George Smith examines a popular touch therapy

Reflexology, one of many touch therapies, is enjoying increasing popularity in a 'consumer led boom' in alternative medicine.[1] It is used by ten percent of alternative therapy consumers. Some family practices and hospitals provide it and many health care professionals incorporate it into their work. Over 20 countries have reflexology associations linked to the International Council of Reflexologists, based in USA.[2] There are several British reflexology schools: therapists are usually members of the British Reflexology Association (MBRA)[3] or the Association of Reflexologists (MAR), founded in 1985 and 1989 respectively.[4] However, Britain does not have any specific statutory regulations. There is little difference between reflexology and the less frequently mentioned zone therapy.

Origins

The Chinese probably used a comparable therapy some 5,000 years ago: acupressure emerged from this followed by acupuncture, which then became mainstream Chinese medicine. Ancient paintings on the foot of the Hindu god Vishnu and inscriptions on the foot of a reclining Buddha suggest a representation of reflex points. A wall picture and hieroglyphics on the tomb of Ankhmahor (probably a royal physician), excavated in Saggara in Egypt and dated c2000 BC, convincingly depict hand and foot touch therapy.[5] North American Cherokee Indians still practise a form of foot massage, thought to have originated from South American Incas.[6]

The Florentine sculptor Cellini (1500-1553) relieved pain using finger pressure.[7] Doctors Adamus and A'tartis wrote about zone therapy in 1582. Dr Cornelius published Pressure Points and their Significance in 1902.[8]

American ENT surgeon William Fitzgerald (1872- 1942) applied clamps and elastic bands to fingers in order to produce arm and jaw anaesthesia, allowing him to perform minor operations. Dr Edwin Bowers, Fitzgerald's colleague, attracted attention with an article in Everybody's Magazine entitled To Stop the Toothache - Squeeze your Toe. Dr Fitzgerald devised a theory that the body was divided into ten vertical zones or slices ending in the five fingers and toes on each side. No explanation is recorded as to how he reached this conclusion. In the 1930s, Eunice Ingham (1879-1974) - an associate of Fitzgerald - produced extremely detailed maps of reflex areas representing all parts of the body on the hands and feet. She trained Doreen Bailey who introduced reflexology into Britain and founded a School of Reflexology.[9]

Principles and Practice

Reflexology is presented as a holistic therapy in which pressure and massage are applied to the feet or hands in order to remove and dissipate energy blocks, break down crystalline structures, encourage toxin release, stimulate the immune system and prevent ill health.

According to Pauline Wills, reflexology '…is about giving and receiving energy. That energy is transmitted to the patient through the hands of the therapist and information is received from the patient's feet.'[10] Reflexologists do not claim to make medical diagnoses but identify body parts that are 'out of balance' and require removal of energy blocks. A medical history is supplemented by information gained by foot palpation. Areas of grittiness or tenderness are presumed to identify organs relating to the reflex area or zone involved. Massage, pressure or techniques such as finger walking across the foot are used to unblock energy channels, stimulate vital energy and promote healing. Individual reflexologists may combine this with colour therapy, yoga, aromatherapy, homeopathy or astrology.

As with many alternative therapies, reflexology may be practised in NHS hospitals, Alternative Medicine Centres in the High Street, private practices or at New Age Mind, Body and Spirit Festivals.

Medical Checklist

1. Is there a rational, scientific basis?

There does not appear to be a rational basis for Dr Fitzgerald's theory of body zones. Any significant anatomical or physiological relationships between the variously shaped body organs and his geometric vertical segments or reflex areas on the foot is hard to imagine and quite incompatible with Gray's Anatomy. Different practitioners' foot maps have similar patterns but show clear variations in the positioning of certain organs. No convincing explanation for these variations has been offered. Reflexologists suggest a cause and cure relationship between minor foot abnormalities (eg corns and bunions) and disease of internal organs.

Diagnosis of blocked energy channels - said to be causing crystalline deposits - by foot palpation is not backed up by scientific investigation or evidence. In New Age settings, a query over whether this is diagnosis or divination must be raised. Life force, vital energy, meridians and chakras all figure prominently in popular reflexology textbooks. The WHICH? Guide to Complementary Therapies stresses: 'Few scientific data have been produced to back up the experiences of reflexology devotees or to confirm the existence of zones, energy lines or crystalline deposits'.[11] Inge Dougans - founder of the School of Reflexology Therapy and Meridian Therapy in South Africa - states, 'There is no one correct theory on how reflexology works'.[12]

2. Does it work?

Reflexology is popular: its practitioners are enthusiastic and caring and many patients testify to its positive effects. A soothing foot massage in a caring environment may well diminish stress and patients often feel better. Yet anecdotal evidence and acknowledgement of the placebo effect cannot substitute for scientific evidence. Feeling better does not automatically imply healing from disease. A survey in WHICH? failed to find any conclusive scientific evidence to support reflexology's effectiveness. In a meticulous scientific review in Professor Ernst's Desktop Guide to CAM, ten random controlled trials were reviewed without revealing convincing evidence for reflexology's efficiency.[13] Further reviews of clinical trials in FACT did not reveal any satisfactory evidence of efficacy. [14]

3. Is it safe?

Significant harm seems unlikely from simple foot massage but foot tenderness, changes in micturition or bowel function have been reported.[15] Caution is advised in patients suffering from depression, epilepsy or vascular disorders of the legs. [16] The greatest risk with potentially serious consequences is when reflexology is used as a substitute for proper medical diagnosis and treatment.

Christian Checklist

Christians need to consider both professional integrity and biblical guidelines when assessing any treatment, orthodox or alternative. Unproven effectiveness or mode of action cause reflexology to fall far short of the evidence-based principles supposedly required of all modern medical treatments.

From a Christian perspective there is much to cause concern. Reflexologists highlight the spiritual significance of healing through the feet. Inge Dougans comments: 'Feet play a significant part in spiritual well being. The feet connect us to the ground and they are therefore a connection between earthly and spiritual life. They are our base and foundation and our contact with the energies that flow through it'.[17] Referring to the biblical account of Jesus washing the disciples' feet, she adds: 'The Christ washed the disciples' feet in order to awake the crown chakra above the head to awake spiritual energies'.[18] Similarly, many other reflexologists find an association with chakras and elements of the Hindu practice of yoga. Its basic philosophy is related to the Taoist Chinese view of the life force ch'i (ying and yang) or its equivalent in other cultures and religions (eg Universal Cosmic Energy). Reflexology, therefore, may provide an introduction to New Age spirituality and eastern religious philosophy. The Christian worldview is of a personal Father God upon whom we depend in all aspects of our life.[19] The idea of an impersonal life force governing all living beings is contrary to this and must surely lead to the conclusion that reflexology is not a right choice for Christians.

Choose you this day whom you will serve…God forbid that we should forsake the Lord to serve other gods. (Joshua 24:15-16, King James Version)