Human beings have always sought methods of easing discomfort. Whether emotional or physical, any feeling that is less than optimal drives us to find something to ease the pain.

Ancient literature is filled with formulas, descriptions of remedies, and examples of maneuvers and procedures aimed at easing pain. While many of these have been forever lost to history, such practices as reflexology have not only survived, but are enjoying a resurgence in popularity. Research focusing on this technique’s potential utility in pain management is increasing.


It is commonly believed that reflexology began in China roughly 5,000 years ago. The ancient Chinese, particularly the Taoists, were known to heal the whole body by tapping pressure points on the feet.

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However, reflexology actually might have originated in Egypt around 2500 B.C. Archaeological evidence unearthed at the tomb of Ankmahor, at Saqqara, details an elaborate foot treatment ritual.1 Surviving pictographs found in this tomb depict two seated men receiving massages on their hands and feet at some time during the Sixth Dynasty (circa 2450 B.C.).1 A series of hieroglyphic inscriptions beneath the images suggests a doctor/patient exchange.  

Although it is difficult to pinpoint precisely where the practice originated and how it evolved, one fact is clear. William Fitzgerald, MD, an American ear, nose, and throat specialist, significantly advanced the modern practice of reflexology.2

In 1913, Dr. Fitzgerald started studying what he called zone analgesia. He exerted pressure on specific body parts, or zones, in patients to determine whether this provided substantive — and lasting — pain relief. In addition he believed that applying pressure to regions of the foot corresponded to relief in other, more centrally located areas of the body. Fitzgerald’s research led him to divide the human body into 10 equal longitudinal zones running from head to toe.

Reflexology’s use of controlled pressure for analgesia may be as effective for promoting good health and for preventing illness as it may be for relieving symptoms of stress, injury and illness.1 Reflexologists today work from maps of predefined pressure points located on the hands and feet.1 In theory, these pressure points can affect bodily organs and glands.


Reflexology uses subtle pressure on specific muscle areas of the feet or hands to stimulate blood flow and nerve impulses that then trigger the release of endorphins and retained toxins.3 The majority of clinical trials examining the efficacy of reflexology have targeted conditions involving pain management and anxiety.

In a recent analysis of several randomized, placebo-controlled trials evaluating the efficacy of reflexology, the practice was found to be weakly positive.4 While objective data may not support the use of reflexology, subjective data were more positive.

To evaluate the potential effect of reflexology on conditions affecting 21 elderly nursing-home residents with dementia, researchers conducted an eight-week crossover controlled study.3 Participants were given either foot-reflexology therapy or no therapy, with groups reversed at four weeks. They were evaluated based on end points of physiologic distress (measured by salivary alpha-amylase), observed pain (by the Checklist of Nonverbal Pain Indicators), and observed affect (by the Apparent Affect Rating Scale).3

Persons in the treatment phase showed significant reduction in both observed pain and salivary alpha-amylase measurements.3   

In a small pilot study exploring the effects of reflexology on persons with advanced cancer, 17 patients completed the six-week protocol.5 Although no placebo control was used in this study, patients were all scored using the Hospital Anxiety and Depression Scale both before and after the six-week trial. The overall outcome of the study showed no statistically significant effects, but there was a positive notation of increased appetite and mobility in participants.5


Not unlike many other alternative therapies, no certification is required to practice reflexology in the United States.6 However, several accrediting agencies do exist, and completion of such a program is often considered a standard for being viewed as a qualified therapist by potential clients.

In 1991, the American Reflexology Certification Board was established, and training standards were set for a certification examination.6 Requirements for certification include a minimum age of 18 years, a high-school diploma, 110 hours of training including 10 hours of supervised practice, and performance of at least 90 postgraduate therapy sessions.6

Cost, safety

Reflexology therapy costs vary widely, but the average fee per session is $40 to $50. Many practices combine this therapy with other similar alternative practices, such as chiropractic treatment or acupuncture, so the cost is often a combination of more than one type of treatment.

No clinical trials noted found any adverse effects of the therapy. On the contrary, most anecdotal comments were positive. Subtle benefits such as the ability to perform reflexology without having to move a bedfast individual or remove clothing to access the foot are attractive reasons for geriatric and immobile patients to try the therapy.


When choosing any sort of alternative therapy, the first question is always safety. Having found no adverse safety issues with this practice, one could surmise that the worst outcome of reflexology would be no effect at all. Health-care professionals that support the holistic treatment of patients should have no misgivings about trying reflexology, specifically those who desire natural treatments.

Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.


  1. History of reflexology page. International Institute of Reflexology website.
  2. Norman L, Cowan T, Coran T.  The Reflexology Handbook: A Complete Guide. Little, Brown Book Group; London, United Kingdom: 2006:17-24.
  3. Hodgson NA, Andersen, S. The clinical efficacy of reflexology in nursing home residents with dementia. J Altern Complement Med. 2008;14:269-275.
  4. Ernst E, Posadzki P, Lee MS. Reflexology: An update of a systematic review of randomized clinical trials. Maturitas. 2011;62:116-120.
  5. Ross CS, Hamilton J, Macrae G, et al. A pilot study to evaluate the effect of reflexology on mood and symptom
    rating of advanced cancer patients. Palliat Med. 2002;16:544-545.
  6. Home page. American Reflexology Certification Board website.

All electronic documents accessed on February 5, 2013.