It is now estimated that between 20- 30% of the population in the UK resort to various types of complementary and alternative medical therapies (generally referred to as CAM) at some time, and reflexology is high on the list in terms of popularity. It is now increasingly being offered in the NHS, sometimes by conventionally trained nurse practitioners. Over twenty countries around the world have specific reflexology associations, usually linked with the International Council of Reflexologists, which is based in the USA and co-ordinates training, qualifications and practice.

Definitions

There are two main streams of reflexology although the distinction between them is often unclear. 'Reflexology' is the more widely used term whereas 'Zone Therapy' has a somewhat different emphasis relating more to theory than practical application. This mixture of Reflexology/Zone Therapy is described variously as a healing art, a science or a mixture of both.

It can be defined as a therapeutic system in which manual treatments (particularly finger pressure) are applied to the feet, or sometimes the hand or ear, in order to stimulate a healing process in a part of the body at some distance from the point of treatment. Each part of the body is represented by a specific reflex area, usually on the foot.

Described as a holistic therapy, reflexology aims to benefit the body, mind, emotions and spirit. It is said to work by unblocking 'energy channels' running up from the foot to an organ affected by malfunction or disease, allowing the free flow of 'life energy' necessary for healing and good health.

Origins, aims and claims

The concepts basic to reflexology (eg zones, channels, meridians, pressure points and life energy) appear to have emerged from ancient origins. It is likely that the Chinese used something akin to reflexology maybe 5,000 years ago and that this merged into acupressure and then acupuncture which became and has remained mainstream in Chinese traditional medicine.

Paintings on the foot of the Hindu god Vishnu, possibly representing reflex points, suggest that the technique may have been practised in ancient India. Others have noted inscriptions on the foot of a reclining Buddha in Burma; these may represent energy centres but appear as rows of regular squares quite unlike today's reflexology charts.

In the tomb of Ankhmahor (thought possibly to be a royal physician) excavated at Saqqara in Egypt and dated around 2,500 BC, wall pictures and hieroglyphics were found. These depicted two dark-skinned figures, one manipulating the foot and the other the hand of two light skinned figures. The inscription reads, 'Do not let it be painful' with the apparent answer 'I do as you please'. Does this illustrate an early reflexology treatment or a rather dramatic pedicure and manicure session?!

References to the use of reflexology as a treatment in Europe were sporadic until the technique was recognised in Germany in a book entitled Pressure Points: the Origin and Significance, published in 1902 by Dr Alfons Cornelius. It is an American ENT surgeon, Dr William Fitzgerald, (1872-1942), however, who is credited with the foundation of modern zone therapy. He observed that pressure on a finger produced partial anaesthesia of the arm up to the jaw and was able to carry out minor operations using a clamp or elastic bands to apply pressure. In 1913 he popularised his treatment through an article in Everybody's Magazine entitled 'To Stop the Toothache, Squeeze Your Toe'. He believed that all the organs in the body were represented on the sole of the foot and worked out a basic plan dividing the body into ten equal vertical zones.

In the 1930s one of his associates, an American physiotherapist, Eunice Ingham (1879-1974), refined much more detailed maps which indicate that the soles of the feet are equivalent to a microcosm of the whole body on which all organs and parts are represented - the so-called 'reflex areas'. Stimulation of these areas reputedly produces harmony, balance and healing by unblocking energy channels to the associated organ. Ingham is considered to be the 'Mother of Modern Reflexology' and trained Doreen Bayley, who first introduced the therapy into this country in 1966. Since then several schools of reflexology have been established in the UK and the British Reflexology Association was founded in 1985.

The common denominator in most theories of reflexology is the concept of some form of 'life energy' (ch'i, prana, vital force etc) and some therapists believe that the channels of this energy connect with the chakras or energy centres prominent in the Hindu philosophy of yoga. In her book Reflexology -A Practical Introduction, Inge Dougans states, 'There is no one correct theory on how reflexology works'. Its aims, however, are to promote good health and mobilise the body's defences and energies against disease. Reflexologists are expected to adhere to a strict code of conduct which includes not practising medicine, not diagnosing disease, not treating for a specific condition and not prescribing or adjusting any medication. Popular textbooks of reflexology, however, suggest the value of reflexology in a long list of diseases including heart disease, asthma, migraine, sciatica, multiple sclerosis and epilepsy, albeit as complementary to orthodox medicine.

Touching techniques

In an initial reflexology session the therapist takes a medical history and may discuss posture and lifestyle. The foot is then inspected, noting any bunions, corns, calluses, warts or infections. Some practitioners believe that such physical problems are closely associated with disease in the organ connected with the affected reflex area on the foot. From a background of orthodox medicine the connection between these local conditions of the foot (for which the causes are well known) and diseases of internal organs seems hardly credible.

Following this, both feet are palpated lightly, noting particularly any areas of tenderness or 'grittiness'. Experienced therapists claim to be able to identify organs which are suffering from an imbalance of vital energy and the channel which needs to be unblocked to bring about healing. A general massage of the foot, during which the patient is encouraged to relax, is followed by detailed massage of reflex points whilst holding the foot in specific grips. Finger techniques involve pressure, rotation, and finger and thumb 'walking' across the foot. Although these are thought to be less effective, similar techniques may also be used on the hands when time does permit a full session on the foot. These reputedly work by stimulating what is variously known as subtle energy, electro-chemical energy, nervous energy or life energy.

Reflexology may be combined with other therapies such as colour therapy, aromatherapy, homeopathy, massage and yoga. In her Practitioner's Manual Beryl Crane also believes that 'astrology can be a valuable guide in helping the diagnosis of these imbalances'.

The big questions

Does it work?

There are many reasons why people seek alternative medical therapies including disillusionment with orthodox medicine, a suspicion of modern drugs and their possible toxic effects, or sheer desperation. They may also be attracted by anecdotal evidence from family, friends or neighbours. For them, the all important question is whether the therapy works, irrespective of the theory or belief system upon which it is based.

Individual therapists report good responses to their treatment but is this real evidence of validity? Is a response due to the specific therapy or some other influence such as the caring attitude of the therapist or a very 'genuine' placebo effect? It is possible that some general benefit, particularly pain relief, might be mediated by the release of endorphins during the therapy but the concept of life force or energy is much more prominent in textbooks of reflexology.

We therefore need to consider the objective assessment of reputable independent researchers. Valuable information appears in such publications as FACT magazine and the Desktop Guide to Complementary and Alternative Medicine, both produced under the editorship of Professor Edzard Ernst, Director of the Department of Complementary Medicine at Exeter University. The WHICH Guide to Complementary Medicine is also popular.

Clearly, anecdotal evidence is not enough and the gold standard of investigation for any CAM or indeed any orthodox therapy has to be a valid randomised controlled trial (RCT). In a review of reflexology in the Desktop Guide, ten available RCT's were carefully considered but failed to reveal conclusive or convincing evidence in support of reflexology. The WHICH Guide stresses that 'few scientific data have been produced to back up the experiences of reflexology's devotees or to confirm the existence of zones, energy lines or crystalline deposits'.

Is it safe?

Although it is universally agreed that reflexology is a safe procedure, some practitioners advise caution when using it in pregnant patients or those with diabetes, gall bladder disease, thrombosis or infection of the blood vessels of the foot and leg. From a medical perspective, it is most unlikely that any significant harmful effects would result but, according to the Desktop Guide, there may be 'foot tenderness, changes in micturition or bowel function and possibly allergy to aromatic oils if used'. The greatest risk, with reflexology as with all CAM therapies, is when they are used as a substitute for proper conventional medical diagnosis and treatment. A serious illness may be missed and correct treatment delayed, sometimes with tragic consequences.

In addition and from a Christian perspective, it is important to recognise that many therapies, including reflexology, have their basis in the concept of life force, vital energy, ch'i (yin and yang), prana or one of the other terms used for this 'energy' at the heart of eastern healing arts and therefore inextricably reliant upon a non-Christian belief system. Whilst some western therapists might wish to disassociate themselves from this, it is difficult to see what is left if the fundamental beliefs upon which the therapy depends are removed. Similarly, many would wish to disassociate themselves from any New Age connections but many of these therapies are available at New Age events and Mind, Body and Spirit festivals.

It is widely agreed that the doctor or therapist is an important figure in both orthodox and alternative medicine and, in fact, many of the apparently beneficial effects of alternative medicine are probably due to the time, care and sympathetic approach of the therapist. If a therapy is being administered by an enthusiastic New Age practitioner, however, this may well serve as an introduction to New Age and even occult practices such as astrology and divination, which are clearly forbidden in the Bible (Dt 18:10-12).

Pressing problems

At first sight it seems most unlikely that there could be any harm in a therapeutic foot massage. Several important problems, however, need to be addressed.

1. The diagnosis of blocked energy channels by means of palpation and the identification of painful reflex areas or sense of grittiness, are said to be due to the presence of crystals (probably calcium) in the reflex points. There does not, however, appear to be any scientific evidence for this. Could it, therefore, be divination rather than diagnosis? 
2. There appears to be no rational basis for Dr Fitzgerald's body zones and any significant relationship between the variously shaped body organs within such vertical segments is hard to imagine. 
3. The concept of meridians in traditional Chinese acupuncture was formulated several thousand years ago, before anatomical dissection was practised. Again, there is no anatomical or histological evidence for these and the pattern by no means conforms to anatomical structures now revealed by dissection. 
4. Although there is a general overall pattern showing the main reflex areas on the foot, charts used by individual therapists are certainly not identical. Such variations, however, are not disputed by reflexologists who suggest that these charts merely represent guides or 'route maps' -somewhat difficult to equate given the precision they often indicate. For example, the liver area can be shown either on one foot or both. 
5. For adherents to the meridian theory, there is an added problem in that meridians do not all end in the foot. It is, however, suggested that meridians connecting with their various organs are in contact with other meridians and organs on the way, with energy diverting to the point required en route! 
6. Some reflexologists highlight the spiritual symbolism of healing through the feet with quotations from the Bible, such as Luke 7:38 which records the washing and anointing of Jesus' feet by a 'woman who was a sinner' and John 13:5 describing Jesus washing his disciples' feet before Passover. According to Inge Dougans, the feet are a connection between earthly and spiritual life. Her understanding of Jesus washing the disciples' feet is that:

'Jesus' gesture was to awaken in his disciples the constructive energies of the solar plexus. The seven main chakras repeat themselves in reverse order from the coccyx to the feet. With this esoteric theory the crown chakra is repeated in the soles of the feet. The Christ washed the disciples' feet in order to awaken the crown chakra above the head,to awaken spiritual energies.'

And finally

In today's climate of advanced scientific progress with great demand for evidence based medicine and clinical excellence, it is particularly interesting that so much alternative medicine should be flourishing. We need to consider whether it is justifiable to use therapies that remain largely unproven and do not conform to the high but reasonable standards required of orthodox medicine. In his book Healing at any Price?, Dr Samuel Pfeifer emphasises that in our search for physical health, we should not ignore biblical guidelines, which could lead to spiritual harm rather than healing.

Alternative therapists widely promote the holistic approach towards healing including body, mind and spirit. Christians would agree that this certainly is the ideal but if spiritual healing is involved it is essential to ask the question, 'by which spirit?' - only the Holy Spirit being acceptable to Christians. So the approach to reflexology, as to so many other alternative therapies, must be 'please tread carefully'. And we can only do this by walking with the Psalmist who said, 'Thy word is a lamp unto my feet and a light unto my path'.(Ps 119:105 (AV)).