Reflexology and Spinal Cord Injuries

Lot's of people keep asking me to publish my university disseration from when I originally studied reflexology back in 2001 so here it is! I will publish my aromatherapy and massage dissertation too in the near future.

Introduction

In all forms of physical therapy, the sense of therapeutic touch is always emphasized. We are reminded that touch is instinctive in reaction (Davis 1988 p.217) and is essential in feeling cared for and nurtured. In describing holistic therapies, there are literally hundreds of books reporting on how re-establishing the balance of our mental, physical and emotional aspects, brings about restoration of health and well-being. Most of these are achieved through touch therapies and manipulation of vital energies.

The aim of this dissertation is to explore whether reflexology, a physical therapy, can be effective when the patient has no sense of the therapeutic touch. The case study followed through this piece of work is a paraplegic as a result of accident trauma in 1995. Since damaging the spinal cord at the junction of T4/T5, there is no feeling from that level of the body and below. It was felt that this would be a true test of working with the concepts of zone therapy, which will be explored throughout. The patient was curious about the therapy and hoped it would assist with correct functioning of internal organs, as well as assisting with the ongoing therapy of non-manipulative skeletal re-alignment therapy, which has helped to regain some sensations around the waist. Reflexology is said to encourage opening and clearing of neural pathways. (Dougans p.18 1991). During these 10 reflexology treatments, no other therapy was conducted, so as to be sure of the exacting outcomes of reflexology.

It was also hoped, that this study will go some way towards helping other therapists being able to work with spinal cord injuries, and offer support to patients. It has proved almost impossible to gain information on any other research work carried out with reflexology and spinal cord injuries, despite having contacted all the major organisations around the world, and the Spinal Cord Injuries Association. The only relevant reference was in the SIA newsletter, issue 25, where a patient in Aylesbury reported, ”I heartily recommend reflexology to the SCI. That’s just a fancy foot rub but man it rekindles the flames”. (Newsletter of the Spinal Injuries Association May-June 1998 No25 pp.24). The same patient also went on to say that a cocktail of treatments was felt to work best, rather than just one therapy on its own.

Exploring Reflexology - Basis and Origins

The origins of Reflexology seem to reach as far back as ancient Egypt where inscriptions and drawings in “Ankmahor’s “physician’s tomb” were found at Saqqara. The hieroglyphics, dated 2330 B.C. have been translated as follows: “Don’t hurt me”.” I shall act so you praise me” (reflexology-usa, 2000). However, in Inge Dougan's book “Reflexology” (1992) she states that the Papyrus Institute in Cairo have translated the hieroglyphics as reading, “Do not let it be painful” says one of the patients. “I do as you please” an attendant replies.

In that ancient painting, some form of massage is being performed particularly on the hands and feet. It is known that body massage was carried out in ancient Egypt (Beck M. (1988) p.5), but this particular inscription favours more the look of what we now refer to as reflexology. Most books seem to quote this inscription as factual in describing the origins of reflexology (Oxford R., (1997) p.7, Norman L., (1989) p.17, Hall N., (1988) p.13), but Beryl Crane in her book “Reflexology” emphasizes that this has never been proven (Crane B., (1998) p.10). It is understood that this form of healing spread to Rome as the Roman Empire spread, as did trade in exotic oils and perfumes at that time. (Reid S., (1985) p.2).

Reflexology is also found to have its basis in Chinese medicine. It is based on similar ideas to acupuncture, in that there are energy lines linking the feet and hands to various parts of the body. Working on the hands and feet can thus hypothetically influence the whole body. Reflexology lines and acupuncture meridians are not one and the same, but the origins are clearly visible when you view the zone charts. Inge Dougans agrees, stating, “there can be little doubt that a strong connection exists between reflexology and acupuncture” (1991 p.5). Many reputable reflexologists have stated their belief that reflexology started in Chinese culture (Hall N., (1988) p.12, Crane B., (1998) p.11 etc.), although Inge Dougans (1992 p.14) in her book “Reflexology” admits that concrete proof of exactly where it began is elusive. The main school of thought is that it originated in the East (Dougans I., (1991) p.4).

Modern reflexology found its initial roots in what is called “Zone Therapy”. In 1582 two eminent physicians Dr. Adamus and Dr. A’tatis published a book on the subject, as did a Dr. Ball from Leipzig around the same time (Harry Bond Bressler “Zone Therapy” p29). From then until the early 20th century, many eminent physicians around the world advocated the link between certain reflexes and other areas of the body. In 1917, Dr. William Fitzgerald (1872-1942) published his findings on zone therapy in the USA and the true basis of modern reflexology was born. According to Crane (1998 P.14), Dr. Fitzgerald never actually penned exactly how he discovered zone theory, but it is believed that he did discover that pressing on certain areas of hand and toe, caused a type of local anesthesia. It is noted that he came into contact with the work of Dr. H. Bressler whilst working in Vienna, who had already been investigating treating organs with pressure points (Dougans I., (1992) p.16). This is more likely where the discovery lays. Dr. Fitzgerald’s colleague, Dr. Edwin Bowers gave it the name zone therapy according to Beryl Crane (1988) p.15), but other physicians before him had already used this term. Eunice Ingham, in the preface of her own book gratifies Dr. Fitzgerald in “his discovery of the Chinese method of zone therapy (Ingham E., 1938), but we must also give credit to all those who experimented before him. In his book, also entitled “Zone Therapy”, we see the division of the body into 10 longitudinal zones. It is probably due to Eunice Ingham that Dr. Fitzgerald is now hailed as the father of modern reflexology.

During the 1930’s, Eunice Ingham (1889-1974) further defined modern reflexology. She was a qualified physiotherapist. In 1938 she published, “Stories the Feet can Tell”, which was followed with “Stories the Feet have Told” in 1945. Ingham mapped the entire body onto the feet and discovered that an alternating pressure on the various points had therapeutic effects far beyond the limited use to which zone therapy had been previously employed, which was that of localised pain relief (reflexology-usa, 2000).

Reflexology Defined

“It is a specific pressure technique which works on precise reflex points on the feet, based on the premise that reflex areas on the feet correspond with all body parts” (Dougans Inge (1992) p.25). However, in the foreword to the same book, Christine Issel shows us that there is really no one correct theory on how it works (Dougans I., 1992). Eunice Ingham checked and re-checked every reflex point before she published her findings in 1938, but even she invited valuable suggestions in the form of an explanation (Ingham E., (1938) Introduction).

When discussing the theoretic workings of this therapy, one has to also explain the zones. It is agreed by all authors that there are ten longitudinal zones from head to toe, which run through the body as well as along the length of the body. So by stimulating any zone in the foot, affects that entire zone throughout the body (Norman L., (1988) p.23 etc). If this is true, then this dissertation should be able to show that the zones of the body in a paraplegic should still be affected, even if the spinal cord is completely severed, as it relies on the movement of chi energy rather than electrical nerve impulses or chemical neurotransmitters. In this particular case study, the spinal cord has been crushed but not severed, as shown on the original MRI scan held at Stoke Mandeville Hospital.

Case Study

The main site of injury is to the third, fourth and fifth thoracic vertebrae. In this region the “spine is particularly vulnerable to any degenerative changes” (Oliver J. and Middleditch A., (1991) p.26) as there is a narrow zone extending from T4 to T9. The damage was due to multiple fractures of the entire vertebral bodies, which effectively narrowed the vertebral foramina and put pressure onto the spinal cord, crushing it. Initially this patient was treated incorrectly at a local hospital. A few days later, treatment was relocated to an acute spinal cord injury specialised unit. This is very important, as otherwise patients may become victims of inappropriate treatment, as general doctors do not understand the pathophysiology of these injuries (Carvell and Grundy 1989 cited by Whalley Hammell K., (1995) p.71). Indeed exercises were given by the local hospital physiotherapist for the neck, as the patient complained of soreness, only to find on the MRI scan at Stoke Mandeville that there were fractures to the second cervical vertebra. Also, whilst at the local hospital, the patient contracted the MRSA virus, where one of the arms narrowly escaped being lost.

The extent of damage in spinal cord injuries depends very much on the type of injury and the exact location. Each injury produces differing results and thus differing recovery of motor and sensory function. A complete lesion such as in this case means that motor and sensory function is lost below the fracture site (Whalley Hammel K., (1995) p.60). The upper motor neuron lesion has also produced spasticity of the limbs, increased muscle tone and spasticity of the bowel and bladder functioning. (Burke and Murray 1975). They also report that 75% of all with thoracic lesions will suffer these spasms as was demonstrated in this case.

The spasticity of the limbs is a continuing problem and is common for those with upper motor neurone lesions (Whalley Hammel K., (1995) p. 90). It is increased by many internal and external stimuli. It has been noticed during treatments that these have occurred and increased during changes in position, ingrowing toenail, burns and an infected leg ulcer. These are confirmed by Grundy and Swain (1993). The spasticity does have some benefits as they help with transferring, help maintain muscle tone in the legs and assist with venous return.

Despite the acute trauma, the patient’s overall outlook on life is quite positive. The patient works part-time and participates in various activities such as going to the gym and playing basketball. In various studies it has been shown that exercising is particularly important for people with spinal cord injuries for many reasons (Rohe and Althelstan 1982 and Stott 1986) but also because it “reduces their substantially elevated risk of heart attack (Brenes 1986 cited by Whalley Hammell 1995). Therefore, the patient was encouraged to continue active pursuits. The overall aim of this therapeutic work is to enhance quality of life, which can be done through the claims of zone therapy, but also by the caring action of the therapist. “Life satisfaction among people with spinal cord injuries has been found to be significantly related to social integration, mobility, occupation, social support, perceived control and self-assessed health status” (Fuhrer et al., 1992).

Results of Treatments

A total of ten treatments were carried out over a period of seven weeks. The patient had already shown some reaction to the spinal reflexes at T4 to L3 level and to the pituitary reflex following Neuroskeletal Re-alignment Therapy. These sensations were described as “feelings coming up from below water”. They always induced a spastic response in the muscles of the lower limbs and abdomen.

With most treatments it is thought best not to press too deep during the first treatment as you do not want the patient to experience a dramatic healing crisis after the first session, as this can put them off coming again. After the first treatment the patient should feel relaxed and somewhat sleepy (Goosman-Legger 1983 p.38). It was decided not to try the light pressure in this case, but instead to try and evoke some responses.

During the first session, the patient felt quite heady when working the sinus reflexes on the left foot and the left Eustachian tube reflex caused spasticity. The left ear and jaw area had felt sore earlier that day, so this was seen as a positive start to proving that reflexology works. The pituitary, thyroid and parathyroid reflexes caused a response, as did the kidneys, fracture site and left shoulder. It was noticed that during the session the patient felt quite uncomfortable throughout, and afterwards felt “plugged in” and very stimulated. Rotations of the feet were difficult because of spasms, but this is important as one should “remember to use rotation whenever you want to give extra attention to a reflex” (Oxenford 1996).

During the follow-up consultation it was found that the stimulation caused by the initial session continued to the point where sleep proved very difficult that night. This is not usually a problem for this client, so was obviously connected to the reflexology, possibly working on balancing seratonin levels (Crane B. 1998 p.23). Brain rocking caused spasticity on both feet during the second treatment and this was felt to be relevant. On working the left whiplash point, hairs on the left arm became raised and the same happened on the right side. There was also a large reaction to the left pituitary reflex where he felt a “rush” and hairs raised on the left arm. Other areas that caused reactions of varying degrees were the gall bladder, the sinuses, the fracture site, the sciatic area, the thyroid and parathyroid, the lateral edge of each great toe and the left shoulder. There was also some reaction to the bladder area on both feet; however, the bladder is not functional due to the super pubic catheter, which connects directly to the collecting duct in the kidneys. One of the main hazards for those with lesions above T6 is autonomic hyperreflexia (Whalley Hammell K., (1995) p. 106). It is typically triggered by bladder over distention and urinary tract infection. For this reason the patient was encouraged to drink plenty of water to aid filtration and to assist the reflexology treatment. This action is confirmed by Grundy and Swain (1993) cited by Whalley Hammell (1995). The patient was well aware of the life threatening problems that can trigger the hyperreflexia (or dysreflexia) and this therapist undertook intense study of the causes, so as to be able to recognize any potential problems whilst carrying out treatments, which are too numerous to include within the limitations of this dissertation. This action is suggested in Whalley Hammell K. (1995) p.97 by stating “This is a severe, acute medical emergency which can lead to cerebral haemorrhage and death. It is therefore essential to carers……..are aware of the signs and symptoms…….It is imperative that swift appropriate action is taken……”

Treatments continued with similar reflexes causing spasticity. After the third session the patient often drifted off to sleep and certainly found it easy to relax. The sigmoid colon came up from the third treatment onwards but no bowel problems were experienced. It was felt this could be emotional due to marital relationship problems. If one is working on energetic levels with reflexology, then this therapist feels that there must also be a link to the chakras. “From a psychoenergetic standpoint, the sacral chakra is associated with expression of sensual emotion and sexuality”. (Gerber Richard M.D. (1988) p.387). The author also states that the large intestine is connected and that the energy flow in this center is “reflective of the degree of involvement with emotional and sexual energy in an individual’s life”. As the marriage was breaking down at that time, this was felt to be relevant and the possible energetic link to the colon reflex.

It was noticed during the remaining sessions that the spasms and referred pain that they caused would drop away, albeit temporarily, for at least 24 hours. During the fourth treatment and working the toe reflexes, a series of spasms occurred through both legs. The patient felt a cold rush and felt as if the hips were thrusted forwards. After the session he felt like a “tuning fork” and could feel a “cold buzz” in the feet, which had been experienced before during Neuroskeletal Re-alignment Therapy, but now intensified. A static feeling was reported around the thighs and it was felt as if there was energy moving around where the feet were perceived to be. This was extremely exciting.

Unfortunately, this feeling was gone within twelve hours and the following session gave little responses and the patient slept right through. The spasms had increased again. However, following that relaxing session the patient reported feeling “very high” for the rest of that day and was able to move around easier in the wheelchair. During the following session the most noticeable reflex was the pelvic/hip region where the patient actually reported “feeling” a sensation around that region of the body. It was also noted at that time that the right foot was noticeably warmer than the left. There are as yet no explanations for this. Following all the subsequent sessions, the patient reported always feeling uplifted and relaxed after treatment, but could not get to sleep easily that night.

The pituitary, sinus, parathyroid and left shoulder continued to show responses throughout all of the sessions. There is an adhesion under the right scapula, which causes pain, but not on the left. He does suffer tinnitus, which is a disorder experienced as a continual noise in the head, defined as a ringing in this case (Ball John (1990) p.231). Although John Ball does not state this as a cause, the S.E.E.D. Institute teaches that tinnitus can be caused by spasm of the levator scapulae muscle (S.E.E.D. Institute, Remedial Massage Course Notes 1998). This muscle raises the scapula and its origin is in the upper four to five cervical vertebrae (Totora & Anagnostakos (1990) p.290). The upper trapezius and supraspinatus can also cause ear problems such as tinnitus according to the S.E.E.D. Institute, and this patient’s adhesion relates to all these muscles, so this could account for the left shoulder reflex. The tinnitus has remained the same throughout the reflexology treatments. Myofascial pain in the shoulder area of spinal cord injuries is a common problem for reasons of over stretching and poor posture. (Spinal cord Injury Information Network, Summer 1999).

The parathyroid reflex came up constantly in both feet, but the thyroid only came up in the first two to three sessions. These glands regulate calcium levels in the body (Totora & Anagnostakos 1990). There is some concern with spinal cord injuries concerning development of bone spurs. Heterotopic ossification is a fairly common complication that can lead to massive bone formation around a joint resulting in total ankylosis (Arkansas Spinal Cord Commission n.d.) After some investigations, it was felt that this is not the cause for the decreased range of motion in the left foot, as it does not occur below the knees. Therefore, the parathyroid reflex remains a bit of a mystery.

Conclusion

Based on the responses in the reflexes and the state of either relaxation or stimulation, it has been proven, through this study, that reflexology does affect the whole body even when the patient has no sensory perception in the feet. It would probably take many more treatments to work through any further benefits. However, the case used in this study wants to return to the usual treatments of Neuroskeletal Re-alignment Therapy and remedial massage, as it is felt that more direct benefit is achieved through these therapies. Part of that is most likely due to the fact that both these other therapies touch areas where sensory nerves are actually felt where they move above the lesion site.

On deciding how reflexology could be best used with SCI patients in the future, this therapist proposes that it could be used in specialised injury units, during the initial recovery phase. At the beginning of this dissertation it was shown how a SCI patient had stated that reflexology had “rekindled the flame”. The patient in this study said he felt it “tuned” him in and increased “background noise”. It would therefore be useful to offer reflexology to those patients who may feel depressed at losing the use of their bodies, to reconnect them to it, so they do not feel that all hope is lost. Empowerment is seen as a key concept in rehabilitation, (Banja J.D. (1990) pp.614-5) and the use of complementary therapies could be very helpful in starting off a positive rehabilitation process. The report in the introduction also suggests the use of a cocktail of complementary medicine treatments and this therapist feels this is very appropriate. During the initial recovery period hand massage or hand reflexology would also be very beneficial for paraplegics to feel touch and feel cared for, and of course the therapist will be an ear for them to express their fear and worries. This could be a time for comfort and encouragement for what will be a difficult time ahead. Peloquin (1990) suggests that a healthy patient/therapist relationship is likely to enable the patient to use his therapist as a resource, to set goals, to solve problems and to reinforce internal focus of control and self-esteem. The therapist will assign equal value to caring and competence. Peloquin’s paper was referring to occupational therapy, but can just as easily relate to complementary therapy.

Tetraplegics would benefit from head massages; even gentle stroking and massaging of the scalp would be blissful when all other sensory perception is lost. Once the fracture site has healed, Neuroskeletal Re-alignment Therapy, or other soft touch bodywork could be carried out to improve chances of recovery. None of these therapies can offer a cure, but used together they offer hope, and that is a very powerful instrument.

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