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Volume 5 • Issue 2 • 1000189
J Yoga Phys Ther
ISSN: 2157-7595 JYPT, an open access journal
Research Article Open Access
McCullough and Hughes, J Yoga Phys Ther 2014, 5:2
Commentry Open Access
Yoga & Physical Therapy
Reflexology use during Pregnancy
Julie EM McCullough* and Ciara M Hughes
Institute of Nursing and Health Research, University of Ulster, Northern Ireland, UK
*Corresponding author: Julie EM McCullough BSc (Hons) PGDip PhD, Institute
of Nursing and Health Research, University of Ulster, Shore Road, Newtownabbey,
Co Antrim, Northern Ireland, UK, E-mail:
Received July 09, 2015; Accepted July 10, 2015; Published July 17, 2015
Citation: McCullough JEM, Hughes CM (2015) Reexology use during Pregnancy.
J Yoga Phys Ther 5: 189. doi:10.4172/2157-7595.1000189
Copyright: © 2015 McCullough JEM, et al. This is an open-access article
distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
Reexology is a specialist massage whereby controlled pressure is
applied to specic points, known as reexes, mainly on the feet, but also
on the ears, face, hands and back. Each reex is believed to correspond
to particular structures or organs of the body [1]. By applying pressure
to these points the reexologist aims to promote homeostasis and, as
a result, restore and maintain physiological and psychological health
and wellbeing [2]. e exact mechanism of action for reexology
has not yet been established; currently modulation of the autonomic
nervous system (ANS) [3-5] and the release of endorphins following
reexology [6] are the most popular hypotheses. However, due to
the lack of an established model for the theoretical and physiological
underpinnings of reexology, many health care professionals (HCP)
continue to question its credibility. Nevertheless, there is a growing
body of evidence to suggest that stimulation of certain reexes can
activate the corresponding regions of the brain [4,7,8]. Reexology
may be a valuable tool as studies have reported positive eects on
quality of life, stress levels and pain levels [9-14]. A recent study has
also reported that reexology reduced low back and pelvic pain (LBPP)
and associated disability during pregnancy [15]. Reexology is a gentle,
non-invasive treatment which may assist maternity caregivers when
certain medications, interventions and procedures are contraindicated
due to advancing gestation. erefore, this report is intended to provide
guidance for reexologists, physiotherapists and other HCP regarding
the current knowledge available from research and experts concerning
the use of reexology during the antenatal period.
Reexology during Pregnancy
To date, there has been little research investigating the eects of
reexology antenatally. Concerns over its safety during pregnancy,
particularly during early gestation, have likely been a major factor
[16,17]. Complementary and alternative medicine (CAM) therapies
such as reexology are used, or suggested, by midwives and other HCP
for a range of pregnancy-related symptoms [18]. Midwives are keen
to incorporate such therapies as they consider them safe, compatible
with the patient centred approach and the natural nature of pregnancy
and childbirth and that CAM “can enhance their own professional
autonomy” [19]. Likewise, women use CAM therapies during pregnancy
as they also consider them safe, natural [20] and oer them control over
their pregnancy and labour [21] and as a method of pain relief [22]. In
fact many investigations into the use of reexology during pregnancy
have been carried out in the intranatal period during uncomplicated
labour for pain relief [23-27].
When can women use reexology during pregnancy?
All reexology treatments should be carried out by fully qualied
therapists. It is a safe and enjoyable treatment to use during pregnancy
[15,25,26,28,29] however, as with many interventions, caution is
recommended during the rst trimester [30]. Tiran [6] suggests that
this is not based on any evidence, but is a precautionary measure to
protect reexologists from legal action in the event of early miscarriage.
However, the following are regarded as contraindications to treatment
and should be observed:
• A history of unstable pregnancy [30,31];
• Hydramnios (excess amniotic uid) [32];
• placenta previa (grade 3 or 4) [32,33];
• A risk of deep vein thrombosis (DVT) or pre-eclampsia [33];
• Enzer [33] also suggests that diabetic mothers should check their
blood sugar levels before and aer treatments as reexology can
aect the hormone balance.
It is important for therapists to assess clients before each treatment
as “risk” is a dynamic factor and women can change from low to high
risk [34]. erefore, advanced training in maternity reexology, along
with a thorough knowledge and understanding of the physiology
of pregnancy, is essential for reexologists to determine a client’s
suitability to receive reexology and how to tailor treatments to suit
each individual.
Reexology research during the antenatal period has investigated
women with a range of pregnancy related ailments such as low back
and pelvic pain [15], tiredness [35] and ankle oedema [28], however,
no studies to date have been carried out in any high-risk pregnant
populations. erefore, each pregnant client should be considered
on a case-by-case basis with the involvement of their obstetric care
Many pregnant women who use CAM therapies, such as reexology,
fail to inform their maternity health care providers [36]. erefore, it is
imperative that the use of reexology and its mechanism of action are
well understood so that midwives and other HCP can advise, discuss
and document pregnant women’s usage [19]. It is also very important
for maternity reexologists to explain to clients the importance of
informing any other HCP from whom they are receiving treatment
and to obtain written consent from obstetricians and midwives prior to
treating women with a high risk pregnancy.
Assisted pregnancy
Tiran [6] and Enzer [33] agree that, due to the purported hormone
balancing eect of reexology, women who are undergoing fertility
treatment or have become pregnant following fertility treatment should
not have reexology until the pregnancy is well established. e drug
therapy involved in stimulating ovulation or assisted pregnancy is likely
to alter the normal hormone balance to facilitate release of the egg from
the ovary or assist the embryo implantation stage. erefore, reexology
may have a negative impact on this desired eect of fertility medication
Citation: McCullough JEM, Hughes CM (2015) Reexology use during Pregnancy. J Yoga Phys Ther 5: 189. doi:10.4172/2157-7595.1000189
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Volume 5 • Issue 2 • 1000189
J Yoga Phys Ther
ISSN: 2157-7595 JYPT, an open access journal
and such women would not be suitable to receive reexology in the rst
Key Conclusions
Further larger studies on how reexology can be best employed
for pregnant women are required to determine the eects on both
mother and baby [15,37] and to provide health care professionals and
reexologists alike with sound information on treatment options during
high- and low-risk pregnancy. HCP who wish to refer or recommend
reexology to their patients should recognise that;
• Reexologists require advanced training on how to eectively
and appropriately treat pregnant women and to provide tailored
individualised treatment that is safe and eective;
• Reexologists should recognise when and when not to treat a
pregnant women and may have certain criteria which renders
some women unsuitable for treatment;
• Consent to treat women experiencing a high-risk pregnancy
should always be sought from the woman’s maternity
health care provider.
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... Relaxation interventions that were self-administered by perinatal women had a greater beneficial effect on sleep quality than intervention provided by a trained professional. Maternity reflexology requires advanced training and thorough knowledge and is necessary to the assessment of the suitability of a treatment ( McCullough and Hughes, 2014 ). Moreover, the credibility of external practitioners is very important to provide a safe massage and reflexology session, which is necessary to gaining the confidence of perinatal women and putting their minds at ease during the sessions ( Tiran, 2006 ). ...
Background: Sleep problem is common amongst perinatal women, and stress may trigger and intensify sleep problems in a vicious cycle. Relaxation interventions are gradually being adopted to improve sleep quality in various populations, but little is known about their effectiveness in perinatal women. Objective: To evaluate the effects of relaxation interventions on sleep outcomes amongst all perinatal women aged 18 and above, and identify the essential type, regime and approach in designing relaxation intervention. Design: Systematic review and meta-analysis of 11 studies among 1046 perinatal women. Data sources: We search Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, PsycINFO, ProQuest Dissertations and Theses, PubMed and Web of Science from their inception until December 15, 2019. Review methods: Studies were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Comprehensive Meta-analysis and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively. Results: A total of 6346 records were identified, and 11 randomised control trials were selected. Significantly large effects were found in relaxation interventions in improving sleep quality (Cohen's d = 2.55), disturbance (Cohen's d = 1.52), latency (Cohen's d = 1.82) and duration (Cohen's d = 1.14) when compared with those in the control groups. Subgroup analyses showed that antenatal women who performed progressive muscle relaxation (PMR) by themselves for preventive function and long-term practice showed improved sleep quality compared with their counterparts. Conclusion: PMR is preferable as a supplementary intervention to current existing antenatal care. The grade of the overall evidence of the outcomes ranged from very low to low. Implications for practice: The meta-analysis addressed the effect of relaxation interventions on sleep outcomes amongst perinatal women. Relaxation interventions may effectively improve sleep quality, disturbance, latency and duration amongst perinatal women early in antenatal period. However, further well-designed trials in large samples are required.
Full-text available
Background: Reflexology is one of the top forms of Complementary and Alternative Medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods: Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception-December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Results: Seventeen eligible RCT’s met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low. Keywords: Biochemistry, physiology, reflexology, systematic review.
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Introduction: The integration of reflexology as one of the non-pharmacological pain relief methods in to midwifery care has become more common in recent years. The aim of this study was to determine the effect of reflexology on pain intensity and the duration of labor in primiparous. Materials and Methods: This clinical trial study was carried out on 80 primiparous women with low risk pregnancy that referring to Karaj hospitals (Iran) then randomized in two groups, intervention group which received reflexology for 40 minutes and control group. Severity of labor pain was shown by visual analogue scale (McGill questionnaire), before, half, one and two hours after intervention. Moreover, the duration of labor was determined for both groups. Results: Severity of labor pain before and immediately after intervention foot reflexology did not vary between case and control groups (p>0.05). But half, one and two hours after it, severity of labor pain in the intervention group was lower than the control group (P<0.001). Duration of labor in the intervention group significantly was lower than the control group (P<0.001). Conclusion: Reflexology can lead to decrease in labor pain as well as duration of labor. Therefore, we can use this non-invasive technique to decrease the labor pain and encourage mothers to normal vaginal delivery that is one of the aims of midwifery.
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Background Reflexology is an alternative medical practice that produces beneficial effects by applying pressure to specific reflex areas. Our previous study suggested that reflexological stimulation induced cortical activation in somatosensory cortex corresponding to the stimulated reflex area; however, we could not rule out the possibility of a placebo effect resulting from instructions given during the experimental task. We used functional magnetic resonance imaging (fMRI) to investigate how reflexological stimulation of the reflex area is processed in the primary somatosensory cortex when correct and pseudo-information about the reflex area is provided. Furthermore, the laterality of activation to the reflexological stimulation was investigated. Methods Thirty-two healthy Japanese volunteers participated. The experiment followed a double-blind design. Half of the subjects received correct information, that the base of the second toe was the eye reflex area, and pseudo-information, that the base of the third toe was the shoulder reflex area. The other half of the subjects received the opposite information. fMRI time series data were acquired during reflexological stimulation to both feet. The experimenter stimulated each reflex area in accordance with an auditory cue. The fMRI data were analyzed using a conventional two-stage approach. The hemodynamic responses produced by the stimulation of each reflex area were assessed using a general linear model on an intra-subject basis, and a two-way repeated-measures analysis of variance was performed on an intersubject basis to determine the effect of reflex area laterality and information accuracy. Results Our results indicated that stimulation of the eye reflex area in either foot induced activity in the left middle postcentral gyrus, the area to which tactile sensation to the face projects, as well as in the postcentral gyrus contralateral foot representation area. This activity was not affected by pseudo information. The results also indicate that the relationship between the reflex area and the projection to the primary somatosensory cortex has a lateral pattern that differs from that of the actual somatotopical representation of the body. Conclusion These findings suggest that a robust relationship exists between neural processing of somatosensory percepts for reflexological stimulation and the tactile sensation of a specific reflex area.
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Purpose/Objectives: To evaluate the safety and efficacy of reflexology, a complementary therapy that applies pressure to specific areas of the feet. Design: Longitudinal, randomized clinical trial. Setting: Thirteen community-based medical oncology clinics across the midwestern United States. Sample: A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy. Methods: Following the baseline interview, women were randomized into three primary groups: reflexology (n = 95), lay foot manipulation (LFM) (n = 95), or conventional care (n = 96). Two preliminary reflexology (n = 51) and LFM (n = 48) test groups were used to establish the protocols. Participants were interviewed again postintervention at study weeks 5 and 11. Main Research Variables: Breast cancer-specific health-related quality of life (HRQOL), physical functioning, and symptoms. Findings: No adverse events were reported. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p < 0.01) and the LFM group (p = 0.02). No differences were found on breast cancer-specific HRQOL, depressive symptomatology, state anxiety, pain, and nausea. Conclusions: Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Implications for Nursing: Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer.
Reflexology in Pregnancy and Childbirth is a definitive text on the safe and appropriate use of reflex zone therapy in pregnancy, labour and the puerperium, focusing on evidence-based practice, professional accountability and application of a comprehensive knowledge of the therapy related to reproductive physiology. Denise Tiran, an experienced midwife, reflex zone therapist, university lecturer and Director of Expectancy - the Expectant Parents' Complementary Therapies Consultancy - has an international reputation in the field of maternity complementary therapies, has researched and written extensively on reflexology, and has treated nearly 5000 pregnant women with structural reflex zone therapy. KEY FEATURES Case histories to ease application of theory to practice Charts, tables and diagrams are used throughout for ease of learning Includes a section on conception, infertility and sub-fertility Covers legalities and ethical issues.
Background: Tiredness is one of the most common complaints among pregnant women, but little attention has been paid to its importance and a way to control it. Reflexology can be employed as a nursing intervention to reduce it. The purpose of this study was to determine the effect of reflexology on the tiredness intensity in pregnant women. Methods: This study was carried out on 74 pregnant women outpatients in Health centers in Ramsar. These women were divided into two groups of test (36 people) and witness (38 people) which were matched according to their ages and jobs. The instrument for collecting data included sample choice form, individual characteristics, social support and a questionnaire for analyzing tiredness intensity. When the forms were filled up by the research units, the reflexology of sole was done in the test group for 5 weeks, two sessions a week, 30 minutes each session; then the tiredness intensity of both groups was analyzed again. The analysis was performed using the following tests: Chi square statistical test, student t, paired t and Pearson correlation coefficient. Results: In this study the average of tiredness intensity in pregnant women showed a significant difference before and after the reflexology, and after the interaction there was a significant difference in tiredness intensity between the two groups of witness and test (p=0.001). There is a significant relationship between social support and tiredness intensity (r=0.46, p=0.002). Likewise, ferros sulfate tablet had a significant effect on tiredness intensity (p=0.001). Conclusion: According to the present study reflexology reduces tiredness in pregnant women significantly. The other variables such as social support and sulfate ferros tablet can reduce tiredness intensity too.
Introduction:One of the problems that occupy pregnant women's mind is the labor pain. Owing to considerable rate of Caesarean sections in our community (due to fear of labor pain) it is our duty to try to increase the rate of normal vaginal deliveries instead. The aim of this study is to investigate the effect of reflexology on the severity of labor pain and labor duration in nulliparous women. Methods: This clinical trial study was carried out on 70 nulliparous women (39 intervention and 31 controls) who referring to labor room of Afzalipour Hospital (Kerman city) with gestational age of 37 weeks and above, and cervical dilatation of 3-4 cm. They had no significant diseases according to their medical records, nor had used any medications during labor. The intervention group received reflexology for 20 minutes (10 minutes each foot) during their uterus contraction in active phase of labor (acceleration). The control group underwent massage for 20 minutes at the same time but on other areas of their feet. Severity of labor pain was shown by Visual Analogue Scale (VAS), before and after the intervention. Moreover, the duration of labor was determined for both two groups. Results: Severity of labor pain before foot reflexology did not vary between case and control groups (p = 0.14) but after it, severity of labor pain in the intervention group was lower than the control group (p < 0.001). The severity of labor pain reduced after the intervention in the intervention group (p < 0.001), whereas, labor pain increased in the control group (p < 0.001). However, the labor durations were same in both groups (p<0.063). Conclusion: Reflexology have an indisputable effect on decreasing labor pain in the first phase, whereas, it does not affect the total duration of labor.
Many pregnant women with low back and/or pelvic pain (LBPP) use pain medications to manage this pain, much of which is self-prescribed and potentially harmful. Therefore, there is a need to find effective nonpharmacological treatments for the condition. Reflexology has previously been shown to help nonspecific low back pain. Therefore; a pilot RCT was conducted investigating reflexology in the management of pregnancy-LBPP. 90 primiparous women were randomised to either usual care, a reflexology or footbath intervention. Primary outcome measures were; the Pain Visual Analogue Scale (VAS). 64 women completed the RCT; retention rates for the reflexology group were 80%, usual care group 83.33% and footbath group 50%. The reflexology group demonstrated a Clinically Important Change (CIC) in pain frequency (1.64 cm). Results indicate it is feasible to conduct an RCT in this area, although a footbath is an unsuitable sham treatment. Reflexology may help manage pregnancy-LBPP; however a fully powered trial is needed to confirm this. Copyright © 2015 Elsevier Ltd. All rights reserved.
to determine the prevalence of women's use of complementary and alternative medicines (CAM) during pregnancy in the UK, reasons for use, who recommended CAM, and the characteristics of women that are associated with use of CAM during pregnancy. cross-sectional questionnaire. Birmingham Women's Hospital. 315 postnatal women were surveyed while on the postnatal ward. the questionnaire response rate was 89% (315/355). CAM use during pregnancy was reported by 180 women (57.1%). CAM users differed significantly from non-CAM users by education level, parity and previous CAM use before pregnancy. Vitamins (34.9%), massage therapy (14.0%), yoga (11.1%) and relaxation (10.2%) were the most commonly reported uses of CAM. 33.0% of women reported they did not disclose their use of CAM to a doctor or midwife, and 81.3% were not asked by their doctor or midwife about their use of CAM during pregnancy. this study found a high prevalence of CAM use during pregnancy, which is within the range of findings of studies from Australia and Germany. It is important that health-care providers routinely ask about CAM use during pregnancy and are able to provide pregnant women with appropriate advice regarding CAM use.
Background: the popularity of non-prescription, over-the counter (OTC) medicines, vitamins, minerals, homoeopathic remedies and herbal supplements (CAM) has grown significantly in recent years. However, we have limited knowledge relating to why pregnant women use CAM and how this may relate to the provision of maternity care. Using an interview approach this study explored the nature of over-the-counter and complementary medicines use in a sample of pregnant women. Methods: this interview study formed part of a larger self-administered questionnaire survey on the extent of CAM use in pregnancy at large NHS Trust in England. The questionnaire provided the opportunity for women to complete a contact information reply slip if they were happy for follow-up interview. Audio recorded, face to face interviews were undertaken with a sample of 10 women. Results: the reasons the women who were interviewed gave for using CAM broadly fell into two areas centred essentially on the contrasting advantages of CAM and disadvantages of conventional medicine. Doctors or midwives were rarely informed about the use of CAM medicines during pregnancy. Conclusion: the women saw CAM as outside of biomedicine and part of a holistic approach to health and well-being over which they are able to maintain their personal control. Non-disclosure of CAM use was common, a feature of which, appears to be some health-care professionals' lack of realisation of the importance, to women, of a holistic approach to their health, key to which is a desire to retain control over decisions associated with their well-being.