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Feet First

With a new foundation course being launched this month and growing interest in the approach, Reflex Therapy is finding its feet. Robert Millett reports

Everybody knows a good foot massage can be relaxing, but a growing number of physiotherapists are working with people’s feet to bring about a range of other benefits.

Liz Cradock, a physiotherapist from Waterbeach in Cambridgeshire, works in the care of older people and has a special interest in falls.

She uses reflex therapy as a treatment modality for patients presenting with acute and chronic musculoskeletal (MSK) problems and neurological conditions such as stroke and multiple sclerosis.

After graduating in 2002, Mrs Cradock began using reflex therapy as an additional physiotherapy approach in her private practice work.

‘I undertook training because I was interested in learning a therapy that used the body’s “inbuilt intelligence” to promote healing and well-being,’ says Mrs Cradock.

‘Although I was somewhat sceptical as to how it could work, I soon became impressed by how powerful and surprising the therapy could be.’

Since then Mrs Cradock has found reflex therapy increasingly useful, either on its own or in combination with other treatments, and says she now considers it an invaluable ‘tool in the toolbox of physiotherapy treatments to choose from’.

In particular, she uses it to help her patients achieve long-term goals for improved gait pattern and balance.

‘I have found that arthritic pain can respond to this type of treatment and increased range of movement can be achieved,’ says Mrs Cradock.

‘Improved blood flow to the feet resulting in the feet being more flexible can result in an improved gait pattern, balance and posture – and its use in areas such as mental health can be extremely beneficial for the psychological aspect as well.’


Reflex therapy derives from reflexology – the study and practice of treating reflex points and specific areas of the hands and feet, which are believed to correspond to specific parts or organs of the body.

Although the two disciplines are very alike Gunnel Berry, a research officer for he Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT), explains that reflex therapy stems from a contrasting knowledge base.

It also differs from reflexology by virtue of the fact that it is only carried out by allied health professionals or other medically-trained personnel.

The principal hypothesis of reflex therapy is that applying a sensory stimulus through the skin directly affects physiological processes (via the nervous system).

Both the autonomic and  psychoimmunoendocrine systems, for example, are affected.

As Ms Berry explains: ‘The peripheral digits appear to have a hypothetical homunculus whereby each part of the foot represents a specific area of the body as a mirror image. The left foot represents the left side of the body and vice versa on the right.’

One of the therapy’s obvious advantages is that feet and hands are easily accessed and ‘non-invasive’ of a patient’s personal space.

Ingela Jacob, ACPIRT’s chair, believes this can prove useful in a number of scenarios.

She notes: ‘I find that it is great when a patient is unable to get into a position where more conventional treatment is used either because of pain, or being heavily pregnant, severely disabled, or when their pain is too severe to tolerate any direct treatment – for instance with whiplash.

You can apply the treatment to the foot or the hand, so it is very accessible.’

The versatility of the therapy also means it can be used as both a standalone treatment or in conjunction with other techniques.

Additionally, it can be given quickly, with brief sessions lasting no longer than a few minutes, and simple self-administered techniques can be easily taught to patients.

‘Resources and treatment times are key objectives these days and my aim is to treat patients in a way that allows them to be independent to carry out their own therapy once discharged,’ says Mrs Cradock.

‘Reflex therapy is not, and never will be, the only treatment I give.But it comes pretty high on my list of options, especially with those cases where the area of injury is too painful to touch, or where improvement in movement and strength have not resulted in a reduction in pain.’

Knowledge gap

The CSP officially approved reflex therapy as a physiotherapy modality in 1992 and ACPIRT was established two years later.

The group now has 124 members and reflex therapy is steadily gaining in popularity among physiotherapists.

However, it remains one of the lesser known skills that physiotherapists have at their disposal.  Ms Berry says there is a huge knowledge gap within the profession about the therapy’s clinical applications and potential benefits.

‘Having worked with this method for 22 years I’ve seen the benefits it can offer patients and I am totally assured of its value in patient care at many levels,’ says Ms Berry.

‘Yet, it is still shrouded in mystique.’

In her own practice Ms Berry uses an adapted form of reflex therapy as a primary application in physiotherapy practice for acute, subacute and chronic issues.

She also recommends the treatment for whiplash injuries, especially when hypersensitivity hinders any topical application on spinal areas, and believes the therapy could easily be applied in the care of older people and for outpatients with osteoporosis or fractures.

‘It works very well to reduce hyperalagesia and hyper irritability,’ says Ms Berry, who also finds it helpful in cases of symphysis pubis dysfunction in pregnancy, community care of older people in pain and for pain in scoliosis, for example. ‘It also facilitates the relaxation process in overactive myogenic and neurogenic components.’

The therapy has maintained a low profile in part, perhaps, because it still lacks the backing of traditional large scale research evidence.

However, its practitioners say case studies and smaller studies have shown a reduction in pain thresholds, changes in cortisol levels and benefits including increased relaxation and reduced stress levels.

‘Research has shown effectiveness in patients suffering from multiple sclerosis, bladder retention control release and pain relief,’ says Ms Berry.

‘And there is research going on with Parkinson’s patients and therapists working in intensive care units with good responses.

We also have reports of good improvement in head injuries and ongoing research into severe constipation in women and constipation in children.’

Raising awareness

ACPIRT’s educational committee has recently established a foundation course in reflex therapy, which was approved by the CSP accreditation process earlier this year.

The course curriculum provides a baseline standard of training to healthcare professionals, while simultaneously promoting a high-quality, evidence-based rationale for providing clinically reasoned reflex therapy within clinical settings.

An awareness day in 2013 also aims to inform fellow health professionals about reflex therapy and provide an opportunity for people to learn from the current research and clinical experience.

The first foundation course starts this month in Exeter. An awareness day in Basingstoke, Hampshire, on 22 March 2013, will be open to all healthcare professionals and the general public.

For details, visit: fl

A 2010 ACPIRT audit of members revealed that reflex therapy was being used in a wide range of applications, both in the NHS and other healthcare settings.

These included:

  •  MSK
  •  oncology/palliative care
  •  mental health
  •  women’s health issues
  •  children and pain
  •  obesity
  •  sports injuries
  •  chronic pain issues
  • whiplash injury
  • amputees
  • neurological conditions
  • chronic constipation
  • care of older people
  • intensive care units.

A patient’s view

Joanne Beckinsall was eight months pregnant when she was referred for physiotherapy following a road traffic accident that left her with whiplash injuries.

At Moorhouse Physiotherapy Clinic in Leek, Staffordshire, she was treated by physiotherapist Linda Skellam, who decided that reflex therapy was the best course of action.

‘Because she was so heavily pregnant reflex therapy was the only reasonable modality that could be used to effectively treat the spinal pain resulting from the accident,’ says Mrs Skellam.

‘She was in quite a lot of pain and experiencing severe headaches on a regular basis, so she was only too pleased to try any therapy that might help.’

Mrs Beckinsall says she found the first treatment soothing and relaxing but it was only after the second treatment that she began to experience the most beneficial, and unexpected, effects.  

‘I had experienced sickness throughout my pregnancy and hadn’t eaten properly for eight months,’ says Mrs Beckinsall.

‘But after the session when Linda worked to manipulate my stomach and digestion I found that my appetite returned overnight.’

Over the next three weeks she received regular treatments and by the end of the course not only had her nausea gone but her spinal pain was reduced; the headaches had diminished and she felt ready to face the challenges of childbirth and motherhood.

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Robert Millett

Issue date

3 October 2012

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