed an effective results in treating the symptoms of the common diseases that been treated with physical therapy such as pain in cancer, osteoarthritis, LBP, and MS.
– Reflexology also shows it is effectiveness in pregnancy and childbirth. Women who actively choose to receive regular reflexology during pregnancy have been shown to gain a degree of relaxation that indirectly impacts on the developing fetus [6].
– Some women may have been attending for treatment prior to conception and may even have sought help for infertility, subfertility, or premenstrual syndrome. Anovulatory infertility may be resolved through the stimulation of the reflex zones for pituitary gland and ovaries whilst general relaxing reflexology can be helpful where stress and anxiety appear to be contributory factors. Stress, tension, anxiety and fear affect every pregnant woman to a greater or lesser degree [6].
– Reflexology can have profound benefits at this time, although whether this is due to physical effects of reflexology, the therapeutic value of human touch or the psychological effects of interaction with the therapist is debatable. Specific physiological disorders of pregnancy can be treated effectively with reflexology or reflex zone therapy. Some physiological conditions respond with just one or two treatments of no more than 10 minutes duration, with no further appointments being necessary. These include nausea and vomiting, constipation, carpal tunnel syndrome and heartburn. Also reflexology can be extremely relaxing, pain relieving and psychologically comforting during labour. Following delivery, reflexology can be used to treat women with physiological disorders of the puerperium, including constipation, haemorrhoids, perineal discomfort and inadequate lactation. Relief from ongoing discomfort following epidural anesthesia, such as backache, neck pain or headache, can also be obtained (Tiran 1996) [6].
3. The contraindications for reflexology are [10]:
If the patient has contagious or acute infectious disease
recent surgery of malignant tumor
foot wounds, burns or infection
deep vein thrombosis/phlebitis
pregnancy (treatment should be done with caution to certain reflexes and caution should be taken particularly in the early stages of pregnancy)
avoid reflexology when you are using alcohol or street drugs or strong pain medication such as morphine
recent or healing fractures
active gout affecting the foot
osteoarthritis affecting the ankle or foot or severe circulation problems in the legs or feet should seek medical consultation before starting reflexology
4. The recommendations for developing and integrating reflexology in clinical practice [6]:
Evaluate hospital provision of reflexology for benefits and find the best ways of delivering treatment through quality research and audit activities.
Presentation of conference papers, workshops and poster sessions on complementary therapies, such as reflexology, covering various specialties.
Share best practice in reflexology in journals covering a wide range of clinical areas, e.g. intensive care, accident and emergency, and orthopaedics
Establish and/or practice in complementary therapy/reflexology networks and specialist interest groups to obtain support and share best practice.
Establish and/or practice in a Trust or hospital’s Complementary Therapy Committee
Ensure that only qualified complementary therapists with experience in managing patient care in the private and public healthcare sectors are employed
Support practitioners to complete courses in specialist application
Provide and support supervision and management arrangements for all practitioners providing reflexology, for example, by employment of a Complementary Therapy Coordinator/Practitioner
5. Conclusion:
Reflexology should not be considered a “cure” for any condition. It is used to relieve or reduce symptoms, problems, and stress affecting the body. Health professionals should be cautious about a reflexologist who claims that this is a valid way of assessing health or for treating diseases. Even reflexology is not a cure but is a technique to reduce the symptoms associated with chronic diseases. From my perspective, I think that physiotherapist should become familiar with the benefits of reflexology and master this amazing technique so they can use it in their treatment sessions; because it is effective in reducing anxiety and pain in cases of chronic diseases such as cancer. There is very little researches about the effects of reflexology. As such studies were set up to examine the effects of reflexology treatments on cancer, arthritis, LBP, MS and pregnancy symptoms, the results were qualitative and quantitative and showed that there are a number of areas of possible benefit for patients with these chronic diseases. But a larger scale study with a longer time frame is needed for a full evaluation of these effects. At the end, I would like to clarify that physical therapy is different from reflexology, but that does not prevent to use it in the treatment of some chronic conditions that are difficult to relief their complicated symptoms by using only physical therapy techniques.
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