By Christine Issel
Originally published in Massage & Bodywork magazine, June/July 2003.
Many people confuse reflexology with massage, but they are two distinct modalities — each with its own strengths. Both, like many therapies (chiropractic, osteopathy and other somatic practices), involve the use of the hands to apply specific techniques to the body, thereby enhancing the client’s well-being.
From a historical perspective, reflexology is more akin to osteopathy in both theory and technique than massage. Osteopathy was developed by Andrew Taylor Still in 1874. He believed in a direct relationship between disorders in joint movement and symptomatology. In addition, Still theorized that the autonomic nerve reflexes were involved in metabolic changes in soft tissues. The goal of osteopathy is not to directly relieve organic diseases, but to improve the structural function and tone of muscles, relieve tension and restore relaxation to the body. As osteopathic physician Myron Beal explains: “Any constriction or congestions will interfere with the vital processes and normal functions of the body tissues ... The zone of the spine from which the nerves emerge which are concerned with any particular organ or area of the body must be specially considered in osteopathic treatment.”1 Osteopathy is not normally used in the treatment of infectious diseases although it may be used in conjunction with other treatments because of its effect on the sympathetic nervous system, circulation and hormone secretion.
No doubt Eunice Ingham was introduced to these concepts, if not through her own interests and research, then during her work at the clinic of the Osteopathic Hospital in St. Petersburg, Fla., and her association with osteopath Joe Shelby Riley in the mid-’30s. She was also a guest lecturer in the 1950s at the American School of Osteopathy. Ingham refers to osteopathic and chiropractic concepts and research in Stories the Feet Have Told. Under a section titled “Osteopathic Concept” Ingham writes, “A spinal lesion2 means an abnormal pull on muscle tissue. If we can release the excessive tension by contacting a specific reflex in the feet, we are helping to bring about a correction of that spinal lesion.”3 In this statement Ingham combines two concepts fundamental to osteopathy and reflexology — lesions and reflexes.
Discovered by Frank Chapman, D.O., Chapman’s Reflexes are painful points located all over the body that, when palpated, he felt could lead to the healing of disease. In An Endocrine Interpretation of Chapman’s Reflexes, 2nd edition, Fred Mitchell, D.O, writes, “Drs. Chapman and (Charles) Owens (D.O.) were of the opinion that these reflexes were clinically useful in three principal ways: 1) for diagnosis; 2) for influencing the motion of fluids, mostly lymph; and 3) for influencing visceral (organ) function through the nervous system.”4
In general, Chapman’s Reflexes are found in soft tissue at various points along both sides of the sternum, the proximal head of humerus, distal and proximal clavicle, occipital ridge, cervicals, ribs, scapula, thoracics, lumbar, sacrum, coccyx, pelvis, pubis, fibula and medial head of the tibia. When the condition involves an organ, the location where the autonomic nerve ganglion branches off the spinal column to the organ becomes one of the reflex points to be palpated.
According to Mitchell, “Chapman’s Reflexes is just a term given to these receptor organs because of the osteopath who discovered their diagnostic and therapeutic value in the location and treatment of disease.”5 Since Chapman’s Reflexes were located all over the body the impression given was that a reflex is an object or point on the skin. Leon Chaitow notes in Soft Tissue Manipulation that reflexes go by many names: Janet Travell, M.D., and associates refer to them as trigger points; Myron Beal as viscerosomatic reflexes; Terence Bennet, D.C., as neurovascular points; M. Gutstein, M.D., as myodysneuric points; Irvin M. Korr, Ph.D., as facilitate segment and referred dysfunction; and in acupuncture they are tsubo points, yet all are discussing the same phenomena.6
At the same time, palpation was thought to create a reflex action of some type. Like Chapman, Ingham uses the word reflex to describe a sensitive area while also using it to describe the physiological process produced by a reflex action. Explaining the results she obtained, Ingham writes, “Try this simple method of producing a reflex action (by manipulation) through the nerve endings on the soles of the feet.”7 Here she is indicating a reflex action. Then, like Chapman, she produced charts that illustrated where points could be palpated to reach various organs and called them reflexes, too.
Chapman himself stressed that results would come more quickly and be less painful by gentle, rather than strong, pressure to the reflex point. The actual time a practitioner worked on a particular reflex could last from 20 seconds to two minutes or more. Mitchell stressed that over-treatment fatigued the reflex arc and nullified the good effect produced. However, he also cautioned that inefficient or insufficient work produced poor results. While admonishing the student to remember the inter-relationship of organ systems, he recommended working the system in the sequence it is found. For example, “Work the distal colon before treating the proximal colon.”8
The 2nd edition of Chapman’s Reflexes contains a foreword that suggests when studying reflex work, the student: 1) learn each reflex by location rather than by sense of touch; 2) learn reflexes by groups (systems) one at a time; and 3) learn to include the endocrine gland along with the nerve and blood supply concerned in the disturbance.9
All three of these points were adopted for reflexology by Ingham. The layout design is also very similar in Ingham’s and Chapman’s books. Each chapter covers a pathology and points to work are indicated.
Two different systems coordinate the working of the body. The nervous system functions by using electrical impulses, while the endocrine system uses chemicals called hormones. Within the nervous system there are sensory neurons that carry nerve impulses from different parts of the body to the central nervous system. Some sensory neurons are directly triggered by stimuli while others are triggered indirectly by special cells or neurons called receptors.
Osteopathic theory concludes that if there is a lesion formed within the soft tissue of the spinal column then a stimulus by palpation will produce a reflex action that will in turn produce a physiological reaction to organs innervated from the autonomic nerve ganglia. To this Chapman linked receptors and the role they play with the endocrine system. Communication does take place within the receptors and this could be why Chapman was the first to link the endocrinology of the body to the concept of reflexes as an osteopathic principle. In her book Zone Therapy, Its Application to the Glands and Kindred Ailments, Ingham also utilizes this theory in her hypothesis of the mechanics of how reflexology works: “May we retain an open receptive mind for aid or suggestions in the scientific explanation of the relation of these nerve endings and their direct association with the tissues involved. Is it not possible that by way of the autonomics, the endoctrines (sic) (glands) are doubtless affected in such a way that a better synergism is brought about between the various important glands of this system?”10
Osteopathy’s Connection to the Feet
An interesting point to consider in Chapman’s work is that nowhere are the feet or hands involved as sites to be worked. However, we do know that sensory neurons are plentiful in the soles of the feet and palms of the hands. Joe Shelby Riley may have reached this same conclusion and adapted Chapman’s concept, which he knew about through his own osteopathic training, to the feet and hands while coupling reflexes with Fitzgerald’s work with zones. Riley’s charts are the oldest that map the various “reflex” points on the feet. Riley’s work was further refined, expanded and popularized by Ingham who worked as his assistant for several months during two successive winters in Florida prior to the publication of her first book.
With Chapman’s concepts in mind, the palpation to the receptors on the feet may support much of the same principles. First, sensitivity in the soft tissue of the foot, [e.g., pain upon palpatory pressure] may affect the body as the fascia forms lesions and adversely affects biomechanical movement. Removal of articular lesions coupled with the hormonal activation triggering an endocrine response, stimulation to the circulatory and lymphatic systems, and all nervous systems makes reflexology a very powerful and holistic therapy. Additionally, the proper alignment of the joints in reflexognosy produces relief of tension to the segmental dysfunction of the dermatomes, resulting in the relaxation of muscular tension and nerves throughout the body. The reduction of pain results as normalization of receptor activity moves toward normal muscle tone. The relaxation process will reverberate up the spinal column and through the autonomic nerve ganglia to the organs and other parts of the body due to the close ties between the central nervous system and the autonomic nervous system.
Ingham simplifies this in Stories the Feet Have Told by writing, “If any degree of tenderness is found in those reflexes in that part of the foot relative to the spine, then by applying this form of compression massage to that area you will relax the muscle tension surrounding that vertebra.”11 In fact, the actual processes the practitioner has affected includes structural alignment, which produces reduced tension on the fascia that may result in improved circulation and pain reduction, improving overall health.
Another link between reflexology and osteopathy is found in the terminology. Typically palpation involves both the use of light touch and deep touch to discover changes taking place in the skin and subcutaneous tissue. Light touch can either be passive, where the fingers rest lightly on the skin, or active, whereby the fingers move from site to site. Beal writes, “In deep-touch, the fingers compress the skin surface, palpating through skin and subcutaneous tissues to the superficial muscle. Further compression leads to palpation of deeper muscles, fascia and bone. Deep palpation utilizes forces of compression and shear. Compression is a force applied perpendicularly to the skin surface. Shear is a force applied parallel to the skin surface. In some instances, deep palpation combines both compression and shear in the exploration of deep tissue texture.”12
Note the use of the term compression. In Eunice Ingham’s statement above, she described her work as “the reflex method of compression massage” before finally settling on the term reflexology. The term massage by Ingham is preceded with the adjective compression, indicating she was not referring to Swedish massage. Her later use of the term reflexology implicates she considered the work to involve a study of the reflexes and reflex action. From this it is clear the techniques and nomenclature employed by reflexologists are closely aligned with osteopathic principles and “reflexes,” not those of massage, as some would claim. To reflexology, osteopathy contributes:
• The terms, techniques and theories of reflexes, reflex action, lesions and compression;
• The importance of the autonomic nerve ganglion innervating the organs and endocrine system;
• Tactile skills and soft tissue manipulation of “reflexes”;
• A holistic approach to illness through the study of the systems of the body utilizing touch.
While at first glance the opposite may seem true, osteopathic theory and techniques are certainly more akin to reflexology than massage in theory and techniques. Reflexologists simply concentrate their work on the feet and hands rather than the spine and trunk of the body.