How Does Reflexology Work, Really?

In Wednesday’s newsletter, we asked you for your opinion of reflexology, and got the above-depicted, below-described set of responses:

• About 63% said “It works by specific nerves connecting the feet and hands to various specific organs, triggering healing remotely”
• About 26% said “It works by realigning the body’s energies (e.g. qi, ki, prana, etc), removing blockages and improving health“
• About 11% said “It works by placebo, at best, and has no evidence for any efficacy beyond that”

So, what does the science say?

It works by realigning the body’s energies (e.g. qi, ki, prana, etc), removing blockages and improving health: True or False?

False, or since we can’t prove a negative: there is no reliable scientific evidence for this.

Further, there is no reliable scientific evidence for the existence of qi, ki, prana, soma, mana, or whatever we want to call it.

To save doubling up, we did discuss this in some more detail, exploring the notion of qi as bioelectrical energy, including a look at some unreliable clinical evidence for it (a study that used shoddy methodology, but it’s important to understand what they did wrong, to watch out for such), when we looked at [the legitimately very healthful practice of] qigong, a couple of weeks ago:

Qigong: A Breath Of Fresh Air?

As for reflexology specifically: in terms of blockages of qi causing disease (and thus being a putative therapeutic mechanism of action for attenuating disease), it’s an interesting hypothesis but in terms of scientific merit, it was pre-emptively supplanted by germ theory and other similarly observable-and-measurable phenomena.

We say “pre-emptively”, because despite orientalist marketing, unless we want to count some ancient pictures of people getting a foot massage and say it is reflexology, there is no record of reflexology being a thing before 1913 (and that was in the US, by a laryngologist working with a spiritualist to produce a book that they published in 1917).

It works by specific nerves connecting the feet and hands to various specific organs, triggering healing remotely: True or False?

False, or since we can’t prove a negative: there is no reliable scientific evidence for this.

A very large independent review of available scientific literature found the current medical consensus on reflexology is that:

• Reflexology is effective for: anxiety (but short lasting), edema, mild insomnia, quality of sleep, and relieving pain (short term: 2–3 hours)
• Reflexology is not effective for: inflammatory bowel disease, fertility treatment, neuropathy and polyneuropathy, acute low back pain, sub acute low back pain, chronic low back pain, radicular pain syndromes (including sciatica), post-operative low back pain, spinal stenosis, spinal fractures, sacroiliitis, spondylolisthesis, complex regional pain syndrome, trigger points / myofascial pain, chronic persistent pain, chronic low back pain, depression, work related injuries of the hip and pelvis

Source: Reflexology – a scientific literary review compilation

(the above is a fascinating read, by the way, and its 50 pages go into a lot more detail than we have room to here)

Now, those items that they found it effective for, looks suspiciously like a short list of things that placebo is often good for, and/or any relaxing activity.

Another review was not so generous:

❝The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition❞

~ Dr. Edzard Ernst (MD, PhD, FMedSci)

Source: Is reflexology an effective intervention? A systematic review of randomised controlled trials

In short, from the available scientific literature, we can surmise:

• Some researchers have found it to have some usefulness against chiefly psychosomatic conditions
• Other researchers have found the evidence for even that much to be uncompelling

It works by placebo, at best, and has no evidence for any efficacy beyond that: True or False?

Mostly True; of course reflexology runs into similar problems as acupuncture when it comes to testing against placebo:

How Does One Test Acupuncture Against Placebo Anyway?

…but not quite as bad, since it is easier to give a random foot massage while pretending it is a clinical treatment, than to fake putting needles into key locations.

However, as the paper we cited just above (in answer to the previous True/False question) shows, reflexology does not appear to meaningfully outperform placebo—which points to the possibility that it does work by placebo, and is just a placebo treatment on the high end of placebo (because the placebo effect is real, does work, isn’t “nothing”, and some placebos work better than others).

For more on the fascinating science and useful (applicable in daily life!) practicalities of how placebo does work, check out:

How To Leverage Placebo Effect For Yourself

Take care!