Reflexology
Thora Jenny Gunnarsdottir
Reflexology is a complex complementary alternative therapy used globally for symptom management and for increasing well-being. In reflexology, the whole body has been mapped out in the hands and in the feet and can be manipulated directly using specific massage techniques. The corresponding areas on the feet are easier to locate because they cover a larger area and are more specific, rendering them easier to work on than the hands. In this chapter the main focus is on reflexology of the feet. Reflexology shares the philosophical base of holism congruent with nursing. As such, it provides nurses with an important tool to increase the healing mechanisms in their patients. Reflexology can be a prime tool in supplying caring, presence, and showing compassion in combination with a feeling of doing something that may help a patient to become more whole and feel better. This gentle intervention has been shown to affect some symptoms, but the scientific basis behind reflexology needs to be further established.
DEFINITION
Reflexology is defined as a holistic healing technique aimed at treating the individual as an entity, incorporating the body, mind, and spirit. It is a specific pressure therapy that works on precise reflex points of the feet that correspond to other body parts as depicted in Exhibit 27.1. Because the feet represent a microcosm of the body, all organs, glands, and other body parts are laid out in a similar arrangement on the feet (Dougans, 2005). Different definitions have been put forth, but they all
express the basic principle behind reflexology—the soles of the feet and the palms of the hands are connected to all parts of the human body, including its internal organs; by applying specific pressure strategies to the soles of the feet, healing effects can be induced throughout the entire body.
express the basic principle behind reflexology—the soles of the feet and the palms of the hands are connected to all parts of the human body, including its internal organs; by applying specific pressure strategies to the soles of the feet, healing effects can be induced throughout the entire body.
Exhibit 27.1. Relationship of Body Parts With Reflexology Points on the Feet
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The International Institute of Reflexology defines reflexology as a science that deals with the principle that there are reflex areas in the feet, and stimulating them properly can help many health problems in a natural way—a type of preventative maintenance (International Institute of Reflexology, 2012). Furthermore, the institute emphasizes that its purpose is not to treat or diagnose for any specific medical disorder but to promote better health and well-being. Kunz and Kunz (2003) state that the pressure techniques stimulate specific reflex areas on the feet and hands with the intention of invoking a beneficial response in other parts of the body. The literature also suggests that reflexology is useful for achieving and maintaining health, enhancing well-being, and relieving the symptoms of illness and disease (Tiran, 2002).
Definitions of reflexology convey that the basic principle behind reflexology is that the extremities are connected to all other parts and internal organs of the human body, and that there is a relationship among organs, systems, and processes. By using specific pressure strategies on the foot or hand, healing the whole body is possible. The left foot/hand represents the left side of the body and the right foot/hand represents the right side of the body. Numerous schools of reflexology have been established throughout the world.
SCIENTIFIC BASIS
The foundations of reflexology can be traced to two different theories or schools of thought documented in the reflexology literature. The first theory originated in traditional Chinese medicine (TCM) and the second one in a Western technique known as zone therapy.
Traditional Chinese Medicine
Reflexology is thought to be Eastern in origin (Dougans, 2005), and it is congruent with the principle of organ representation from TCM: “the whole represents itself in the parts” (Kaptchuk, 2000). This statement means that the feet are seen as a microcosm of the body, as a kind of holographic image in which all organs, glands, and other body parts are mirrored on the soles of the feet. The idea that the whole body can be represented in its parts is not new. For example, tongue diagnosis has been documented in China for at least 2,000 years. It is also evident in the iris of the eye, the face, and the ear (Maciocia, 2005).
TCM posits that there are a number of invisible energy pathways, or meridians, within the body that carry an energy called Qi, which is the vital energy behind all processes. All organs are interconnected with each other by a meridian network system and, to maintain health, energy needs to be flowing in balance. Factors impeding the free circulation of Qi are divided into categories of excess and deficiency. Excess refers to the presence of something that is too much for the individual to handle—too much food to digest, too much waste to eliminate, and so forth. Deficiency refers to the absence or relative insufficiency of one or more aspects of the life energies necessary for sustaining health and well-being. A deficiency or excess of life energy can allow outside factors to overwhelm the individual, thus inducing pathology and leading to pain and illness (Maciocia, 2005).
In a healthy person with energy in balance, the feet feel soft when palpated and should have the same texture in every area. When an area is
felt to be empty or is lacking in texture when palpated, it is an indication of deficiency in the energy of that particular organ or area in the body. If an area feels stiff and hard in texture when palpated, it indicates an excess of energy. If a lack of energy is found in one area, this means that some other area has too much energy because the energy must be in balance. On empty areas, it is necessary to slowly build aggressive pressure to increase the energy flow, and more vigorous, light but firm pressure is applied on the area that has too much energy to direct the flow out and away from this area. In that way, reflexology redirects excess energy from one area into another where there is an apparent deficiency, so as to supplement a deficiency or to subdue an excess pattern.
felt to be empty or is lacking in texture when palpated, it is an indication of deficiency in the energy of that particular organ or area in the body. If an area feels stiff and hard in texture when palpated, it indicates an excess of energy. If a lack of energy is found in one area, this means that some other area has too much energy because the energy must be in balance. On empty areas, it is necessary to slowly build aggressive pressure to increase the energy flow, and more vigorous, light but firm pressure is applied on the area that has too much energy to direct the flow out and away from this area. In that way, reflexology redirects excess energy from one area into another where there is an apparent deficiency, so as to supplement a deficiency or to subdue an excess pattern.
Zone Therapy
The second theory, often referred to as zone therapy, originated in the West. At the beginning of the 20th century, Dr. William Fitzgerald found that pressure applied to some parts of the feet induced anesthesia in specific parts of one’s body. He then determined that the entire body and all its organs were laid out in a certain configuration on the soles of the feet. He divided the body into 10 longitudinal zones, running from the top of the head to the toes, and proposed that parts of the body within a certain zone were linked with one another—hence the name zone therapy.
An American therapist, Eunice Ingham, is credited with establishing reflexology in its present form (Ingham, 1984). She used the zones as a guiding map, but began to chart the feet according to where pressure would produce distinct effects in the body. She developed a map of the entire body on the feet and called the areas reflexes. Her proposition was that when the bloodstream becomes blocked with waste materials or excess acid, calcium deposits start to form in the nerve endings, impeding the normal circulation of the blood and creating an imbalance in the various parts of the body, depending on the location of the blockage. She believed that by using the specific pressure of reflexology, the calcium deposits on the feet could be detected as “gritty areas” that may feel painful when touched. Ingham describes these as “particles of frost” or “crystal blocks” when examined under a microscope. The pressure and massage techniques taught in reflexology are designed to dissipate these formations and break down their crystalline structures. By doing so, the corresponding area connected with this particular nerve ending will receive an added supply of blood. In this way, the circulatory and lymphatic systems are stimulated, thus encouraging the release and removal of toxins, and the body starts to heal itself. Other theories have been considered in the literature but are not detailed in this chapter.
No theoretical framework for reflexology has been directly proven, which may partially explain why there is not universal agreement on how to classify reflexology. The National Center for Complementary and
Alternative Medicine classifies reflexology as a manipulative and bodybased method (NCCAM, 2012).
Alternative Medicine classifies reflexology as a manipulative and bodybased method (NCCAM, 2012).
INTERVENTION
The patient will be lying comfortably, covered by a blanket, somewhat higher than the chair in which the reflexologist sits, and will have pillows under the knees and the head to induce relaxation. In addition, the patient will be barefoot and in a comfortable position, with any tight clothes loosened so as not to hinder circulation. Then the patient will be assessed continuously for tolerance to the amount of pressure applied. The pressure needs to be firm enough to activate the body’s healing potentials but must also be tolerable to the patient. Sensitivity varies in each individual, and the feet usually become more sensitive with subsequent treatments. Each area is worked, finishing the toe area on the one foot and then treating the toe area on the other foot, and so on, going from one foot to the other.
Although it is emphasized that reflexology is to be applied to the feet as a whole, it is important to work specifically on several systems of the body. These specific systems are, for example: the digestive system to increase proper elimination; the lymphatic system, to increase the clearance of waste materials; the bladder and kidneys, to increase urine and energy flow (the kidneys are one source of Qi); the solar plexus (where feelings and emotions are stored), to increase relaxation; all internal glands, to stimulate their respective functions; and the lungs, to increase oxygen consumption. A foot map with physical locations and corresponding body systems is illustrated in the interactive website (www.dk.co.uk/static/cs/uk/11/features/reflexology/footchart.html). By using reflexology on these body systems, the reflexologist is both increasing circulation and elimination and affecting the flow of Qi because all organs are interconnected with each other by meridians.
Techniques
There are several techniques used, depending on the area of the foot. One hand supports the foot while the fingers and the thumb of the other hand massage the skin. A period of 45 minutes to 1 hour is estimated to be enough time to perform the reflexology on both feet and will allow for extra time to work on specific areas that need further care. At the end of each session the receiver is encouraged to relax for several minutes. There are some standard pressure procedures for working on the reflexes of the feet. The two techniques described here are thumb-walking and hook and back-up (Kunz & Kunz, 2003). Other grips can be used, depending on the area of the foot in question. It is important not to forget any area and to finish one area before starting the next one (see Exhibit 27.2).
Exhibit 27.2. Techniques
Thumb-Walking
The goal of the thumb-walking technique is to apply a constant, steady pressure to the surface of the foot or the hand:
1. With the other hand (holding hand) stretch the sole of the foot. Rest the working thumb on the sole and your fingers on the top of the foot. Drop your wrist to create leverage, which exerts pressure with the thumb.
2. Bend and unbend the thumb’s first joint, moving it forward a little bit at a time. When your working hand feels stretched, reposition it and continue walking it forward. Take a little step forward with each unbend. The goal is to work with a small area in each step to create a feeling of constant, steady pressure. Always walk in a forward direction, not backward. Keep your thumb slightly cocked as you work to prevent overextending it.
Hook and Back-Up
The hook and back-up technique is used to work a specific point rather than to cover a larger area. It is a relatively stationary technique, with only small movements of the working thumb involved. To avoid digging your fingernail into the flesh, apply pressure using more of the flat of the thumb:
1. Support and protect the area to be worked with the holding hand. The hand wraps around the area while the thumb and fingers hold it in place. Place the fingers of the working hand over those of the holding hand.
2. Place the working thumb in the center of the area to be worked. Hook and back-up, using the edge of the thumb.
Adapted from Kunz and Kunz (2003).
Measurement of Outcomes
The philosophy behind reflexology states that it affects the body as whole; however, based on the literature, more studies have measured physiological or psychological outcomes of reflexology than its overall effects. It is important to measure the effect of reflexology over a number of sessions to gain insight into its overall benefits.
Precautions
Reports from people have indicated reflexology to be a largely pleasant experience, leaving them both calm and relaxed. However, it must be emphasized that many do not like to have their feet touched and approval from the patient is needed before starting. Before beginning reflexology, the condition of the feet must be examined for swelling, color, ulcerations, toe deformities, and odor. The physical condition of the person is also very important; hence, the health history is reviewed. The therapist must be careful about the pressure of the massage, if there is a problem regarding the blood flow to the limbs because of diabetes, neurological diseases, or arteriosclerosis. Older adults may require special precautions, due to such concerns as restricted movement, incontinence, arthritis, and aching joints. When dealing with such conditions, it may be better to consider the person’s comfort and feel of the touch as the primary goals. Children have also been participants in research, where the effects of reflexology on constipation were reported on 3- to 14-year-olds without any adverse effects.
Some symptoms of adverse effects after undergoing complementary therapy are often referred to as “healing crisis.” This is said to present frequently during and immediately following treatment as localized or distal pain, perspiration or shivering, and changes in the heart rate, respiration, or temperature. This phenomenon is also described as a cleansing process. The treatment is believed to activate the body’s healing power; accumulated waste products and toxins, which have often lain dormant in the body, are released into the bloodstream. In one study where the effects of reflexology on fibromyalgia syndrome were studied, the participants were specifically observed and asked about healing crisis as part of the reflexology treatment (Gunnarsdottir & Jonsdottir, 2010). The participants, six women who were given 10 reflexology treatments, described several symptoms as healing crisis: headaches, increased thirst, increased pain, increased urination, more frequent bowel movements, aggravated skin conditions, increased perspiration, fatigue, feverishness, dizziness, and exhaustion, and also increased energy. These symptoms appeared during the early stages and lasted for 1 or 2 days each time. Due to reports of such reactions, it must be emphasised that reflexologists may need to be extra careful when applying reflexology on people who are seriously ill, such as cancer patients, because they may not tolerate a healing crisis well. It is also important to explain to people what can be expected after a treatment.
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