Reflexology? Isn’t that an alternative therapy? And as such, a physiotherapist would not normally use it, most of us might think.
Well, think again! Here is what the UK Chartered Society of Physiotherapists writes about reflexology:
Developed centuries ago in countries such as China, Egypt and India, reflexology is often referred to as a ‘gentle’ and ‘holistic’ therapy that benefits both mind and body. It centres on the feet because these are said by practitioners to be a mirror, or topographical map, for the rest of the body. Manipulation of certain pressure, or reflex, points is claimed to have an effect on corresponding zones in the body. The impact, say reflexologists, extends throughout – to bones, muscles, organs, glands, circulatory and neural pathways. The head and hands can also be massaged in some cases. The treatment is perhaps best known for use in connection with relaxation and relief from stress, anxiety, pain, sleep disorders, headaches, migraine, menstrual and digestive problems. But advocates say it can be used to great effect far more widely, often in conjunction with other treatments.
Reflexology, or Reflex Therapy (RT) as some physiotherapists prefer to call it, clearly is approved by the UK Chartered Society of Physiotherapists. And what evidence do they have for it?
One hundred members of the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT) participated in an audit to establish a baseline of practice. Findings indicate that experienced therapists use RT in conjunction with their professional skills to induce relaxation (95%) and reduce pain (86%) for patients with conditions including whiplash injury and chronic pain. According to 68% of respondents, RT is “very good,” “good” or “as good as” orthodox physiotherapy practices. Requiring minimal equipment, RT may be as cost effective as orthodox physiotherapy with regards to duration and frequency of treatment.
But that’s not evidence!!! I hear you grumble. No, it isn’t, I agree.
Is there good evidence to show that RT is effective?
I am afraid not!
My own systematic review concluded that the best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.
Does that mean that the Chartered Society of Physiotherapists promotes quackery?
I let my readers answer that question.
28 Responses to Does the ‘Chartered Society of Physiotherapists’ promote quackery?
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This may seem a little extreme, but of all the mainstream practices carried out in the NHS, physiotherapy seems to me the nearest to quackery. They have a jargon incomprehensible to me, (and I have found to my orthopaedic colleagues) and many practices which seem to me bizarre, and often un evidenced. For example, is there any evidence that ultrasound does anything useful as a therapeutic manouvre? They ponce around with stethoscopes around their necks for some reason unclear to me but I suspect reflects a secret desire to be doctors. On a few occasions I have come across what I thought were physios doing something I thought might be useful, but it turned out they were actually OTs.
Rant over, suitable offence caused, will crawl back under my rock.
DZ
It is alarming that reflexology is being promoted, we need to keep clear of quackery in all its forms. What next – Pranic Healing anyone? I would also include K-tape in this bracket. There is very little evidence that ultrasound does anything outside of the acute injury. We do have an incomprehensible language to a certain extent, but the same can be said of many professions within the NHS. I have had to ask nurses, OTs and doctors what certain phrases and acronyms mean. Part of the role of a physio on a ward is respiratory management and maintaining patients at their baseline mobility to prepare/assess them for discharge. When I was a junior physio I worked on a respiratory ward and would have to auscultate to give an indication as to how to position a patient to optimise VQ matching or as an outcome measure to give an indication as to whether I had successfully removed secretions from a patients lungs. I’ve never harboured a personal desire to be a doctor, it was a vital tool of the trade.
Nobody who is up to date with EBP uses ultrasound. Some of the leading minds in the realm of pain management and science are physiotherapists.
In terms of your remark about stethoscopes, I found this hilarious and true ! The same could be said for Drs however.
P.S. Don’t blame my profession, blame the lazy and outdated individuals who sit within ALL health professions (including physicians).
P.S. I was called late last night by a doctor to see a patient in regards to respiratory treatment. FiO2 weaned, SpO2 improved and respiratory rate reduced to within normal range. They were thankful, as was the patient. Please be respectful.
Hahahahaha this is the funniest and most accurate description of a Physiotherapist I have read…and I am one! The physio degree is so unbelievably broad and shallow in depth that we are supposedly ‘superheroes’ and can do anything including charging over £100 an hour for our therapy…There is even a new physio role in A&E as apparently we are also paramedics…The CSP are so ignorant and can’t even write a journal without at least 7 spelling and grammar errors in the first 2 pages. Thankfully I can use my expired student membership number to pretend I’m a member these days without having to fuel their radiculously large egos £40 a month in membership fees.
Thank you for your article does The Chartered Society of Physiotherapists (CSP) promote quackery. I have copied you article to a CSP members forum to see measure the reaction of the profession.
Ouch…. As a physio, a skeptical and cynical one who regularly criticises and critiques all that we do, I find this highly embarrassing but at the same time I am grateful that you have highlighted it as I hope that this will wake a few more physios up that we need to sort out our own house before we can call ourselves a truly evidenced based profession.
And although this particular piece was writtern 10 years ago, I wish I could say things have moved on… they haven’t
This maybe fanning the flames, but so be it, the woo and quackary that is associated with my profession needs to be highlighted to force a change in my opinion.
And i’m just talking about the more well know gumpf that many physios use such as acupunture, dry needling or manipulation but also some of the more alternative nonsense, for example did you know the CSP has an association of energy medicine healers, I kid you not, details here http://www.csp.org.uk/professional-networks/acpem
This stuff drives me crazy and as a physio makes me ashamed to call myself one at times.
I think physios have an important and vital role to play in public health and in helping those with neuromusculoskeletal issues, not just pouncing around with stethoscopes as Deigo Fox rather eloquently and hilariously put it (a lot of physios do do that, and worse) but to do so this type of rubbish surrounding us needs to be flushed out and eradicated
EE shouldn’t it also be tagged “physiotherapy”?
I believe that many of the treatments provided by physiotherapists would not be considered “evidence based” if you were to look closely Edzard and apply your standards. For example, manual therapy, acupuncture, modalities such as ultrasound and electrical therapies and even exercise advice. Much of the evidence on these treatments is very weak and their use is often based on consensus views.
“Does that mean that the Chartered Society of Physiotherapists promotes quackery?”
The answer = yes.
I’m a chartered physio trying my best to make sense of a lot of the half baked concepts in our profession. It annoys me greatly to think that the organisation i pay an annual membership to (the CSP) gives woo any air time. Our profession is having a hard enough job trying to evidence what we do as valuable without this gush undermining physiotherapy any further.
To be fair though a lot of doctors base their practice on out of date ideas, use of antibiotics for every sniffle & cough, surgical fixation for wrist fractures and many more examples. Why would Physiotherapy be any different.
I agree we need to look better at some of the evidence for our practices and treatment, and a lot of that has to be done at University before graduation and qualification.
I do though take offence at saying physio’s ponce around Hospital with stethoscopes (as do most medical doctors), they play a huge role in treatment of chest problems and if it wasn’t for them God knows how many patients would die whilst we wait for IVAB’s to cure everything!!!
Rant over!
“Does that mean that the Chartered Society of Physiotherapists promotes quackery” As a chartered physio I do not believe that my professional body promotes quackery but there is a minority of members who fully embrace the experience based approach of complementary and alternative (CAM) healthcare and who do not accept scientific methodology to validate their clinical practice. Such an approach holds that the proof of the effectiveness of a clinical methodology is their experiences as clinicians and if they see that patients get better then their methodology is correct.However it is wrong to single out physiotherapists and ignore the fact that this same CAM mentality heavily affects the other healthcare professions especially in primary care. The references above to electrotherapy within physiotherapy is talking about something which is now rather out of date. The real issue here is for physios who believe in scientific practice to form a grouping to promote this and ensure that quackery in all its forms is exposed and rejected. At present there is a “pluralist”approach in the profession which allows multiple views on CAM and after more than 15 years of so called “evidence based practice” there has not been an automatic triumph of scientific research over subjective experience. Clinicians of all professions generally reject challenges to their professional beliefs so it will need more than high quality research papers to persuade people to change especially if rejecting CAM or its approach will result in personal financial loss.
Isn’t it about time there was some sort of rationalization of the ‘physical therapies’ so that the bullshit can be ejected and the sensible and scientific practices incorporated into ONE profession providing evidence-based care MSK disorders. Quackery flourishes throughout Chiropractic, Osteopathy AND Physiotherapy. FACT. But, in each of these professions there are some truly excellent clinicians who are tarred with the same brush as their charlatan brethren. Surely a new profession could be developed from the best of these with principles steered by science and practices overseen by appropriate governance. With GP’s so apparently overworked it seems to make sense that an MSK PRACTITIONER with the right clinical skills, highly trained, drawn from all of the physical therapy professions and free from esoteric claptrap could do a decent and reputable job.
As a matter of interest, my colleague Professor Kim Humphries and I promoted exactly this sort of professional development some ten years ago and the idea was adopted by a local University which also runs a degree in Medicine. Unfortunately the project was torpedoed…..by another physical therapy profession (so called!). Guess who.
that should of course have read ‘…evidence-based care for MSK disorders’. Apologies
Hi All,
Yes Ouch! Sadly true. There are several PTs working to try and change the level of acceptance of alternative therapies of no proven benefit within the practice of physiotherapy by chartered PTs. In the past the CSP have pushed out CST from being practiced as PTs (as you are aware from your Pulse blogging days) but that is but the obviously bonkers thin end of a very big wedge. IMO there are too many vested interests in treatments like acupuncture within PT practice and they see the thin end of the wedge as being the same AltMed wedge that they are part of and so block the policy forming body of the CSP – our Annual Congress – from putting forwards motions that would promote scientifically sound evidence based medicine.
IMO discussions on blogs like this will help the CSP to clean out its Augean Stables of AltMed practice as therapy. The concern that this might get into the MSM and the damage to our standing that might ensue should make it act. The role of the governing body as both union and professional standards keeper does IMO give it trouble however in making changes that might impact on the numbers of people willing to pay their subs.
Kind thoughts,
Ste5e
I fully endorse the comments posted above by my physiotherapist colleagues and I frequently despair at the gullibility and guru – worship demonstrated by many in the profession.My focus is on encouraging patients to move and function after injury and surgery.This often involves attempting to overcome the fear-avoidance caused by statements such as “it’s bone on bone in your knee” or ” your spine is crumbling”.So perhaps your orthopaedic colleagues should reconsider their jargon,
Diego
..and whilst we’re on the subject of ‘jargon’ can we ever hope to eradicate the phrase “slipped disc”??
I am afraid that if physiotherapy does not promote quackery too often it tolerates or turns a blind eye to it. THis and other areas have been subject to some internal debate, however there is a tendency to laissez faire under the guise of being a “broad church”. What is worse perhaps is that there are other practices with even less evidence and a higher quacking content. I kid you not.
ANdy
Thanks for the post. As a Physio and a member of the CSP I am disheartened by some of the rediculous notions they support. However there is a growing element of Physios who strongly reject this nonsense and advocate a more reasoned evidence based approach. Rather than targeting professions should we not target bad practice in general? There are numerous practices in medicine such as: cortisone injections of tendon problems still widely practiced with no evidence to support it (and some to suggest long term harm), surgery that has no more benefit than doing nothing at all and certain medicines that have numbers needed to treat in the hundreds. And as mentioned previously, terrible terminology used by all professions (especially GPs and orthopods) that causes huge fear in patients and will often exacerbate their pain problem (eg bulging discs). Fair is fair.
It’s always the small few that give a generally reliable profession a bad name. But, my GP did suggest that I try acupuncture for back pain…
Kevin states… ‘It’s always the few that give a generally reliable profession a bad name’.
I would agree with that, but that doesn’t explain the 6000+ strong membership of the Acupuncture Association of Chartered Physiotherapists’. 6000 isn’t a few, it seems to me to represent the majority. If acupuncture is quackery then you have at least 6000 quacks in the profession.
I sincerely do not mean to be antagonistic, but as I said earlier, ‘physical therapy’ as a whole really does need cleaning up.
Hi All,
I note ACPEM (Association of Chartered Physiotherapists in Energy Medicine) are considering changing their name to ACPIM – moving away from the zeitgeist of the 80’s where ‘energy’ was ‘cool’ to the now where ‘integrative’ is on trend. Smoke and mirrors. That there is are enough of them to form an association creeps me out.
Sigh.
Edzard – I note how impressed you are by the phrase ‘integrative’ from your previous blogs 😉
To put this in perspective, the Chartered Society of Physiotherapy (CSP) is a membership organisation. The organisation is inclusive, open to students, assistants & qualified Physiotherapists working in all manner of areas. About 45,000 people are members of the CSP. Part of the role of the CSP is overseeing training programs which lead to a level acceptable to qualify in the UK as a Physiotherapist and register with the HCPC. Post graduate training is not really part of their remit.
So the question here is does the CSP support all Physiotherapists being trained in Reflexology? The answer is no, because as far as I am aware there is no Reflexology training in CSP recognized courses leading to registration with HCPC. However being an inclusive membership organisation with the core that members must have completed a CSP recognized course they are not in a position to prevent members from completing all manner of post graduate training.
In addition if a group of members band together and suggest that they want to set up a special interest or clinical practice group then the CSP consider it. So if a hundred members want to set up their own group then the chance is that the CSP will say yes. This is why there are so many differing groups, but the groups are run by the members of that group not by the CSP.
In terms of regulation the HCPC regulates the professional title of Physiotherapist & Physical Therapist. It is the HCPC who review CPD and fitness to practice not the CSP. So really the question here should address whether the HCPC consider that a Physiotherapist on their register who completes training in non-NICE recognized methods or evidence based processes has really met their CPD requirement. If let’s say the HCPC defined more closely that ‘This’ is physiotherapy and ‘That’ is not ‘physiotherapy’ obviously there would be clear boundaries. However that’s not the case because the HCPC don’t go in depth into what physiotherapy actually is. So providing the practitioner practices methods that fall within the 4 pillars of practice as defined by the CSP, it is physiotherapy.
The CSP has a high membership because part of the fee to be a member covers very reasonable cost professional indemnity & public liability insurance & trade union representation. The indemnity insurance has caveats on how much assessment & diagnostics must to be carried out for a clinician to be working as a Physiotherapist and therefore covered by insurance. But it doesn’t state this that or other ‘method’ is or is not covered. This is a great advantage to many clinicians who are well aware that for example motivational interviewing techniques or CBT or graded motor imagery or hands on manual therapy or progressive clinical exercise appears to work really well and get good outcomes with their chosen client group.
However a disadvantage can be that two groups who for both work with very similar client groups and seem to get good outcomes from two very differing approaches, set up in conflict with each other. It may be that perhaps at core to both groups get good outcomes from a high degree of placebo coming from what they do. But that is a whole other debate.
Moving on, it is perfectly possible for a Physiotherapist in the UK to be registered with the HCPC and take out their own insurance and not be a member of the CSP.
Plus we have something that is probably more an area of consideration than the CSP or HCPC, especially in this digital age and that is Advertising Standards. All clinicians regulated, non-regulated, quacks or whatever are subject to ASA.
So my question would be does the statement on the CSP website cross the ASA guidelines and I don’t think it does.
That may not be the case with individual Physiotherapist professional websites which is a whole other area.
Plus I have my doubts on statements similar to the NetDoctor website. What think you? http://www.netdoctor.co.uk/healthy-living/complementary-health/health-benefits-of-reflexology.htm
the netdoctor site is, in my view, highly questionable. I am sure there are dozens of sites which are similarly dubious. but they are not the sites of physicians’ professional organisations. please compare like with like.
Its challenging to find a website to compare like with like in this case. I did have a look and cant really find any other HCPC profession or nursing / medicine with such an awful site. Or making references to modes of therapy. Well not in the UK anyway. I can find such in Australia, but that might not be good because the argument would be yes but they are not UK. What about the EU? Would the EU work as a comparison? After all we are moving toward EU recognition/regulation of professions
As an aside, The Chartered Society of Physiotherapy do, in my own view, have an interesting relationship with membership. This whole thing of the society having a royal charter is a bit outmoded. But despite that there are still Physiotherapists who proudly state ‘Chartered’ next to their name as if it means anything. Or they put SRP meaning state registered Physiotherapist. State registration overseen by the CSP died with the HPC / HCPC birth. Physiotherapists in the UK seem loathe to leave what they have and set up a new membership group, maybe because they are so very separated nowadays by the actions of the CSP that they feel isolated. Who knows.
If I can be clear I’m not for one minute standing up and shouting ‘but Reflexology is amazing, evidence based and …but but..’ However, I do think a foot massage feels nice, plus its nice to lie relaxing in a chair while having a massage. That can be really cozy and feel cared for.
I was just wanting to raise some of the idiosyncracy of our professional membership organisation
Chartered Society of Physiotherapists is one of the most recognizedorganizations which promote Quackery but it is always advised to research well before going for any services.
The CSP does promote quackery as it has little or no control of the nonsense that Universities pump out to its students. They have no power and the membership is dropping and losing popularity. They spend phenomenal amounts on winning and dining the council which is an ever widening bunch of fat cats who are in the large as far removed from what it is to be a physiotherapist.
Im sad to say it as a Physiotherapist, but the comments about the HCPC, although factually correct are a side line. The profession needs to consolidate, strip off all the leeches and concentrate on its foundations.
I found the evidence! Gunnel Berry led an audit of members of ACPIRT (the Association of Chartered Physiotherapists in Reflextherapy). The audit assessed the usage and involvement of reflextherapy in physiotherapy treatments in the UK. All 94 respondents thought reflextherapy was a good intervention procedure for their patients. They recommended the treatment to be taught in physiotherapy schools and wider. They wanted more publicity and wider audience participation for inclusion of reflextherapy in physiotherapy training. 50% thought that 25% – 50% of patient improvement was due to the placebo effect but that the rest was an effect of physiological changes. The membership was divided whether to call it reflexology or reflextherapy in context of the treatment application.
To purchase a copy of the audit please contact Gunnel.
In UK I think we have to look at the physiotherapy profession as 2 separate entities. One is Physio provided by the NHS and the other is Private physio.
Private physio types are trained on NHS but you do not need a GP referral for private physio unless you are using private medical insurance. Both types seem to be registered with CSP but private physio also has its own membership organisation as well. I think the NHS physio is largely regulated as the NHS is bound by NICE guidelines so is not so free to offer acupuncture , reflexology etc. However cost cutting in HNS seems to have resulted in very little being offered in the way of therapy apart from ‘talk’. Private physios on the other had are much freer to offer manual therapy for which they don’t seem to make outrageous claims but recognise that it does help with rehab and maintenance. There are scrupulous ones ( I see one regularly for maintenance whom I admire immensely) whose treatment is rooted in evidence based medicine and pain science but there are so many others who will still offer these alternative treatments. The trouble is it is impossible to distinguish among them until you have been to one and then even then this knowledge is only gained with hindsight and we should not forget that most seeking therapy do so because they are compromised with pain and not in the best position to make value judgements at the time. NHS training of Private Physios and thus its pedigree seems to be private physio’s greatest attribute as it should indicate a professionalism and reputation of efficacy, however what it actually does is lead people into a false sense of security in some cases.
I have long wondered why the CSP is not more rigorous with its members as with internet and social media it should be much easier to police them. And why private physios do not distance themselves more obviously from non evidenced based medicine therapies as they will still have a lot of patients.