Reflexology and its impact on the body

When challenged to justify the proposal that reflexology, as well as reducing stress and helping restore the body to a state of balance, may also help balance hormones within that same framework, it has been helpful to go through the process of looking at what evidence there is for suggesting this in the context of reflexology research alongside wider research into stress and its impacts on the body’s hormonal functions.

 ·         Hormones are produced by many areas of the body but mostly by our main endocrine glands: hypothalamus, pituitary, thyroid, thymus, parathyroids, adrenals, pineal body, the ovaries, the testes. Optimally they must all work together in harmony given that no hormone or set of hormones may be considered to operate entirely independently of our body’s overall functioning given the overall control exerted by the Pituitary, Hypothalamus and Thyroid in particular, together with our limbic system, and the feedback / negative feedback loops constantly switching on and switching off as our body’s messaging system demands responses.

Refs: 14.  23.  25.  26. 

 ·         The impacts of stress on the body are wide-ranging and are very well explained by, for instance, the American Psychological Association, disrupting as they do the levels of hormones circulating around the body because our bodies respond instinctively to stress factors by pumping a sequence of hormones into our blood stream to support us in fighting or running away (fight and flight). Indeed there is growing evidence that in this process stress can impact our ability to fight infections, to digest our food effectively, to reproduce appropriately and more – ‘it is not safe to have a baby now’ in just the same way as if running from a tiger or facing a firing squad your body might say ‘you don’t have time to digest that food’, ‘we need to offload that full bladder and evacuate that colon’.’

Refs: 2.  3.  4.  7.  8.  9.  14.  21.  23.  24.  25.  35. 36.

  ·         Reflexology aims to return a body to a greater state of homeostasis or balance and it is widely accepted now that reflexology helps address the symptoms of stress – including anxiety, sleep, fatigue, mood, pain, blood pressure. Signs recognised also as indicative of a hormone imbalance: as too severe mood swings, irregular menstrual cycles, acne, weight gain, hair loss, PMS, bleeding or spotting between cycles and generally the things experienced by females going through puberty or the menopause.

Refs: 1.  5.  6.  10.  11.  12.  13.  15.  16.  17.  18.  19.  20.  22.  27.  28.  29.  30.  31.  32.  33.  34.

References:

1.      AfitapOzdelikara et al (2018)  Altern Ther Health Med 2018 41487 4 24 The Effects of Reflexology on Fatigue and Anxiety in Patients With Multiple Sclerosis PMID:29332021 Conclusions: The study indicates that reflexology can be an effective method for reducing fatigue severity and anxiety in patients with MS.

2.    Aimagambetova G et al (2020)  The effect of psychological distress on IVF outcomes: Reality or speculations? PLoS One. 2020 Dec 14;15(12):e0242024. doi: 10.1371/journal.pone.0242024. PMID: 33315878; PMCID: PMC7735622. 

3.    American Psychological Association (2023) Stress effects on the body (apa.org)   

4.    An, Y et al (2023)  Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: Psychological and neurohormonal assessmentJ Assist Reprod Genet 30, 35–41 (2013). https://doi.org/10.1007/s10815-012-9904-x  Conclusion: State anxiety is associated with both pregnancy rate and live birth rate in IVF patients, an effect that is partly mediated by activities in the HPA axis and SNS (sympathetic nervous system).

5.   Anwar N, et al (2022) Effect of Foot Massage on Decreasing Blood Pressure and Anxiety in Older People with Hypertension in Indonesia. Journal of Health Management. 2022;24(2):260-267. doi:10.1177/09720634221087786  Conclusion: Foot massage intervention is effective in reducing blood pressure and anxiety in older people with hypertension.

 6.    Asltoghiri, Maryam et al  (2011)  The effects of Reflexology on sleep disorder in menopausal women https://doi.org/10.1016/j.sbspro.2011.12.049  “The result of this study suggests that reflexology is an effective non-hormonal approach for treatment of sleep disorder. Over the course of the study, women reported significant decrease in sleep disorder for the reminder of the trial.  Based on the present results, we suggest that the reflexology is beneficial for improving sleep disorder in menopausal women. Therefore nurses can learn it and teach it to menopausal women.

 7.    Bakkensen, Jennifer B. MD et al (2022)  Psychological Stress And Infertility: What Do Women In Medicine Believe?  DOI: :https://doi.org/10.1016/j.fertnstert.2022.08.281   Conclusions The belief that stress causes infertility and adverse pregnancy outcomes is prevalent among female physicians, particularly among those who have personally experienced infertility and have recently completed training. Although OB/GYNs appear less likely to harbor these beliefs, the high endorsement of stress as a causal role in reproductive experiences indicates the need for additional education about stress and fertility in medical training.

 8.    Coubrough, R.I.; et al. (1985)  Stress and fertility: A review  Onderstepoort Journal of Veterinary Research, Volume 52, 1985 45  http://hdl.handle.net/2263/44393  “In the reproductive process of any female animal taken from oestrus to parturition, the stage from oestrus to implantation appears to be the one most susceptible to the possible adverse effects of stress (Moberg, 1975). Stress on any female during pro-oestrus and oestrus, when the utero-hypothalamo-hypophysio-ovarian axis is delicately poised in an intricate negative feedback interchange associated with folliculogenesis and ovulation, has decidedly detrimental effects on subsequent reproductive events (Hennessy & Williamson, 1983; Marschang, 1973; Moberg, 1975; Monty & Wolff, 1974). The clinical manifestations of stress-effected oestrous cycles are essentially the same in all females, reflecting STRESS AND FERTILITY as delayed ovulation or anovulation; cyctic ovarian degeneration; a shortened less intense oestrus; reduced conception rates; embryonic death, and irregular oestrous cycles. These deviations from the norm may follow on exposure to either environmental or managemental stress” It points out that “Since reproduction is the ultimate measure of an animal’s ability to adapt to an ever-changing external milieu, as well as forming the basis of life-time productivity, research should be aimed at obtaining greater clarity of the hormonal interactions involved.” and reminds us that we too are animals susceptible to the same factors.

 9.    Ebbesen, S.M.S., et al (2009)  Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study, Human Reproduction, Vol24, Iss 9, Sept. 2009, Pages 2173–2182, https://doi.org/10.1093/humrep/dep185  Conclusions: A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as oocyte retrieval outcome.

 10.  Farhad, Ramezanibadr et al (2018)  The impacts of foot reflexology on anxiety among candidates for coronary angiography: A three-group single-blind randomized clinical trial  Complement Ther Clin Pract 2018 200-204 32  PMID: 30057051   DOI: 10.1016/j.ctcp.2018.07.005 

 11.  Gozuyesil, Ebru et al (2016)  The effect of foot reflexology applied to women aged between 40 and 60 on vasomotor complaints and quality of life  Complement Ther Clin Pract 2016 Aug:24:78-85  PMID: 27502805   DOI: 10.1016/j.ctcp.2016.05.011 Conclusion:  Reflexology can be effective in decreasing vasomotor (hot flashes, sweats, and night sweats) problems and increasing quality of life in the menopausal period     

12.  Hasanpour, Marzieh et al (2019)    Effects of reflexology on premenstrual syndrome: a systematic review and meta-analysis   Biopsychosoc Med. 2019; 13: 25.   doi: 10.1186/s13030-019-0165-0  PMCID: PMC6815051    PMID: 31673284 Conclusion  In general, results of the present study indicated that the reflexology could relieve PMS symptoms, so that overall scores, somatic and psychological symptoms of PMS decreased by applying the reflexology intervention. Furthermore, an increase in the length of reflexology time in each session increased its efficiency. Reflexology can be used as an effective intervention in a patient care program by nurses and its efficiency can be enhanced by increasing intervention time in each reflexology treatment session.

 13.  Huang, HuiChuan; Chen, Kee-Hsin et al (2020)  Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a metaanalysis of randomized controlled trials  December 2020  Journal of Advanced Nursing 77(2)    DOI:10.1111/jan.14699  Conclusion The findings suggested that foot reflexology produced significant improvements in sleep disturbances. Impact Foot reflexology is a noninvasive and convenient intervention and regularly receiving foot reflexology can be considered complementary therapy to improve the sleep quality of adults with sleep disturbances. Furthermore, healthcare providers can actively press the solar plexus and heart zones to alleviate sleep disturbances when performing foot reflexology. 

14.  Jacques, Angela et al (2019) The impact of sugar consumption on stress driven, emotional and addictive behaviors  School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia  / Institute of Health and Biomedical Innovation at Translational Research Institute, Brisbane, Australia Neuroscience & Biobehavioral Reviews Volume 103, August 2019, Pages 178-199   This review summarizes the neurochemical changes and neural adaptations including changes in the dopaminergic system that influence emotion and behaviour following sugar consumption.

15.  Jordan, Anne (1994) A Study Of 28 Staff Seen Within The Worcester Hospitals Between March 1993 And June 1994 Using Reflexology Session, Association of Reflexologists, U.K., First European Conference. 28 subjects (22 females & 6 males, aged 22 to 66 years) measured for: pain, mobility, lassitude and psychological stress. All subjects reported some improvement after six sessions, with significant improvement being reported by: 74% of the 23 subjects experiencing pain, 53% of subjects concerned about mobility, 62.5% of subjects concerned with lassitude, and, 55% of subjects concerned with psychological stress. It is concluded that reflexology is a cost effective treatment for companies and institutions concerned about absenteeism and sick leave.  

16.  Kim YH, Cho SH et al (2002)  The Effect of Foot Reflexology on Premenstrual Syndrome and Dysmenorrhea in Female College Students, Korean J Women Health Nurs. 2002 Jun;8(2):212-221. Korean. Department of Nursing, Sun Cheon Cheong Am College, Korea   The relieved symptoms after foot reflexology was fatigue (50%), insomnia (40%), abdominal pain (35%), lower abdominal pain (30%) and constipation (30%). Foot reflexology was effective in improve the symptoms of the female college students who have the premenstrual syndrome and dysmenorrhea.  

 17.  Lee YM. (2011)  Effects of self-foot reflexology on stress, fatigue, skin temperature and immune response in female undergraduate students. J Korean Acad Nurs. 2011 Feb;41(1):110-8. Korean. doi: 10.4040/jkan.2011.41.1.110. PMID: 21516005 A significant difference was also observed in climacteric symptoms in fatigue, in total cholesterol and in the level of cortisol. Lee in 2006 expressed that there was a statistically significant difference in depression, perceived stress, systolic blood pressure, natural – killer cell and IgG in women with reflexology. They suggest that a self –foot reflexology massage could be utilized as an effective nursing intervention to reduced depression and stress response and to strengthen immune systems in middle – aged women.

 18.  Lestari, Ni Kadek Yuni et al  (2023)  The Effect of Feet Reflection Massage on Blood Pressure in Hypertension Patients at Community Health Centers II Petang  Nursing and Health Sciences Journal Volume 3, Number 1 (March 2023)  DOI: https://doi.org/10.53713/nhs.v3i1.151  Conclusion: there is an effect of foot reflexology on blood pressure in hypertension sufferers in Community Health Center II Petang. Foot reflexology can be used as an alternative to non-pharmacological treatment programs for patients to prevent further complications from uncontrolled hypertension.

 19.  McCullough, Julie EM et al  (2018)   Reflexology: A randomised controlled trial investigating the effects on beta-endorphin, cortisol and pregnancy related stress   Complement Ther Clin Pract. 2018 May:31:76-84.  doi: 10.1016/j.ctcp.2018.01.018. Epub 2018 Feb 3.  PMID: 29705485     10.1016/j.ctcp.2018.01.018  Conclusion: Reflexology during pregnancy may help reduce lower back and/or pelvic girdle pain, and associated stress. However, antenatal reflexology is under researched and requires further investigation.

 20.  McVicar, AJ et al  (2007)   Evaluation of anxiety, salivary cortisol and melatonin secretion following reflexology treatment: a pilot study in healthy individuals  Complement Ther Clin Pract. 2007 Aug;13(3):137-45.  doi: 10.1016/j.ctcp.2006.11.001. Epub 2007 Jan 4.   PMID: 17631256  DOI: 10.1016/j.ctcp.2006.11.001 Conclusion: By evaluating psychometric and biometric changes following reflexology, this pilot study has also showed that reflexology significantly reduced ‘state’ anxiety and related cardiovascular parameters.

 21.  Mínguez-Alarcón L, et al. Women’s preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study. Front Glob Womens Health. 2024 Feb 5;5:1293255. doi: 10.3389/fgwh.2024.1293255. PMID: 38379838; PMCID: PMC10877713.  In conclusion, we found that women’s preconception psychological stress was negatively associated with the probability of live birth and this association remained among women using IVF. Women’s preconception stress was not, however, associated with gestational or birthweight in the overall or stratified analyses. These results support the association between women’s preconception stress and live birth among subfertile women. They also highlight the importance of considering the mode of conception and the preconception period when evaluating these relationships. Given the impact of socioeconomic factors on stress as well as the growing number of babies born using ART, future studies to confirm the observed findings in other (and larger) study cohorts are warranted.

22.  Oleson, Terry PhD and William Flocco (1993)  Randomized Controlled Study Of Premenstrual Symptoms Treated With Ear, Hand, And Foot Reflexology  American Journal of Obstetrics and Gynecology, Vol. 82, No. 6, December 1993   Results: Analysis of Variance for repeated measures demonstrated a significantly greater decrease in premenstrual symptoms for the women given true reflexology than for the women in the placebo group. The treatment group showed a 46% reduction in premenstrual symptoms, which was sustained at 41% during the post treatment period. It was concluded that ear, hand and foot reflexology is an appropriate therapy for the treatment of PMS.

23.  Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011 Jan;15(1):18-22. doi: 10.4103/2230-8210.77573. PMID: 21584161; PMCID: PMC3079864.  Conclusions: In today’s competitive modern world one encounters stress in various aspects of life. As an adaptive response to stress, there is a change in the serum level of various hormones including CRH, cortisol, catecholamines and thyroid hormone. These changes may be required for the fight or flight response of the individual to stress. However, long-term exposure to stress may lead to many deleterious consequences leading to various endocrine disorders. Also, stress leads to change in the clinical course or status of many endocrine conditions.

 24.  Rooney, KL, et al. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018 Mar;20(1):41-47. doi: 0.31887/DCNS.2018.20.1/klrooney. PMID: 29946210; PMCID: PMC6016043. Conclusion: It has been well documented that infertility causes stress. The impact of stress on ART outcome is still somewhat controversial. However, it is clear that psychological interventions for women with infertility have the potential to decrease anxiety and depression and may well lead to significantly higher pregnancy rates.

 25.  Sapolsky, Robert M. (1994)    Why Zebras Don’t Get Ulcers (now in 3rd edition)    Sapolsky, a Professor of Biological Sciences and Neuroscience at Stanford University, compares the “real” stresses of life – encountered “episodically” by wild animals (whereby typically they run away or fight) – and the psychological stresses experienced by humans which often build up iteratively where we tend to worry: leading to chronic issues including cardiovascular disease; destroying our sleep; aging us faster, and more. He shows how stress links to these health problems due in large part to the hormones that trigger the stress response via the release of hormones but, although many might see stress as a mechanical process, Sapolsky makes clear that the cost of stress on the body of these hormonal surges is not just a mechanical equation – a reductive view of biology where everything is considered to trace simply back to physical factors such as genes, hormones, bacteria, viruses, etc. Sapolsky considers also how stress can be purely psychological, affected for example by how someone perceives their own sense of control. He states that “reproduction, probably the most energy-expensive, optimistic thing you can do with your body (especially if you are female) is curtailed – worry about eggs and sperm and that sort of thing some other time, keep your mind and your energies on the job in hand e.g. running from the perceived “threat”. Females are less likely to ovulate or carry pregnancies to term”. He also has an extensive chapter entirely on Sex and Reproduction explaining how stress of all types, including for instance dieting, can impact fertility and also why so much research in this area is problematic e.g. when it is conducted on females who have been having years of failing to conceive and this alone could be responsible for their stress thus skewing the data. In pulling his findings together he draws heavily on how animals in the bigger picture respond to stress and its impact on reproduction for us all as the animals we are.

 26.  Sharma K, et al  Stress-Induced Diabetes: A Review. Cureus. 2022 Sep 13;14(9):e29142. doi: 10.7759/cureus.29142. PMID: 36258973; PMCID: PMC9561544. “Experiencing persistent hyperglycemia in people with diabetes may be influenced by stress. Blood sugar levels may rise due to hormones being released in response to stress. Although this has adaptive significance in a healthy patient, in the long run, it can cause insulin resistance and lead to diabetes. Additionally, diabetes may cause abnormalities in the regulation of these stress hormones.”

 27.  Sitoresmi, Hayyu et al  (2020) The effect of foot massage in lowering intradialytic blood pressure at Hemodialysis Unit in Indonesian Hospital Clinical Epidemiology and Global Health   Volume 8, Issue 4, December 2020, Pages 1272-1276  https://doi.org/10.1016/j.cegh.2020.04.026   Conclusion The foot massage is beneficial in controlling intradialytic hypertension and can be applied in the management of hemodialysis patients by nurses.

28.  Soheili M, Nazari F, Shaygannejad V, Valiani M. A comparison the effects of reflexology and relaxation on the psychological symptoms in women with multiple sclerosis. J Educ Health Promot. 2017 Apr 19;6:11. doi: 10.4103/jehp.jehp_166_14. PMID: 28546976; PMCID: PMC5433640.  Conclusions: The results showed that reflexology and relaxation in relieving anxiety, stress and depression are effective in women with MS. Hence, these two methods, as effective techniques, can be recommended.

29. Valiani M, Babaei E, Heshmat R, Zare Z. Comparing the effects of reflexology methods and Ibuprofen administration on dysmenorrhea in female students of Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):371-8. PMID: 22069413; PMCID: PMC3208937  Conclusions: Reflexology was superior to Ibuprofen on reducing dysmenorrhea and its treatment effect continued even after discontinuing the intervention in the third cycle. Therefore, considering that reflexology is a non-invasive, easy and cheap technique, it seems that it can replace anti-inflammatory drugs (NSAIDs) to avoid their adverse side effects.

30.  Vieira, Amanda KS et al (2021)  Effect of Foot Reflexology Protocol on Premenstrual Syndrome Symptoms in Nursing Students: a Pre–Post Pilot Study  Int J Ther Massage Bodywork. 2021 Dec; 14(4): 1–11. doi: 10.3822/ijtmb.v14i4.631  PMCID: PMC8629353  PMID: 34900066    

 31.  Whatley, Judith et al (2022)  Reflexology: Exploring the mechanism of action https://doi.org/10.1016/j.ctcp.2022.101606  ‘Taking hormonal balance as an example, there is evidence to suggest that menstrual functioning is disrupted by stressors that activate the hypothalamic-pituitary-adrenal (HPA) axis [12]. The hormonal response to stress is the release of cortisol, one of the glucocorticoids. Functional menstrual disorders such as polycystic ovary syndrome are associated with an increase in cortisol. There is some evidence to suggest that reflexology can have a positive impact on menstrual patterns [13,14]. It follows then, that reflexology may have potential for the correction of hormonal balance in the same way as mind-body approaches akin to mindfulness and exercise [15,16]. 

 32.  Williamson et al (2002). Randomised controlled trial of reflexology for menopausal symptoms. BJOG An International Journal of Obstetrics and Gynaecology, 109 (9) p 1050-1055. https://pubmed.ncbi.nlm.nih.gov/12269681/   Anxiety, depression, severity of hot flushes and night sweats all showed improvement in both the reflexology and the ‘non-specific foot massage (control) group. In the control group, 14/37 believed they had not received true reflexology. 

 33.  Wiratama, R. D. ., Muhith, A., & Zahro, C. (2023). Reflexology On Blood Sugar Levels In Patients With Diabetes Mellitus: Literature Review. Journal of Applied Nursing and Health, 5(2), 276–286. https://doi.org/10.55018/janh.v5i2.157 Conclusion This literature review shows that the application of reflexology in patients with diabetes mellitus effectively lowers blood sugar levels, with this reflexology restimulate points that affect lower blood glucose, stimulating blood circulation. By improving circulation, the body’s organs receive adequate blood supply, and the adrenal glands reduce the secretion of the hormones epinephrine and norepinephrine, with a decrease in cortisol secretion resulting in a decrease in blood glucose and HbA1c. This relaxation therapy can be done regularly on the feet for 12 times. That is three sessions per week for four weeks, reflexology on the feet regularly, each lasting 20-30 minutes; the results show that it effectively reduces blood sugar levels.

 34.  Wyatt, Gwen et al (2012)  Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer    Oncol Nurs Forum   2012 Nov;39(6):568-77.   doi: 10.1188/12.ONF.568-577.   PMID: 23107851  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576031/   Conclusions: Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Implications for nursing: Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer.

 35.  Zanettoullis, A.T et al. Effect of Stress on Each of the Stages of the IVF Procedure: A Systematic ReviewInt. J. Mol. Sci. 2024, 25, 726. https://doi.org/10.3390/ijms25020726  Conclusions: There may be an association between chronic stress and the fertilization stage. Only chronic stress impacted the embryo transfer stage and further evidence suggested that stress decreased during this stage. The pregnancy rate stage was weakly associated with stress. Follicular cortisol was found to affect three stages. Chronic and acute stress significantly and negatively affected the egg retrieval time point. Chronic stress was associated with a lesser extent with the fertilization point, and no significant relationship between acute stress and the embryo transfer and pregnancy rate stages were found. Follicular cortisol was found to affect the process. This review contributes to the research of the relationship between stress and IVF success.

36.  Lynch CD, et al (2014). Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study–the LIFE study. Hum Reprod. 2014 May;29(5):1067-75. doi: 10.1093/humrep/deu032. Epub 2014 Mar 23. PMID: 24664130; PMCID: PMC3984126. Conclusion: Higher levels of stress as measured by salivary alpha-amylase are associated with a longer time-to-pregnancy (TTP) and an increased risk of infertility.