by Karen Ball, L.M.T.

Reflexology and Massage Around the World, MASSAGE MagazineAs a reflexology instructor of many years, I constantly witness the confusion that exists in people’s minds about reflexology. Since most massage schools on this continent do not teach reflexology in-depth (or at all), it’s not surprising most practitioners are left thinking reflexology is simply the inclusion of applied static pressure during a massage on points of the feet or hands as indicated on a reflexology chart.

In this short article, I will describe the similarities and differences between reflexology (as we know it in North America) and massage therapy. I will also briefly describe how reflexology in the Western world compares to the modality as it is practiced in other countries.

The licensing laws defining massage therapy differ state to state, province to province. In general, though, they all in some way convey the systematic manipulation of the soft tissue of the human body as the basis of therapeutic massage. Reflexology also manipulates the soft tissue—of certain parts of the human body (feet, hands, ears, face). Both modalities, therefore, qualify as a “manual therapy,” and both aim to enhance the quality of the recipient’s experience of herself.

Where reflexology and massage differ is in their intent, not something readily discernable if you observe a practitioner in action. Similar to a family medical doctor and a cardiovascular surgeon, they’re both physicians and licensed under the same health department, but their work and intent of their work is distinct from each other.

The primary intent of classic Western massage techniques is to relax tension held within the soft tissue of the body. Reasons for this may be to diminish pain, increase circulation, improve posture and structural function, as well as produce physical, emotional and mental relaxation.

Reflexology provides deep relaxation, and like massage, reflexology increases circulation of the blood and lymph. Although the effects of conventional reflexology may include relaxation of the musculature, the intent is quite different. Western reflexology’s primary intent is to improve physiology, the functioning of the body’s systems. The focus of the session is on the points related to the various organs and glands of the body’s systems, not the connective tissue elements of the foot or hand.

The mechanism by which reflexology affects the internal structures of the body is through the systematic application of alternating pressure to the tissue of both feet (or hands) in entirety. Reflexology takes a constitutional approach, treating the entire body, as opposed to the allopathic model of addressing only the area of complaint. The stimulation of the sensory nerve pathways provided by very specific techniques sends messages to the brain, which in turn instructs the various organs and glands to alter the release of chemicals that control the balance and functioning of the systems.

When I see therapists massaging the feet and occasionally pushing their thumbs into certain areas, it is clear to me they have not been trained in reflexology. The absence of alternating pressure, which is the technique that “talks” to the brain, guarantees that although the recipient will likely feel relaxed afterward, her body will not have been provided the neurological environment that allows for the many recognized internal benefits of reflexology to occur. (That neurological environment, by the way, is not attained by applying pressure so deep as to cause pain in either the recipient and/or practitioner. The corresponding effect on the related body part is determined by the size of the nerve endings, not the “weight” put on the reflex point.)

Many people love to receive reflexology and regularly schedule expensive sessions at world-class spas and resorts. When a foot massage is passed off as reflexology, these clients are quite vocal with their discontent. Spa directors often contact me after one or more of these unpleasant incidences occur to come and instruct their staff in giving a true reflexology session. If you’re not trained in reflexology, it’s better to give a top-notch foot massage and call it just that, rather than discredit yourself, your employer and the profession.

Just as the field of massage therapy has many methods and styles of application, based on differing theories and desired outcomes, so does reflexology.

I was first certified as a reflexologist in 1983 in my birth country (Canada), and for many years assumed the thumb-and-finger-walking procedures I had so diligently practiced were what reflexologists worldwide were doing. As I exposed myself to foot reflexology practiced in other countries, I was forced to redefine my concept of reflexology. I discovered a huge collection of techniques quite different from what I had learned. I now acknowledge that, worldwide, reflexology is a science and artful manual therapy applied to a specific body part with the desired goal of positively affecting the entire organism.

Stay tuned next month when I will debut my reflexology blog on

Karen Ball, MASSAGE MagazineKaren Ball, L.M.T., certified reflexologist and aromatherapist, has been a manual therapist since 1983. She was trained and certified by the Reflexology Association of Canada as an instructor in 1985, and has been sharing the art and science of reflexology with students, licensed professionals and laypeople ever since. For more information, visit