Πέμπτη, 17 Σεπτεμβρίου 2015
My ppt presentation for the ICR 2015 Conference and...
“Throw away” Energy and Reflexology charts for a while.
Let’s have a good look at feet anatomy and the physiology of what we are doing!
by Spiros Dimitrakoulas, Orthopedic Reflexologist (OR)
Competing interests - The author declares that he has no competing interests.
I have chosen to throw away energy and Reflexology charts for some simple reasons.
The matter of energy because firstly the vast majority of scientists and physicians claim that there is currently no conclusive evidence that energy healing is more effective than placebo.1 The reason it works when it does is because CAM practitioners spend a lot of time listening and expressing empathy – which is probably their secret to success (not the “magical” properties of energy healing) 2. This of course does not have a negative effect on energy methods being incorporated into a hospital setting, especially if we were to include praying for oneself or for others. 3
The theory of the Reflexology charts is put aside initially because of the inconsistent reflexology foot maps. 4 There are many charts depicting the same reflex in different areas of the feet and according to our claims and those of our clients they all work. Also because in everyday practice experienced Reflexologists eventually will work the point(s) they believe best despite their common training.5 Finally if we are working on a mirror image of the body that is projected on the feet we must consider the anatomical variations that occur, for example heterotaxia.6
In order to proceed we must first lay down some basics and a question, or at least I want too.
Question: Is it a “reflex” or a “reflection”?
1. Ingham made the claim that the application of reflexology massage to reflex points on the feet increases blood supply to the corresponding mapped organs in the body. In her teachings, the reflexology haemodynamic treatment-related effect is thought to be distinct from non-specific foot massage components, such as simple touch, therapeutic exchange and placebo effects, even though these components can themselves cause haemodynamic responses. 7
2. Ingham described her technique as a “slow creeping rotary and slight pulling back movement” 8
3. The duration is 20-30 minutes and for those trained in the method half that length of time. 8 pg.29
4. Our clients are people with chronic, unexplained, and unresolved health issues; they are desperate and willing to try anything to solve these issues.9
I use complementary medicine/therapy because....
1. Conventional medicine was not effective for my health problem.
2. I believe that complementary/alternative medicine allows me to take a more active role in maintaining my health.
3. The conventional medicine treatment I received had unpleasant side effects.
4. I value the emphasis that complementary/alternative medicine places on treating the whole person.
5. I had difficulty communicating with my medical doctor (for example, he/she didn't understand my problem, didn't listen, etc.).
6. I am desperate to solve my health problem and I will try anything.
5. Science is changing, classical theories are being challenged, how are we to prove ourselves? 10,11
6. Research and its findings are biased to say the least. “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” Dr. Marcia Angell 12,13
The Heart reflex
Jones and Leslie of the Stirling University reported the inconsistencies in reflexology teaching literature regarding treatment strategies and marked inconsistencies that exist in the heart reflex point placement.14 Despite these inconsistencies there are Reflexologists and clients who claim that they have witnessed Reflexology to be of benefit. The same authors also reported that reflexology massage applied to the upper part of the left foot in the area thought to relate to the 'heart' may have a modest specific effect on the cardiac index of healthy volunteers, but no specific haemodynamic effect on patients with various gradations of cardiovascular disease.15 Frankel also noted that the reflexology and foot massage groups showed significantly greater reductions in Baroreflex Reflex Sensitivity BRS compared to the control group.16
The baroreceptors are stretch-sensitive mechanoreceptors. The baroreflex provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the heart rate to decrease and also causing blood pressure to decrease. Decreased blood pressure decreases baroreflex activation and causes heart rate to increase and to restore blood pressure levels.
Jones and Leslie asked the Reflexologists to administer treatment in the upper part of the left foot compared to the control group who focused on the heel. If we observe the anatomy of the plantar foot we will see that there exist more and larger arteries in the first area compared to the control. If for example there is “constriction - stiffness” of the tissues in this area of the foot (metatarsal bones) this could possibly lead to arterial stiffness which would lower BRS thus increase systolic arterial pressure SAP. If someone were to release the “constrictions – stiffness” this would alter the BRS and thus lower the SAP. This has been examined with different exercise training.17
Referral areas – Cross reflexes
Ingham in her book Stories the feet can tell pg. 99 suggests the use of referral areas and the evolvement of this idea is cross reflexes. The earliest documentation of this idea was probably by Celsus in his book De Medicina.18
Through research it has been observed that in unilateral tendinopathy sensory and motor systems present deficits bilaterally. This implies potential central nervous system involvement. This indicates that rehabilitation should consider the contralateral side of patients.19 Also there is indirect evidence to indicate that neural adaptations accompany resistance training from the phenomenon of 'cross education', which describes the strength gain in the opposite, untrained limb following unilateral resistance training. It has been estimated that the magnitude of cross education is approximately equal to 7.8% of the initial strength of the untrained limb.20 There is also Interlimb coordination (Crossed extension reflex) which primarily involves movements requiring sequential and simultaneous use of both sides of the body with a high degree of “rhythmicity”. More precisely, it involves the timing of motor cycles of the limbs in relation to one another (Swinnen & Carson, 2002). Such actions are commonly divided into two categories: bimanual coordination and coordination of hands/feet.
Somatosensory ascending pathways carry peripheral sensations to the brain; the dorsal column system and the spinothalamic tract are two major pathways that bring sensory information to the brain. Stimuli from the head and neck travel through the cranial nerves—specifically, the trigeminal system. The dorsal column is separated into two component tracts, the fasciculus gracilis that contains axons from the legs and lower body, and the fasciculus cuneatus (T6) that contains axons from the upper body and arms. The dorsal column system is primarily responsible for touch sensations and proprioception, whereas the spinothalamic tract pathway is primarily responsible for nociception and temperature sensations.
The second neurons in both of these pathways are contralateral, because they project across the midline to the other side of the brain or spinal cord. In the dorsal column system, this decussation takes place in the brain stem; in the spinothalamic pathway, it takes place in the spinal cord at the same spinal cord level at which the information entered.
The explanation to this communication is still incomplete but definitely many lower and higher central nervous system areas are involved.
Reflexology significance: Cancer patients request CAM treatments in order to “be in the driver’s seat” and Reflexologists teach them to work on referral areas and cross reflexes and one would initially be tempted to attribute any positive results to suggestion and placebo. But it is interesting that this might work because the CNS evaluates not only the affected limb but also the space/side the limb resides.21 Put simply, if you were to place your affected limb across the midline of your body, or your healthy limb on the affected side this might spatially confuse your brain and its output (pain) will also change. Maybe that’s how therapeutic knitting works also.
Besides an existing neurological coordination of hands/feet based on a serial organization (communication between levels) of the motor system, there exists also a myofascial explanation.
The Functional Lines, according to Tom Myers, extend the Arm Lines across the surface of the trunk to the contra lateral pelvis and leg and vice versa.. These lines are called the 'functional' lines because they are rarely employed, as the other lines are, in modulating standing posture. They come into play primarily during athletic or other activity where one appendicular complex is stabilized, counterbalanced, or powered by its contralateral complement. An example is when you throw a rock with your right hand; you will power up through your left leg and hip to add extra speed to that rock.
While the applications to sport spring to mind when considering these lines, the essential example is the contralateral counterbalance between shoulder and hip in every walking step. Excess strain or immobility at any part along the line could lead to a progressive 'pile-up' elsewhere on the line that could lead to problems over time. 'Silent' restriction somewhere on any myofascial meridian, Reflex zone, Chinese meridian could be creating 'noisy' problems elsewhere.22
Autogenic inhibition - Reciprocal inhibition reflex - Golgi Tendon Organs – muscle spindles
When we are offering reflexology to our clients, their bodies are usually in a relaxed position and no forces are acting on their feet, yet we still find painful reflex areas accompanied with “deposits/crystals”. These reflex areas are located on muscles, bones, tendons.
When we start working on these reflex areas/muscles, at times we are applying low force ongoing tension and the Golgi tendon organ (located between the muscle belly and its tendon) at hand is activated. This stimulus will enter the spinal cord and synapse onto an inhibitory interneuron that will synapse onto the motor neuron of the muscle that we had just activated. The end result will be a relaxation of this muscle (reflex inhibition) and a contraction of the antagonist muscle. This process is called autogenic inhibition and it is seen during static, low force, 7-10 second duration stretching.
At another moment or reflex we might apply a sudden “sharp” and still stretching stimulus. The muscle spindle, which is located within the muscle belly and stretches along with the muscle, will be activated (stretch reflex) and now cause a reflexive contraction of the reflex/muscle we had just stimulated and relax the antagonist muscle. This process is called reciprocal inhibition. The patellar reflex or knee-jerk is such a reflex and the grading response is indicative of possible abnormalities. Similar to this would be a positive Babinski sign in adults, the hallux dorsiflexes and the other toes fan out, which should lead us to considering the respected spinal level and all associated structures.
Reflexology significance of GTO’s
Because GTO’s are inhibitory by nature, stimulating those in the feet triggers a relaxation generated at the local spinal reflex (L4-S2), and reduces nerve activity in the associated organs and muscles. This has the potential to create many positive, local effects. If we hold the pressure long enough the GTOs have a substantial inhibitory — relaxing or defacilitating — effect in the brainstem also. Then, you get a more systemic effect of relaxing/healing the entire system. Also worth mentioning is the case when reflexes/muscles in the sole of the foot do not relax/loosen with our direct techniques. Something we may try, is to work on the dorsal muscles/reflexes, “front – back” relationship.23 Finally, if you have a “tight” foot reflex/muscle you might want to work on the GTO’s, but in the case of a loose/weak foot reflex/muscle you might want to work on the muscle spindles.
Pfluger's Laws +2 more
Eduard Friedrich Wilhelm Pflüger (7 June 1829 – 16 March 1910) was a German physiologist born in Hanau.
The Physiological Law of Facilitation (the path of least resistance): When an impulse has passed once through a certain set of neurons in your brain to the exclusion of others, it will tend to take the same course on a future occasion, and each time it does, the resistance will become less. Pain does this also!
Arndt- Shultz Law-Weak stimuli (stroking) activate physiological processes. Very strong stimuli inhibit them.
Initial stimulus will have an effect on the respected spinal level and its associated structures on the same side (intense stimuli - contralateral side) thus of benefit for one specific issue. Persistent and continuous stimulus will radiate (-tion law) to higher levels effecting the CNS, and even more stimulus will have a general (-zation law) effect on all the body. Keeping in mind that most of our clients are dealing with multiple issues and chronic pain, and that their pain is a product of the law of facilitation, we can utilize this same law to the benefit of our client. Arndt- Shultz Law, cited mostly by homeopaths, may be a good guideline for us according to recent research findings.28 The generalized inhibitory affect in the overall system through hands, feet and the face, are due to them offering the largest amount of sensory information, large amount of nerve endings and largest areas in the homunculus are present.
Wolff's law and Nerve Reflexology (NR works primarily on the periosteum): Wolff's law states that bone in a healthy person or animal will adapt to the loads under which it is placed. If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading. If this continues calcium is laid down along lines of stress (zones, muscle chains, meridians) resulting in bony spurs, joint immobility and calcified ligaments. The inverse is true as well.
Reflexology significance – Dr. Hans Selye and the general adaptation syndrome: A stressor has been placed on the body causing an alarm reaction; if this goes on what follows will be the adaptative stage (clear positive reflexes), if the adaptations remain this will eventually lead to the stage of exhaustion leading to the feeling of pain. The work we do with NR might also be affecting this route, the opposite way of course.
Other spinal reflexes
In the developing vertebrate embryo, somites split to form dermatomes, skeletal muscle (myotomes), tendons and cartilage (syndetomes), neurotomes and bone (sclerotomes).
Due to an overlap of these structures in every segment of the spinal cord (viscerosomatic convergence) these structures are interacting/influencing positively and negatively. Viscerosomatic convergence does not only occur in the spinal cord or brain, it also occurs in the dorsal root ganglion, the most peripheral part of the CNS!
Some examples of how dysfunction in visceral structures and somatic structures can influence the functionality of visceral and somatic structures that are segmentally related are listed below:
Somato-somatic reflexes “Localized somatic stimulation produces patterns of reflex response in segmental related somatic structures.”
Viscero-somatic reflexes “Localized visceral stimulation produces patterns of reflex response in segmental related somatic structures.”
Somato- visceral reflexes “Localized somatic stimulation produces patterns of reflex response in related visceral structures.”
“Nerves with a high neurovisceral portion are involved, like the median nerve or the tibial nerve.” Book - Manual Therapy for the peripheral nerves. Barral/Croibier
Viscero – cutaneous reflex “Localized visceral stimuli produce patterns of reflex activity in segmentally related skin areas”.
Cutaneo – visceral reflex “Localized cutaneous stimuli produce patterns of reflex activity in segmentally related visceral structures.”
Viscera – visceral reflex “Localized visceral stimuli produce patterns of reflex activity in segmentally related visceral structures.”
Nociception vs Pain - Gate Control Theory of Pain. – Closing the door of nociception.
Nociception refers to the process through which information about peripheral stimuli is transmitted by primary afferent nociceptors to the spinal cord, brainstem, thalamus, and subcortical structures. In contrast, the experience of pain can result only when there is activity of thalamocortical networks (brain/emotions also) that process the information conveyed by pathways of nociception. In the spinal cord for the body and the trigeminal nucleus for the head some interneurons make connections with motor neurons that generate nociceptive withdrawal reflexes – discussed previously. Pain is a product of higher brain center processing, whereas nociception can occur in the absence of pain. 29
According to the gate control theory, pain signals (nociception) are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether nociception should reach the brain or not. In other words, pain is perceived when the gate gives way to nociception and it is less intense or not at all perceived when the gate closes for the signals to pass through. This theory gives the explanation for why someone finds relief by rubbing or massaging an injured or a painful area, or even along its dermatome. There exists dermatome variability among us, and of course there are significant variations in current dermatome maps in standard anatomy texts 30, like the variations in our reflexology charts.
When nociception carried by the small fibers (A-delta and C fibers) are less intense compared to the other non-nociceptive sensory signals like touch, pressure and temperature, the inhibitory neurons prevent the transmission of the pain signals through the T cells. The non-nociceptive signals override the nociceptive signals and thus the nociception is not perceived by the brain so it is not evaluated. When the nociceptive signals are more intense compared to the non- nociceptive signals, the inhibitory neurons are inactivated and the gate is opened. The T cells transmit the nociceptive signals to the spinothalamic tract that carries those signals to the brain. As a result, the neurological gate is influenced by the relative amount of activity in the large and the small nerve fibers.24
Reflexology significance - When a client whishes for us to address their pain, besides utilizing Dr. Fitzgerald’s zones or Chinese/Greek meridians, we can now utilize a dermatome map also. All of them only as a guide, and respecting that it is very likely that they might prove inaccurate for our given client. Light brisk rubbing or thumb walking on zones, reflexes, meridians, dermatomes, myotomes, sclerotomes may relieve the pain experienced by “closing the door/gate behind us”.
Now utilizing this knowledge we can decide when to use the feet, the hands, the face and the ears.
Diffuse noxious inhibitory control (DNIC) is commonly known as counter irritation. This phenomenon goes back to the Hippocratic aphorism: “If two sufferings take place at the same time, but at different points, the stronger makes the weaker silent”.
Neurones in the dorsal horn of the spinal cord were found to be inhibited when a nociceptive stimulus is applied to any part of the body that is distinct from the excitatory receptive fields of the dorsal horn neurones that are inhibited (hence the origin of the term “diffuse” as opposed to the similarly observed hypoalgesic effects of painful stimulation to the same segmental region of the body, as for instance during transcutaneous electrical nerve stimulation). This “pain inhibiting pain” effect is well known from folk medicine across many cultures. Indeed, in early surgical procedures on humans and animals this concept was harnessed without realization of the underlying mechanisms (for example, use of the twitch in horses and nasal forceps in cattle during caudectomies or castrations which are both potentially very painful procedures). Many stressful stimuli are able to produce such counterirritation which has led to the term “stress induced analgesia”. 36
CNS sensitization is the situation where an individual has pain lasting longer than 3-6 months and that can last for years. There is no injured tissue, healing times have surpassed, and thus there are no true noxious stimuli - nociceptive input. A sensitized patient actually feels pain; it is not from the periphery anymore but rather from within the CNS, “it’s in their head”! Due to the presence of pain, a lack of movement will follow with the hope that this strategy will generate less pain. This lack of movement will tend to blur the CNS maps (homunculus) also called sensory motor amnesia SMA. Common areas for SMA are the feet, hip joints and upper thorax. On the basis of experiments, many experts believe that gaps, smudges, or other inaccuracies in the body maps can be a significant contributing factor in many , and that fixing these problems is a potential way to cure pain.25
Characteristic of these patients are increased sensitivity to light, touch, noises, pesticides or temperature. Sleep disturbances, swollen feeling, tingling numbness and/or poor concentration have shown to be associated.
Proprioception is the brain’s ability to sense the relative positions and movements of the different body parts. The key to understanding proprioception is the body maps. Each part of the body has a separate area of the brain dedicated to moving and sensing that body part. So, we have feet, and we have virtual feet in the brain – parts of the brain that represent the size, shape and position of the feet. When mechanoreceptors in the feet are stimulated by a mechanical force (reflexologists hands), they send a signal through the nervous system to the part of the brain devoted to sensing that part of the body. Research has found that plantar massage and joint mobilization of the feet and ankles has a positive impact on balance in the elderly. 31
Movements that are most likely to lead to changes in the quality of the maps are movements that are curious, exploratory, novel, interesting, rich in sensory input, , gentle, mindful, non-painful.
Motor mental ability/disability
In normal infants developmental milestones such as eye – hand coordination and visual tracking occur at predictable ages. Intellectual development and motor development go together, consider the presence of primitive reflexes in a new born which would control gross movements. These primitive reflexes normally fade away as the child’s nervous system develops giving rise to fine motor control, like picking up an object with your thumb and index finger – intrinsic muscles/reflexology muscles!
Chronic pain may lead or be associated to CNS sensitization. These higher levels from where pain is expressed are in charge of fine movement too, which in turn is expressed through intrinsic muscles that also exist in our feet/hands. When we apply Reflexology, like it or not, we are also offering stimulus to the maps, possibly readjusting the maps and desensitizing the CNS. Also of importance, is that the body relies a great deal on the mechanoreceptors of the feet for proprioception adjusting in turn its entire posture accordingly. In both cases it is like formatting your pc.27
Why does Lynne Booth’s VRT and zonal triggers work?
One aspect of vertical reflexology is treating the client in a standing – weight bearing position, where all the reflexes can be accessed through the dorsum of the foot. Initially the first VRT treatments were directed towards orthopedic problems and this is where Lynne saw her first positive results. Having to do with an explanation for these positive results Lynne states
“I propose that VRT puts the body into a neutral state where the long-term legacy of strain, tension, degeneration or scar tissue in its systems is bypassed to allow direct access to the original problem.”
Noticeable is also that “The client will also observe that the feet feel much more tender when worked in a weight-bearing position, and the therapist should be aware of this factor and decrease the pressure accordingly.”32
In my opinion the advantage of VRT compared to a normal Reflexology session is that the client is in the weight bearing position but not because it is in neutral state, as I understand it (nonaligned, disengaged state) rather because it is in the exact opposite state. When we are weight bearing our body is aligned and engaged for movement, or even for keeping us standing still (kinetic chains/ myofascial chains, meridians, zones), and is this not the time when most people have pain? I find it only natural that our client’s positive reflexes (disturbed reflex presents pain and/or “finding”) will appear, or at least appear differently when they are weight bearing then compared to when they are lying down as in the usual Reflexology position. This could also explain the larger perception of tenderness felt by the client in this position.
“The zonal triggers (ZTs) are deep ankle reflexes that play an important role in activating the zones extremely quickly so that the body is more receptive to healing.” In my opinion I believe the ZT area is of great importance, standing or lying down, because of the inferior extensor retinaculum (the superior is of importance also), the superior - inferior peroneal retinaculum and the flexor retinaculum.
A retinaculum is a band like thickening of the deep fascia in distal portions of the limbs that holds tendons in positions when muscles contract. Though muscles have a relatively straight line of pull, the muscles of the distal extremities are much different. The long extensors of the toes are a good example. They travel the length of the lower leg and then over the top of the foot they take close to a 90 angle bend over the top of the foot near the ankle joint to the toes. The retinaculum is there in order for these tendons to be mechanically efficient and held close to the joint. If they weren’t there would be a tendency for the tendons to be pulled away from the joint when the muscle contracted. Due to repetitive motion/friction, sprains, postural compensation patterns, or compression during movement tenosynovitis, fibrous adhesions or a roughening of the surface between the tendon and its sheath may develop. There is a common tenosynovitis condition that develops over the top of the foot where the long extensors of the toes pass under the extensor retinaculum called “lace bite” because tight shoelaces are often the primary cause.
By the 'everything-connects-to-everything-else' fascial principle, the Superficial Front Line (SFL) connects the entire anterior surface of the body from the top of the feet to the side of the skull in two pieces -toes to pelvis and pelvis to head - which, when the hip is extended as in standing, function as one continuous line of integrated myofascia. So releasing existing adhesions between the tendon and its sheath in this ZT area will have an effect on the SFL, or zones, or meridians, or reflexes. Interestingly Tom Myers states, “The need to create sudden and strong flexion movements at the various joints requires that the muscular portion of the SFL contain a higher proportion of fast-twitch muscle fibers.” , could this be the reason Lynne states “…that the body is more responsive to a healing and energetic stimulation when treated briefly in a standing position.”?
Why does Ingham’s chronic reflex area for sciatica, reproduction and rectum work and what’s the connection with SP6 – Sanyinjiao or Three ladies having tea?
In the section Rectal Disorders page 84, “Stories the feet can tell” Eunice tells us “…we will find this reflex on the inner side of each ankle about half an inch from the cord leading up the back of the leg. The tenderness here may extend three to five inches up from the heel...”
Spleen 6 is the point at which the Spleen, Liver and Kidney meridians intersect, hence the name, Three Yin Intersection or three ladies having tea. Indicated for anything gynecological, reproductive health in men, painful urination, insomnia, dizziness, low back and knee pain, digestive disorders. (ORGANS!!!!)
Tom Myers approach places this area/reflex point as a part of the Deep Front Line DFL. The three structures at hand would be the posterior tibialis, flexor digitorum longus and flexor hallicus longus, and they account for the deep posterior compartment (Yin). The myofascial structures of the DFL accompany the extensions of the viscera (organs) into the limbs.
They can only be palpated directly just above the ankle. Tibial nerve is also entering the tarsal tunnel and so is tibial artery. Anatomy Trains Myofascial Meridians
So, if this reflex area is positive to work on, what issues might we be positively affecting according to Tom Myers?
Any feet problems (arches, cramps), deep calf muscles (tiredness, cramps), knee (capsule, back of knee popliteus, medial femoral epicondyle), adductor issues (abdominal syndrome), hemorrhoids, pelvic floor issues, psoas, all organs, diaphragm, pericardium, scalene muscles, neck muscles, tongue.
Non-specific low back pain symptoms seem to improve in a similar pattern in clinical trials following a wide variety of active as well as inactive treatments. It is important to explore factors other than the treatment that might influence symptom improvement. The placebo treatment/waiting list control/no treatment group didn’t differ from the treatment groups. 33, 34
“It ain’t what you do it’s the way that you do it, and that’s what gets results”
The Reflexology problem at the Aretaieio Hospital Pain Clinic
Neural correlates of a single-session massage treatment
In contrast, the massage with a wooden object, which involved pressure and strokes along the same areas of the foot as applied in the Swedish massage, had no significant effect on the BOLD signal in either of the brain regions. This latter finding is particularly noteworthy since it suggests the possibility that the human touch component (as opposed to the same pattern of massage with an object) had a profound influence upon the impact of the treatment. It is important to note that the massage with the object may not have activated the foot’s muscle receptors as strongly as the reflexology and/or Swedish massage. 35
Understanding the role of stimulation in reflexology: development and testing of a robotic device
I believe the most significant benefit that massage (Reflexology) can offer this person is comfort. I believe that my greatest gift to this person is my ability to use touch to remind her that her body can still be a source of joy. That she can still feel pleasure; that her body is still a good place to be. 37 Kerry Jordan
Spiros Dimitrakoulas - http://spiros-reflexologia.blogspot.gr/
3. 2010 COMPLEMENTARY AND ALTERNATIVE MEDICINE SURVEY OF HOSPITALS
7. Reflexology – Science or Belief (Jones, Leslie)
8. Stories the feet have told pg 21 – Stories the feet can tell pg 9.
22. Anatomy Trains Myofascial Meridians for Manual and Movement Therapists, 2nd Edition. By Thomas W. Myers
How does foot reflexology works? A hypothesis.
If we ask: “how does foot reflexology works”, we have to agree on one thing. It has to be the nervous system that transfers the stimulus on the foot to the target organ. This means that the stimulus on the foot is transferred to the spinal cord by peripheral nerves and from there to the brain by ascending tracts or ascending pathways. Somewhere in the brain the stimulus is transferred back to the spinal cord by descending tracts or descending pathways and by peripheral nerves to the organ. In other words: in these areas in the brain where the ascending stimulus from the foot arrives, there must be an overlap with the descending tracts that go to the specific organ.
Lets look at these different steps and see if we can get enough science-based materials for this hypothesis.
1. The stimulus from the foot to the spinal cord.
When we are bringing in stimuli on the foot by thumb, fingers or other materials we are stimulating different nerve endings. We agree that the stimuli are firm but not that powerful that it causes pain under normal conditions. So, we are stimulating mechanical nerve endings in the skin, connective tissue, muscles and tendons of the foot. These mechanical nerve endings are encapsulated nerve endings like Merkel or Vater-Paccini nerve endings. The nerves that transfer these stimuli to the spinal cord are of the A-alfa, -A-bèta and A-delta1 type = fast conducting, myelinated nerves. The peripheral nerves that transfer these stimuli to the spinal cord are: Tibial and peroneal nerve reassembled in upper leg by the sciatic nerve. The sensory endings of the siactic nerve are entering the spinal cord at the levels of L4-S2. (Kahle, W, Leonherdt, H, and Platzer, W, 1986; Benninghoff, 1985)
2. Ascending pathways to the brain.
From the spinal cord levels L4-S2 two pathways are involved in transferring the stimuli to the brain: the dorsal pathways and the spinal-thalamic tracts.
2.1. The dorsal pathways
These pathways are converting directly to the lateral nuclei of the thalamus. On their way up to the brain this pathway is reassembling all mechanical information from mostly all the musculo-skeletal movement system (propriosensoric information).
On the other hand 10% of the nocisensoric information of organs is also reassembled in this pathway. Nocisensoric means: nerves that bring over information on tissue damage in organs. These nerves are C-nerves: slow conducting, non-myelinated nerves.
In the thalamus, especially in the VPL-nucleus (ventro-postero-lateral nucleus), nocisensoric (tissue damage) information from organs is coming together with propriosensoric (non-nocisensoric) of the musculo-skeletal system. (APKARIAN A et al, 1995)
What we know for sure is that in this nucleus there is a somatotopic organisation or homunculus in the VPL nucleus. This means: the whole body is reflected in nerve cells on exact anatomical reprint. (Figure 1). In this representation the C-fibers that are reporting tissue damage of organs are overlapping the propriosensors of the musculo-skeletal system like sheets overlapping each other.
Fig 1: VPL homunculus
From the lateral nucleus of the thalamus the dorsal pathways are going into the postcentral gyrus of the cortex. In this gyrus, there is also a “homunculus” or anatomical representation . (Fitzgerald, M. J. T., 1995; APKARIAN A et al, 1995)
Fig 2: homunculus in the sensory cortex
2.2. The spinothalamic tracts .
These pathways are divided in a lateral and a medial spinothalamic tract. The lateral tract transports predominantly Ab and Ad1 fibres while the medial tract transports Adand C-fibres, mostly nocisensoric, from both organs and musculo-skeletal system.
The lateral tract is emerging into the lateral side of the thalamus and from there to the postcentral gyrus of the cortex where they meet the nerves of the dorsal pathways.
The medial tract is emerging into the medial thalamus and from there to the postcentral and frontal gyrus of the cortex.
2.3. The spinal trigeminal nucleus and the sciatic nerve.
Propriosensors of the foot sole, transported by the sciatic nerve, are meeting propriosensors of the upper cervical spinal joints and muscles in the spinal trigeminal nucleus (brainstam-C2). This is necessary for a good general balance. This nucleus is closely related to the reticular formation in the brainstam, where musculo-skeletal nerve endings are meeting organ nerve endings. Also in the brainstem we find a homunculus representation of the body. (OSHIMA K et al, 2005)
3. How does foot reflexology works?
In the research literature we can find many reports that indicate thet in different parts of the brain there is a somatotopic representation of the body. In these homunculi Aa, Ab and Ad nerve endings of the musculo-skeletal system meets Ad and C- fibres of the organs. (DREWES et al, 2006; OGINO et al, 2005; OSHIMA K et al, 2005; LEE, 2002; APKARIAN et al, 2001; Fitzgerald, M. J. T., 1995; APKARIAN A et al, 1995)
Let us take an example of an inflammation of the stomach.
Ad en C- nocisensoric fibres will enter the dorsal horn of the spinal cord at the level of T6-T8 by sympathetic sensory nerves and in the brainstam by vagal nerves. Ascending pathways (see higher) will alarm the brainstam for neuro-endocrine changes, the thalamus for motor changes, the sensory and motor cortex for motor changes, the prefrontal cortex for psycho-emotional changes etc…
In the homunculi in these parts, these nerve endings will overlap the Aa,Ab and Ad of the stomach zone of the foot sole. These nerve endings are normally not pain sensitive. But, by the neurotransmittors of the stomach nerve endings, they will be sensitised and they will become painfull.
If we are stimulating the nerves of the stomach zone of the foot, we are stimulating the thick myelinated nerves and they will release neurotransmittors that are de-sensitising the nocisensoric fibres of the stomach and stimulate healing processes in the different parts of the brain for curing the stomach.
We might say that there is enough science based evidence of how foot reflexology can work. However, these research papers are not talking about reflexology. They handle about other research goals. But, the conclusions of these studies might be extrapolated to reflexology. Real good research on how reflexology works are lacking. It seems that researchers are not interested or…there is no money. If all reflexology associations all over the world should ask their members to contribute 1 dollar or 1 Euro each year for this kind of scientific research, I am sure that in five years there will be enough money to pay a team or scientific researches to detect the neural pathways of reflexology. What are we waiting for???