To complement the MASSAGE Magazine article, “Expert Advice,” by Paula S. Stone, in the April 2011 issue. Article summary: Reflexology is one of the most popular forms of bodywork, with industry statistics showing about half of massage therapists practice this modality. Reasons for doing so include reflexology’s effectiveness at addressing a variety of conditions, and its portability. (There is no disrobing required; only the feet are bare.)

by Karen Ball

For most of the time reflexology has been practiced in the West, reflexologists have operated under the hypothesis that the “crunchies” found in people’s feet are metabolic waste products (specifically, uric and lactic acids) that have accumulated at nerve endings. These crystals have been credited with causing pain and impeding the flow of nervous information within the body.

This sounds reasonable, but new scientific evidence from Europe is suggesting something quite different.

Jesus Manzanares, M.D., a physician and medical researcher living in Spain, has been shocking the North American reflexology community with his groundbreaking, theory-shattering research.

Over the past 30 years, Manzanares has conducted more than 70,000 clinical studies in two teaching hospitals in his home city of Barcelona. Through colored biopsy photos, he shows us the make-up of both congested and asymptomatic foot reflexes in live patients. The deposits in both groups show a mass of connective, vascular and nervous tissues in the hypodermis. Of particular interest to reflexologists, the deposits show no evidence of metabolic waste products.

Manzanares’ studies indicate that the asymptomatic (control) samples are made up of 8 percent nervous tissue while the congested samples are made up of 42 percent nervous tissue. According to Manzanares, what we are feeling in the tissue is not crystals or metabolic waste deposits, but rather an entanglement of the excess nervous tissue created in response to, and as an indicator of, an unhealthy organ.

With more nerve fibers, we see higher concentrations of bradykinin, a neuro-polypeptide that incites chronic pain, and substance P, an amino acid peptide that elicits inflammatory responses and functions as a pain neurotransmitter. Specific reflexology techniques applied to congested reflexes can “untangle” the nerve fiber adhesions and break the biomechanical link between them.

Manzanares’ research points to the conclusion that:

  1. Deposits in the feet indicate an anatomical or functional imbalance.
  2. Deposits are not attached to tendons or muscles.
  3. Deposits felt by the therapist and experienced as painful by the subject indicate subacute or chronic pathologies.
  4. Deposits experienced as mildly sensitive by the subject, but not felt by the therapist, suggest an acute pathology. (Insufficient time precludes the existence of physical deposits with a newly developing pathology.)

There are hundreds of studies that demonstrate to what extent reflexology affects people with certain homeostatic imbalances. What makes Manzanares’ work exciting is its contribution to the understanding of how reflexology works. Anecdotal testimonials attest to the fact that reflexology works. Perhaps now, we are finally beginning to uncover the scientific evidence of how it does so.

Karen Ball, N.B.C.R., L.M.T., has been offering reflexology education to professionals and lay people in the U.S., Canada and Costa Rica since 1985. A full bio is available at Ball blogs for MASSAGE Magazine at /massage-blog/reflexology. To learn more about the Manzanares’ science-based principles of reflexology and his North American teaching schedule, visit