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Reflexology Research Doesn’t Put Its Best Foot Forward

While a foot massage can be relaxing, reflexologists use low-quality studies to justify fancy health claims

Imagine you have appendicitis. You are rushed to the hospital where a surgeon needs to operate on you to remove your appendix which is full of bacteria and ready to burst. Only, instead of a classically trained surgeon, you are operated on by a doctor who studied the Morrell method of surgery, where they were taught the appendix is in the right thigh. Meanwhile, at a hospital across town, a different surgeon uses the Vaxuflex method of surgery, which uses a map of the body where the appendix is underneath the clavicles. One thing both surgeons agree on: they can help you.

What I have done is to transpose the absurdity of reflexology onto medicine to showcase one of the many problems with this practice. Reflexology is based on the claim that the body can be divided into zones that have their endpoints in the hands and feet. You can visualize various bits and pieces of the human body—the eyes, the lungs, the bladder—with little strings coming out of them, and these strings descend all the way to specific points on the soles of your feet. They are “reflected” there, hence the name. By pressing the bladder spot on the sole of the foot, you would, according to this eyebrow-raising theory, stimulate your actual bladder, like a puppet master moving a marionette around.

Because reflexology is used in the health space, it is surrounded by a thick cloud of claims: that it can relieve stress, help with insomnia, treat all manner of diseases and conditions (including rectal prolapse!). And, of course, you will never run out of testimonials from people who swear by it.

Reflexology is also a reflection of every complementary and alternative “medicine” under the sun, and by looking at it from different angles we can learn what distinguishes it from evidence-based medicine and why its semblance of effectiveness has sustained it for centuries.

First, there are the implications of reflexology if its theory is true. If every organ in the body maps onto the sole of our feet and the palm of our hands, and these organs can be supported by pressing on these discreet spots, what happens when we walk? when we grab objects? when people go rock climbing? when a boxer punches a bag and their fingers press into the stomach and liver areas? Either we would be injuring or healing our inner organs every day simply by interacting with the world.

Then there’s the issue of the maps themselves. They disagree with each other. The idea of pressing down on hands and feet to treat illness dates back thousands of years, but the modern birth of reflexology is traced in its literature to Dr. William Fitzgerald, an ear, nose and throat doctor, who claimed to discover that these pressures could cause partial anesthesia and thus allow him to perform surgery without anesthetics. He and a man named Edwin Bowers published about this “reflex zone therapy” in 1917, and people in the ensuing decades refined and changed his theory. We thus ended up with a number of methods: the Ingham method, the metamorphic technique, the Morrell method, Vaxuflex reflexology, holistic multidimensional reflexology, and others. And their maps of which part of the foot to press to reach the right organ don’t all agree, like telephone keypads with some of the numbers mixed up. There seems to be particular disagreement over where the pituitary gland, the solar plexus, and the heart can be accessed. The heart! That’s never a problem for cardiologists, but reflexologists from different schools of thought simply agree to disagree.

Something else that distinguishes reflexology from science is its unfalsifiability. Philosopher of science Karl Popper famously proposed that real science is distinct from fake science because it can be falsified or proven wrong. It turns out that this is an overly simplistic solution to a complex problem, but whether or not a claim can be shown to be wrong is certainly something to keep in mind when trying to determine if it is scientific or reliable. Reflexology simply cannot be wrong. First, it has been claimed that it is impossible to treat “inappropriate” zones on the feet because all zones have an effect on the body. Even if you massage the wrong area, all organs are linked, so the healing process will reach where it needs to go. But more boldly than that, some reflexologists claim their intervention can cure future problems! Therefore, if you think a session of reflexology was not beneficial to you, it may only be because you don’t know about the future stomach upset it helped prevent. Neat trick.

The idea that the body is separated into zones that end in the hands and feet is simply not supported by medicine, but that has not stopped reflexologists from guessing as to how their specialty might work. Maybe it’s tapping into acupuncture meridians (also not a thing). Maybe diseased organs launch crystals of calcium and of uric acid down nerves and they deposit on the soles of the feet, and reflexologists can break them up with their hands. Maybe this pressure sends signals up the nerves that silence pain signals. Speculating on possible mechanisms of action is easy but it does not mean much if the technique itself is shown not to work. So does reflexology actually work?

A body of evidence dead on its feet

To say that reflexology has been understudied would imply that more money should be spent researching it. But the number of scientific studies of reflexology is not enormous. Still, a fair number of systematic reviews of this evidence have been published and they highlight how junk science can appear convincing. Yes, some studies of reflexology report positive results. But when we dig, as the systematic review authors did, we find what’s going on underneath the surface.

Some studies compared reflexology to nothing. Imagine being a cancer patient who is in pain and getting either a relaxing foot massage or nothing. I too would feel better after a bit of reflexology. A study like this cannot tell you if there is something specific about reflexology—about the discrete spots the therapist must apply pressure to—that works. Many studies don’t mention if relaxing music was playing or if candles that smell good were burning. Those will certainly lift your spirits, especially if the only outcome that is measured is subjective: how do you feel? how is your pain? how is your quality of life? Many studies don’t do a long enough follow-up. It is easy to imagine that people undergoing reflexology for a chronic condition may feel temporary relief simply because the symptoms of a chronic condition wax and wane over time. And most studies do not state which type of reflexology (think Vaxuflex or Morrell) was tested, making comparisons between studies a tad treacherous.

That is why a common refrain in those systematic reviews is “low” or “poor quality.” This often means that the majority of so-called scientific studies of reflexology involve too few participants, often somewhere between 20 and 40, who are split into two groups. Moreover, there is the risk of bias in the data, which is often high. This is when the results can hardly be believed because, for example, the participants knew if they were receiving reflexology or nothing (so they were not “blinded”). Any intervention can be shown to work if you throw rigour out the window and invite chance to roll the dice.

The scientific evidence we have to date does not allow us to conclude that reflexology works for any condition. I can see how a session of reflexology would be relaxing, which is not to be dismissed, but there is nothing special about reflexology in this regard that you can’t get from a regular massage. The potential harms of reflexology, on the other hand, are the same found in its siblings, like homeopathy and Reiki. Some practitioners resolve themselves to only treat clients who have mild ailments, like the occasional headache or a stressful job. But others seem to believe they have god-like powers, and why not? If you truly believed you could stimulate healing of the heart by pressing on someone’s foot, might you not get drunk on this potential? The literature reports anecdotes of people not getting a proper diagnosis for a severe medical condition in time or even getting a scary diagnosis from a reflexologist that turned out to be bogus. Few studies even attempt to measure “adverse events,” meaning bad side effects that could potentially result from reflexology. It’s easy to declare something safe if you never check for problems. And of course, there’s the money. Reflexology is not free, and some even sell sandals and (at least back in the 1990s) steering wheel covers to allow you to practice reflexology on the go!

This bit of empowerment can feel great, especially if you’re struggling with a painful chronic condition, but one sentence I read about this made me pause: “Many patients choose [complementary and alternative medicine] as a way to empower themselves in the management of their illness and thus may not be seeking evidence of efficacy.” I will leave it there without comment.

My final observation on the topic of reflexology is that pseudoscientific therapies can earn undue credibility simply by withstanding the passage of time. All of the bare-bones credentials of reflexology—the fawning testimonials, the positive studies, the irrefutable claims—can be replicated with a made-up, hands-on therapy. Today, I could start a school training prospective healers in the ancient art of “bakovdeneeology.” In this system, the entire body maps to the back of the knee. By playing pleasant relaxation music, lighting some candles, and massaging the specific spot on the back of the knee that connects to the defective organ, I guarantee you my therapists will help your body heal itself. We will have low-quality studies with positive results. We will publicize abundant testimonials from satisfied customers. And if you claim ten sessions of bakovdeneeology did nothing for your insomnia, just think of the future anxiety we helped prevent! Oh, you will feel anxiety in the future but less than would have happened without our amazing therapy. That’s our guarantee.

Our therapists will wait on you hand and foot, just like reflexologists!

Take-home message:
-Reflexology is based on the false claim that every organ of the body maps to the sole of the feet and the palms of the hand, and that applying pressure to a specific spot will help the corresponding organ heal itself.
-Reflexology may look like it works because it is relaxing, because unreliable testimonials are used to publicize it, and because tiny studies that lack rigour report encouraging findings
-Systematic reviews of studies of reflexology report that we cannot conclude that reflexology works for any health condition


@CrackedScience

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