Reflexology is a protocol of manual techniques, such as thumb and finger-walking, hook and backup and rotating-on-a-point, applied to specific reflex areas predominantly on the feet and hands. These techniques stimulate the complex neural pathways linking body systems, supporting the body’s efforts to function optimally. The effectiveness of reflexology is recognized worldwide by various national health institutions and the public at large as a distinct complementary practice within the holistic health field. Reflexology was developed in the early part of the 20th century by American medical professionals, Dr. William Fitzgerald MD, Dr. Shelby Riley MD, and physiotherapist Eunice Ingham. While there is evidence of therapeutic foot and hand work over a multitude of cultures and time periods, Reflexology as developed, named and practiced is of American medical origin and is not an Asian Bodywork Therapy. Reflexology is recognized as a legitimate, stand alone non-invasive complementary health modality by the National Cancer Institute, National Center of Complementary and Integrative Health-NIH, and has been defined by resolution by the National Federation of Women Legislators. ​ Reflexology has it’s own history, theory, vocabulary and technique. In countries across the globe, Reflexology is considered an allied health discipline and is often recommended by medical doctors in support of conventional medical treatment. Reflexology has state, national and international organizations, recognized professional educational standards, code of ethics, standards of practice, established scope of practice, recognized educational institutions and independent educators and three national certifying boards. Members of these associations meet the highest educational standards in the industry and exceed the standards set forth by the three national certifying bodies. Reflexology practitioners can access liability insurance, including through major carriers such as AMTA and ABMP. The Massachusetts Association of Reflexology (MAR) is a 501c6 not for profit organization and a Reflexology Association of America affiliate since 2005. ​ Reflexology professionals practice in a variety of settings including integrative and functional medicine practices, wellness centers, spas, fitness centers and gyms, hospitals, rehabilitation facilities, chiropractic and acupuncture practices, retirement communities, hospice and private studio practices.

Currently, there’s not a definitive explanation of the mechanism of action for Reflexology, however, there are several working theories. ​ Under the Autonomic-Somatic Integration Theory, the application of alternating pressure to the feet, hands and ears causes predictable reflexive actions within the nervous system. This type of alternating touch engages the parasympathetic nervous system which slows breathing and heart rate, inducing a deep state of relaxation. According to Dr. Frances Tappan, a leading researcher and author on the effects of touch therapies states that therapeutic touch “stimulates the sensory and proprioceptive nerve fibers of the skin and underlying tissues, and that these messages pass along the afferent fibers to the spinal chord. From there it is conceivable that these stimuli may disperse through the central and autonomic nervous systems – producing various effects in any zones supplied from the same segment of the spinal chord. … Such reactions are called reflex effects” (Dr. Frances Tappan, 1988). Another theory related to the mechanism of action for reflexology is the Gate Control Theory. ​ Reflexology is primarily a stress -reduction technique. Many of our health issues can be directly linked to stress. The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt your body’s processes.

Although some massage therapists may have a basic knowledge of reflexology with 8- 30 hours of training; a foot or hand massage that uses some reflexology techniques is a significantly different experience than a reflexology session from a professionally trained Reflexologist with 200 or more hours of reflexology-only education. Though many of the benefits are the same, massage is based on the therapeutic manipulation of the soft tissues (fascia, muscles, tendons, and ligaments), superficial and deep, over the entire the body. The massage therapist using moderate to deep pressure will utilize a variety of techniques involving fingers, hands, forearms and elbows. The massage client is usually unclothed, but draped, during the massage. ​ Reflexology, by contrast, utilizes very light to moderate touch on the skin’s surface to induce relaxation using unique-to- reflexology thumb and finger techniques. The reflexology client removes only shoes and socks to experience a reflexology session. What can one expect during a Reflexology session? Usually, a session begins with a client health intake and interview. You may be asked to sign a consent form. Your reflexologist will explain what to expect in the session and answer any questions you may have. S/he will also inform you that reflexology does not treat specific illnesses and is not a substitute for medical treatment. The session takes place with the client fully clothed, except for sock and shoes, while reclining in a chair or lying on a therapeutic table. The practitioner will begin by cleaning and assessing your feet for open wounds, rashes, sores, plantar warts or bunions and will ask you about any foot or leg pain. Once complete, the session will begin. ​ The application of Reflexology should not be painful or leave bruising /discomfort after a session. Reflexology is generally applied using light to moderate touch with the fingers and thumbs, not tools. The practitioner should make every effort to utilize the appropriate pressure for each individual. Since we generally don’t spend time having our feet/hands/ears touched, during a session one may notice unexpected sensitivity, which may due to footwear, usage or clothing; or the sensitivity may be an indication of where the body is holding tension. ​ A reflexology session can range in time from a 30 mins to 90 mins. Depending on the training and experience of the practitioner, expect to pay between $60-$150+ for an hour session. ​ When seeking reflexology, it is of the utmost importance to be an informed consumer. Currently in the Commonwealth of Massachusetts there is not a state law governing the practice of Reflexology, though many towns and cities have their own regulations that vary in requirements. There are some businesses that say they offer “reflexology” and “bodywork” but are actually fronts for human trafficking. Their staff don’t have formal training in reflexology, anatomy, physiology, pathology or universal precautions, which not only misrepresents the services they claim to provide, but more troubling, put the health and well being of the public at risk.

Practitioner has completed at least 200 hours of reflexology-only training and has a certificate of completion or diploma from an accredited school or recognized educator. S/he is a member of state and/or national reflexology associations such as the Massachusetts Association of Reflexology or the Reflexology Association of America. Members of these organizations have the industry’s highest educational standards, abide by Standards of Practice and a Code of Ethics. Practitioners may choose to further distinguish themselves through holding national certification and carrying liability insurance. Practitioners will have credentials and professional affiliations in plain view or easily accessible for review. If the practitioner has an online presence, there will be a biography with training, credentials and affiliations. S/he will generally not advertise on Craig’s List. Sessions are generally available by appointment only. S/he will be dressed in an appropriate and professional manner and will comport themselves accordingly. Practice space will be clean, well lit. The practitioner will be able to communicate clearly about what to expect during your session, will be able answer questions and will understand and address any concerns you may have. Prior to the session, the client will be asked about their lifestyle and complete a confidential health history including a list of medications. Client may also be asked to sign an Informed Consent. The client remains fully clothed except for the removal of socks and shoes. The session is performed only on the clients’s feet, hands or outer ears while reclining on a chair or lying on therapeutic table. The practitioner washes his/her hands before and after each session. Fresh linens will be provided for each client. The practitioner will clean and thoroughly examine the clients feet, hand or ears noting any wounds, abrasions, bruising, bunions, plantar warts, corns and unique anatomical features. S/he will practice within their scope and will not diagnose, recommend treatment, prescribe supplements or medications, make claims about reflexology curing ailments nor will they proselytize. The practitioner will be comfortably positioned chest level to the feet/hands/ears in order to effectively and ergonomically perform the session. The practitioner will use little or no lotion/oil and will use their hands and fingers to apply reflexology techniques. S/he will review the session with the client and take notes about the session. If the client wishes for reflexology to be a complement in support of a particular concern, the practitioner will design session protocols and schedule future appointments. Appropriate pricing of $60- $150+ per hour, depending on training and experience. Practitioners spend hundreds of hours and thousands of dollars to be professionally trained. Furthermore, they voluntarily spend hundred of dollars annually to maintain their affiliations with state and national organizations, certifications and insurance.​