Professional female massage therapist giving reflexology massage to woman's foot.

Reflexology is a technique used worldwide to promote such benefits as stress reduction, relaxation, pain management, overall health enhancement and improved body function.

Defined by the Reflexology Association of America as “a noninvasive complementary modality involving the use of alternating pressure applied to the reflexes within the reflex maps of the body located on the feet, hands and outer ears,” this technique can be a valuable addition to a massage therapy practice.

How Reflexology Works

Imagine a map of your body on your feet, hands and ears, with points, or reflexes, corresponding to each part and organ. Tissue changes noted by the reflexologist might represent congestion of sorts, which prevents the area or organ from functioning optimally.

Think of a car battery covered in corrosion, causing the car to run poorly—or not at all. When you clear the corrosion from the battery cable, the car returns to optimal working order. To achieve this type of effect with reflexology, specific touch techniques are employed, such as thumb and finger-walking (unique to reflexology) and relaxation techniques, which bring these areas back to a more normalized, relaxed state.

Client reaction during a reflexology session can range from falling asleep, enjoying complete relaxation or zoning out to being present throughout the session. Overall effects and changes, such as decreased pain, can vary from immediately post-session to a day or two after the session.

Circulation and nerve conduction are enhanced, and clients report a variety of conditions and disorders are ameliorated as a result of reflexology.

We also know energy can play a large role in the results achieved in a reflexology session, in providing needed balance to body and mind. Still, there is more to learn, and much ongoing research is being done to shed new light on other mechanisms of action to further explain just how reflexology works.

Although mechanism studies haven’t decoded reflexology’s effects, research has shown this technique to benefit a variety of clientele and conditions:

Effects of reflexology on premenstrual syndrome: a systematic review and meta-analysis

A Randomized Clinical Trial of Caregiver-delivered Reflexology for Symptom Management during Breast Cancer Treatment

The Effect of Foot Reflexology on Hospital Anxiety and Depression in Female Older Adults: a Randomized Controlled Trial

The effect of reflexology on pain perception aspects in nurses with chronic low back pain in Isfahan


The first written record of reflexology, and the basis for our current therapeutic techniques and theories, came from four people in the 20th century. William Fitzgerald, an American physician, first presented the Vertical Zone Theory in 1914, outlining 10 vertical reflex zones along the hands and feet, along with the theory that a sore spot on the hand or foot could mean an imbalance anywhere along that vertical zone.

Joe Shelby Riley, also from the U.S., later built upon that work by locating five horizontal zones. Paul Nogier, a physician from France, developed the map of reflex points on the outer ear.

Then, Eunice Ingham, an American physiotherapist and Riley’s nurse, further defined areas of the feet and how they reflected the body. She wrote Stories the Feet Can Tell, one of the first books about reflexology, in 1938. The Ingham Method of Reflexology is still widely learned and practiced.

The Technique in Action

Reflexologists share the intention of assisting clients in reaching an optimal level of balance in body, mind and spirit; however, certified reflexologists never diagnose medical disorders, treat medical conditions directly nor prescribe or adjust a client’s medication.

Some reflexologists work solely on the feet, while others include the hands, and still others work on the feet, hands and outer ears. Foot, hand and ear accessibility makes reflexology uniquely convenient. I once performed reflexology in a dentist’s office, for example, on dental patients during their procedures, and the added relaxation seemed to vastly improve their overall experience.

Many reflexologists use a massage table, while others choose a zero-gravity chair. Clients are clothed and sessions are tailored to each individual’s need, with sessions typically lasting one hour.

Reflexologists work in a variety of environments, including hospitals, spas and home offices. They partner with chiropractors, acupuncturists and massage therapists, and are often employed at integrative or other health-care clinics.

A Growing Profession

Many health-care centers nationwide are realizing the benefits of incorporating reflexology as part of their overall care. Linda Thompson, a rehabilitation nurse at Rady Children’s Hospital in San Diego, California, finds she can be “more effective and less invasive” by using reflexology, even taking time to teach the reflexology points as she works and explaining what each will do for her patients and their parents. This helps patients and parents feel more empowered, and it aids in their physical and emotional recovery, she says.

Reflexologist Marilyn Alling has worked with Dana Farber Brigham and Women’s Cancer Center in Boston, Massachusetts, administering 30-minute foot reflexology sessions while oncology patients are at their infusion bays undergoing chemotherapy. She says she has seen extreme nausea totally alleviated in one session.

“Patients look at you right in your face and say, ‘thank you’ with such calm, like they forget where they are and what they’re going through for a while,” Alling says.

Paul Harvey has practiced integrative reflexology as a clinical reflexologist at the Whitaker Wellness Institute in Newport Beach, California. There, physicians treat patients, many of whom are living with diabetes or cardiovascular ailments, using a variety of complementary therapies. Harvey works on hands, feet and ears, and says he has seen “truly rapid results” in a short time.

For Harvey, reflexology is a “catalyst, providing a more synergistic effect, helping the body more readily accept other forms of therapies and allowing them to work more efficiently.”

Reflexology provides profound relaxation and therapeutic value on its own, and many reflexologists concentrate on this modality only; however, energy work, massage, craniosacral therapy, myofascial release and other modalities can be combined with reflexology with great success.

Massage-Reflexology Sessions

Massage therapists trained in reflexology can incorporate this technique into massage sessions to achieve great results.

 “Reflexology enhances massage by making it a more thorough experience, without it needing to be deep tissue, via working the points on the feet,” explains massage therapist and reflexologist Jackie Goree of Sacramento, California. “When someone presents with an issue, such as a painful shoulder, I ask, ‘Does this feel tender?’ while checking the shoulder reflex on the foot. Then I loosen up the area at the reflex point of the feet before working directly on the shoulder.”

Gorcee says she works in a similar manner with low-back pain, headaches and menstrual issues, addressing the reflex points on the feet before moving to the specific area on the body with massage.

“I can more effectively get into the issue without hurting the client, who is already in pain upon coming in for the session,” she says, adding that she finishes each session with 20 minutes of reflexology.

Likewise, when Dot DeCesare of Metheun, Massachusetts, first learned massage, she felt the hands and feet weren’t allotted enough time. “Adding reflexology gives me a more effective way to work the feet and hands than with massage technique alone, with deeper core benefits—and it’s less taxing on my body,” DeCesare says.

It is very important to note that hand massage and foot massage, even when done with much pressure, are not the same as reflexology, the practice of which involves specific education in reflex points and zones on the hands, feet and ears.

Education in Reflexology

There are a number of schools across the nation where students can earn reflexology certification. Course requirements vary, but the curriculum usually includes anatomy and physiology, hands-on technique and business acumen. Continuing education workshops are available post-certification. Testing generally includes hands-on technique, a written exam and documentation of educational hours.

To accommodate the growing number of reflexologists and schools taking reflexology to the next level as a profession, the American Reflexology Certification Board was created in 1991. This national, independent testing agency sets the standards for educational requirements and professionalism and is the highest level of certification a reflexologist can receive in the U.S. 

The board exam represents a culmination of the certified reflexologist’s study, professional ability and experience, and is a testament to one’s dedication to the technique.

A Growing Specialty

In 1995, the Reflexology Association of America was created with the intention of working together in unity while embracing diversity and combining efforts for the professional development of the field of reflexology.

In 2004, in an effort to further promote, on behalf of its members and society, the scientific and professional advancement of the study and art of reflexology, the association reorganized into a national and state-affiliated member organization to ensure the continued strength of the profession. The Reflexology Association of America has two membership levels, associate and professional, and welcomes reflexologists and all interested parties who support the growth of reflexology nationwide to join.

Reflexology is a growing hands-on specialty, one being validated by client results and, increasingly, clinical research. Along with other beneficial therapies, reflexology stands ready to take its place as a viable health-care solution for the 21st century.

About the Author:

Michele Milder is a reflexologist with a practice in the Los Angeles, California area. She has experience with traditional Western medicine, pharmacology and alternative healing modalities.