Here below you will find bits and pieces of advice with regard to treating patients with back pain in the best possible way and thoughts about our profession and the relentless debate “deep pressure-light pressure” bearing in mind certain inescapable anatomical and physiological truths about feet. Feel free to comment using the Contact form. The most interesting comments will definitely be posted.

1. Helping your patients

I debated with myself whether to go over techniques relative to back pain in this section and realized that that would just be silly. You, my colleagues, know perfectly well which techniques you need to use on your patients suffering from back pain. And if you feel there is room for improvement, you can always go back to the books, ask a colleague, or take a refresher course. We don’t all use the same techniques because we’ve been to different schools and the purpose of this section is not to make an exhaustive list of all reflexology techniques available worldwide.

What is extremely important on the other hand, is to understand the nature of the back pain you are treating. And for that, it is important to ask relevant questions to your patients, the most relevant question of them all being:

How long has the patient been suffering from back pain?

When a problem is recent chances are someone made a wrong move, or carried something too heavy, or there was a fall or an accident of some kind where an impact took place. In those cases, serious muscular imbalances due to avoidance/overprotection behavior have not yet had the time to set in, making your work easier in the sense that you need only concentrate on the reflex areas corresponding to the pain spot(s) – if the patient is in great pain, you will naturally also treat the reflex areas concerned with the reduction of stress as well as all the glands in order to optimize the natural healing process.

On the other hand, if the problem is older, recurrent, or chronic, you now know that in 85% to 90% of cases you will be faced with what is referred to as non-specific back pain. You can start by reassuring your patient that even though they are in great pain this is not something serious or devoid of solutions. On the contrary, this is a problem of muscular weakness, probable lack of postural hygiene/discipline, possible inadequate mattress, and almost definite lack of physical activity. And all these things can be fixed. The role of the reflexologist in these cases is to reduce the pain to a level sufficient for the patient to begin becoming more active and strengthening his/her back. You need to be adamant about the consequences of not doing so. The medical data and advice regarding back pain discussed on this website have their source in the most reliable and most recent medical research regarding back pain. On this website you will find what the best back pain experts will tell you.

If someone has non-specific chronic or recurrent back pain, the only way out in the long term is: STRENGTHENING THE BACK MUSCLES. Be aware that old pain in combination with overprotective behavior and inactivity can lead to pain spreading throughout the back, going into the neck and causing headaches, going to the shoulders and arms, going to the ribs, going into the buttocks, hips, legs, knees, ankles, and even feet. Something which in words is as simple as “muscular weakness of the back” can cause absolute havoc in certain people. If you are presented with such a case, you need to try and reduce the pain everywhere and therefore, next to the direct reflexes, work also the Central Nervous System, all the affected plexuses, the Solar Plexus, and all the stress-related reflex areas.

If, on the other hand, the back pain is specific and caused by a structural problem such as scoliosis or disk degeneration, part of the solution is also to reduce the pain through reflexology and STRENGTHEN THE BACK MUSCLES, since this will slow down – even possibly prevent - further damage. In these cases, preventing further damage is a high priority. I have seen with my own eyes the metamorphosis that adapted and adequate strengthening exercises can bring about in people of all ages who start out in an appalling state and believe wholeheartedly that all hope is lost for them.

It is equally important to explain clearly to your patients that overprotecting their back is incredibly counter-productive and can only make the problem worse by further weakening the back muscles.

Also, it is wise to establish contact with local physical therapists whom you can send patients in need of a back strengthening program to.

Remember: back pain is a leading cause of disability in the world, especially in developed economies, according to the WHO. As such, it only makes sense that every reflexologist should carefully understand what makes a back healthy and what doesn’t. Back pain being a leading cause of disability means that you will regularly and unavoidably have patients suffering from back pain – even if it is not the primary reason for their visit to you. Even if you specialize in fertility, work mostly with cancer patients, or with the elderly, the back pain mechanisms remain the same. For example, you know for a fact that the woman who would like you to help her get pregnant and already suffers from back pain will have even greater back pain once she is pregnant. It is your job to explain this and guide her in the right direction by telling her what the scientific facts are and how she will benefit from strengthening her back and abdominal muscles while simultaneously helping her in terms of fertility.

There have been many reactions to this website and among those a reaction of mixed feelings emerged: on the one hand a fantastic website with the right information but on the other the fact that, as reflexologists, we don’t diagnose or prescribe, and as such I seem to be giving too much medical advice for my capacity. The advice that I give is not mine and I would like that to be very clear. It is based on what back pain experts say, on their research and on the latest data and clinical results on the subject. This is unambiguously stated in the section Understanding Back Pain. What’s more, the entire text of that section was reviewed and approved by one of Europe’s top back pain experts at the Kovacs Foundation. As reflexologists, we are not qualified to diagnose or prescribe but does that mean that we are not allowed to read, to learn, or to better ourselves in order to help our patients? There is an important difference between me saying to back pain sufferers “this is what you should do” or saying “this is what the experts in back pain recommend, this is what the research shows and proves, here’s how you could go about finding solutions, and here are the references to these experts should you want to read more on the subject”. It goes without saying that a reflexologist should never make up medical facts based on their personal opinions or beliefs. That would be irresponsible, absolutely unprofessional, and completely useless to his/her patients. This is precisely why we need to be better informed and more knowledgeable about our patients’ illnesses and conditions.

The health care world is evolving towards something called integrated medicine. The integrated approach to medicine combines traditional Western medicine with complementary therapies but is overseen by doctors. This is an evolution that is already well under way. In other words, this is our place either in the present and certainly in the future. Do you think that doctors will be willing to work in cooperation with reflexologists who are ignorant about the medical conditions of their patients? Unlikely. So far the integrated approach has shown amazing results in oncology and orthopaedics. And this is fantastic news for us reflexologists. However, if integrated medicine is our future – and it is – we need to get on board and present ourselves more scientifically, we need to get the right studies regarding the effectiveness of reflexology on various medical conditions to happen, we need to defend our profession with facts! It doesn’t matter what we think, it doesn’t matter what we believe, it only matters what we can prove.

2. The hard pressure vs. lighter pressure debate

Some of you have suggested that I discriminate against the lighter touch reflexology. I can see how some of the wording would lead you to think that.

First of all, let me insist that this is a distorted and incorrect interpretation of what I am saying as well as an oversimplification. I object to oversimplification because it is simply too easy to oversimplify. In point of fact I think the entire debate of one pressure being better than the other shouldn’t even be a debate. Reflexology is about both types of pressure and any well-trained reflexologist who understands his/her profession knows that. You cannot be just about the one type of pressure or the other. Reflexology should at all times integrate both types of pressure.

We all know that gentler pressure should be applied on babies, the elderly, and the chronically ill as a measure of precaution. And obviously, if you specialize in treating babies, you will have much more experience with lighter touch techniques than with the deeper pressure ones. The truth is, gentler pressure should be applied in almost every treatment. When you relax your patient and use soothing techniques, you apply a lighter touch. If you have a patient who is very self-conscious about their feet and afraid of the first treatment, you will also use lighter techniques to put him/her at ease and in following treatments you will gradually augment the pressure. To me, the very thought that we should choose one or the other in every single case is not the right debate. Reflexology should be about integrating both techniques and every reflexologist should know how much of the one and the other to give during each session.

However, if you think that light touch reflexology is as good for every patient as the deeper touch techniques – therapeutically speaking purely from a results point of view – then the physiological facts are against you. This is not about what I believe, these are undeniable facts about the anatomy and physiology of our feet and the purpose of our treatments.

1/ Blood flow and lymphatic system: one of our principal aims as reflexologists is to assist and stimulate the blood and lymph circulation. In our bodies, and that goes for the feet as well, there is a more superficial – subcutaneous – vascular system and then there is a deeper vascular system. In the feet, without deep pressure it is impossible to access the deep vascular and lymphatic systems and therefore stimulate either. In other words, by applying exclusively lighter pressure techniques you would achieve stimulation of the superficial vascular system but you would leave out the entire deeper veins and pumps which allow for optimal circulation back to the heart. What a shame! Especially if your patient can handle the pressure!

2/ Nerve flow: another one of our main objectives when giving a treatment is to optimize nerve flow. Similarly to the vascular network, there are several types of nerve endings in the feet. Some nerve endings can be found at skin level or close under the skin. Other nerve endings will be found inside the muscles and are deeper in the foot. These are often the nerve endings of major motor nerves. It is physically impossible to contact these nerve endings and therefore stimulate these major nerves without pressing deep into the foot muscles. Again, if your patient can handle the pressure, what a shame to deprive them of the benefits of stimulating these nerves!

Some reflexologists tell me that they have experienced and seen very effective lighter touch treatments, especially for back pain. As we have just seen, with a lighter touch treatment you would activate the superficial blood and lymph circulation as well as all the skin level nerve endings. So, naturally your treatment would have a positive therapeutic effect on your patient. But you are missing a significant part of the effect you could give which could result in a faster and fuller recovery for instance. Another possible scenario in the case of back pain is that your patient’s back pain and muscle spasms are mostly caused by stress. An hour of gentler touch techniques is extremely soothing, thus deeply de-stressing your patient. And if that’s the case, then you’ve used the right techniques for the right problem, which brings me back to my original point: it is essential to integrate both types of techniques and know when the one is better suited than the other. Talking to a patient before the first treatment and assessing why they’ve really come to you is essential to make the right choice of techniques (balance between soft and deep). I have back pain patients who insist I skip the soft techniques as they feel the very deep techniques are the only ones truly relieving the pain. The choice must be made on a case by case basis.

The reason some of you have interpreted my wording as “anti light touch techniques” is because you are reflexologists. Imagine for a moment that you suffered from back pain and you knew almost nothing about reflexology. How would you know if the person giving reflexology to you is doing it right or not? How would you know the difference between therapeutic (medical) reflexology and spa reflexology? It is not for you, the reflexologists, that I have painted such a black and white picture, but for those who are in pain and don’t know what our beautiful profession is about. If they are in pain they deserve to find quickly a good reflexologist who can help them, and not throw their money out the window or come to the conclusion that reflexology is useless. I hope you can understand now why I have presented the information the way I did.

Read our latest newsletter:

- Feature article: Alarming Frequency of Back Pain among Teenagers

- Interview: Nico Pauly talks to us about Nerve Reflexology

- Send us your experiences or useful tips!

- Recommended reading: The Human Foot

“We cannot solve our problems with the same thinking we used when we created them.”

Albert Einstein
(1879-1955)