Reflexology in Pregnancy and Childbirth

Denise Tiran

• Publisher: Churchill Livingstone
• Year: 2010
• eBook ISBN: 9780702047893
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Reflexology in Pregnancy and Childbirth is a definitive text on the safe and appropriate use of reflex zone therapy in pregnancy, labour and the puerperium, focusing on evidence-based practice, professional accountability and application of a comprehensive knowledge of the therapy related to reproductive physiology.Denise Tiran, an experienced midwife, reflex zone therapist, university lecturer and Director of Expectancy – the Expectant Parents' Complementary Therapies Consultancy - has an international reputation in the field of maternity complementary therapies, has researched and written extensively on reflexology, and has treated nearly 5000 pregnant women with structural reflex zone therapy.KEY FEATURESCase histories to ease application of theory to practiceCharts, tables and diagrams are used throughout for ease of learningIncludes a section on conception, infertility and sub-fertilityCovers legalities and ethical issues.Fully evidence-based Focuses on safety Academic Includes Case histories to illustrate points discussed in the text Charts, Tables and diagrams used throughout for ease of learning Relevant anatomy, physiology and conventional care covered Section on conception, infertility and sub-fertility Legalities and ethical issues Professional accountability

1. Theoretical background to structural reflex zone therapy

CHAPTER CONTENTS

Introduction to reflexology1

Mechanism of action of reflexology3

Types of reflexology7

Reflex zone therapy10

Introducing structural reflex zone therapy12

The spine13

Structural adaptation15

Changes in the spine and musculoskeletal system during pregnancy18

The relationship between structural reflex zone therapy and the musculoskeletal changes of pregnancy19

The evidence base for reflexology20

Conclusion22

INTRODUCTION TO REFLEXOLOGY

“Reflexology” is a generic term denoting a system of complementary healthcare which is based on the principle that one small area of the body represents a “map” or chart of the whole. It is both a new science, having an emerging physiological basis to underpin it, and an art, encompassing creativity, sensitivity and holism. Reflexology is becoming increasingly popular in the Western world, not least because of its nurturing approach. It is a form of touch therapy, in common with massage, aromatherapy, shiatsu and others, yet it is not simply foot “massage” – it has its own theories, mechanisms of action, effects, contraindications and precautions, as well as a developing body of research evidence. Together with other touch therapies, reflexology is slowly being integrated into some aspects of mainstream, conventional healthcare, such as cancer and palliative care, and multiple sclerosis and learning disability care (Bull 2007, Kohara et al 2004, Magill & Berenson 2008, Wang et al 2008, Wilkinson et al 2008). In maternity care, mothers are enjoying its relaxation effects and finding that it can be beneficial for helping them to cope with various pregnancy-related symptoms, and midwives and therapists are responding to this by developing the skills to use reflexology and touch therapies safely for expectant and childbearing women (Field et al 2008a, McNeill et al 2006, Mollart 2003).

Reflexology as a therapeutic modality is derived from ancient Chinese, Indian and Egyptian techniques, and was used in Europe as far back as the 14^th century. In Russia the therapy was introduced by a neuro-psychiatrist, Dr Bekhterev, in the late 19^th century, whilst in Germany the personal experience in 1890 of Dr Alfons Cornelius, recovering from illness, revealed that pressure, applied only to parts of the body which were painful, encouraged recovery more quickly than massage of the entire body. At about the same time, modern reflexology began to evolve from the observations of the American ear, nose and throat surgeon William Fitzgerald, who noticed that patients would frequently subconsciously apply pressure to their hands in an attempt to suppress pain. He discovered that native American Indians used a health system which focused on massaging the feet for relaxation and to ease pain. Fitzgerald harnessed this principle of “zone analgesia” to perform minor ear, nose and throat surgery without local anaesthesia and then investigated widely in order to define the “maps” of the reflex zones on the feet and hands. Fitzgerald and his colleagues, notably Dr Edwin Bowers and Dr Joseph Shelby Riley, refined the practice and theory of the therapy, added horizontal delineations and produced the first chart of reflex zones. Further development in the USA by the masseuse Eunice Ingham resulted in the production of the first of the modern reflexology charts and a change of name to “reflexology”, while in 1950s Germany the nurse and midwife Hanne Marquardt further refined the reflex zone concept. Although reflex zone therapy (RZT) is a form of reflexology which can be used in various clinical specialist areas (see below), it has been used extensively in European midwifery practice, notably in Germany and Switzerland.

In the 21^st century, UK reflexology has been classified as a “supportive” therapy in Group 2 of the House of Lords report (2000). This implies that reflexology should not normally be used in isolation but is helpful as an adjunct to other complementary therapies or to conventional healthcare. However, reflexology is more than simply a relaxation therapy and can be a very powerful therapeutic intervention in its own right. There has latterly been a move towards federal regulation within complementary therapies, instigated by the Prince of Wales’ Foundation for Integrated Health following government directives for regulation of all health professionals as a result of the Shipman enquiry (O'Hara 2007). Reflexology as a generic therapy profession is gradually progressing towards voluntary self-regulation under the auspices of the Reflexology Forum, with a common core curriculum and accreditation of training establishments for pre-registration education, a requirement for continuing professional development and the establishment of codes of conduct. In January 2009 the Complementary and Natural Healthcare Council (CNHC) became the voluntary regulator for complementary therapies following a long period of consultation in association with the Prince of Wales’ Foundation and with the support of the Department of Health. Its key objective is to encourage the use of complementary therapies as a “uniquely positive, safe and effective experience” (see www.cnhc.org), although Edzard Ernst, Professor of Complementary Medicine at Peninsula Medical School, believes it does not go far enough to protect the public (The Guardian 21^st January 2009). (See References and resources section.)

MECHANISM OF ACTION OF REFLEXOLOGY

Reflexology aims to engage the body's own self-healing processes, treating the whole person, i.e. the body, mind and spirit. Unlike conventional medicine, but in common with other complementary therapies, reflexology does not merely suppress the symptoms but intends to limit the adverse effects of disease or disorder, working with, rather than against, altered physiology. The function of the therapist is to act as a conduit to encourage the body to become receptive to self-healing through a focused ability to “read” and interpret the clues presented by the feet, taking into account every factor which contributes to the overall wellbeing of the individual, however trivial they may seem. To a certain extent it can be likened to learning a new language to assist in the process of restoring and maintaining homeostasis. It is claimed that reflexology is relaxing and de-stressing, relieves pain and inflammation, aids circulation and excretory processes, promotes muscle tone and balances the nervous system (Crane 1997:xii) and much of this has been verified, at least in part, by contemporary research (see Evidence base, below).

There are many theories about the mechanisms of action of reflexology. In conventional medicine the term “reflex” implies an involuntary and unconscious response to a stimulus. Reflexology aims to treat through “stimulation” of reflex points or zones on one small area of the body which appear to link involuntarily to others via an, as yet unproven, network of channels, neurones or transmitters. This “stimulation” via pressure or palpation of points on a part of the body, which represents a micro-system of the whole, aims to rebalance and maintain homeostasis, to assist in achieving physical, emotional and spiritual wellbeing. Most commonly the feet are used as this micro-system so that, through manual manipulation, distal areas of the body can be treated, since “stimulation” is reflected back from precise points – or zones – on the feet to corresponding organs or tissues. Reflexology can also be performed on the hands, tongue, face or back. Similarly, auricular acupressure focuses on the ear as a micro-system, whilst in iridology the irises of the eyes are used as the “map” which provides a tool to aid diagnosis, although iridology is not a therapeutic intervention in its own right. It should be noted, however, that in RZT (as opposed to generic reflexology) “stimulation” is only one of a range of treatment techniques; in some situations sedation or other techniques may be used to effect resolution of a particular problem. In structural RZT, manipulation is a significant feature of treatment, focusing specifically on the reflex zones for the musculoskeletal system (see Structural RZT, below).

Several theories about the mechanism of action relate to the general concept of touch, such as the relaxation factor induced by the release of endorphins and encephalins and the analgesic effect of manual pressure (Bender et al 2007). Touch, mainly in the form of therapeutic massage, has been shown to reduce the levels of the stress hormones, cortisol and noradrenaline (norepinephrine), and increase the “feel good factors”, serotonin and dopamine (Field et al 2002, 2005, 2008, Hernandez-Rief et al 1999, McNabb et al 2006), effectively reducing stress, aiding relaxation and inducing sleep. The effects of touch on pain have been demonstrated in a number of studies: massage has been shown to lower the duration and intensity of phantom limb pain in amputees (Brown & Lido 2008), headache (Moraska & Chandler 2008), post-exercise pain (Frey Law et al 2008) and muscle fatigue (Ogai et al 2008). However, reflexology is distinctly different from massage, in that it also attempts to stimulate internal body organs and can be classified as a somatic therapy (working from inside–outwards), whereas massage generally facilitates topical relief of muscular and joint pains (working from outside–inwards).

Each foot has more than 7200 nerve endings, which interconnect with the central nervous system, enabling us to feel pain and pressure, hot and cold sensations, etc. Early theories about the mechanism of action focused on the belief that these nerve endings could be “stimulated” by manual pressure from the therapist, indirectly linking with other areas of the body and therefore facilitating wellbeing and health through a fine-tuning of this sensory apparatus and its neural pathways. Furthermore, since stress patterns are also thought to manifest on the feet, disruption of these patterns with reflexology stimulation essentially relieves general stress, although there is no evidence supporting the notion that specific points on the feet link directly to the named body part, according to the “map”. For example, why should pressure applied to the big toe relate specifically to the head and neck, as opposed merely to inducing a general sense of relaxation?

The skin contains different types of sensory nerve receptors, connected to sensory nerve endings (corpuscles) which make the feet sensitive to pressure and movement. Fine touch and slow vibration stimulate Meissner's corpuscles, situated about 0.7mm below the surface of hairless skin; mild pressure stimulates tactile cutaneous mechanoreceptors, situated superficially in the epidermis, and Ruffini mechanoreceptors in the middle of the epidermis. Stronger pressure and fast vibration stimulate Pacinian corpuscles, found at a deeper level within the dermis, as well as in subcutaneous layers, joints, periosteum and some viscera. Pressure or touch causes the cells to emit an electrical current (an “action potential”), which is carried to the brain via sensory nerves, then to local muscles for a response. The type of nerve fibre involved and the speed of transmission depend on the stimulatory effect, e.g. touch, pressure, variations in temperature and types of receptors or nerves. It has hitherto been difficult to measure objectively the manual force applied via RZT or to identify the exact physiological basis of the therapy (Tiran and Chummun 2005). However, contemporary work suggests that it may become feasible to record, via special technical apparatus, the impulses of specific skin receptors and thereby to identify the precise physiological pathways by which these impulses become effective (Asamura et al 1998, Ascari et al 2007, Makina & Shinoda 2004).

The mechanism of action has also been attributed to the placebo effect and to the therapeutic relationship between client and therapist, although both touch and the placebo effect are common to other manual therapies and are not exclusive to reflexology. The fact that the majority of clients leave a treatment session with their preconceived expectations met or even exceeded, feeling relaxed, refreshed and nurtured may contribute to its current popularity, although this does not explain the apparent success of reflexology in treating specific conditions. Evidence to demonstrate the scientific merit of reflexology is limited and the majority of studies are neither randomised, nor controlled. Further, trials in which “sham” reflexology or foot “massage” is used as a placebo arm of a study do not adequately address the potential for a therapeutic effect from the touch aspect alone. Numerous investigations of both complementary and conventional medicine demonstrate that some benefit can be obtained from any intervention, irrespective of its true therapeutic intent, suggesting that reflexology studies require a control group in which the subjects receive no treatment, in order to assess the true placebo effect (Ernst & Resch 1995, Meissner et al 2007). In addition, reflexology clients frequently exhibit or report signs and symptoms which appear to be responses to treatment, either during or after the session, including some reactions which do not normally occur with massage or other touch therapies (see Chapter 2, Reactions to treatment).

RZT is thought to be a combination of reflex signs, referred pain and trigger points. Referred pain occurs in an area of the body distal to the affected area, for example pain in the arm following angina pectoris or myocardial infarction. This concept was first described in the late 19^th and early 20^th centuries, notably by the neurologist Sir Henry Head, who recognised the reflex signs of disease, in which any internal dysfunction can be observed externally. He believed that, as internal organs do not have a comprehensive pain receptor system, impaired organs are unable to transmit pain impulses to conscious areas of the brain, but instead transmit messages to related skin (dermatomes), subcutaneous tissues and muscles in the related spinal segments, which cause either increased or decreased sensitivity to pain. A dermatome is an area of skin supplied by a spinal nerve, within a specific segment (level) of the spinal cord. Nerve impulses convey messages from the skin to the organs and vice versa, as well as between organs. Disease or disorder of an organ results in changes within the autonomic nervous system, sometimes producing pain at a point distal to the affected organ, as with shoulder pain in the case of gall bladder pathology. Conversely, dermal stimulation results in the unconscious transmission of impulses to internal organs via the afferent nerves. In the presence of pathological conditions, reflex signs arise, mediated via the autonomic nervous system, for example changes in the skin, subcutaneous tissues, muscles, joints and visceral organs. In RZT it is believed that additional reflex signs of disordered physiology can be found on the feet (using the map corresponding to the whole body), and that relevant foot zones will elicit autonomic nervous responses (reactions to treatment) in the event of related pathology, although these processes are not fully understood and have not been demonstrated in formal research studies.

Trigger points are specific hyperirritable points in skeletal muscle, associated with palpable nodules in taut bands of muscle fibres. On pressing the skin these points become sensitive to pressure, via kinetic chains, known to involve groups of muscles mobilised in complex movements of the body (Lavelle et al 2007). An example of this from conventional medicine would be the skin electrodes that detect changes in heart muscle during electrocardiogram. An active trigger point actively refers pain elsewhere in the body along nerve pathways. A latent trigger point does not yet actively refer pain, but as they influence muscle activation patterns, it may result in reduced muscle coordination and balance.

Spasm and pain in a muscle occur as a result of local or distant noxious stimuli, consequently stimulating a myofascial trigger point in the spine, leading to the formation of painful secondary trigger points. These, in turn, radiate further to more distal trigger points – arguably located as far distant from the original causative point as the soles or dorsum of the feet. This neural pathway relationship theory (Baldry 2005) is based on the activation, when disease develops, of peripheral nerve receptors (nociceptors) in the skin and in muscle, which send pain impulses to the brain. It was originally identified through the work of Kellgren in the late 1930s (Kellgren 1938, 1939), in which intramuscular hypertonic saline produced pain distal to the site of injection, initially thought to follow a spinal segmental pattern (Travell & Simons...

Table of contents

• Cover image
• Table of Contents
• Copyright
• Foreword
• Preface
• Acknowledgements
• 1. Theoretical background to structural reflex zone therapy
• 2. Clinical practice of structural reflex zone therapy in maternity care
• 3. Reflex zones used in structural reflex zone therapy for maternity care
• 4. Structural reflex zone therapy for pregnancy
• 5. Structural reflex zone therapy for labour
• 6. Structural reflex zone therapy for the puerperium
• References
• Glossary of terms
• Appendices
• Index