Is reflexology valid?

Reflexology is an alternative therapy that uses pressure at various points on the feet with the aim of alleviating symptoms elsewhere in the body. Its proponents claim that the feet carry a map of the rest of the body, and that pressure, for example, on the big toe can have effects in the head. Each point on the foot is said to be a 'reflex' for another part of the body. The term 'reflex' indicates a kind of mirror image (a reflection), rather than a more specific reflex mediated by nerves. In fact, the direct physical connections between the feet and other areas of the body as proposed by reflexologists have no foundation in anatomy or physiology.

Neither is there any evidence to support the idea that 'energy channels' connect the areas; in fact, the whole notion of energy and its flows, as proposed by many alternative therapists, is completely meaningless from a scientific point of view. Of course the body uses energy, but it is described by transformations between chemical, thermal, electrical and mechanical forms, and not by mystic emanations.

Another mechanism suggested by reflexologists is that accumulations of calcium salts or uric acid in the feet relate to health problems elsewhere. There is no evidence to support this theory, either. Unusual thickenings of areas of the feet can be more easily ascribed to badly-fitting shoes.

But setting aside the how, does reflexology work? As with all such alternative therapies, fans of the technique believe sincerely and strongly that it does. Reflexology is claimed to have beneficial effects on many stress-related conditions such as headaches, and on other conditions with a more direct physical cause, such as kidney stones, asthma and cataracts. Some practitioners claim to be able to diagnose conditions simply by feeling the feet, although controlled trials carried out at the University of Exeter have shown that - unless the reflexologist can talk to the patient - their success rate is no higher than would be expected by chance. There have been a number of trials of reflexology, but their results have not supported any claims of a significant benefit of the technique. The one exception to this, reported by a group in North Carolina, may be the relief of premenstrual symptoms, although the evidence for this is not strong.

Yet practitioners and many clients firmly believe that reflexology does have beneficial effects. [Read reflexology practitioner Elizabeth Rabone's personal view of the history and mechanisms of her work] The mechanisms they propose to explain the effects do not stand up to scientific scrutiny, so if the effects that people claim are real, are there more plausible mechanisms to explain them?

The benefits of certain types of massage are well documented, and massage seems to be particularly good for relief of back pain, constipation, and for improving feelings of well-being. Our sense of touch is closely linked to many beneficial physical and psychological effects learned from infancy. It is possible that the effects of reflexology are simply the result of having the feet rubbed, a process considered by many people to be relaxing and 'stress-busting'.

This could certainly explain some of the pain relief reported anecdotally following reflexology. Moreover, reducing stress has several physical benefits such as lowering blood pressure and heart rate, and, even if only temporary, these changes can have many knock-on effects throughout the body. Feelings of anxiety and depression can be reduced, and this immediately makes us feel better, regardless of physical symptoms.

Another possibility is that what reflexology is really doing is tapping into the placebo effect. This is the effect seen when patients feel better after receiving treatment that is pharmacologically inactive, such as a sugar pill. Initially dismissed as an example of poor research practice and patients' gullibility, the placebo effect is now being seriously studied, with some surprising results.

When a patient believes that they will get better, specific changes in brain activity can be seen by scanning and other techniques, and the level of the changes seems to be linked to the amount of improvement reported by the patients. We are learning more and more about the body's ability to heal itself, and it may turn out that the placebo effect is an incredibly powerful one, and underlies not just reflexology but many other therapies too.

References

Leuchter AF, Cook IA, Witte EA, Morgan M, Abrams M (2002) Am J. Psychiatry 159: 122-129
Oleson T, Flocco W (1993) Obstet Gynaecol 82: 906-911
Stevinson C, Ernst E (2001) Am J. Obstet Gynecol. 185: 227-235
Wager TD, Scott DJ, Zubieta J-K (2007) PNAS 104: 11056-11061
White AR, Williamson J, Hart A, Ernst E (2000) Compl Ther Med 8: 166-172

What did Kathy discover?

In her film for the Alternative Therapies series, Kathy Sykes found very little to suggest that there is a scientific basis to many of the specific claims of reflexology. She found no reliable evidence to support its defining idea – that the entire body is mapped onto the soles of the feet and by pressing particular points you can affect the corresponding areas of the body. Nor could she find any robust evidence from medical trials to back up any specific health claims. However, she did find a doctor who was using it to help make cancer patients feel relaxed during treatment and this led her to investigate the importance of massage and touch and what roles they might play in modern medicine. Find out more about the reflexology programme.

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