Podiatry Arena members do not see these ads

From the latest edition of the Medical Journal of Australia.

__________________
*****************************************
Remember, it's just a foot.

Related thread:
Systematic review of the efficacy of reflexology
Other threads tagged with reflexology

__________________
Are you addicted to Podiatry Arena?
Have you added your location to the map? (Map FAQ's)
Earn CPD Points

Well who woulda thunk it!!! All we need now is the RCT study for how Chiropractic cures asthma!

Quackwatch sum it up as:

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

I think we need to have a holistic view around health care. I believe reflexology along with many alternative therapies have their place in the health care system.

Stop running scared from it all and maybe give it a go.

The evidence says its useless. I prefer not to defraud my patients.

Running scared? There is nothing to be afraid of - it doesn't do anything!

Hi DaVinci

"The evidence says its useless. I prefer not to defraud my patients."

Kinda find that last part of the above statement somewhat inappropriate. Equally I'm not sure I can concur with the first part of the statement. I no longer practice Reflexology as a part of my business but regular use it on family members and occasionally on friends.

When using it as part of my business I would argue strongly that no attempt was made to defraud anyone ( its benefits and limitations made clear to all who partook of it). Whilst the above trials may well take a negative view a number of medical books based around hospice work and hospital practices (now given away rather untimely) would not have concurred with the above conclusions as being the final word.

Is the relaxation factor a strong component. Yes, undoubtedly, it is one of the components. Did it help people with IBS, absolutely. I guess you could send people to the medics and get prescriptions of internal medication with its possible side effects or you can, if you have the skill, do reflexology and possibly gain them benefit without the side effects. Personally, I feel that my understanding of the healing mechanisms of the psychosoma are far to limited to make such profound statements as you have made above.

Then again I come from a esoteric background so you could put my valuing of reflexology down to delusion I suppose!

Now, as to how Reflexology may or may not work, that could be a different discussion of course.

Cheers
Ian

Ian ... I think Davinci is just being a provocateur.

I go where the evidence takes me. Just because the evidence tell me reflexology does not work, that does not mean a good foot massage does not have health benefits due to relaxation. Its just the way "reflexologists" dress it up that is probably the problem.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

At the risk of shocking those who know me, I can't agree with the op.

Granted that the mode of action for reflexology owes more to history and imagination than deduction and science. And granted that it does not stand up to placebo trials. But is that the same as it being ineffective?

One of the thing which frustrates me about alternative or complimentary medicine is the lack of ambition on the part of it's followers to investigate or even try to understand the mode of action. Placebo seems to be a dirty word, yet it can have a real physiological effect and cause improvement in many, many conditions. It's a complex psychological effect which is not fully understood. Some studies for things like back pain and headache have a placebo rate of 40% or more. That's huge. They're surrounded by data in the form of all the myriad complimentary therapies people get better from, yet they don't try to understand how or why their weapon of choice works!

Meanwhile, in the other camp, we dismiss things as ineffective because the rather silly mode of action... Ignoring the fact that the treatment does have an effect.

Seems to me that both sides rather miss the point.

I must be mellowing.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."

Come Come Robert - you are mellowing.

I take the view that anything which causes an individual to feel better and does not cause harm cannot be a bad thing. However, to claim that a treatment which all the RCTs have shown to be ineffective per se, "does have an effect", is missing the point. As you rightly say, the only effect is the placebo effect and going naked in the garden at full moon and turning 3 times widdershins may well have an indentical outcome (never tried an RCT on that one). Thus, by logical analysis, if reflexology has only a placebo effect, then the placebo is the effect and reflexology as a treatment has no direct effect at all.

I recall the claim by reflexologists that hard skin was created by exudates due to nephropathy 'leaking' from the skin of the foot. Ever heard of a patient undergoing kidney dialysis having their plantar keratoma spontaneously shed?

All the best

Bill

Hey Bill.

I think I must be! Run a marigold thread and we'll see for sure .

Kinda depends on "the point"! I've not read the studies but I rather suspect that the ones who showed it to be ineffective did no such thing. I suspect they showed it to be only as effective as the placebo. But that, like it or not, is still an effect. The midnight cavort may also have an effect! Placebo is a powerful effect and it needs something to "ride in on". Some things are more effective than others.

Depends how you break it down. Is a placebo, or to be more specific the psychological effect, of a treatment of itself or the way a treatment works. If its a treatment in its own right then I'd agree, I don't beleive reflexology has any other effect. However if you consider the effectiveness of any treatment, mainstream or alternative, to be comprised of x % direct and y % placebo then the placebo is a valid part of the treatment. And who can separate the mind from the body? Well the French revolutionaries had a machine for it but you see where I'm coming from.
And its that sort of thing, and many complimentary therapists seem very prone to it, which keeps them out in the cold. As long as they just make stuff up which sounds good and has no basis in reality, how can they be taken seriously.

Mind you, I can think of a few podiatrists who do similar with biomechanics!

Regards

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."

Whilst I concur that the placebo effect may play a part in much mainstream medicine, off the top of my head (Mon Dieu), the administration of epinephrine to an unconcious patient will have the same effect as administration of the same drug to a concious patient. There are many similar examples which can be demonstrated by RCTs and other acceptable means.

Walter Raleigh is famed for observing the axe on on the scaffold just before his napper was removed and stating "'Tis a sharp remedy, but a cure for all ills", so he beat the Frogs to it by 300 years!

Cheers

Bill

Hey every one of us performs massage and can be labelled as a healer - my point is when a child fall or hurts themselves what do we do - rub it better!!! As with reflexology another form of massage ( used since times of zzzzz) does indeed have a postitive effects on the psyche similar to the placebo effect ( which is a treatment in itself). In my business I provide medical care and complementary therapies such as reflexology - I never use this as a diagnostic tool as this is unethical, not vaidated or indeed proven effectively on the research arena. I should know as a 3rd year Research Student....

BUT if it helps my patients ie as in increasing healing times, providing a stress free treatment ( I use for calming children and in learning difficulties rather than just diving in to treat their feet) WHY not? I am not deceiving anyone, never make stupid claims, but use it as another modality - hey I may do a research project on this topic!!!

ANyway don't slam any treatment until either you have tried it, seen case studies or seen the research ( if it is indeed valid).

Hey Tracy

Firstly, Kudos for having the guts to come onto a thread which is mainly anti and take a different view. Shows integrity and courage .
I personnally would disagree that the placebo is a treatment in itself. Nobody ever comes to you and says "can i have a placebo please". I think placebo is one of the ways in which many treatments work (excluding Bill's coma patient of course).

The closest thing to a "pure" placebo treatment IMO is Hypnosis (which I do use). It is not really accurate to say that hypnosis is a placebo, more that any placebo is a form of hypnosis. Hypnosis, in the broader sense of the word and with the modern "non state" interpretations incorperates many areas of suggestion and many other complimentary therapies use very similar methods.

The difference is that hypnosis sets out its stall as a psychological treatment which uses subconcious suggestion to affect change, other complimentary methods use the same subconcious methods, but less overtly.

More power to you! I've never had a problem with this sort of thing as a compliment to mainline therapy, its when its advertised as an alternative that I consider it ethically dubious (as in Dr Khan pushing homeopathy as an alternative to surgical management of HAV.)

Now here, as a research student, I suggest you should know better. The onus is on any treatment to prove its efficacy, not upon the critic to prove its lack thereof. Reflexology has failed to prove the claims it makes for itself and as such I think it is reasonable to slam it! And from the point of view of academic debate (which is what a thread such as this constitutes) having tried it, or indeed seeing case studies, is of profound lack of relevance.

If I said that I used Bill's Idea of
And it cured my personality defects, and further that I recommended it to patients (for a price) you would not need to provide research, nor try it yourself to tell me I was a wassok.



BTW Tracy, have I met you? Your name seems familier.


One of the reasons I don't think we can simple say "its not effective." There are conditions such as IBS, blood pressure, LBP etc where relaxation could reasonably be said to have clinical benefit. Reflexology involves quite deep relaxation. QED.

Regards

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."

The only definitions i could find regarding reflexology were along the lines of the following:
- massage to relieve tension by finger pressure; based on the belief that there are reflex points on the feet, hands, and head that are connected to every part of the body.
- This ancient Chinese therapy uses finger-point manipulation on pressure points in the soles of the feet, which correspond to a different part of the body.

My question is how many "Podiatrists" are actually practising reflexology? if you are then perhaps you need to confirm that your insurance covers you to be treating outside of your chosen field (I am also interested to know how many patients come to the Podiatry clinic for IBS and the like). Therefore are you practicing the art of reflexology or are you using a form of massage or trigger point therapy?

i guess i am confused as to why people are jumping to the defence of reflexology, yet nobody has made a substantial link to using it in its traditional form (as per its definition). There has been a lot of talk around placebo effects but i fail to see how this relates specifically to podiatry and reflexology. i understand we need to view the patient holistically however if somebody is experiencing symptoms outside our scope of practice why are we not referring them?

this is my first post on Pod Arena so please be kind in reply.

Regards
Kurt

Hey Kurt, welcome to the arena. May your stay be a long and happy one .

Fair question.

I suppose if somebody has trained as a reflexologist they would consider these things to be within their scope of practice as a reflexologist. I suspect most people who consult reflexologists are ALSO under the care of the medical team. If not then they should certainly be directed there first.

Back to the issue of alternative medicine vs complimentary medicine.

Welcome again

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."

Hi Kurt

Well said! And, I suggest, referring them (maybe via the G.P.) to the medical practitioner best able to treat the presenting complaint. This means not sending the patient to an individual who 'treats' gall stones by placing crystals on the skin overlying the part. Like so many 'complimentary therapies' this is sympathetic magic and we should have left it behind in about 1600. Following the same philosophy, in Anglo-Saxon Britain infection could be treated by hanging a bag of dog excrement around the neck. Since the RCTs regarding relexology have demonstrated no effect, other than placebo, we do not have to carry out an RCT on dog excrement to show that it will have a similar effect. Now there's a tip for the merry complimentary band!

All the best

Bill

Dear Bill,
The dog excrement in a bag around the neck is new to me and sounds as though it may have some positives as a therapeutic tool. Tracy.....how are things in Wales? I remember you kindly from June 2007 in Glasgow. The power of belief in something can be enough for some to produce a subjective beneficial effect - if you think its making you better you tend to feel better. Some people believe there are fairies at the bottom of their garden - an uncle in Australia had duck-bill platypuses at the bottom of his - I have seen convincing evidence that the strange marsupial does exist; although I have never seen the fairies, it doesn't mean they don't exist - just that I haven't seen them (...yet!)
Regards from Dublin.

Certainly not wanting to get into debate about this area as it is pointless but here is a little something that is a conundrum for me and may take the discussion a little differently.

If I now take what is purported to be the best research evidence (as OP) it could be considered that I should cease attempting any form of reflexology improvement for an individual, even if that improvement might only be considered as placebo. However, if I take the other part of Sacketts definition of EBM and consider my more than 10 (clinical?) years of using reflexology with frequent benefits for people with, e.g., IBS and over that 10 years the areas of discomfort in the foot have consistently corresponded to areas representing that part of the body in which IBS resides then I should take notice of this. Neither alone is enough.

Here in is the conundrum. My experience in this has been consistent for many years - to a point where I cannot morally ignore or decry it because it does not fit within an acceptable scope of medicine or practice or because it may confirm others views who may consider me involved in quackery or snake oil.

Do I deny my own considered experience and dismiss what for me has been consistent and effective treatment approach because of RCT's? Should I consider the RCT's to be the definitive comment on something - even though they are counter to my own considered experience?

To leave something behind because of increased or new insight is not a problem for me, however, neither am I convinced that scientific rationalism is necessarily "right" and the tools it may use to assess something is always.

To blindly deny the results of the RCTs would be foolish, churlish and reflect lack of consideration. To dismiss 10 years of experience strikes me as being equally as foolish

Interesting conundrum. At least for me!!

Ian

You can't beat a bit of enthusiasm and superstition, nor should we ignore the limitations of the available science. To quote John Lennon: "whatever gets you through the night". Me? I'm generally Johnny Sceptical, I'm sure that it sometimes shows a little bit on the odd occasion. However, I've had reflexology on a few occasions and on each occasion there has been point sharp pain in an area of my foot allegedly corresponding to an area of my body that has been a bit poorly at the time, which the reflexologist was not made aware of by me. Perhaps the reflexologist took a look at me and worked out I'd got a mild urinary tract infection and pressed a bit harder there, perhaps the other one knew I had ear-ache, but it certainly felt completely different to me and I certainly didn't tell them. Now, I don't think you can treat lung cancer with reflexology. But, at the same time I am intrigued, as I was when Howard D had fun with the Chapman's reflex points at my pubic region as to why the pressure/ pain which I was able to reproduce myself in those areas felt completely different to equal pressure exerted on the rest of my foot? Acupuncture and accu-pressure are interesting areas, I see reflexology as an extension of these.

BTW have you noticed patients that smoke with really deep, really painful corns in the area of the foot that allegedly corresponds to the lungs? Just an observation I've made over the last couple of decades. However, I smoke and I don't have a corn there.

I've learnt many things on the road, not least that there is more about this world that we don't truly understand than that which we do. What I really want to know is how Derren Brown predicted the balls that were going to be drawn in the National Lottery on Wednesday so that I can stop thinking about all of this stuff and go away and live a life of luxury.

__________________
Science is the antidote to the poison of enthusiasm and superstition

My location

It was clever wasn't it!

Here's my prediction. The balls change half way through the show so i suspect a rack of balls is inserted via some kind of camera trickery. Either that or the tube base of the pedestal has some gimmick which shoots balls up the middle! How did he get the right numbers? Well he said about the year of his life so my bet is that it will be a similar thing to the coin toss trick in "the system" where he had to shoot many, many versions to get the right one. How he made it live I have NO clue.

I don't think the theories about LED balls or etching the numbers are his style but the balls definatly found their way onto the rack AFTER he turned the TV off.

Or it could be far simpler, that the lottery draw is actually not shown live but recorded a few hours earlier, before the tv show but after ticket sales stop. I'm sure I heard that somewhere. I'll be disappointed if its that

Either way Its Damn clever. The show beforehand where he reproduces psychic tricks making it very clear that they ARE only tricks was good too.

Roll on 9pm

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

"The story so far: As usual, Ginger and I are engaged on our quest to find out what the hell is going on and save humanity from my nemesis, some bastard who is presumably responsible."

To quote the wife's favourite band "could it be magic?" My reply: "No", but their recent stage production is to be commended. BTW the title of this thread infers that they have tested the efficacy of reflexology in the treatment of every known condition. This clearly has not been done. I am growing very weary of systematic reviews. Go away and do some good quality original research, rather than concluding that the research that has been done is of poor quality- just a thought, as I am capable of reading and judging the quality of the research for myself, without you publishing a paper to tell me that, but thank you very much for your efforts. Like I said, I need to win The Lottery.

__________________
Science is the antidote to the poison of enthusiasm and superstition

My location

Hi Simon

Intrigued by your comments. Its possible we might even have a valuable conversation around the whole area if we ever met. Certainly Robeer and I have chewed the cud a few times on such issues and he still speaks to me!!!

I don't actually subscribe to the 12 zones of energy approach of Reflexology and I'm sure my own limited thoughts are not for here but there is an intrigue about the thing.

Ian

You are probably only intrigued by my comments because they are not in line with your preconception of what you thought my comments would be on this topic. Despite the fact that you don't know a great deal about me. That is not a bad thing, just an observation. I was born sceptical and moreover born to take things apart to find out how they work, which is what I have spent my life doing, from toy cars, to radios, to engines, to... theories of foot function etc. When I find puzzles that I can't find the answer to, I get really interested. Working out how to test the stiffness of foot orthoses is a piece of piss because it obeys the laws and I already understand how that works, therefore it is interesting, but easy. Working out why reflexology points are "hot" is not so easy, so it is really interesting. I don't spend too much time on these topics, because they don't pay the rent. But, nevertheless every now and then I'l look into it a little more, only to find I still can't take it apart and put it back together again. When I finished podiatry school I won a prize for my research that consisted of some book tokens- I purchased a book on reflexology because that subject had been taboo at podiatry school, as I said earlier today: I don't toe lines. But, neither do I have the answers to this topic. I said to Robert earlier this week that I believe that breadth of reading is important. That is, depth of reading is not everything. My chemistry teacher used to tell the story of the little yellow bird that flew in ever decreasing circles... I'm rambling now. Suffice to say, I don't think that reflexology can treat anything particularly, other than by relaxation, but I am interested in why these spots become "hot".

And I truly do believe that science is the antidote... There is nothing wrong with the scientific method, it's us scientists that are flawed. Enter religious quote of your choosing... Or, "whatever gets you through the night".

"No monster me, sadly no saviour either... " - Stockholm, New fast Automatic Daffodils, from the album: body exit mind. Go figure as our American comrades like to say. But hey, they can't say bum-bag.

__________________
Science is the antidote to the poison of enthusiasm and superstition

My location

Is there any scientific research that shows reflexology does anything more than give someone a good feeling from their foot massage? To my knowledge, there is none.

Therefore, until the research does show clinical significance, or until someone can provide us with a reasonable physiological explanation of the proposed mechanism of reflexology, I will remain a non-believer in reflexology and tell my patients that ask about reflexology that it does nothing more than a good foot massage does for someone.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

There are a whole host of studies which suggest that reflexology might do something, unfortunalty, like many of the studies in our own field of interest, foot orthoses research, many of them don't meet the "gold" standard. See Pratt DJ (2000): A critical review of the literature on foot orthoses. Journal of the American Podiatric Medical Association, Vol 90, Issue 7 339-341. http://www.barefootscience.com/data/research/Ar06.pdf

Here's one that looks OK, I only briefly scanned it:
http://jdc.jefferson.edu/cgi/viewcon...=nancy_hodgson

Here is yet another systematic review published last year:
http://www.ncbi.nlm.nih.gov/pubmed/18489444

__________________
Science is the antidote to the poison of enthusiasm and superstition

My location

"You are probably only intrigued by my comments because they are not in line with your preconception of what you thought my comments would be on this topic."

Not at all. Having discussed this with scientists of various ilks in the past, as well as religious thinkers, I am interested in anyones thoughts on the matter.

Preconception about people is something I long ago learnt to try and minimise. Guess it comes with the territory I've had to walk in life.

Cheers
Ian

I don't have any doubts that foot massage has therapeutic benefits. However, the claims that reflexology can cure various systemic ailments or that reflexologists can somehow diagnosis systemic conditions by analyzing the bottoms of feet, seems rather "Rothbartish" to me.

Attached Images

reflexology.jpg (85.2 KB, 231 views)

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hi Kevin

I think claims are probably determined by a number of things:

Some less robust schools of Reflexology training
Popularist reflexology books that may not have medical understanding behind them
Lack of broader medical reading by practitioners post their training
Not enough exposure by practitioners to other schools of thought

When I trained it was made clear that diagnosis of a medical condition was not occurring and most people I know who practice it would hold that view. Many of course may not.
Ian