Chapter contents
Introduction81
‘Rules’ in reflexology practice82
Conclusion94
Acknowledgements95
References95
Key words
ABSTRACT
Reflexology has become more professionalised, more evidence-based and more integrated into some specialisms within mainstream healthcare, and some of the traditional ideas, which were a feature of reflexology practice for so long, have now been largely rejected, although this is by no means universal. This chapter explores some of the ‘rules’ and traditions of reflexology and challenges their validity in contemporary reflexology clinical practice, especially when reflexology is incorporated into mainstream healthcare.
Introduction
When one looks at its status within twenty-first-century mainstream healthcare, reflexology is still an evolving profession, despite the work of various respected authorities who have worked tirelessly to promote its benefits and to demonstrate that, by working in an integrated manner in conjunction with conventional healthcare professionals, the potential risks can be minimised. When complementary therapies are presented with clear expectations of outcomes, possible benefits and, most importantly, their limitations, they are usually welcomed into conventional healthcare. For example, most hospices and some NHS cancer hospitals in the UK employ complementary therapists as part of the multidisciplinary team, and cancer support centres offering complementary therapies are recognised as an integral part of community palliative care in many areas. Reflexology can be used to relieve pain, reduce symptoms associated with medical treatments and ease stress and the emotional aspects of life-limiting illness (Kohara et al., 2004 and Williams et al., 2009). Similarly, reflexology and other complementary therapies are increasingly part of mainstream maternity care, particularly in view of the rising Caesarean section rates, and have been used to facilitate normal birth, relieve physiological symptoms of pregnancy and aid adaptation to parenthood (Tiran 2009). Another clinical field in which complementary therapies such as reflexology have become popular is that of learning disability care, calming and relaxing clients, improving mobility and enhancing quality of life (Gale & Hegarty 2000).
However, although research evidence remains limited (see Ch. 6), reflexologists do their profession no favours by making exaggerated claims based on anecdotal evidence, and the medical profession sometimes finds it difficult to accept complementary therapies which are accompanied by unscientific and unlikely explanations and unevaluated enthusiasms. Research, audit and collation of clinical evidence can contribute to the acquisition of new information about the benefits and potential side effects associated with reflexology, especially in relation to specific clinical groups. It could be argued that it is no longer entirely appropriate to consider reflexology solely as a relaxation modality, but to acknowledge that it is an extremely powerful and valuable tool in its own right, which can be added to other tools used in both conventional medicine and complementary healthcare.
‘Rules’ in reflexology practice
Various ‘rules’ have traditionally been included in reflexology training and were intended as a means of protecting both clients and therapists. Some guidelines for practice are included at pre-registration level but, following qualification as a reflexologist, further training and experience enable the boundaries of safe practice to be stretched. For example, therapists in training are often discouraged from treating women in the first trimester of pregnancy, yet there are many midwives and some therapists who now treat women for problems which occur in very early pregnancy (see Ch. 9). Other ‘rules’ are based on differences in legal definitions and the current regulatory status of reflexologists in relation to conventional healthcare professionals (see Ch. 4). Greater integration of complementary therapies into orthodox healthcare has resulted in in-depth explorations of basic and post-basic training, regulation, insurance and other issues, which are gradually producing highly competent and knowledgeable practitioners, able to take their place with credibility and professionalism in the wider healthcare arena (see Ch. 3). Debate continues surrounding the issues of standardisation within the reflexology profession, not least the need to work together to clarify traditional beliefs about the therapy, to consider uniformity of reflexology charts and to challenge variations in practice and theoretical principles which underpin practice. Let us, then, explore further some of these ‘rules’ that have previously placed somewhat unnecessary restrictions on practice but which are now being seen less as mandatory parameters for practice and more as guidelines which can be questioned and adapted on condition that the practitioner is able to justify his or her actions.
Standardisation
Styles of reflexology and variations in charts
One of the difficulties for the generic profession of reflexology is that there are so many styles of practice, from ‘salon’ reflexology for general relaxation, to clinical reflex zone therapy for the treatment of specific conditions, from the very scientific focus of new styles such as Adapted Reflextherapy (see Ch. 11) to methods with a more traditional and esoteric background such as Five Element reflexology. If reflexology was purely an artistic discipline it would be acceptable to have many different styles, as we see in painting, with modernist, impressionist, fauvist and so on. However, reflexology is also a scientific discipline requiring sound knowledge accumulated through systematic study and organised by general principles. It is, perhaps, the wide variations in styles and theories which cause many conventional healthcare professionals – and some reflexologists – to challenge the validity of reflexology practice in academic and scientific terms. Whilst it is interesting to have different schools of thought which facilitate rich academic debate aimed at progressing professional practice, the existence of so many differing styles makes it difficult to standardise the profession without compromising some authorities. However, ongoing debate contributes to the development of a more cohesive profession, and increasingly the fundamental principles which are common to most styles of reflexology are debated, tested, researched, practiced and evaluated.
General reflexology is primarily a relaxation therapy which aims to restore homeostasis. Many schools teach the Ingham method™ which is based on the original work of Eunice Ingham and her nephew, Dwight Byers, using techniques which were formerly termed ‘compression massage of the feet’. Vertical reflexology, adapted from the Ingham method™, uses reflex points on the dorsal surfaces of the hands and feet to treat clients whilst in a temporary weight-bearing position which is thought to facilitate stimulation of deeper reflex points, enabling therapeutic effects in a shorter period of time. Precision reflexology (see Ch. 14) builds on general reflexology, using a process known as ‘linking’ in which two or three reflexology points are held simultaneously to enhance its overall impact and to enable treatment of specific conditions. In synergistic reflexology the hand and foot are worked simultaneously and several points are worked together, as in precision reflexology. These forms of reflexology have a similar theoretical basis and use largely the same charts, albeit with minor adaptations to suit the individual style.
Reflex zone therapy (RZT) is a specific clinical modality and can be administered in what might be accused of as being reductionist, rather than holistic, with short focused treatments according to the precise health needs of the individual. Whilst it has the same basic principles embedded within its theoretical background, reflex zone therapy has a more Western conventional scientific approach than some other forms of reflexology. The Metamorphic technique, an off-shoot of RZT, focuses primarily on the foot zones corresponding to the spine, thought to reflect a time period related to the nine months of intrauterine life; treatment aims to correct imbalances thought to be caused by activities occurring both before and immediately after birth. In a similar manner, spinal reflexology acknowledges the neurological link between the spinal vertebrae and specific nerves, organs, muscles, etc., but in this method the therapist uses the hands and thumbs on the client’s back to identify which vertebrae are out of balance so that both the affected organ(s) and the nerves that serve the organ are treated.
Whilst the philosophy and mechanism of action are considered to be similar in many styles of general reflexology, some schools teach a method which is more closely linked to the meridians of Chinese medicine, based on the notion of energy lines (meridians) linking one part of the body to another. This type of reflexology requires an understanding of Eastern philosophies and knowledge of the meridians as used in acupuncture. It includes Chi reflexology, a relative newcomer, which was developed by Moss Arnold, and the ancient Five Element reflexology incorporating yinyang balance and the elements of fire, water, metal, wood and earth. A Japanese form, Zoku shin do, thought to be over 5000 years old, also focuses on yin–yang harmony and balance. Vacuflex reflexology™, a modern system of treatment, combines meridian rebalancing and reflex point stimulation via suction boots on the feet, and suction cups on other parts of the body attached to a suction pump.
Some forms of reflexology use techniques in which the pressure applied to the foot is adapted to suit the theory underpinning the particular school of thought. The Advanced Reflexology Technique (ART™) devised by Tony Porter focuses on the precise texture of reflex points, with pressure being deeper than in many other styles of reflexology, although that used in RZT is considerably firmer than in generic reflexology. An even firmer pressure is used in the Taiwanese Rwo Shur, in which treatment is applied using not only the hands but also wooden or plastic bars and a special cream to reduce friction. Conversely, in Morrell reflex touch, an extremely light touch is used to activate both neurological and energy pathways, and the more contemporary Gentle Touch Reflexology™ is based on a belief, similar to that in homeopathy, that the more gentle (or ‘dilute’) the application, the more powerful it becomes. Other variations relate to whether or not creams, lotions or implements are used in the treatment: ART™ involves the application of special cream to enable the practitioner’s hands to pass over the client’s feet without friction, whereas in reflex zone therapy, creams, lotions or talcum powder are avoided, as it is felt that they may mask signs which can be clinically significant, e.g. the odour of the feet or the amount of perspiration on them.
Several styles combine aspects of other therapies, for example SMART Ayurvedic Reflexology is a blend of the reflex maps of foot reflexology and a special foot massage routine used in Indian Ayurvedic medicine, using oils selected according to the individual’s energy balance and incorporating meridian work. Other styles are emerging in which the reflexology maps of the feet are used as a medium through which to apply different therapeutic interventions, as in Foot-applied Bowen therapy (see Ch. 14). Coordinative Reflexology, an Israeli therapy devised in the 1980s, incorporates a series of flowing techniques similar to dance and may involve treatment being given by one or two practitioners. Integrative reflexology encompasses the zones and reflex points of traditional reflexology, as well as the inter-relationships linked by the body’s meridians and proprioceptors, together with structural alignment techniques based on the manual therapy of rolfing. Structural reflex zone therapy (see Ch. 14; Tiran 2009) is theoretically based both on the principles of RZT and those of osteopathy, in which the body is assessed in terms of musculoskeletal misalignment, and the reflex zones on the feet are used as a medium through which to realign any significant deviations. Adapted reflextherapy (see Ch. 11) is also based on the RZT model, but has a specific application to physiotherapy practice, although it can be applied to other clinical specialisms if appropriate.
These many styles each differ slightly from each other, which can be challenging to practitioners and confusing to sceptics who seek to denigrate reflexology and to reject the notion of a cohesive profession of reflexology. At an academic level the variations between styles can be exciting and fascinating, but one could argue that, until we have a greater degree of uniformity within reflexology, we are in danger of never being able to standardise practice, theory or research, since different practitioners may approach their work from different perspectives from that of their colleagues. The charts used by different schools have minor or – in some cases – major variations, with reflex points varying considerably, which has to be a fundamental issue needing resolution before we can develop further. Perhaps what we can see evolving in contemporary practice is a range of different therapies which are based on reflexology, but which are, in fact, individual therapies in their own right.
Diagnosis and prescription
The issue of whether or not complementary practitioners should ‘diagnose’ has hitherto fuelled much debate, not just amongst reflexologists. The word ‘diagnosis’ originates from the Greek dia meaning ‘through’ and gnosis meaning ‘knowledge’ and an ‘investigation or analysis of the cause or nature of a condition’ (Merriam Webster Medical Dictionary 2009), ‘the discovery and identification of diseases from the examination of symptoms’ (Collins Online Dictionary 2006), or, more recently, ‘the act or process of identifying or determining the nature and cause of a disease or injury through evaluation of a patient history, examination and review of laboratory data’ (American Heritage Dictionary of English Language Online 2009).
In relation to complementary therapies in general and to reflexology in particular, the UK situation regarding diagnosis by therapists is compounded by the European Community’s reliance on Napoleonic law in which the term ‘diagnosis’ refers to a process undertaken only by qualified medical practitioners. However, ‘analysis of the cause or nature of a condition’ does not necessarily imply attaching a specific title or label to a set of signs and symptoms, but can apply in general terms and to that part of the process which leads to a conclusion. In medical practice, it is not always possible for a single individual or discipline to reach a conclusion in isolation, and a team approach may be needed to document the data and combine their ideas in order to reach a diagnosis. There are, in addition, different categories of diagnosis, including ‘clinical diagnosis’ based on signs, symptoms and laboratory tests, and ‘differential diagnosis’ whose signs and/or symptoms are shared by various other conditions. A contemporary list expanded to include allopathic diagnosis, complementary diagnosis and reflexology diagnosis would enhance the diagnostic potential for clients by drawing on the individualised skills of a multidisciplinary team (see Case Study 7.1).
A general practitioner (GP) referred a young mother for reflexology for migraine and depression. Initial assessment identified a constant ‘fuzzy’ head, ‘gritty’ eyes and perpetual tiredness to add to her depression, and inspection of the feet revealed a candidial infection of the toenail. During the next four treatments the reflex area for the thyroid gland became progressively more tender and palpable. The reflexologist sent a letter to the GP suggesting blood tests for thyroid dysfunction. However, soon afterwards, further research during a programme of personal study caused the practitioner to appreciate that all the mother’s symptoms, including the toenail infection, were signs of underactive parathyroid glands (indistinguishably in the same reflex area as the thyroid) and he contacted the GP again to suggest tests for parathyroid gland function, with subsequent positive results. Vitamin D treatment was commenced along with continued reflexology and the client quickly recovered and progressed. This demonstrates the integrated diagnostic power of reflexology and conventional medicine and the importance of continuing professional development.
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