Reflexology originates from ancient Chinese, Indian and Egyptian techniques, and the practice reached Europe in the fourteenth century. The modern reflexology profession evolved from the early twentieth-century work of William Fitzgerald, who recognised the principle of ‘zone analgesia’ and investigated widely in order to define the ‘maps’ of the reflex points on the feet and hands. The American masseuse, Eunice Ingham, developed one of the original ‘maps’ and produced the first of the modern reflexology charts, while the German midwife, Hanne Marquardt, further refined the reflex zone concept. In the UK, contemporary reflexology is classified as a ‘supportive’ therapy (House of Lords 2000) with the implications (1) that it is a complementary therapy rather than one which can be used in isolation, and (2) that there is a relatively limited body of research evidence (compared to other therapies). Reflexology is progressing towards voluntary self-regulation through the Reflexology Forum, which has defined a common core curriculum and the requirements for continuing professional development of qualified practitioners (see Ch. 3).

It is claimed that reflexology helps to restore and maintain homeostasis, to be relaxing, destressing and to relieve pain, and there is much anecdotal evidence to support this. It has been said to aid circulation and excretion, reduce inflammation, balance the nervous system and even improve muscle tone, ‘through nerve stimulation’ (Crane 1997:xii–xv). Some consider that reflexology has the potential to assist, indirectly, in cell renewal and wound healing through increased circulation and other purported physiological effects. Reflexology treatment aims to facilitate the person’s innate self-healing processes, not merely suppressing symptoms but possibly also limiting the effects of disease.

We know, from observing clients, that reflexology is a powerful relaxation tool. Clients frequently report improved sleep and experience effects of treatment such as increased excretion of urine, stools or sweat, and an improvement in the presenting condition, or a temporary resurgence of old symptoms. These reactions are considered a ‘healing crisis’ which allow the body to rid itself of the negative effects of disease, in order to regain homeostasis, although this theory does not appear to have been extensively researched. Reactions also occur during treatment, including temperature changes, emotional responses and tenderness in parts of the feet apparently related to the presenting condition. Experienced practitioners will also notice changes in the feet as a result of the treatments, either visually or on palpation, or the client will report symptomatic reactions to treatment.

However, what we do not know, at least from a scientific perspective, is precisely how reflexology works, its mechanism of action, how it differs from other manual therapies, and – somewhat contentiously – which reflexology ‘maps’ or charts are accurate. It is these aspects which need to be clarified in order to raise the credibility of the profession of reflexology, especially in the eyes of conventional healthcare practitioners. A profession is characterised by a set of specialist skills based on a specific body of knowledge, acquired through formal education and continuing professional development, with advanced practice based on research evidence where possible. However, until there is agreement amongst reflexology authorities, with standardisation of theory and practice, it will be impossible to develop reflexology further as a profession. Teachers, practitioners and academics of reflexology remain unable to agree on the precise location of many reflex points and there are numerous different charts available, a fact which has provoked considerable debate for many years (O’Hara 2002; see also Ch. 7). Whilst it is professionally acceptable – and, indeed, desirable – to have academic debate which may lead generic reflexology to evolve into many different styles, the lack of consensus about the basic principles and the theoretical background from which we all work needs to be relatively uniform. Lack of consistency between reflexology charts is akin to having different textbooks for anatomy from which student doctors can select their preferred style.

Reflexology aims to treat through ‘stimulation’ of reflex points or zones on one small area of the body which appear to link involuntarily to others via a network of channels, neurones or transmitters. Reflexology is a touch therapy, in common with massage, shiatsu, aromatherapy or osteopathy, and many people believe that its therapeutic effects stem largely from the impact of touch in general, rather than working on any specifically identified points. Others suggest that any benefits arise from the placebo effect and/or the interaction between the client and the therapist. It is, of course, impossible to distinguish the effects of touch, nor those of the therapeutic relationship, from the overall clinical benefits of reflexology. Indeed, it is this very interaction which may make reflexology a definitive clinical modality which is distinctly different from massage or other therapies. If a client ‘feels better’ from having reflexology – and no harm is done – it is irrelevant, at least in human terms, how or why the treatment has led to this outcome. However, in scientific terms it is important to understand more about how reflexology works, as this will facilitate further developments and give us a deeper appreciation of indications for use, as well as contraindications and precautions for safe practice.