MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Reflexology is one of the most popular of all alternative therapies. Anyone who has ever had a session knows why: it is a strangely pleasant and oddly agreeable experience. Reflexologists massage your feet which can be mildly painful but usually is quite relaxing. They look for and subsequently focus on areas of tenderness believing they correspond to specific organs or whole organ systems. Even though few reflexologists would admit to it, they tend to make vague and unreliable diagnoses: if they feel something unusual at a certain point of the sole of your foot, they assume that a certain inner organ is in trouble. Reflexologists even have maps where the sole of a foot is depicted showing which area corresponds to which organ.

The treatment might be enjoyable but the assumptions that underpin it are nonsensical for at least two reasons: firstly, there are no nerve or other connections between a specific area on the sole of a foot and a certain organ. Secondly, the maps which reflexologists employ differ and fail to agree which area corresponds to which organ. Thus there are inconsistencies within the realm of reflexology and there are inconsistencies in relation to the known facts regarding physiology, anatomy etc.

Proponents of reflexology are quite undisturbed by these problems and seem to believe that not their assumptions but science must be wrong. After all, reflexology does work! That is to say that patients perceive benefit from it, pay out of their own pocket for the experience and tend to come back for more.

Several years ago, we asked 8 UK professional organisations of reflexology which conditions they thought could be treated effectively with reflexology. We gave them a list of 25 conditions to chose from, many of which were serious, e.g. cancer and AIDS. Collectively, the organisations felt that 22 of these illnesses would respond to reflexology.

But this is opinion, not evidence! What do the trial data tell us? Is reflexology more than a placebo?

As with many other areas of alternative medicine, controlled clinical trials are scarce; but this is not to say that none at all are available. Our own trial of reflexology for menopausal symptoms failed to show that this therapy has any effects beyond placebo. More recently, we published a systematic review to evaluate all of the 23 studies that had been published at that stage. They related to a wide range of medical conditions and their methodological quality was often poor. Nine high quality randomised clinical trials (RCTs) generated negative findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia. These studies, however, were wide open to bias. Therefore, our conclusions had to be cautious: the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.

For you and me, this simply means that there is currently no good evidence to suggest that reflexology works. But the story does not end here. There will be more studies and enthusiasts are most likely to concede that our conclusions were incorrect. In fact, a further trial has just become available.

This new single-blind, randomized and placebo controlled study included 20 moderately to severely affected multiple sclerosis patients. Each participant received for 8 weeks, 1 hour per week of either reflexology or sham reflexology. The primary outcome measure was the Multiple Sclerosis Impact Scale at baseline, 8 weeks and 16 weeks. The results revealed improvements in both groups but no statistically significant differences between the two groups at either 8 or 16 weeks. The conclusions of the investigators were clear: The results do not support the use of reflexology for symptom relief in a more disabled multiple sclerosis population and are strongly suggestive of a placebo response.

There is, of course, nothing wrong with a relaxing foot-massage; it is agreeable, no doubt, and if someone wants to pay for the luxury, why not? By contrast, there is a lot wrong with reflexology, I think. A foot-massage is not administered under the pretence of generating any specific therapeutic effects. Reflexologists, however, claim they can exert highly specific effects on inner organs, influence the natural history of a wide range of diseases, and provide reliable diagnoses. They thus mislead their clients. This is not just wrong, it also has the potential to do serious harm. I believe it is time to end this nonsense.

36 Responses to Reflexology is pleasant enough, but does it work?

  • I’ve been for some reflexology, as it was available for free from a centre near me. I found it more enjoyable than foot massage, and think that this was partly because of the ritualised and medicalised nature of it. Because the therapist was acting as if there was some purpose to the therapy beyond my pleasure, which they could be getting on with, it was easier for my to just focus on enjoying it. Also, to be fair to the therapist, they didn’t really make any claims about the ‘treatment’ – they’d just ask me how I was feeling and then if there was anything wrong would mutter something like “Okay, I’ll see if I can help that” as they went about their work.

    It wouldn’t surprise me at all if something like this was as, or more, helpful to people than ‘befriending therapy’ – which itself seems to be as valuable as things like CBT for many conditions. When it comes to treatments whose positive effect seems to largely stem from the practitioner seeming nice to the patient, there could well be room for more ritualised foot massage. I’m not sure how keen therapists will be on that though.

  • Randal has pre-empted much of what I was going to write about my experience with reflexologists. I will add that some of them had me so preoccupied by their ‘diagnosis of my faulty organs and glands’ that I developed short-term OCD, which was an almost pleasant distraction from my actual health problems! All joking aside, what they did was deplorable.

    What I’m learning is to think outside the box… The initial consultation with a qualified medical practitioner is to enable the practitioner to make informed decisions. Firstly, and of paramount importance, the practitioner must consider the question “Am I suitably qualified to treat the patient’s presenting condition?” The answer to this question determines what follows for the best care of the patient.

    Now, let’s consider the initial consultation with a CAM practitioner. I would be very interested to see a study of their ‘accurately documented reasons’ for either offering treatment to the client or referral to an alternative practitioner. (Apologies for not being able to resist that word play.) A reflexologist who has been taught that they can diagnose and treat a plethora of health problems is, I suggest, much less likely to refer a client than would a physician.

    One may be strongly tempted to assume that the initial consultation with a CAM practitioner is for the purpose of gathering enough client information to enable the practitioner to provide the best course of treatment. However, I ask the reader to consider this: the practitioner was gullible enough to pay for their accreditation course provided by an issuing institution that thrives on having students who do not insist on having even the basic level of robust evidence required by the Advertising Standards Authority (ASA) and Trading Standards.

    On reflection, it seems to me that the primary purpose of an initial CAM consultation is to establish the gullibility of the potential client. To put it another way, if during the initial consultation the client asks searching questions about UK Advertising Codes, ASA adjudications, and evidence for efficacy then a sensible practitioner would refer the client elsewhere (and destroy any notes taken during the interview).

    • Pete 628 wrote: “On reflection, it seems to me that the primary purpose of an initial CAM consultation is to establish the gullibility of the potential client. To put it another way, if during the initial consultation the client asks searching questions about UK Advertising Codes, ASA adjudications, and evidence for efficacy then a sensible practitioner would refer the client elsewhere (and destroy any notes taken during the interview).”

      That’s a very perceptive point. Most CAM practitioners have to be good sales people and rely on their trade bodies to show them the necessary parlour tricks for locking patients into a lucrative care schedule. For example, many chiropractors are taught how to persuade patients into signing up for ‘lifetime care’ by exploiting the initial phase of patient contact:

      Quote
      “The examination procedures are not diagnostic, they are to emphasise to the patient that weakness exists in his body and that they have been caused by spinal fixations. By fortifying the patient’s knowledge of the ‘spinal cause’ by the use of test instruments and graphs, the patient is able to see beyond any doubt that he is actually physically sick, that a spinal condition caused it, and that something needs to be done chiropractically to correct it…the history and consultation period is like a courtship. This is the time when your patients develop, in the back of their minds, the depth of commitment to you, the doctor. The examination can be compared to the engagement, and the report of findings to the wedding or final ceremonial.”

      Ref: Magner, G. Chiropractic: The Victim’s Perspective, pp.72-73. Prometheus Books (1995)

      IOW, it’s crucial for CAM practitioners to be skilful at cold reading their new patients in order for the ensuing indoctrination process to run smoothly. Unfortunately for the unwitting patient, there will be a wealth of personal information (especially with regard to chronicity) for the CAM practitioner to take advantage of once the patient history has been taken.

      • Thanks, Blue Wode, for giving me three missing pieces of the jigsaw puzzle that I need to carry on with forming my overall picture (my understanding).

        One of the essential pieces: I had been totally underestimating the influence of instrumentation. The lay person is unable to distinguish between scientific measuring instruments and pseudoscientific measuring instruments therefore each type (when used as part of client diagnosis) adds the same persuasive force to the practitioner’s credibility.

        Reflexology somewhat cleverly bypasses the need for actual pseudoscientific measuring instruments by claiming that the reflexologist is the measuring instrument. The ‘evidence’ for this claim is provided by charts of the feet and hands. I can think of some other branches of CAM that rely on this folly, but I refrain from mentioning them here because I have no wish add a list pseudoscientific keywords to Edzard’s post about reflexology.

  • I disagree with your reasoning on the 2 underlying assumptions being nonsensical. There is an indirect connection between the foot and a corresponding internal organ through the brain. And while two maps may differ, it’s possible that both are correct since there may be more than one solution to a problem. I believe most of the maps are at least similar.
    In my personal experience, the maps are strangely accurate to my health problems. Massaging the sore areas made my feet feel better, which may have some relaxation benefit for the corresponding organs. When my health problems cleared, these areas were no longer sore.
    However my health likely improved due to other measures I was taking. I don’t believe reflexology cured my health problems, since the only noticeable benefit was to my feet and it would only last a few days. If there was relief to a corresponding organ then it was probably also temporary. I suspect sore spots on my feet were symptoms, and massaging them didn’t affect the underlying cause. But there is a relationship, so I wouldn’t consider the notion nonsensical..

    • In this case, reflexologists would be able to accurately diagnose disease. However, the evidence shows that this is not so. Either your impression is erroneous or the science is wrong. Which do you think applies?

  • I am a qualified reflexologist and would never in a million years diagnose anybody with anything! I have no idea where that information has come from, we would all be struck off under the code of ethics/practice of our professional body memberships. Reflexology, or zone therapy, is a holistic complimentary therapy, as is any form of body massage, , hot stone massage…..any other therapy which treats the body as a ‘whole’. You are quite right that we refer to maps of the foot and that they also differ……but not greatly and are generally in the same ‘area’…all of which will get massaged as part of the treatment routine. During the treatment we find little crystalline deposits, known as ‘inbalances’. You could have a client whose feet are riddled with them….that absolutely does mean their body is going to shut down and they are going to die…they could simply be run down, depressed, stressed. You could have a client who has very few, if any, inbalances. I had one lady recently whose only one was in her hip…..could mean nothing at all, although she is pregnant. ..could be that. The aim of reflexology is to disperse these inbalances by massaging & applying a rotating motion repeatedly over the area. You could return to it and it may be gone never to be felt again, or it may take a few treatments to disperse, or it may always remain. My husband had a very persistant one on his elbow, I would try to disperse it but it never went away. A while later he randomly discovered he has chipped a bone in his elbow. My mum had a few inbalances over the bladder area…turned out she needed a wee!! A client suffering with sinus problems may well have inbalances over the area that correlates with the sinuses. Even if I found them I certainly wouldn’t say ‘you have sinusitis’, I would continue to try and disperse them at each treatment. If the client was concerned he/she can consult their doctor. Someone with a toothe ache may have inbalances in the area of the teeth/face/head. I would never diagnose, nor claim to cure. And any reflexologist who says otherwise should not be practising. By dispersing the inbalance we find on the foot, we may help an ailment. There is evidence, my clients for me, that this is so. And be that purely because they feel less stressed, more relaxed, happier…..then how can anyone write that off as not working? The happier and more stress free a person is, the healthier they are. Is regular reflexology a pure coincidence? There have not been enough studies to prove or disprove, but I have yet to meet anyone who has had a reflexology say they wont have it again :)

    • I am a qualified reflexologist

      How is that determined?

      and would never in a million years diagnose anybody with anything!

      Glad to hear it.

      I have no idea where that information has come from, we would all be struck off under the code of ethics/practice of our professional body memberships.

      Not sure what information you’re referring to…but what would anyone be struck off for? And how many have?

      Reflexology, or zone therapy, is a holistic complimentary [sic] therapy, as is any form of body massage, , hot stone massage…..any other therapy which treats the body as a ‘whole’.

      What does treat the body as a whole mean?

      You are quite right that we refer to maps of the foot and that they also differ……but not greatly and are generally in the same ‘area’

      You’ve missed the point. What call it a map when there is no connection with any other part of the body?

      …all of which will get massaged as part of the treatment routine.

      So, are you saying you don’t concentrate on just parts of the foot, but give the whole thing a massage? What happens if you over-massage one area? Do reflexologists believe that can cause over-stimulation somewhere and perhaps even some harm? If you don’t believe it can cause harm, how do you know?

      During the treatment we find little crystalline deposits

      Any clinical evidence for those?

      known as ‘inbalances’.

      Do you mean ‘imbalances’ or is this a made-up term?

      You could have a client whose feet are riddled with them….

      Riddled?

      that absolutely does mean their body is going to shut down and they are going to die…

      I sincerely hope you tell them to see a medical professional immediately? Or do you call an ambulance? But you said you “would never in a million years diagnose anybody with anything”, but don’t you think that death is a diagnosis?

      they could simply be run down, depressed, stressed.

      Diagnosing again?

      You could have a client who has very few, if any, inbalances.

      That word again?

      I had one lady recently whose only one was in her hip…..could mean nothing at all, although she is pregnant. ..could be that.

      I’m confused: was the ‘inbalance’/’little crystalline deposit’ in her hip or in her foot?

      The aim of reflexology is to disperse these inbalances by massaging & applying a rotating motion repeatedly over the area.

      Why rotating motion and not just a lateral motion?

      You could return to it and it may be gone never to be felt again, or it may take a few treatments to disperse, or it may always remain.

      Convenient, that…

      My husband had a very persistant one on his elbow, I would try to disperse it but it never went away. A while later he randomly discovered he has chipped a bone in his elbow.

      Ah, the mandatory anecdote. But, seriously? In a chipped bone in his elbow?

      My mum had a few inbalances over the bladder area…turned out she needed a wee!!

      Are you saying these ‘inbalances’ appear and disappear every time we need to pee and relieve ourselves?

      A client suffering with sinus problems may well have inbalances over the area that correlates with the sinuses. Even if I found them I certainly wouldn’t say ‘you have sinusitis’, I would continue to try and disperse them at each treatment. If the client was concerned he/she can consult their doctor. Someone with a toothe [sic] ache may have inbalances in the area of the teeth/face/head. I would never diagnose, nor claim to cure.

      Sorry, I’m dismissing your unverified and unverifiable anecdotes as easily as you have asserted them.

      And any reflexologist who says otherwise should not be practising.

      Perhaps, but can you saw if this drastic action has ever happened?

      By dispersing the inbalance we find on the foot, we may help an ailment.

      Apart from the fact you claim never to diagnose, what good evidence do you have that you can help an ailment?

      There is evidence, my clients for me, that this is so.

      Ah. you mean you have no evidence that is verifiable.

      And be that purely because they feel less stressed, more relaxed, happier…..

      No doubt a nice foot massage could be relaxing – and there may even be some good evidence for that – but what good evidence is there for any more than that?

      then how can anyone write that off as not working?

      If reflexologists only ever made claims that their foot massage was only ever relaxing, then there would be little problem. However, many go a lot further than that – as you do here – and that’s when it gets problematic. That’s when we can say it doesn’t work.

      The happier and more stress free a person is, the healthier they are.

      Possibly, but not guaranteed.

      Is regular reflexology a pure coincidence?

      Yes. Unless you have good evidence to the contrary?

      There have not been enough studies to prove or disprove

      Then why are you taking money from customers?

      but I have yet to meet anyone who has had a reflexology say they wont have it again

      As I said, I’m sure the massage and attention is relaxing, but you’ve not provided any good evidence it is any more than that.

      • Oh Alan, your patronizing/condescending replies are so refreshing. Especially the “inbalances” part. I hope you don’t mind some creative criticism, but your little art piece rant falls apart a bit when you say:

        “What call it a map when there is no connection with any other part of the body?”

        and my favorite: “Perhaps, but can you saw if this drastic action has ever happened?”

        But overall, I’d rate you an 8 out of 10 on the stick up the ass scale – you get extra points for your usual inclusion of some sideways logic, and the always fun “What does treat the body as a whole mean?”. If I hadn’t read some of your other posts…I would have thought you were being sarcastic.

        Good grief, sigh, etc. blah blah blah.

        • Perhaps you think I should have said to kate that I was totally convinced by her sound, rational argument and thank her for presenting a cogent, evidence-based, scientific analysis of reflexology?

          As I said, ‘inbalances’ appears to be a made-up word. It may well have been a typo, but then kate used the same word seven times. Do reflexologists confer some special meaning to their made-up word that ‘imbalance’ cannot do? Or is it yet another example of quacks trying to sound all sciency and use mystical words?

          But of course, I note that you have not tried to help kate by providing any evidence of what she claimed nor actually answered any on my (many) criticisms. Perhaps you can tell us about the good evidence for reflexology?

          • Alan:

            – Those aren’t your only two options.

            – So you sincerely believe that ‘inbalances’ is a technical reflexology term? My apologies for doubting you. In my defense, you seem to be able to comb the web for whack job websites for “proof” of the dangers of this that or the other…I figured you could do the same for ‘inbalances’.

            – Answer your ‘criticisms’? I am curious about your statement “Why rotating motion and not just a lateral motion?”. I didn’t think you were serious. But after your ‘inbalances’ explanation, maybe you are. I’d love to hear your analysis of lateral vs rotational manipulation.

          • jm said:

            Those aren’t your only two options.

            I never said they were. But if you have some other alternatives, please do say.

            So you sincerely believe that ‘inbalances’ is a technical reflexology term?

            No.

            My apologies for doubting you.

            Thanks.

            In my defense, you seem to be able to comb the web for whack job websites for “proof” of the dangers of this that or the other…I figured you could do the same for ‘inbalances’.

            Before this turns into a meta-discussion about etymology, perhaps you’d like to say what you believe the word means? So far, since kate hasn’t said, all we have to go on are standard dictionary definitions and Google searches. I’ve not found the word in online dictionaries and it only seems to appear on reflexology websites, but I’ve not found a meaning for it. perhaps you know what it means, jm?

            Answer your ‘criticisms’? I am curious about your statement “Why rotating motion and not just a lateral motion?”. I didn’t think you were serious. But after your ‘inbalances’ explanation, maybe you are. I’d love to hear your analysis of lateral vs rotational manipulation.

            All it takes is some curiosity, jm. kate said “applying a rotating motion” and that made me wonder why rotational and not some other kind of movement/massage? I found it curious why rotational might be preferred – or even necessary – over some other type of movement. I wondered if there might be some evidence that suggests rotational motion is better. That might have been fascinating, don’t you think?

          • “perhaps you’d like to say what you believe the word means?” hmmm…cant’ say for sure, but I’ll bet it’s an autocorrect issue. You could always google it.

            “I never said they were. But if you have some other alternatives, please do say.” Common decency would be a good one. You could disagree with Kate without being an arse.

            “I found it curious why rotational might be preferred – or even necessary – over some other type of movement. I wondered if there might be some evidence that suggests rotational motion is better.” Really? You’re sincerity is just dripping all over the place.

          • jm said:

            “perhaps you’d like to say what you believe the word means?” hmmm…cant’ say for sure, but I’ll bet it’s an autocorrect issue. You could always google it.

            I did. perhaps you didn’t read my last comment?

            “I never said they were. But if you have some other alternatives, please do say.” Common decency would be a good one. You could disagree with Kate without being an arse.

            LOL!

            “I found it curious why rotational might be preferred – or even necessary – over some other type of movement. I wondered if there might be some evidence that suggests rotational motion is better.” Really? You’re sincerity is just dripping all over the place.

            That gets you another LOL! You don’t seem to get this curiosity thing, do you?

            Now, do you actually have any answers to any questions raised about reflexology, or are you intent on simply pursuing your meta argument?

          • I meant you could google “inbalance autocorrect”. Or is that what you did?

            No reflexology answers for you here. The only thing I know about it is that the maps are quite interesting looking. But since you bring up the whole curiosity thing…rather than lateral or rotational manipulation, I’d suggest starting with your question “What call it a map when there is no connection with any other part of the body?”. I think all anatomy/physiology models would agree that feet are connected to the rest of the body.

            And, a discussion on lateral vs rotational manipulation actually is quite fascinating, but you would consider it in the realm of fantasy, or antiquated, or whatever. If you can’t understand that there are different ways to look at a human body…that discussion would be meaningless to you.

          • jm said:

            I meant you could google “inbalance autocorrect”. Or is that what you did?

            TBH, I can’t say I care whether some algorithm or other might produce ‘inbalance’ instead if ‘imbalance’, but I’ve tended to notice that autocorrect usually produce words that are in a dictionary, not ones that are made up – that’s the whole point of them, isn’t it?

            The real point is whether ‘inbalance’ does actually have a specific, identifiable meaning but it seems we are no further forward on that.

            No reflexology answers for you here. The only thing I know about it is that the maps are quite interesting looking. But since you bring up the whole curiosity thing…rather than lateral or rotational manipulation, I’d suggest starting with your question “What call it a map when there is no connection with any other part of the body?”. I think all anatomy/physiology models would agree that feet are connected to the rest of the body.

            Yep. You’re right. Everything in the body is (trivially) connected to everything else the body. That tells us nothing about reflexology or maps.

            And, a discussion on lateral vs rotational manipulation actually is quite fascinating, but you would consider it in the realm of fantasy, or antiquated, or whatever.

            Well, we’ll need to wait to see if someone manages to produce some evidence one way or the other so we can discuss it.

            If you can’t understand that there are different ways to look at a human body…that discussion would be meaningless to you.

            Ah…’different ways’…

          • nice but fictitious dialogue; to pick up your last point: THE SAFETY OF A TREATMENT ON ITS OWN IS IRRELEVANT, IT’S THE RISK/BENEFIT BALANCE THAT COUNTS.

          • “Everything in the body is (trivially) connected to everything else the body.”

            That’s awesome. Thanks for the laugh!

        • How old are you “jm”?

  • jm, there are also different ways to look at celestial bodies: astronomy and astrology — one is science, the other is quackery.

    • You couldn’t be more right, Pete. Different ways of looking at celestial bodies is a quite similar to different ways of looking at the body. This is from Wikipedia:

      “Chinese constellations (Chinese: 星官, xīngguān) are the groupings used in traditional Chinese culture to organize the stars. They are very different from the modern IAU-recognized constellations based on Greco-Roman astronomy: the only major similarities are clusters similar to the Big Dipper and Orion”.

      Someone should explain to China the proper way way to organize the night sky.

  • The make-believe basis of reflexology states that the internal organs/body parts are represented by a “zone” on the hands and feet.

    It may elevate our spirits in these heartbreaking times, to refresh the memory of John McLachlan’s brilliant parody of a similarly fabulous fantasy involving a n homunculus-like mapping of the different distant parts on our distinguished derriere. : D

  • which tags are used to get those nifty quotes?

    Dr. E. Ernst
    Reflexology is one of the most popular of all alternative therapies.

    Me:
    It’s not an alternative therapy. It often works as an adjunct to allopathic medicine, and acupuncture, and massage, and chiropractic, any mode you may or may not like…. Complementary is a preferred term. “Alternative” implies a false dichotomy. I wish my peers would ditch the term. Furthermore, as a trained, registered, insured professional, it’s not a therapy either, not in the traditional sense.

    Dr. E. Ernst
    Anyone who has ever had a session knows why: it is a strangely pleasant and oddly agreeable experience.

    Me:
    Yes, it is indeed. I hope you try it for yourself, minus your preconceived notions. Be as selective about choosing a reflexologist as you would a neurosurgeon removing a tumor from your brain. People pay money for “pleasant and oddly agreeable”. When patients see you, they don’t know what to expect. When they see me, they get a feeling of well being and that is what they pay for.

    Dr. E. Ernst
    Reflexologists massage your feet which can be mildly painful but usually is quite relaxing. They look for and subsequently focus on areas of tenderness believing they correspond to specific organs or whole organ systems.

    Me:
    Believing? fMRI studies on the brain verify the corresponding reflexes. This information is not that new so it surprises me that a person with more degrees than a thermometer would write on a subject that, evidently, hasn’t got all the facts.

    http://www.reflexology-research.com/index.php/what-is-reflexology/reflexology-information/reflexology-research/new-reflexology-studies/fmri-functional-magnetic-resonance-imaging/reflexology-and-fmri-comparison-of-reflexology-and-acupressure

    http://reflexologyresearch.wordpress.com/

    Dr. E. Ernst
    Even though few reflexologists would admit to it, they tend to make vague and unreliable diagnoses: if they feel something unusual at a certain point of the sole of your foot, they assume that a certain inner organ is in trouble. Reflexologists even have maps where the sole of a foot is depicted showing which area corresponds to which organ.

    Me:
    First, a properly trained reflexologist can only diagnose a tender reflex. I don’t know what country you polled reflexologists from, I’m guessing Somalia. . Upon finding a tender reflex, there is nothing wrong with asking the client questions pertaining to the corresponding organ, joint, bone or muscle. That is not making a diagnosis.
    Second, it is not the reflexologists that says ouch. It is the client/patient. However there are some reflexologists with a higher degree of tactile sensitivity than others. (I am not one of them) The same can be said for surgeons.. That does not affect the outcome of a good session. . Notice I use the term “session” and not “treatment”. Technically, a reflexology treatment is a misnomer because nothing is being treated. That is a concept you cannot or will not wrap your head around. The body is set up to heal itself, there should be no claims of curing anything. You are force fitting a square peg into a round hole and tossing the peg because you think it doesn’t belong. Different schools of thought does not make them invalid because they are different.

    Third, say what you will about maps. Give the same criticism to acupuncture maps and ridicule meridians because you never saw one on the OR table or the morgue.

    Dr. E. Ernst
    The treatment might be enjoyable but the assumptions that underpin it are nonsensical for at least two reasons: firstly, there are no nerve or other connections between a specific area on the sole of a foot and a certain organ.

    Me:
    See the link above.

    Dr. E. Ernst
    Secondly, the maps which reflexologists employ differ and fail to agree which area corresponds to which organ. Thus there are inconsistencies within the realm of reflexology and there are inconsistencies in relation to the known facts regarding physiology, anatomy etc.

    Me:
    Maps are guidelines, not rocket plans.

    Dr. E. Ernst
    Proponents of reflexology are quite undisturbed by these problems and seem to believe that not their assumptions but science must be wrong.

    Me:
    Reflexology is an art and a science. So is medicine last I checked.

    Dr. E. Ernst
    After all, reflexology does work! That is to say that patients perceive benefit from it, pay out of their own pocket for the experience and tend to come back for more.

    Me:
    I’ll be sure to tell my 85 year old patient suffering from barometric migraines that the immediate disappearance of her headache was just a perception because Dr. Ernst said so and I am a con artist. Geez…She also had to juggle between the headache pain and the sickening side effects of her prescribed p.r.n. medication.
    But that’s anecdotal so it doesn’t count, isn’t that right?

    Many reflexologists have dozens, some hundreds, of amazing success stories. I suggest you start palpating your patients for tender reflexes, but first you have to learn how its done. If you ever find a tender reflex associated with an x-ray in your face, somehow I don’t think that will convince you.

    Dr. E. Ernst
    Several years ago, we asked 8 UK professional organisations of reflexology which conditions they thought could be treated effectively with reflexology. We gave them a list of 25 conditions to chose from, many of which were serious, e.g. cancer and AIDS. Collectively, the organisations felt that 22 of these illnesses would respond to reflexology.
    But this is opinion, not evidence! What do the trial data tell us? Is reflexology more than a placebo?

    Me:
    The aim of the survey was to determine opinion, there was no trial data. You are not being fair. I read links, but will you read mine?. Probably not. You are defending a paradigm. More and more people are increasingly dissatisfied and somehow, in the midst of collapsing health care systems, that threatens you. Reflexology is not a threat to allopathic medicine, it is a complement. We are on the same side.

    Dr. E. Ernst
    As with many other areas of alternative medicine, controlled clinical trials are scarce; but this is not to say that none at all are available. Our own trial of reflexology for menopausal symptoms failed to show that this therapy has any effects beyond placebo.

    Me: Oh yea? My 3 kings beats your ace:
    http://www.reflexologyresearch.net/ReflexologyMenopauseResearch.shtml
    If it was your own trial it seems you found what you were looking for.

    Dr. E. Ernst
    More recently, we published a systematic review to evaluate all of the 23 studies that had been published at that stage. They related to a wide range of medical conditions and their methodological quality was often poor. Nine high quality randomised clinical trials (RCTs) generated negative findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia. These studies, however, were wide open to bias. Therefore, our conclusions had to be cautious: the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.

    Me:
    It looks contradictory to me, good Dr. Which side did the bias lean on which studies? Enumerating the caveats would have been nice. The eight effective RCT’s don’t count because the methodology was biased or was it the patients were biased because their improvements were subjective? This systematic review demonstrates systematic confusion, and doesn’t prove anything.

    Dr. E. Ernst
    For you and me, this simply means that there is currently no good evidence to suggest that reflexology works. But the story does not end here. There will be more studies and enthusiasts are most likely to concede that our conclusions were incorrect. In fact, a further trial has just become available.
    This new single-blind, randomized and placebo controlled study included 20 moderately to severely affected multiple sclerosis patients. Each participant received for 8 weeks, 1 hour per week of either reflexology or sham reflexology. The primary outcome measure was the Multiple Sclerosis Impact Scale at baseline, 8 weeks and 16 weeks. The results revealed improvements in both groups but no statistically significant differences between the two groups at either 8 or 16 weeks. The conclusions of the investigators were clear: The results do not support the use of reflexology for symptom relief in a more disabled multiple sclerosis population and are strongly suggestive of a placebo response.

    Me:
    I don’t know where you got the idea that reflexology is a panacea. . Cherry picking a disease that destroys the very pathways that reflexology functions on is playing dirty. Permit me to quote Kevin Kunz:

    >The little piece of propaganda today seems to be based on a pretty bad protocol by Ernst. Reflexology is no better than a foot massage. So if you are making that argument you are saying that the epiccritical nervous system is just the same as the protopathic nervous system.
    >You didn’t look at Hans Selye very closely did you? He had two types of adaptive syndrome. There is the General Adaptive Syndrome and the Local Adaptive syndrome. So stress is both generalized and very specific.
    >A foot massage is not the same as foot reflexology. At least that is what is starting to come out in the fMRI studies. And the Doppler sonograms of the kidneys and digestive system are double blinded randomized control studies. They show that specific application to areas on the feet effect blood flow to specific parts of the body. Of course you knew that from your in depth survey of research literature.< end quote

    Dr. E. Ernst
    There is, of course, nothing wrong with a relaxing foot-massage; it is agreeable, no doubt, and if someone wants to pay for the luxury, why not? By contrast, there is a lot wrong with reflexology, I think. A foot-massage is not administered under the pretence of generating any specific therapeutic effects. Reflexologists, however, claim they can exert highly specific effects on inner organs, influence the natural history of a wide range of diseases, and provide reliable diagnoses. They thus mislead their clients. This is not just wrong, it also has the potential to do serious harm. I believe it is time to end this nonsense.

    Me:
    That’s why reflexology schools have standards of practice and ethical guidelines. There has to be formed professional associations for the sake of public safety. No one has ever died from Reflexology.
    Real reflexologists have liability insurance. They can’t get that without credentials and a reflexologist cannot bill an extended health care plan unless they have both. Lots of people claim to know reflexology, and maybe they do, but that does not make them a reflexologist. “trained reflexologists” is all you have in your research papers. That doesn’t mean anything. The issue is structure of governing bodies and regulation and neither of that is addressed in your straw man arguments. We have strict rules here in Canada and given some high caliber practitioners that have come from the UK, I don't believe there are no rules.

    No serious harm has ever been the result from a competent reflexologist. No law suit has ever been filed against a reflexologist, at least not in Canada. Can your profession make that claim? Your charge is unwarranted.

    • Peter Cllemens RRPr. said:

      which tags are used to get those nifty quotes?

      HTML blockquote tags.

      It’s not an alternative therapy. It often works as an adjunct to allopathic medicine, and acupuncture, and massage, and chiropractic, any mode you may or may not like…. Complementary is a preferred term. “Alternative” implies a false dichotomy.

      First, provide some good evidence that reflexology has any benefit.

      • I agree that it will be very interesting to see what the loquacious Mr. Cllemens can procure in the form of convincing evidence for the healing benefit of massaging the sole of our feet. Apart from a sensuously soothing feeling which may temporarily relieve some stress of course.

        Perhaps the loquacious Mr. Cllemens can also produce references to support these interesting statements?:

        A foot massage is not the same as foot reflexology. At least that is what is starting to come out in the fMRI studies. And the Doppler sonograms of the kidneys and digestive system are double blinded randomized control studies. They show that specific application to areas on the feet effect blood flow to specific parts of the body. Of course you knew that from your in depth survey of research literature.

        A Nobel prize must be forthcoming for those who find previously completely unknown and physiological pathways that no-one but specially trained foot masseurs are able to invoke.

        And… what in the world is RRPr?
        Academic and other scholarly titles usually produce a prompt and concise explanation from uncle Google.
        My inquiry only produce three interpretations of this acronym: “Reduced Range Practice Rocket”, “Runaas Resources Public Relations” and “”Rada Research & Public Relations”

  • I don’t know where the heck you got your credentials, oh right university trained to think in one way, and wow you haven’t done your research at all. Reflexology has been going for many many thousands of years, and every trained certified reflexologist code is not to diagnose…. let’s see how well your chemo or your disease is being treated with medications down the road, medications certainly proven to save ?
    really, and hopefully one day when you are sick and need help there will be a trained individual to take pity on you and ease your burdens . I am fed up with people like you. sooth Sayers yea may you live long and well

  • HTML blockquote tags.
    Thanks, Allan. My inability to understand HTML codes parallels your inability to understand Reflexology. I offered good evidence. fMRI's don't lie. Yet you demand good evidence. Acedemiacs have a joke about the acronym for PhD: Piled higher and Deeper.

    If you wish to ignore or deny the evidence already posted, then piling it higher and deeper won't make any difference to you. However, I will take up the challenge for the sake of the readers.

    The American Academy of Reflexology conducted the first reflexology research study to ever be published in scientific medical literature, when the study appeared in the prestigious journal, Obstetrics and Gynecology, Vol. 82, #6, December 1993. This ground-breaking study was reported around the world, including in Journal Watch, which is published by the same people who publish the New England Journal of Medicine.

    Publishing of the study, and the wide spread reporting that followed in magazines, newspapers, numerous professional journals, as well as on radio, television, for the first time, gave Reflexologists around the world the ability to say, "Yes" when asked if there was any published scientific Reflexology Research validating that Reflexology works.

    Since the study was published, many other Reflexology Research Studies have been reported around the world. For any number of reasons, the PMS Reflexology Research Study has helped open doors for others around the world to conduct their studies.
    http://www.reflexologyresearch.net/PMSResearchCover.shtml

    In 2005 the National Institutes of Health (NIH) awarded Michigan State University (MSU Kellogg Center, East Lansing, Michigan) a grant for $3.1 million to study“The Effects Of Reflexology On Women With Breast Cancer Undergoing Chemotherapy.” It was the largest and the first federally funded grant in the USA for reflexology. The results of the 5-year study (2005-2010) were published in Spring 2011.

    Principal Investigator
    Gwen Wyatt, RN, Ph.D.,
    (oh my, an opposing PhD.. Maybe all the PhD's in world should have a symposium in the form of a football game to define "good evidence" and eliminate the referees just to avoid bias).

    s a professor and served as the principal investigator of the study for the College of Nursing, at Michigan State University. Gwen had wonderful results with reflexology to facilitate the healing of a broken tibia bone that had refused to mend using allopathic treatment options. Able to see and feel the benefits of reflexology first hand; she was led to explore the benefits of reflexology in her own field of nursing care for breast cancer. Michigan State University and Dr. Gwen Wyatt partnered with Branch Reflexology Institute for the study. Gwen has previously addressed the RAA conference in 2008 in Portland, Maine, where she explained the anatomy of research.

    Traditional Medicine and Holistic Therapies
    In grant writing and the study, our challenge was to blend the knowledge of traditional allopathic medicine and the holistic [modality] of reflexology. This involved learning to fit in the academic realm and adapting the grant to what was scientifically required by academia. Protocol design had to be based on a clear understanding of our goal and hopefully the outcome of the study would support this. The goal of the study was to determine if reflexology could improve the quality of life for women with breast cancer who were undergoing chemotherapy.

    Design Elements
    Four hundred fifty one women with advanced breast cancer on chemotherapy agreed to participate, and 385 provided complete data. Of these 385, 146 women were assigned to reflexology, and 141 women were able to complete their sessions with reflexology. Patients received 4 sessions of reflexology, 4 weeks in a row. One hundred and forty three (143) women received manipulation of the feet that was designed to be similar to reflexology, but delivered by lay people. Finally, 96 women were in the control group. Data were collected over 12 weeks.

    On a scale of 0-100, reflexology improved physical function by 5 points, or about 10% compared to the control group. This improvement is substantial and reflects better ability to walk, carry groceries, climb stairs etc. This improvement in physical function resulted from the reduction in difficulty breathing from having received reflexology. Women in the reflexology group had less trouble breathing compared to women in the control group, and also compared to women who received lay foot manipulation.

    Protocol Design
    • The sessions were held to 15 minutes per foot with 5 minutes of introduction and closure built into the session.
    • Patients received 1 session per week for 4 weeks.
    • Patients were studied a total of 16 weeks – 8 weeks out from the conclusion of their reflexology sessions.

    The Study 9-Step Protocol
    Since the goal of reflexology is to open the flow of energy and circulation throughout the entire body, I felt the results of these steps would be effective in two ways. First to open pathways to receive the chemotherapy more thoroughly and second to release the residual byproducts of the chemo after it has accomplished its function. The reflexology protocol was composed of 9 steps working the reflexes in this order:

    1. Spine as the gateway to the Central Nervous System.
    2. Chest/Lung as the breast reflex was the primary location of the cancer.
    3. Lungs on the plantar surface of the feet were worked because of the 3-dimensional nature of the body and some cancer sites are deep within the breast.
    4. Diaphragm for the reduction of stress. The diaphragm is the first place we carry stress. Constriction of the diaphragm keeps one from breathing deeply, slowing circulation. Working the diaphragm reflex allows for deeper breathing, increased circulation to the lungs, and contributes to the overall effectiveness of the chemo traveling throughout the system, as well as facilitating a pathway for the release of chemicals after they have accomplished their desired effect.
    5. Kidneys for stress and detoxification.
    6. Adrenal glands for stress and detoxification.
    7. Spleen, as a blood purifier, helps to raise blood cell count, and energy level.
    8. Intestines both small and large colon for detoxification: The small intestine to absorb the treatment and large intestine to release the chemicals.
    9. Lymphatic system—the upper and lower lymph reflexes for tissue drainage and immunity.

    Exciting Outcomes
    There was a 10% improvement in the quality of life. This was determined by patients reporting they were better able to walk, carry groceries, climb stairs, etc. This improvement in physical function resulted from the reduction in difficulty breathing from having received reflexology. Women in the reflexology group had less trouble breathing compared to women in the control group, and also compared to women who received lay foot manipulation. The 10% improvement in the quality of life is considered statistically significant in research. Also, not one patient had a negative side effect from receiving reflexology. This is a very important finding, especially in this fragile population. The three things this grant has established for reflexology are its: 1. safety; 2. feasibility; and 3. efficacy.

    NIH Awards a Second 5-Year (2011-2016) Grant for $2.65 million
    This grant will use the same protocol to study the effects of the 9-steps reflexology protocol with primary caregivers delivering the sessions. The reflexologists who participated in the first grant are now training the primary caregivers to deliver the 9-steps. The goal of this study will be to see if frequency of sessions shows to enhance the quality of life for these women as each primary caregiver will be able to perform the 9-steps on their spouse, family member, or friend as often as they would like in the week as long as they complete the full 9-steps.

    Barbara Brower, lead reflexologist in the MSU study, designed the 9-step reflexology protocol that was used. This article was originally published in ARCB’s Summer 2012 issue of Reflexology Today. Reprinted with permission of the author and ARCB. More info on the MSU study can be found at www.branchreflexology.com.

    http://www.washingtonreflexology.org/tag/reflexology-breast-cancer/

    There is more, Allan. And there are just as many critical and sceptical web sites with the same boring straw man arguments that Ernst uses. Before I sign off, lets get one thing straight. Reflexology does not claim to cure cancer. I hope I have made myself clear.

  • Reading through the study can be a challenging task. We developed the below chart to help clarify
    the percentage change that occurred between the three reflexology groups. The most significant comparison is between the 46% change in the Active Reflexology Group and 19% change in the Placebo Reflexology Group, a statistically significant difference of 27%.
    http://www.reflexologyresearch.net/PMSResearchChart.shtml

    Here’s more from Google. You can sift through them all and cherry pick one that suits you.
    http://www.bing.com/search?q=+PMS+STUDY+research+RESULTS+reflexology+&qs=n&form=QBRE&pq=pms+study+research+results+reflexology+&sc=0-0&sp=-1&sk=&cvid=fd9ee99b934246129f278d21daa3c520

  • Correction

    completely unknown and physiological pathways

    should read:

    completely unknown physiological pathways

  • Bjorn Geir, Alan is correct. RRPr. is an acronym for Registered Reflexology Practitioner, which is a federally recognized legal trademark, and I don’t debate with children who parrot the same remarks contrary to the evidence presented. If you insist fMRI’s lie, that’s your problem. (as it is with Dr. Earnst, who is strangely silent on the matter)

    A Randomized Control Trial to Determine the Effect of Foot Reflexology on Intensity of Pain and Quality of Sleep in Post Caesarean Mothers
    http://www.scribd.com/doc/237959287/A-Randomized-Control-Trial-to-Determine-the-Effect-of-Foot-Reflexology-on-Intensity-of-Pain-and-Quality-of-Sleep-in-Post-Caesarean-Mothers

    Michigan State University and the National Institutes of Health have now concluded a $3.1 million grant 5 year Reflexology study from 2005-2011 in which 451 women with advanced breast cancer on chemotherapy agreed to participate. Here is a summary:

    Original article found here: http://www.jackmarriott.com/reflexology-breast-cancer-results-are-in/comment-page-1/

    • These references raise two important questions.
      First, which is more cost effective, to let nurses to sit and massage the soles of patients or to teach nurses something useful about how to design, perform and present science. The latter is severely lacking in my part of the world also. The most incredibly poorly done “studies” are usually found in nurses publications for some reason. This is one of them and does not prove anything other than foot massage is nice.

      Second, where is the paper published about this fantastically expensive, long-term study? It seems like it is breakthrough material so it should have been published by now? We have no way of appreciating it unless you provide a better citation.

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