This chapter analyses the process of consultation and diagnosis, which are the essential prerequisites to deciding on the correct treatment.
The first steps in consultation are to observe, question and listen to the patient/client in order to understand the problem. All the information gained should be recorded in a case history, using a consultation card or index card.
There needs to be a thorough diagnostic analysis prior to commencement of treatment, through a methodical appraisal of the feet, hands and ears (see also chapters 5–7 for specific areas). The therapists should be aware of behaviour patterns and how they may affect the patient/client’s health. Other factors that may be important need to be considered also. For instance, environmental factors may be affecting the patient/client. These processes lead to a differential diagnosis to understand the cause of the patient/client’s problem.
Finally, the therapist needs to decide on and recommend a treatment. However, there may be patients/clients for whom treatment is contraindicated, and the reflexologist needs to be aware of these.
The general order of the consultation process is therefore as follows:
• observation
• questioning and listening
• diagnosis
• recommending treatment.
Observation should include both observations of the body generally, and detailed observation of the feet.
General appearance should always be noted; this can only be achieved by a methodical scrutiny of the person as described below to give some idea of their problem.
Being aware of and paying attention to the movement and the physical mannerisms of the person entering the room is of the utmost importance, as many things are noticeable in the first few minutes. These are important as people do not consciously adjust their movements or their mannerisms whilst unaware that they are being observed.
When walking, for example, do they walk on their heels? This could indicate hypersensitivity in the plantar region of the foot, which may indicate peripheral neuropathy. If there is a spring in the step it indicates that the supportive ligaments and muscles are well developed and there is less probability of a spine problem. Is the person flexible in movement when walking? This is a good sign and it shows there is little tension in the body. If the reverse is evident it often indicates the patient is stiff and rigid, and shows that the muscles are tight. This could be due to a muscle injury, a neurological disorder and even arthritis affecting the joints.
The position of the head is important to note. When the body is in the correct position the head is straight and lifted up, the shoulders are relaxed, and this indicates a lack of tension in the person. When the body leans forward it may create pressure on the cervical region, and pressure on the frontal area of the brain; this is thought to be a contributing factor to depression. It also causes pressure on the lower lumbar spine because the weight is not central. The word ‘depression’ means ‘pressure’ or ‘weighing down’; a posture with a dropped head and hunched shoulders may signify that the person is in a low state of mind. Such a posture can in turn cause pressure on the thoracic cavity and abdominal organs. If the shoulders are drawn in the breathing capacity is also diminished; this lowers and impairs the ability of the circulating blood to reach all areas of the body. Many of the problems associated with rounded shoulders are those linked with respiration, such as asthma, bronchitis and upper respiratory infections.
When clients are seated, the therapist should note the following. Are they relaxed? Are the hands held still and at ease, showing a state of calmness and peace, or are they fidgeting, squeezed or twisted in a wringing action, showing unease and discomfort? Other visible signs of unease include plucking of hair and other movements. For instance, do they cross and uncross their legs, cross their feet, or move around? Attention should also be paid to clients’ speech. For instance, do they speak fast without drawing a breath? What is the tone of the voice; is there modulation, or is it high pitched?
All of these behaviour patterns could indicate unease, but there are other explanations. For instance, continual leg movements could be due to discomfort in the lower back or hip area. We should not make a hasty diagnosis, or jump to conclusions. However, the initial observation should enable the therapist to begin to form an assumption of what the problems may be.
A number of specific features can also be observed and are particularly significant.
Difference in skin colour is due to the amount of melanin pigment in the skin. However, a good pink facial colour in fair-skinned people is a sign of a healthy circulation and general good health, as the colour of the skin also depends on the quality and quantity of blood moving through the capillaries. Erythema or redness of the skin can be due to many factors; for instance, the client could have rushed to make their appointment, they may be a little embarrassed, or there could be some allergic reaction (as in hives where the skin is often red and irritating). Any undue redness of the skin should be therefore investigated further. Pale skin may indicate a reduced blood flow, or excess time spent indoors, or just that person is enervated by their problems. A grey appearance may indicate illness or total exhaustion; it could even be caused by a lack of oxygen due to respiratory problems. A greying colour can also occur after a sudden shock.
Dry skin or moistureless prematurely aged skin may be indicative of a hormonal imbalance or that the diet is lacking in some nutrients. Any acne, pustules, pimples and spots is nature’s way of discarding toxins through the skin. They indicate that the endocrine system may be out of balance, and diet, hygiene and lifestyle may need to be addressed. If the problem is acne, the sebaceous glands may have become blocked, or it could also be due to an allergic reaction to other substances.
The ears should have the same colour and tone as the facial skin. However, if there is a slight red tinge around the edges this could indicate an uneven blood circulation. If there is a bluish discoloration it may indicate a lack of oxygen and a deficient circulation. Pallor of the skin here in comparison to the face also shows inadequate circulation. (Note, however, that the outside temperature must be noted when doing ear analysis.) Dry skin or exfoliation of the upper layer indicates a possible imbalance in the diet. (See chapter 7 for more information on the ear.)
Good health is shown by bright shining hair; poor health is indicated when the hair is dull and lifeless. If the hair is thinning excessively there could be an immunological disorder; this could also occur after an illness, or even excessive dieting. Brittle hair could signify a mineral deficiency or endocrine imbalance, because the endocrine system is responsible for the stimulation of the sebaceous gland – sebum helps hair from drying out, but too much sebum can create oily hair.
The lips should be moist and of a pink healthy colour; this indicates good health and good circulation to the peripheral parts of the body. As the lips are extremely sensitive and have numerous sensory receptors they are often prone to allergic reactions from cosmetics, which can make them appear cracked, dry and sore looking. Also it is necessary to see whether the person produces sufficient saliva (see below), as this also aids lip moisture. How lips and mouth are held gives a good indication of how the person feels; tight pursed lips often indicate tension or unhappiness.
A dry mouth can be due to incorrect breathing through the mouth, or lack of saliva. This watery secretion containing enzymes begins the process of digestion, and a lack of this secretion could cause constipation or sluggish bowel action. The secretion is entirely controlled by the nervous system, so can be affected if the person is overstressed. It usually indicates that the sympathetic and parasympathetic nervous systems are not in tune with each other.
It is not in the remit of the therapist to take over the diagnostic role of the medical practitioner. However, certain signs do help make an overall assessment of the client’s general health. A large flabby tongue often indicates general weakness or possibly the onset of some debility. A furred tongue is often evident if the person constantly breathes through their mouth or is a heavy smoker. In some cases a thick tongue coating could signify a gastric disorder or some other disorder that may be in the process of manifesting. An even, red and shiny tongue could be due to a nutritional disorder. Constipation or an imbalance in the bowels can also cause cracks and crevices together with a heavy coating that appears yellow and brownish.
Note should be taken of the general appearance of the eyes. Iridology is an ancient diagnostic tool; the iris patterns, just like fingerprints, are unique to each individual. They help the therapist to see whether the patient is predisposed to ill-health or is generally in good health. As this is quite a complex subject it cannot be covered in any depth here. However, the iris is like the feet and hands a microcosm of the body; each organ has its corresponding position in the iris, and anything abnormal such as a mark or discoloration is an indication of an imbalance. There is in particular a close connection between the central nervous system and the eyes. White ‘nerve rings’ around the iris may be due to some emotional upset or trauma. Small pupils indicate some nervous irritation.
Bright, clear eyes with a clear sclera or outer coating indicate good oxygenation to the eye and general good health. Lacklustre eyes indicate an indisposition. Dry eyes may be due to a nutritional imbalance. Yellow discoloration is symptomatic of a toxic system.
All the above observations should be taken together and are useful in assessing the overall well-being of the body. For instance, four of the senses are used throughout the analysis of the feet: hearing, sight, smell and touch.
• Hearing – this is used during the initial consultation and assessment process. If the breathing is laboured it could mean a respiratory problem. If the breathing or speech is too fast this could indicate the person is stressed. If a patient sighs this could be indicative of depression.
• Sight – observations are utilized throughout an assessment session, particularly noting behaviour patterns and imperfections.
• Smell – this is a vital factor that is often overlooked and should be used throughout the assessment session.
• Touch – this is an essential factor to help assess the client’s vitality and to note whether there are any imbalances.
By looking at the body and comparing it with the feet or hands we get a complete picture of the size and shape of the person. The term ‘mirror image’ when applied to the feet or hands is misleading as this implies that the representation is seen with the right side of the body appearing on the left foot or hand and the left side of the body on the right foot or hand. The term ‘microcosm’ fits the description much better, as the feet and hands represent all the characteristics and attributes of the body. Each organ or part has its corresponding area on the feet, hands or ears.
If the person is short and rotund the feet will show these characteristics also, while if the person is tall and thin this will also be seen in the feet. Even the length of the toes are exactly like the proportions of the neck. If there is an imbalance on one side of the body this is immediately duplicated in the foot.
The longitudinal arch of the foot parallels the shape of the adult spine. The vertebral column also has four natural curves when it is viewed from the side, and the foot has four natural curves almost imitating the line of the spine (see chapter 2 for more details). So if the person had a flat foot (pes planus) this would indicate a bad spine, which would interfere with the flow of nerve energy and the circulation.
The foot areas are represented in figures 2.21, 2.22a and 3.1 and plates 1 and 2. The phalanges (toes and fingers) correspond to the cranial cavity, which houses the brain and all its principal parts. Each toe or finger should be in the same plane when you look at the person, if one toe or finger is higher than its opposite partner, that corresponding eye is also set higher on the face. If the little toe or finger curves in towards the fourth toe and third finger respectively is somewhat tucked under, it invariably reflects an imbalance in the shoulder area.
The metatarsals in front of the ball of the foot correspond to the thoracic cavity, the upper trunk between the neck and the diaphragm, housing the lungs, heart, oesophagus and their associated structures.
The abdominopelvic cavity is represented by the foot between the ball and the heel. It is divided into two parts: the first, between the ball and the midfoot, signifies the diaphragm down to the umbilical area, containing the organs of digestion: the stomach, liver, gall bladder, pancreas, spleen and a small portion of the small intestine. The second, from the midfoot to the heel, represents the central and the lower portion of the abdominal cavity to the pelvic cavity containing the small intestine and most of the large intestine. (There is a slight overlap of the three cuneiform bones into the abdominal cavity.)
Figure 3.1 The lines of the foot
The tarsals (the seven bones of the ankle) correspond to the pelvic cavity, which contains the genitourinary tract and the last portion of the large intestine.
So there are four natural divisions of the foot and we can also divide the hand into four parts. In addition, specific lines on the foot are believed to represent lines on the body. These are as follows (figure 3.1):
• Shoulder or neck line – this divides off the phalanges, and the head-related and neck muscle areas.
• Diaphragm line – this includes the distal point of the metatarsals and metacarpals, covering the upper part of the body: the chest, lung and breast, also heart and upper back muscles. (See plates 1 and 3.)
• Waist line – the waist line is measured on the foot from the fifth metatarsal tuberosity (the protuberance at the proximal base) on the lateral aspect. On the hand it is measured from just below the fifth metacarpal on the ulnar side (see plate 4). This is found when the fist is clenched to form a transverse crease. The area between the waist line and the diaphragm line covers the middle section of the body: the liver, gall bladder, kidney, adrenals, stomach, pancreas, spleen and solar plexus.
• Heel line – the waist line down to the heel line covers the intestinal areas, also the bladder, pelvic and buttock areas. It is found in line with the medial malleolus encircling the heel to the lateral malleolus. On the hand, it is taken from the trapezium bone and the proximal point of the first metacarpal where the muscles bulge at the base of the thumb (thenar eminence), to the middle of the hypothenar eminence on the ulnar side.
• Ligament line (on the foot) – this is a guide line. First work either side of it; at the end of the treatment session you should be able to work on it.
As an example for diagnosis, you can examine the fifth metatarsal notch to assess the waist line. If there is a greater proportion of the foot in front of this imaginary line it denotes that the person is long waisted, but short in the leg; if the reverse is true, this denotes that the person has very long legs. If the medial malleoli at the lower end of the tibia are not level it indicates a low lumbar problem.
This aspect of diagnosis, whether using a Western or an Eastern system, can be summed up by an old Chinese quotation called the ‘ten askings’:
• One, ask chill or fever
• Two, ask perspiration
• Three, ask head or trunk
• Four, ask stool or urine
• Five, ask food intake
• Six, ask respiratory
• Seven, ask deafness or thirst
• Eight, ask past history
• Nine, ask energy
• Ten, ask causes (nowadays we would look at behaviour patterns and lifestyle).
This ancient Chinese system is still used today even in the West. In reflexology we must ask questions, not necessarily to find the nature of the disorder, but to ascertain which organ or part of the body may be in a disturbed state. When palpating on the feet, hands or ears we can also diagnose imbalances by tender spots; however, painful reactions can be caused by all sorts of variables.
During questioning the reflexologist should note carefully what the patient is complaining of. Specific questions may include the following:
• Onset – is the disease or disorder acute or chronic?
• Is there an overactive or deficient organ?
• Are there tender spots on the feet, hands or ears? These can be a signal of a functional problem that is not yet evident.
• Is the person suffering from overtiredness?
• Is there an inherited tendency?
• Are there any foot complaints?
• Have there been any injuries or accidents to consider?
• Where is the site of pain? Does it radiate up or down?
• What is the nature of the pain? Is it sharp or dull? Is it constant or intermittent? Is the pain bearable?
• Is it a slight problem (this means that the patient can still attend to their daily tasks with a little discomfort)? Is it severe (meaning that the patient cannot carry out the normal daily tasks)?
One of the keys to effective therapy work is the skill of active listening. Active listening could be said to consist of:
• Looking at the person who is talking, and sitting quietly with them
• Responding naturally with gestures and expressions
• Doing nothing else but listening to their particular problem
• Reflecting back the essence of what you just heard so that you can explore any inconsistencies (as a means of helping the client to understand their own problems)
• Asking only a few questions.
For reflective listening skills, the practitioner must develop the ability to concentrate on each individual’s problems during consultation, and to give as much space and attention to each and every patient as required. Try and listen and do not be judgemental or too critical of patients’ problems. Take note of their tone of voice and watch their body language; it often tells you more than their speech. Awareness and perception play an important role and patients must be allowed to go at their own pace, as the healing process can be slower than you may have allowed for. Never rush a person through their experiences as this will only force the process. Part of the therapeutic encounter is to develop a mutual trust of each other; as well as becoming a teacher and a guide, it is useful to remember that we can learn from our patients. The holistic healing process is aimed at treating the whole person, the mind as well as the body. Make sure in particular that you are ready to deal with their emotions, as during a reflexology treatment emotional release is often likely to happen. This can take many forms: agitation, anger, anxiety, distress, laughter, often slightly uncontrolled, and tears. All of these are the result of an emotional overload. This release is very important and plays a part in the curative process.
Listening is the key to communication; there is a real art in being a good listener. Some people do not listen. Not listening is much more common in our society than listening. Think about your own experiences. When was the last time someone gave you their complete attention while you were talking? The following situations are indications of not listening:
• Interrupting someone while they are talking
• Taking over a conversation that someone has started
• ‘Switching off while someone is talking, or fidgeting and looking at your watch
• Changing the subject, or responding with an inappropriate answer.
These should be avoided during the questioning process.
The information gained from observation, questioning and specific diagnostic techniques (such as palpation) should be exactly recorded for future reference. This is usually done by keeping a case history. A case history consists of many things that might be related to the patient’s disorder. It allows for a methodical evaluation.
It should record the following at the first consultation or treatment session:
• Date of commencement
• Date of birth
• Name and address
• Telephone number
• Sex
• Name of medical practitioner
• Brief medical history
• What medication the person is taking
• What the complaint is and any other health problems
• Dates of all treatments, with a brief evaluation.
The medical history usually consists of information about past severe complaints or medical problems that the person has experienced. Some of these may relate to the present disorder. It is also imperative that the family medical history is explored in case there is some connection. A general social history (e.g. occupation) to give some background information is also advisable.
It is not necessary to have a tick list of topics to note, but attention can be given to the following:
• Skin quality (feet, hands and ears)
• Nail quality (feet and hands)
• Hair quality
• Weight – obese or underweight
• Posture
• Exercise, also hobbies and relaxation
• Joints – restricted movement or hereditary defect
• Gait analysis
• Muscle tone
• Sleep patterns
• Behaviour patterns and mannerisms
• Diet – nutritive or convenience foods
• Alcohol – regular or occasional drinker
• Tea/coffee intake – if in excess of six cups per day
• Water intake
• Smoker
• General circulation
• Blood pressure
• Allergies
• Hormone imbalance
• Emotional state and stress level
A record should be kept of any tender reflexes so that symptoms and tender areas can be reviewed throughout the treatment sessions.
Finally, a record must also be kept of the patient’s attendance and the amount charged. If you ask your client to refer anything to their doctor, make a note of the date and time you advised them and their response.
The above points are given purely as a guide. They indicate the type of information needed for a case history sheet or index card. It cannot be emphasized enough that the keeping of adequate records is a way of professional life. It also covers practitioners in the event of any claims of any incorrect treatment. One should therefore adopt best and safe practices at all times.
Reflexologists do not diagnose in the allopathic sense, but use a differential diagnosis, taking many other factors into consideration and many other variables to ascertain where there are imbalances within the body. This is why it is important to assess behaviour patterns at work situations and in the home.
Diagnostic techniques are usually performed in medicine to determine the nature of the disorder by analysis of the signs and presenting symptoms. They usually include tests of blood or urine and other laboratory tests to make a diagnosis or to eliminate other possibilities. The differential diagnosis used in reflexology is drawn from signs and symptoms and close observation, often comparing and analysing the differences between the two hands, feet or ears. The aim is to find areas of the body that are out of balance. The conclusions drawn from this are not necessarily totally conclusive, as so many factors and variables could be causing an imbalance in the patient’s health. Therefore perception and skill are required to determine whether there is a need to refer the patient to a medical authority or other discipline.
In palpation a practitioner will explore by examining, touching and probing with the thumb and forefinger to find any sensitive reflexes, or feel a change in texture, such as a deposit and crunchy feeling, or an air bubble and popping sensation beneath your finger, which may indicate an imbalance within that zone. This is where astuteness and dexterity are required, also intuition and perception. Reflexologists use a unique and precise alternating acupressure technique or palpation over all areas of feet or hands to detect any imbalances. The slight changes of texture beneath the thumbs and fingers are often likened to crystalline deposits, although there is no medical evidence that this is correct, but it is enough that these ‘congested areas’ are noted by therapists. Until alerted that there is a tender area, the patient is usually unaware of overuse of a joint. The reaction may include the following: ‘Yes, I do sleep on that side’, ‘I must have at least two pillows’, ‘I always carry my bag on that shoulder’, ‘Yes, I do cross my legs as I am sitting at my desk’, ‘I always support my elbow on the window while driving’, ‘I only do the breaststroke as I do not like my hair getting wet’ or ‘I like tucking my legs up on the settee while watching television’. Such comments indicate how behaviour patterns may cause no end of problems (see below).
This process also therapeutically stimulates the nerve endings, and the soft tissue palpation has a curative effect throughout the whole zone, that is from fingertips to the brain and down to the tips of the toes. With reflexology there are many different analytical techniques; it does not matter which method is used so long as the areas are covered in a systematic fashion, and the practitioner adapts the pressure used according to the person’s needs.
During palpation the strength of the fingers and hand are felt, also the flexibility of joints are noted, and the resilience and springiness of the tissues are observed. All these are of importance in assessing the patient’s energy and vitality. Hand and nail care can often also give an insight into the person’s self-esteem. All these points need to be observed in a systematic way. The practitioner must also adopt a holistic attitude, seeing the patient as a whole. Physical, mental and social factors must be embraced and not just the individual parts of the body.
Illness is a particular state that is produced by many factors. Any excesses in the regular patterns of daily life can cause an instability. The general state of mind is also most important; both our basic attitude and moods, which may change according to the anxieties suffered. Bad temper and anger create stress, which may leave the person disturbed, uptight and unable to cope, creating the right environment for ill-health to manifest. Stress such as repetitive mental tension and emotional strain can lead to many psychosomatic disorders (emphasizing the relationship between mind and body) and other organic changes in body systems such as headaches, migraines, hormonal imbalances, peptic ulcers, irritable bowel syndrome (IBS), neck and low back problems. This is because internal feelings can change the heart rate, causing sweating and rapid breathing. Even muscular tension can be related to stress. It is most important to understand that no two people respond to stress in the same way.
Mental stress from external influences can also cause chronic problems to manifest. The problem may be related to other people. The old saying ‘you are a pain in the neck’ is so true, as a difficult person can create a problem for an individual. The ‘stress syndrome’, leading to many complications, can also be caused by work problems. Fibromyalgia, which is often thought of as a rheumatic disorder, can be stress related. It is an aching and progressive stiffness of the fibrous tissue within the muscle; this affects in turn the neck and shoulder joint and even down to the lower back (so the old adage ‘you are a pain in the backside’ may also be true). So if a patient comes with an acute or sudden onset of stiff neck or lumbago and no physical exertion can explain it, always check to see whether they had any great emotional upset, particular mental strain or work problem prior to the onset of their predicament.
The old adage ‘We are what we eat’ and ‘We are what we do’ are both true, and are wise proverbs that we should all adhere to. By taking an in-depth case history, eating patterns should be discovered. Many food allergies are caused by the very food the person most enjoys. Gastritis is often caused by incorrect eating or lifestyle, and anxiety and stress also play a role.
As many of the daily activities of the patient as possible should be determined. Behavioural adjustment can help an individual to correct everyday patterns and mannerisms of movement that are second nature to the person but that they are often unaware may be causing the problem and over a period of time leading to imbalances occurring in the area of the body concerned. This imbalance in turn can spread until the whole zone is affected. People often comment, however, on which is their ‘bad side’, referring to whether most discomfort is felt in the left or right side of the body. When a patient comes complaining of chronic neck or shoulder problems, it is essential to ascertain the behavioural activity that is making the problem worsen. Many people do not realize how much they can help themselves. The following are some of the activities that may cause or aggravate an existing neck or shoulder problem or cause other complications.
Watching television. If a person is not sitting correctly and looking straight at the television this can cause neck problems and low back problems. If the person curls their legs up it throws the hip joint out. When watching television the chair should be placed directly in the viewing line, and the neck and shoulder should not be twisted. Never allow young children to lay on the floor and look up to the television as this places undue strain on the back of the neck and spine.
Holding the telephone. Does the patient use a telephone and have to write at the same time? Often people try to grasp the telephone between the neck and the shoulder and do other jobs at the same time, but over a period of time this will cause no end of problems in the cervical region.
Carrying heavy bags. Carrying a bag always on one shoulder means that the person elevates the shoulder to keep the bag in place. This creates an imbalance that is evident in females with a shoulder bag and golfers carrying their golf bags. Carrying a heavy briefcase always in the same hand, or heavy shopping, can also cause elevation of one shoulder. Weight should always be evenly distributed between two carriers, one for each hand. School children as young as 9 years of age may suffer with neck and back problems due to carrying books and other classwork in a satchel on one shoulder. Instead they should carry it in a haversack or rucksack on both shoulders, thus spreading the load. School children and students should be made aware of how these postural bad habits repeated over any period can create neck, shoulder and back problems.
Incorrect sleeping patterns. Many people do not have the correct support for their necks when asleep. Each individual body is unique and may require more or less support. It is imperative that the cervical spine is not arched or angled incorrectly and this all depends on the width of the person’s shoulders. The line of the spine should be as straight as possible. Even though the whole spinal column can move slightly and is quite flexible it is often subject to distortion, rendering it more susceptible to overstrained muscles and ligaments. The body naturally repairs itself while we sleep, and attempts to return to a normal position. Given the right conditions in a correct sleeping position the muscles therefore relax and recover, but if the wrong position is maintained during sleep the muscles maintain their tension and the person awakes tired, wearisome and stiff, along with a stiff neck or suffering from cervicalgia, which in turn can affect all the muscles down the neck and possibly involve the shoulder and arm.
The two main muscles that turn the head are the thick sternocleidomastoid muscle and the splenius capitis muscle. These muscles stiffen very quickly if they remain in one position for any great length of time. When a person is asleep the muscles of the neck relax immediately, and that is why it is imperative to have the right support. If the neck is twisted to the side (as in the case of a person sleeping on their front) then over a period of time this may cause a stiff neck or over a longer span of time spasmodic torticollis. This condition would also travel down and involve the trapezius muscle causing general myalgia (pain in the muscle) or even myositis (inflammation of the muscle) in the whole neck and shoulder region, which in turn can travel down the spine to the hip. (Shoulder and hips are always related in reflexology through the zonal pathways.)
Because muscles draw up when there is any sustained involuntary muscular contraction, it is easy to observe the position of the neck of the patient and note whether the shoulders are level; this will give some indication how severe the problem is. All muscles and the surrounding connective tissue need a good nerve and blood supply to supply nutrients and oxygen to the area. Restriction of muscles may cause muscle spasm. If the patient is not aware that a sleeping habit is creating an imbalance to the muscle structure, the problem can only deteriorate further.
If a patient complains that they often feel worse in the morning it is invariably due to an incorrect sleeping pattern. Before treatment, the reflexologist should therefore explore the right pillow support for the person, using the treatment couch for them to demonstrate how they sleep. The pillow should sit in the crook of the neck and the neck should not be out of alignment with the cervical spine; too high a pillow will cause the neck to be raised off the cervical spine, while too low a pillow will cause the neck to drop away because in sleep there is no muscular support. The person should not sleep on their front as this causes acute restriction on the cervical region and all the muscles that move the head.
Office work. Office workers need to be aware of work patterns, such as holding a telephone in the crook of the neck (see above). Continuously reaching to one side to lift an object, such as a file or book, can also create neck, shoulder and back problems.
Typists are often prone to wrist problems owing to incorrect chair height or position whilst typing. Tenosynovitis, which is inflammation of the tendon sheath, is also common in people who do a lot of writing or drawing work. Also the second, third and fourth fingers are drawn up into the palm, and this can lead to trigger finger with a total impairment of extension in any one of the fingers.
Tennis elbow. This is not necessarily caused by tennis, as this term covers any overuse of the forearm muscles, which may cause restriction of movement and painful inflammation of the tendons. It is common in drivers who rest their arm up on the right side window while driving. This elevated position of the arm can cause no end of problems to the arm and shoulder (see also chapter 8, A-Z of disorders of the body, Repetitive strain injury).
Sitting for prolonged periods, and lack of exercise or movement.
These habits can create some of the following:
• Cramp – this painful spasm in the muscles can be due to an imperfect posture, or it could relate to a circulatory problem, or an imbalance of salts. This can be caused by working in a very warm environment, in which excessive sweating may occur and the person is further depleted by constant coffee drinking and not enough water intake.
• Rheumatic-type pains – these are often in the lower and upper limbs.
• Back pain – this is often due to incorrect posture or faulty seating whilst working.
• Haemorrhoids – these are often aggravated by prolonged sitting and a restriction to the circulation to the rectum.
• Constipation – apart from dietary causes, this can be caused by ignoring the first impulse or sensation in the rectum; it is easy to remain seated when you have a lot of work to do.
• Urinary tract infections, both male and female – these disorders can be further aggravated by prolonged sitting as the bacteria that cause this are also on the skin surrounding the anus, and increased moisture as a result of wearing or sitting on incorrect fabrics allows the bacteria to enter the genitourinary tract.
• Problems in the reproductive system – these may be due to prolonged sitting on synthetic coverings, or in females wearing tights or synthetic underwear, which are more prone to bacteria proliferating.
When palpating the feet, the muscles in the lower arch of the foot may appear soft and floppy; this area corresponds to the low abdomen, and shows there may be a bulging stomach caused by excessive sitting, both in men and in women. This can cause, as stated above, a deficiency in the upper parts of the body, which in turn can create shoulder, neck and lower back stress.
When at home or at work when sitting or driving, people should always be made aware of their seated position. Do they have support for their lower back, or are they slumping in their chair? The wrong position can cause havoc when repeated over a period of time. Is the patient a manual worker, as lifting heavy goods correctly is paramount? Bending at the knees and keeping the back straight, the person should try not to twist or turn when lifting as this will distort the back muscles. It is quite surprising how the obvious does not occur to some people. Equally, decorators, or anyone who works above their head or with arms outstretched for long periods, are prone to lumbar problems; often this is because the posture is altered and the head and neck are off the centre line of the body, so they are either leaning backwards and over their head, or stretched forwards; there is too much arm work in awkward positions.
People cannot change their occupations, but it is necessary to make them aware that they are usually causing their own problems by unvarying uniform movements, and over a period of time these may lead to repetitive strain injury, or RSI.
Standing for prolonged periods with little movement and relaxation of lower abdominal muscles.
These can cause any of the following:
• Varicose veins – these are a mass of enlarged blood and lymphatic vessels that can become tortuous and swollen because of the internal pressures from higher in the body. The great saphenous vein or its tributaries are the ones usually affected; these are on the medial side of the leg and foot. Any occupation that involves long periods of standing with very little movement will not supply the necessary pumping action that is required to discharge the blood from the veins. There is also often an inherited tendency to varicose veins or faulty valves; this contributes to a loss of elasticity in the walls of veins and valves (structures in blood vessels that regulate the direction of flow of blood) making them flaccid, which may cause an obstruction to blood flow. These inherited conditions are often made worse from prolonged standing and the vessels become distended even more because of the pressures from within the walls and the blood accumulates. Constipation can aggravate this further, as well as inadequate exercise.
• Phlebitis – a poor circulatory system can cause phlebitis, an inflammation to the vein, and one should be very careful when palpating or treating the ankle or lower leg area because of this impaired circulation. Problems may often appear about 4 inches (10cm) above the ankle down to the heel area. If there are signs of broken blood vessels, extreme caution should be used when working on the foot or leg; it may be advisable to work on the hands only.
• Problems in the reproductive system – these can be exacerbated by excess weight of the trunk on the lumbar spine and pelvic areas.
• Oedema of the legs – this is a fluid accumulation in the lower parts of the body, often due to varicose veins.
• Disorders of the legs or lower back – these occur if undergarments are too tight or from prolonged sitting with the legs crossed or standing in one spot for too long. Many such everyday activities may cause a restriction to the blood flow and this may cause tingling and even discoloration in extreme cases.
Many times behaviour patterns and sedentary lifestyle or physical inactivity can create a disorder or exacerbate a problem. Too much standing, or too much sitting, or any activity in excess, are contributory factors that the reflexologist should always bear in mind. Being overweight can also cause too much pressure in vessels; that is why it can often be a common problem of pregnancy.
It is imperative that if there is any prolonged inactivity, simple stretching exercises are suggested. Even flexing and rotating the feet and wriggling the toes will promote a healthy return of the circulation. Or you can get up and walk around on tiptoes to relax the shoulders, then walk on the heels for the lower back.
Reflexology is beneficial for many of the behavioural problems discussed above, especially vein problems and haemorrhoids, because stimulation encourages the venous return to the heart. It also stimulates the connective tissue and improves circulation generally, and helps disperse oedema, especially if there is swelling in a joint, and alleviates pain in spinal areas, possibly because of increased blood supply so nutritive compounds are transferred to muscles without any overload of toxic lactic acid (which is produced through voluntary muscle contraction). It helps in tissue renewal as it triggers growth hormone release from the pituitary, which stimulates new bone growth, aiding in healing of fractures.
Before commencing treatment, one has to consider many different factors. For instance, is the illness of sudden onset, or chronic? If it is chronic the system would be very depleted. The age of the person is not really important because young and old alike will benefit. Contraindications must always be considered, also the person’s threshold of pain, and their reaction to reflexology during, between and after treatment. A patient should always react positively; if there is any uneasiness during treatment one should always stop and use one of the many relaxation techniques. These can be used to calm, tranquillize, balance or revitalize. The body seems to know when it needs invigorating and when it needs to be restful. When treating patients we have to take into consideration all these many factors.
Specific factors in a patient’s condition may make it unwise to pursue a reflexology treatment. These can include medication and some illnesses. Reflexology can often be given on the hands when a person is very sick or depleted as this ensures that there are less toxins released into the body. Every practitioner must learn to be able to adapt their pressure and area to work on, according to each of their patient’s individual needs.
If the body is depleted by any disorder and there is a homeostatic imbalance within that particular problematic system, there is often exhaustion and less energy within the body. This condition creates its own toxins as the internal environment has not got the power to fulfil all the feedback mechanisms to ensure normal functioning of all processes.
There should be no need for a contraindication list as reflexology cannot harm anyone. Any kind of massage to the feet will increase a sense of bodily harmony and well-being, however; the unique techniques of reflexology have the ability to enable all organs and systems to function at peak performance. However, with the increase in medical litigations nowadays, it is sensible as a professional to protect oneself. Even a skilled, qualified practitioner cannot foresee some of the outcomes of treatment when the body is in an unstable state. Therefore, there are certain occasions on which a practitioner must be aware that care must be taken as there may be factors in a patient’s current condition when treatment may be detrimental to the well-being. In these cases, certain reflex points must be omitted, or the patient should be referred elsewhere.
In general, the pituitary point should not be worked throughout pregnancy as the pituitary gonadotrophins are blocked, and the corpus luteum maintains increasing levels of progesterone and the oestrogens until about the fourth month, when the placenta takes over. Many other cautionary areas during pregnancy lie on an acupoint, for instance the chronic uterus area, which lies in the pathway of SP-6, a well-known acupoint on the Spleen meridian that is used for irregular menstruation. One can see in the case of an unstable pregnancy why it would be ill-advised to work this area. Another acupoint on the Bladder meridian, B-60, is used for lumbago; it is marvellous for this, but is also a good point for treating placental retention. The placenta is attached to the wall of the uterus and part of its function is to secrete the chorionic gonadotrophin hormones to maintain the secretion of progesterone and the oestrogens that regulate and maintain the pregnancy. That is why it is another contraindicated reflex point to work on throughout pregnancy. The last contraindicated point is LI-4, known as Hegu in Chinese; this is an acupoint on the Large Intestine meridian of the hand, used for amenorrhoea, so again one can see why caution is needed not to work this point during pregnancy as it stimulates menstrual bleeding. (See also Pregnancy in chapter 8).
In the first 12 weeks it is imperative that the fetus develops normally. Because of the great change in hormonal production at this time, progesterone levels should remain normal and not drop. Problems that may occur are: the fetus may have abnormalities, there could be low placental implantation or the person may not be aware that they have fibroids, cervical erosion, or a defect in the uterus such as a bicornate (subdivided) uterus. There could even be an autoimmune disorder or genetic defect. Even certain infections may damage the fetus. The body goes through so many changes, with the increased levels of the hormones oestrogen and progesterone. It is very important that nothing is done to interfere with the normal production of these hormones as it may affect the formation of the baby.
If the client has never received reflexology before and is in her first trimester, it is best to avoid treatment as we are not sure how the pregnancy is being maintained, and most of the hormones are working to maintain the lining of the womb. After the first trimester it is necessary to start treatment quite gently if the person is unused to this type of stimulation. If the person was used to reflexology before conception then as long as the treatment is modified to the person’s needs there should be no problem.
(See also Pregnancy here, for a more detailed discussion.)
Powerful drugs often have powerful side-effects. Any medical book or formulary will detail the predictable or expected side-effects and unexpected reactions that may be caused by patients’ allergic reaction to some drugs. At one time all drugs were naturally occurring; these were taken from plants, some animals, and certain minerals were also used. Nowadays, most drugs are laboratory produced, the theory being that this is safer and more efficient. However, many such drugs inhibit or alter normal chemical reactions within the body. The organs that may be involved are the liver, intestines and kidneys. The majority of drugs also do not act specifically on the target organ, but also involve other tissues or organs. Other drugs to be aware of are those drugs given together with in-vitro fertilization, as strong fertility drugs are used to stimulate the ripening of the eggs; ovulation is also induced with drugs, and because of the amount of drugs involved the person is susceptible to miscarriage.
Many people with heart disease have more than one problem. Often the drugs given can change the heart rhythm; even the medication for heart problems may cause an imbalance in the heart beat, or eventually may cause damage to the heart muscle. Beta-blockers slow down the heart rate and reduce the force of contractions; these drugs are also used to regulate abnormal rhythms and to reduce the workload of the heart. As reflexology may increase elimination of the drug from the system it is always advisable to refer such patients to their medical practitioner prior to treatment.
In heart problems the systems of the body are having to work overtime to compensate for the inadequate pumping action of the ventricles. The liver and the lungs may become congested, and the body may become totally overloaded with excess fluids in the tissues, causing oedema, and extra stress on the kidneys. In such a depleted system it would be unwise to give a full reflexology treatment in case the person’s body could not deal with more toxins being released into the already overburdened organs and tissues. Treatments should commence on the hands only, once a week to start with, gradually building up to one daily, and then work can commence on the feet, with a weekly treatment together with the necessary changes in diet and lifestyle.
In milder heart problems again the hands are a powerful aid in normalizing palpitations and irregular heart beat, and even angina. (See also Heart disorders in chapter 8).
Infections are often due to harmful organisms such as bacteria, fungi or viruses. Common sense should prevail here. It is of paramount importance that the therapist does not contract the disorder or transmit it to a third party. In all infections, any increased circulation may move the infection through the body quicker so that the body cannot build the necessary antibodies required swiftly enough. Reflexology will not actually spread an existing infection as it only works to harmonize and heal; however, if the system is so weakened by existing toxins, only the lightest of treatments should be given. Reflexology applied gently can help most problems once the acute stage and the infection has passed. Then it will strengthen the body’s immune system. There are a number of points.
1. There should be no physical contact with any open wound, not only for the practitioner’s sake but also because the recipient does not want their problem to be exacerbated. In the case of eczema or dermatitis work on the cross reflex (or see hydrotherapy of the hands and feet in chapter 9).
2. In the case of damaged tissue there is often a referral area that you can work on, as again direct contact could cause Microorganisms to enter and cause further problems to the patient.
3. In the case of verrucas on the plantar aspect of the foot, or occasionally on the hands, these are very contagious so it would be inadvisable to work directly on them. Either cover them or work on the cross reflex: hands-feet or feet-hands. Sometimes these are very difficult to see, but often they are felt on palpation, so it is important when scrutinizing the feet during foot analysis that care is taken to note them.
4. Inflammation of the venous system such as phlebitis or thrombosis is a homeostatic imbalance of the cardiovascular system. If the tissue is damaged in any way then work on the hands. The already weakened venous system is under a lot of strain so treatment is aimed at reducing the inflammation by working on the adrenal reflex on the hands and the referral point for the affected part; also work the ear points for the powerful anti-inflammatory properties. Some books state that we should not work if there is a blood clot as stimulation would cause it to move towards the heart; this would be contrary to everything we know about reflexology as the whole process is to normalize and balance, which encourages the body to heal itself.
5. If a patient has a myelogram it is best to treat only after 72 hours have elapsed, as the medium used to inspect the spinal cord in this X-ray is introduced into the body system. As this is a dye and a foreign substance to the body it may cause a headache; this is the reason a patient is kept quietly resting for a few hours afterwards and told not to take any vigorous activity for a few days. It is better not to stimulate this substance to move around the body, but to let the eliminating processes get rid of it in the normal way.
6. Vaccinations or immunizations are often cultured viruses or bacteria and they are given to stimulate the body into producing the appropriate antibodies to confer immunity. These are usually introduced in several stages, thus allowing the body to deal with this antigenic material. If a reflexology treatment is given at this time, because it improves the circulation it will move the medium through the body before the necessary antibodies have been formed and this may cause some unpleasant side-effects. It is advisable to leave 1 week after any vaccinations either for holidays or for influenza.
Schizophrenia is often linked to a degenerative personality disorder and there are many disturbances in the psychological processes, so it is best dealt with by the medical profession. However, there is still some doubt as to the cause, as with many of the other psychoses. Provided that the therapist works with the medical practitioner’s advice, then anxiety and confused states can be helped enormously. Also epilepsy in its milder form benefits, as reflexology treatment seems to act as an anticonvulsive. There is a particular acupoint crossed when working the neck reflex, which is a point used for convulsions (see Nervous disorders in chapter 8).
There are many differing views on reflexology treatment with these disorders. With reflexology it is the person and not the disorder that is treated, so unlike some complementary treatments that would be frowned upon by the medical profession, with the holistic process of reflexology it would be neither unethical or illegal to treat. However, one should always work closely and with the permission of the medical practitioner. Reflexology applied by a very caring and sensitive practitioner and working extremely gently will aid the patient’s immunological system and improve their general energy levels, giving them deep relaxation and improving their whole emotional outlook. It may as well considerably reduce pain levels. This treatment also improves all the eliminating processes, thus getting rid of toxins and helping to reduce oedema.
These disorders are all dealt with in chapter 8. The reason why they are listed in some books as a contraindication is unknown. Many such imbalances are further aggravated by the clients’ own mismanagement of their diet. If these areas are worked properly we can only improve the functioning. Using precise techniques to work the areas of assistance also (that is, those reflexes that are linked to the organs and have an anatomical link in supporting their function), the treatment then becomes a powerful therapy in improving and normalizing the vital body processes.
Some final points to remember about supporting and caring for the client during the consultative process are:
• Consideration of the patient or client should take precedence over all other factors. Interruptions should be dealt with so that they cause minimal disturbances. This should include answer phone facilities, or someone else should be available to answer the telephone and deal with other callers and visitors.
• Clients need to be shown sympathy for their suffering, and awareness and understanding, as this inspires the right relationship to establish mutual confidence.
• The treatment should always appear reasonable and the client should both benefit from it and enjoy the treatment, even though it may be a little uncomfortable at times. The therapist should appear to be involved with the patient’s progress at all times.
• A consultation is a two-way process, so ensure you do not monopolize the conversation, and allow the client to speak in their own time.
• Where and how the initial consultation is carried out is vitally important to establishing rapport with the client.
• Each client is an individual and should be treated so; an explanation of treatment should be given and the expected conclusion of treatments should be discussed and agreed.
• Only give practical advice if needed; however, knowledge of different local and national support systems is very useful (see Appendix I for statutory support systems).
• Always give encouragement and help if a client is trying to give something up (such as smoking); do not decry any efforts.
• Health and hygiene of self and the client should always be adhered to, as the feet and hands are a common site of many fungal infections, usually in the webs of the third, fourth and fifth toes. On the hands this is often seen as a nail disorder.
• The treatment in its entirety is aimed at the client attaining a holistic balance of their health.