What Is Reflexology Massage? Can It Be Used in Cancer Patients as a Complementary and Alternative Medicine Method?

Reflexology; is a complementary, alternative medicine method involving pressure on certain points, usually on the feet (sometimes the hands), to relieve particular complaints. In reflexology, thought to have a history of approximately 5000 years, specific foot points are believed to connect through energy channels to certain organs or systems in the body, and applying pressure to these points is believed to provide relief in the corresponding organ/system.

However, no evidence has yet been obtained for these claimed connections and mechanisms of reflexology. Studies to date have focused on reflexology’s effects in reducing complaints rather than these connections and mechanisms. Some studies obtained positive results, particularly for pain and anxiety. However, these studies also have methodological deficiencies. In conclusion, reliable evidence for reflexology’s use in any clinical condition currently does not exist. Nevertheless, considering that it is also thought safe in terms of adverse effects, offering it to patients as an auxiliary care service may be considered.

What is reflexology?

Complementary and alternative medicine methods are occupying an increasing place, controlled or uncontrolled, in cancer patients’ lives. According to survey data from Europe, approximately 36% of cancer patients resort to complementary, alternative medicine methods. Reflexology, part of manipulative and body-based practices, is also generally one of the 6 most frequently used complementary medicine methods in America.

Reflexology is a complementary medicine method based on the principle of providing relaxation and healing by systematically applying pressure to specific reflex points, mostly on the feet and, in some practices, the hands. It is believed that certain energy channels pass through specific foot points and that pressure opens blocked channels, restoring balance in the corresponding organs, glands or systems. Some reflexologists also claim that tenderness or a sandy sensation felt by touching specific foot points indicates organ or system imbalance, meaning the method is also diagnostic.

History of reflexology

Although treatment by pressure on hands and feet is claimed to have first emerged 5000 years ago in China, the oldest evidence of use appears in Egyptian papyri dating to around 2300 BC. In Europe, it began spreading in the 14th century under the name “zone therapy.” In the early 20th century, Dr. William Fitzgerald, described as the father of reflexology, observed numbness elsewhere in the body when pressure was applied to certain bony projections and thought these reflex responses could be used as treatment. Later, physiotherapist Eunice Ingham mapped reflex points on the hands and feet, laying the foundations of today’s reflexology points. Reflexology subsequently became preferred by many people for reasons including safety, reliance on simple manual techniques without any drug or intervention, and ease of application.

How is reflexology performed?

Reflexology sessions generally last 1 hour and are given weekly. The setting must be relaxing. For a patient attending a first session, a thorough medical history should first establish current health and complaints fully. The patient should then be asked whether they have consulted a doctor about these complaints and, if not, told they should. It should also be stated that no medication should be stopped during this period without consulting their doctor. After the medical history, the reflexologist’s second step is carefully observing the feet. If a condition preventing the procedure is seen (such as a wound, edema, infection or vascular disease in the feet), it should not be performed. If observation raises doubts about health or suspicion of a specific problem, the reflexologist should not describe this to the patient, but only advise seeing a doctor, because reflexologists lack authority and competence to diagnose. After the session, the patient should also be informed about possible side effects and told to make contact if an unexpected effect occurs.

When reflexology is applied to cancer patients, the oncologist must be aware. Particular care is needed in those receiving chemotherapy, radium or hormonal treatment, and the reflexologist performing it must be fully qualified.

What is the mechanism of action?

Possible mechanisms of reflexology are explained through energy channel theory, lactic acid theory and neuromatrix pain theory. Energy channel theory argues that closure of energy channels disrupts balance in organs and systems and reflexology opens these channels to restore balance. Lactic acid theory holds that pressure and massage break down lactic acid crystals accumulated in the feet and increase energy flow. Neuromatrix theory is also the theory generally used to explain massage’s effects. In this theory, stimuli from touch and pressure are transmitted faster than pain, closing neural gates in the spinal cord and blocking pain transmission. Another view holds that reflexology relaxes patients simply as a basic care method, thereby reducing tension and stress.

What are the results of clinical studies on reflexology’s effects in cancer?

The literature contains many studies on reflexology’s effects in reducing complaints in cancer and many noncancer diseases. In cancer patients, the focus is particularly on pain, nausea, depression, anxiety and shortness of breath. Although many obtained negative results, some studies obtained positive results. However, these also have substantial methodological deficiencies. The only current conclusion about positive effects may be that reflexology reduces stress by providing general relaxation and benefits pain relief, even if briefly.

A review published in 2008 including 5 clinical studies evaluated reflexology’s effect in relieving cancer-related complaints. The studies were found methodologically limited for drawing a clear conclusion. Another review published in 2008 likewise stated that reliable evidence for any specific effect of reflexology in any condition did not exist, although it might benefit urination problems in MS (multiple sclerosis) patients. Another review published in 2009 evaluating 18 clinical studies concluded that convincing data for reflexology’s use in any health condition did not exist. A review published in 2010 involving breast cancer patients found benefit in reducing pain, weakness and nausea. However, the risk of error is high because of inadequate case numbers, inappropriate control groups and short observation or treatment periods. A meta-analysis published in 2015 evaluated self-administered reflexology after training for complaints such as stress, anxiety and weakness and parameters including blood cortisol, blood pressure and pulse, again concluding that evidence was insufficient to recommend its use.

In a comprehensive clinical study published in 2012 evaluating 385 women with advanced breast cancer receiving chemotherapy and/or hormonal treatment, physical function improved in the reflexology group, particularly with less shortness of breath. However, methodological shortcomings reduce the study’s reliability. Another clinical study published in 2010 involving 183 women with early-stage breast cancer showed significantly improved quality of life with postoperative reflexology. Because of the study design, however, attributing this to a specific reflexology effect is difficult. In two other clinical studies, in 2000 with 23 and in 2007 with 86 cancer patients, reflexology reduced pain intensity and anxiety, but these effects were short-lived.

In a small study involving 35 patients with metastatic (distantly spread) cancer in 2003, reflexology benefited pain reduction, but assessment 3 hours afterward showed no significant difference. Thus, it provided some pain relief, but the benefit was short-lived. In a study published in 2016 with 26 breast cancer patients experiencing lymphedema after axillary lymph node removal, reflexology applied to the feet provided some benefit for breast cancer-related lymphedema. In another study involving 17 patients with advanced cancer, one group received reflexology and another simple foot massage; both provided temporary relaxation, with no superiority of reflexology over simple foot massage. In another study in 2013 investigating effects on blood pressure, heart rate, heart rhythm and blood flow rate, reflexology had no significant effect on these parameters.

Is reflexology safe?

Because reflexology relies on simple manual techniques without drugs or interventions, it is considered safe. Apart from a few reports and warnings, there are no major reports of adverse effects caused by reflexology in the literature. Some studies reported effects such as weakness and changes in kidney and bowel function. A study involving 130 patients undergoing abdominal surgery applied reflexology from the day before surgery for 10 days, assessing effects on general condition and pain. It found that reflexology not only failed to significantly reduce pain but further triggered postoperative abdominal pain. Another study stated that repeated sessions might increase tenderness at sensitive foot points and cause minor additional discomfort. Some sources emphasize possible adverse effects such as fatigue, swelling at the application site and increased urination frequency, and that patients should be warned beforehand.

Conditions preventing the procedure include ulcers, infections, wounds-bruises, lymphedema, gout, peripheral vascular disease and deep vein thrombosis (clots in veins) in the treatment region. The most emphasized warning is that reflexologists lack authority and competence for diagnosis or treatment, and the method cannot be used as a primary approach to diagnose or treat any medical condition beyond supportive care.

So what should be done?

Clinical studies to date have obtained no significant findings that specific foot points correspond to particular organs or systems or benefit their disorders, as claimed in reflexology. Many studies examine its effects particularly on pain, anxiety, depression and shortness of breath in cancer patients, and some obtained positive results. However, these studies carry high error risks because of methodological problems such as inadequate case numbers, deficient control groups and differences in application. Nevertheless, considering its safety and study findings, although not sufficiently strong, of short-term relaxation and pain relief, it is a method that can be applied in safe hands that will not abuse it. Particular attention is needed to the fact that it cannot diagnose or treat any disease and may be used only as a care technique for relaxation.