Health: Footloose and pain-free

Reflexologists say they can alleviate symptoms of PMS, asthma and anxiety by massaging pressure points on the feet. There is no scientific evidence to support this complementary treatment, but its popularity grows. Professor Edzard Ernst continues his series

Reflexology goes back to a form of treatment developed by the Indian tribes of North America. In recent years, it has become one of the most popular complementary therapies. About 6,000 therapists practise in the UK at present and this number is growing steadily.

Reflexologists describe their therapy as the "practice of working on reflexes in such a way as to produce a relaxation and response in the corresponding body regions. By applying controlled pressure with the thumbs or index fingers to the reflex points and areas on the feet, the body is stimulated to achieve its own state of equilibrium and good health. Pressure on the reflexes not only affects the organ or region of the body but it also influences the relationship between the different functions, processes and parts."

The foot, ear, hand, back and other body locations are believed to represent "holographic reiterations of the anatomy of the body," or a "perfect microcosm or miniature map of the whole body," or a "scanner screen-recording bodily functions." Maps were drawn up where one particular area of the foot's sole is assumed to represent one particular internal organ or organ system. These maps are based on the assumption that 10 "energy zones" run longitudinally through the body. Each foot has five of these lines, and all body organs are believed to lie along one or more of these lines.

Reflexologists postulate that a malfunctioning organ or body system leads to deposits of uric acid or calcium crystals. These, in turn, impinge on the nerve endings on the feet or obstruct the lymph flow. Treatment aims at breaking down the deposits so that they can be re-absorbed and eliminated. Reflexologists also believe that treatment can improve blood flow and that reflex points are nerve receptors whose stimulation will induce "deep relaxation" or emit "impulses to all parts of the body." Other hypotheses involve the lymphatic system, suggesting that the body's waste products are removed through reflexology massage, and the general enhancement of the body's inherent balance. All of these theories are unsubstantiated. A scientific rationale for reflexology simply does not exist.

By searching for "blockages" or increased areas of sensitivity on the foot, reflexologists also diagnose diseases or organ malfunctions. A positive finding in the reflex zone of the kidney, for instance, would imply to a reflexologist that the patient suffers from kidney disease. As with most other complementary diagnostic techniques (Box 1), there is no evidence to support the validity of such diagnoses.

What happens during a reflexology session?

n The reflexologist would normally take a short case history of the patient; few will carry out an actual conventional physical examination. Patients are then asked to lie down and show their feet. Treatment usually consists of palpating and massaging the feet. Sometimes other parts of the body, such as the hands, are also treated. Reflexology can be mildly painful, but it is normally agreeable and also intensely relaxing.

Prices can vary between pounds 30 and pounds 40 for one 30-minute session. Six to 12 treatments per series are usually recommended. Thus, the total costs for one series of treatments can be up to pounds 240. Since reflexologists usually treat chronic conditions that often require repeated attention, a total bill of something in the region of pounds 1,000 per patient per year may not be exceptional.

What is it for?

n The list of "indications" given by enthusiasts is long (see Box 2) and there is a worrying lack of agreement between various authors on the subject. Some of the more surprising "indications" are appendicitis, high-blood pressure, cirrhosis of the liver, common cold, diabetes, hernia, infertility, jaundice, pneumonia, tumours and whiplash injuries. According to a fairly recent survey, the most frequently treated conditions are the following: back problems, tension/stress, migraine/ headaches, sinusitis, arthritis, neck/shoulder pains, digestive problems. Of these, tension/stress, back problems and migraine/headache were said to respond best. In most (if not all) cases, reflexology is advocated as an adjunctive and symptomatic treatment, and not purely as a cure in itself.

The above indications are not based on evidence from controlled clinical trials. In fact, only very few such studies have been published The only conditions for which encouraging trial data exists are anxiety and pre- menstrual syndrome. In both cases, the studies have not been replicated by independent research groups, a precondition that is required before accepting results as reliable.

What are the potential risks?

n No adverse effects of reflexology are on record. The treatment is, according to books on the subject, contra-indicated in conditions such as heart problems or shingles. This obviously carries risks. Furthermore, considerable harm can be caused by using reflexology as a diagnostic tool: it is likely that some healthy individuals will be declared ill, while some diseased people will be pronounced healthy. In the most extreme cases, this may result in the cost of lives.

In conclusion

Reflexology is popular, usually perceived as relaxing and, as a therapy, carries few risks. Unfortunately, there is as yet no truly convincing evidence that it is specifically effective for any medical conditions. The diagnosis of disease through reflexology is also likely to cause harm. This, unfortunately, applies to several diagnostic techniques that are used in complementary medicine.

Association of Reflexologists, 19 Benson Road, Henfield BN5 9HY

For further reading, `The Reflexology Handbook' by Norman L, The Bath Press, 1988

Clinical

Trials

Condition

n Anxiety

n Headache

n Asthma

n Post-op treatment

n PMS

Result

Positive

Negative

Negative

Inconclusive

Positive

Complementary Techniques

n Applied kinesiology shown to be unreliable by at least one research group

n Bioresonance - shown to be unreliable in the majority of tests

n Iridology - shown to be unreliable by at least four research groups

n Kirlan photography - not scientifically proven and evidence is contradictory

n Radionics - not scientifically proven and evidence is contradictory

n Reflexology - shown to be unreliable by two independent research groups

n Vega test - shown to be unreliable by most tests