Updated March, 2026

Reflexology is a manual healing method in which points on the feet, hands, and/or ears are compressed to alleviate pain and treat medical problems. Although the mechanisms for how reflexology works in the body are not well established, this practice has been relieving pain and other stress-related conditions for decades. As with other CAM therapies, many accredited massage schools offer reflexology courses because this healing modality has brought relief to patients across the globe.

Massage therapists who add reflexology to their repertoire may serve spa clients or anyone looking to relax. This approach is less common in massage careers, so those with reflexology training tend to receive client referrals for their unique skill. Let’s take a look at the history of reflexology, and how it works.

Introducing Reflexology

Ancient healers in Egypt, India, and China worked with energy points in feet and hands to improve health. Egyptian hieroglyphics suggest foot treatments were part of Egyptian society as far back as 2330 BC. The idea of treating illness through massaging the hands was widespread in Europe by the late 1300s. 

In the nineteenth and twentieth centuries, healers such as William Fitzgerald and Eunice Ingham developed reflexology as we know it. William Fitzgerald encountered reflex therapy while traveling in the early 1900s. (The term “reflexology” was actually coined by Russian neurologist and psychologist Vladimir Bekhterev in the early 1800s.) In 1913, Fitzgerald introduced his zone therapy to the West. He mapped ten vertical zones in the body where pressure could alleviate pain in corresponding areas. 

Twenty years later, Eunice Ingham was working with physiotherapist Dr. Joe Shelby Riley, who had mapped zones on the feet and hands. Ingham realized that the feet were highly sensitive. She developed detailed foot charts, and referred to her therapy as “reflexology,” distinguishing it from zone therapy. Her 1938 book, Stories the Feet Can Tell, popularized reflexology to the general public.

Reflexology Massage Therapy: Basic Practices

During a reflexology session, the therapist applies pressure to parts of the feet, hands, and ears with the intention of improving health in referring organs. Reflexology identifies these areas as microcosms for the whole body. Applying pressure to specific points enables communication with any system in the body. (Shirley, 2023). For instance, if a patient is complaining of urinary problems, the reflexology practitioner might refer to his or her foot map, find the bladder point within the foot’s arch, and apply pressure there.

The foot, hand, and ear charts used in reflexology do not directly correspond with the Meridian lines found in other forms of Eastern medicine. Rather, Reflexology is a unique system.

How Reflexology Works: Biological Mechanisms

Research has not established exactly how Reflexology works in the body. However, as Whatley et. al (2022) conclude, the mechanisms for this and other CAM therapies are likely to be complex, and some combination of:

  • Therapeutic touch, environmental cues to relax, and the placebo effect;
  • Mechanotransduction, or the conversion of mechanical pressure into biochemical changes, potentially via the body’s matrix of connective tissue; and
  • Lymphatic flow changes through mechanotransduction. 

Benefits of Reflexology

While the mechanisms of Reflexology have yet to be uncovered, clients often report the following advantages:

–Pain relief (Kandemir, 2022).
–Improved Emotional Well-Being (Malone, 2025).
–Improved sleep (Whatley, 2022)

Researchers have found physiological changes following Reflexology sessions in a variety of circumstances, including:

  • Patients about to receive a stressful situation (a colonoscopy) experienced reduced anxiety and physiological changes including lowered systolic blood pressure and lowered heart rate (Golitaleb et. al, 2025).
  • Among Leukemia patients, foot reflexology was found to be helpful for  “managing procedural pain and anxiety” (Mehri et. al, 2025).

For more complete research into the benefits of reflexology, we recommend ReflexologyResources.com.

If you’re interested in adding Reflexology to your massage offerings, consider learning about it through East West College’s massage continuing education courses. 

Upcoming CE Massage Classes related to Reflexology

At our massage school in Portland, Oregon we offer exceptional instruction from experienced instructors specializing in a wide array of approaches. Here are a few upcoming courses related to reflexology:

Reflexology I
Instructor: Shantika Bernard, LMT
Dates: June 27 – 28, 2026
Schedule: Saturday, 9:00 a.m. – 4:00 p.m. (1 hour lunch break);
Sunday, 9:00 a.m. – 4:00 p.m. (1 hour lunch break)
In this two-day course you’ll learn reflexology techniques, methods for discovering affected areas, and a systemic approach to providing effective treatment while preventing overuse of your thumbs and joints. There will be plenty of time for discussion and practicing application as well. 

Sources:

Embong, N. H., Soh, Y. C., Ming, L. C., & Wong, T. W. (2015). Revisiting reflexology: Concept, evidence, current practice, and practitioner training. Journal of Traditional and Complementary Medicine, 5(4), 197–206. https://doi.org/10.1016/j.jtcme.2015.08.008

Golitaleb, M., Safdari, A., Rafiei, F., Yaghoobzadeh, N., & Mokhtari, R. (2025). Comparing the impact of foot and hand reflexology on anxiety and  physiological indices in colonoscopy candidates: A randomized clinical trial. Contemporary Clinical Trials Communications, 44(April). https://doi.org/10.1016/j.conctc.2025.101449

Kandemir, D., Abdullayev, A., Seyhan Ak, E., Altun Uğraş, G., & Kanan, N. (2022). The effect of reflexology on low back pain in operating room nurses. Holistic nursing practice, 36(2), 112–118. https://doi.org/10.1097/HNP.0000000000000428

Malone, D. (2025, May 1). Beyond the physical: Massage therapy for emotional health. American Massage Therapy Association. https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-emotional-health/ 

Mehri, M. & Golitaleb, M., Safdari, A., & Madadi, S., Rafiee, F., Shahbazi, H., Mokhtari, R., & Nejat, N. (2025). Effect of foot reflexology on pain, anxiety, and physiological indices in leukemia patients undergoing bone marrow aspiration: A Randomized Clinical Trial Study. Contemporary Clinical Trials Communications, 44(4).  DOI:10.1016/j.conctc.2025.101427

Shirley, C. (2023). How does reflexology work? Massage Magazine. https://www.massagemag.com/how-does-reflexology-work-141938/   

Whatley, J., Perkins, J. & Samuel, C. (2022). Reflexology: Exploring the mechanism of action. Complementary Therapies in Clinical Practice, 48. https://doi.org/10.1016/j.ctcp.2022.101606