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.

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

  • Randal says:

    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.

  • Pete 628 says:

    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).

    • Blue Wode says:

      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.

      • Pete 628 says:

        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.

  • Peter916 says:

    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..

    • Edzard says:

      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?

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