Reflexology: The Definitive Practitioner's Manual: Recommended by the International Therapy Examination Council for Students and Practitoners

Carrying heavy bags. Carrying a bag always on one shoulder means that the person elevates the shoulder to keep the bag in place. This creates an imbalance that is evident in females with a shoulder bag and golfers carrying their golf bags. Carrying a heavy briefcase always in the same hand, or heavy shopping, can also cause elevation of one shoulder. Weight should always be evenly distributed between two carriers, one for each hand. School children as young as 9 years of age may suffer with neck and back problems due to carrying books and other classwork in a satchel on one shoulder. Instead they should carry it in a haversack or rucksack on both shoulders, thus spreading the load. School children and students should be made aware of how these postural bad habits repeated over any period can create neck, shoulder and back problems.

Incorrect sleeping patterns. Many people do not have the correct support for their necks when asleep. Each individual body is unique and may require more or less support. It is imperative that the cervical spine is not arched or angled incorrectly and this all depends on the width of the person’s shoulders. The line of the spine should be as straight as possible. Even though the whole spinal column can move slightly and is quite flexible it is often subject to distortion, rendering it more susceptible to overstrained muscles and ligaments. The body naturally repairs itself while we sleep, and attempts to return to a normal position. Given the right conditions in a correct sleeping position the muscles therefore relax and recover, but if the wrong position is maintained during sleep the muscles maintain their tension and the person awakes tired, wearisome and stiff, along with a stiff neck or suffering from cervicalgia, which in turn can affect all the muscles down the neck and possibly involve the shoulder and arm.

The two main muscles that turn the head are the thick sternocleidomastoid muscle and the splenius capitis muscle. These muscles stiffen very quickly if they remain in one position for any great length of time. When a person is asleep the muscles of the neck relax immediately, and that is why it is imperative to have the right support. If the neck is twisted to the side (as in the case of a person sleeping on their front) then over a period of time this may cause a stiff neck or over a longer span of time spasmodic torticollis. This condition would also travel down and involve the trapezius muscle causing general myalgia (pain in the muscle) or even myositis (inflammation of the muscle) in the whole neck and shoulder region, which in turn can travel down the spine to the hip. (Shoulder and hips are always related in reflexology through the zonal pathways.)

Because muscles draw up when there is any sustained involuntary muscular contraction, it is easy to observe the position of the neck of the patient and note whether the shoulders are level; this will give some indication how severe the problem is. All muscles and the surrounding connective tissue need a good nerve and blood supply to supply nutrients and oxygen to the area. Restriction of muscles may cause muscle spasm. If the patient is not aware that a sleeping habit is creating an imbalance to the muscle structure, the problem can only deteriorate further.

If a patient complains that they often feel worse in the morning it is invariably due to an incorrect sleeping pattern. Before treatment, the reflexologist should therefore explore the right pillow support for the person, using the treatment couch for them to demonstrate how they sleep. The pillow should sit in the crook of the neck and the neck should not be out of alignment with the cervical spine; too high a pillow will cause the neck to be raised off the cervical spine, while too low a pillow will cause the neck to drop away because in sleep there is no muscular support. The person should not sleep on their front as this causes acute restriction on the cervical region and all the muscles that move the head.

Office work. Office workers need to be aware of work patterns, such as holding a telephone in the crook of the neck (see above). Continuously reaching to one side to lift an object, such as a file or book, can also create neck, shoulder and back problems.

Typists are often prone to wrist problems owing to incorrect chair height or position whilst typing. Tenosynovitis, which is inflammation of the tendon sheath, is also common in people who do a lot of writing or drawing work. Also the second, third and fourth fingers are drawn up into the palm, and this can lead to trigger finger with a total impairment of extension in any one of the fingers.

Tennis elbow. This is not necessarily caused by tennis, as this term covers any overuse of the forearm muscles, which may cause restriction of movement and painful inflammation of the tendons. It is common in drivers who rest their arm up on the right side window while driving. This elevated position of the arm can cause no end of problems to the arm and shoulder (see also chapter 8, A-Z of disorders of the body, Repetitive strain injury).

Sitting for prolonged periods, and lack of exercise or movement.

These habits can create some of the following:

• Cramp – this painful spasm in the muscles can be due to an imperfect posture, or it could relate to a circulatory problem, or an imbalance of salts. This can be caused by working in a very warm environment, in which excessive sweating may occur and the person is further depleted by constant coffee drinking and not enough water intake.

• Rheumatic-type pains – these are often in the lower and upper limbs.

• Back pain – this is often due to incorrect posture or faulty seating whilst working.

• Haemorrhoids – these are often aggravated by prolonged sitting and a restriction to the circulation to the rectum.

• Constipation – apart from dietary causes, this can be caused by ignoring the first impulse or sensation in the rectum; it is easy to remain seated when you have a lot of work to do.

• Urinary tract infections, both male and female – these disorders can be further aggravated by prolonged sitting as the bacteria that cause this are also on the skin surrounding the anus, and increased moisture as a result of wearing or sitting on incorrect fabrics allows the bacteria to enter the genitourinary tract.

• Problems in the reproductive system – these may be due to prolonged sitting on synthetic coverings, or in females wearing tights or synthetic underwear, which are more prone to bacteria proliferating.

When palpating the feet, the muscles in the lower arch of the foot may appear soft and floppy; this area corresponds to the low abdomen, and shows there may be a bulging stomach caused by excessive sitting, both in men and in women. This can cause, as stated above, a deficiency in the upper parts of the body, which in turn can create shoulder, neck and lower back stress.

When at home or at work when sitting or driving, people should always be made aware of their seated position. Do they have support for their lower back, or are they slumping in their chair? The wrong position can cause havoc when repeated over a period of time. Is the patient a manual worker, as lifting heavy goods correctly is paramount? Bending at the knees and keeping the back straight, the person should try not to twist or turn when lifting as this will distort the back muscles. It is quite surprising how the obvious does not occur to some people. Equally, decorators, or anyone who works above their head or with arms outstretched for long periods, are prone to lumbar problems; often this is because the posture is altered and the head and neck are off the centre line of the body, so they are either leaning backwards and over their head, or stretched forwards; there is too much arm work in awkward positions.

People cannot change their occupations, but it is necessary to make them aware that they are usually causing their own problems by unvarying uniform movements, and over a period of time these may lead to repetitive strain injury, or RSI.

Standing for prolonged periods with little movement and relaxation of lower abdominal muscles.

These can cause any of the following:

• Varicose veins – these are a mass of enlarged blood and lymphatic vessels that can become tortuous and swollen because of the internal pressures from higher in the body. The great saphenous vein or its tributaries are the ones usually affected; these are on the medial side of the leg and foot. Any occupation that involves long periods of standing with very little movement will not supply the necessary pumping action that is required to discharge the blood from the veins. There is also often an inherited tendency to varicose veins or faulty valves; this contributes to a loss of elasticity in the walls of veins and valves (structures in blood vessels that regulate the direction of flow of blood) making them flaccid, which may cause an obstruction to blood flow. These inherited conditions are often made worse from prolonged standing and the vessels become distended even more because of the pressures from within the walls and the blood accumulates. Constipation can aggravate this further, as well as inadequate exercise.

• Phlebitis – a poor circulatory system can cause phlebitis, an inflammation to the vein, and one should be very careful when palpating or treating the ankle or lower leg area because of this impaired circulation. Problems may often appear about 4 inches (10cm) above the ankle down to the heel area. If there are signs of broken blood vessels, extreme caution should be used when working on the foot or leg; it may be advisable to work on the hands only.

• Problems in the reproductive system – these can be exacerbated by excess weight of the trunk on the lumbar spine and pelvic areas.

• Oedema of the legs – this is a fluid accumulation in the lower parts of the body, often due to varicose veins.

• Disorders of the legs or lower back – these occur if undergarments are too tight or from prolonged sitting with the legs crossed or standing in one spot for too long. Many such everyday activities may cause a restriction to the blood flow and this may cause tingling and even discoloration in extreme cases.

Many times behaviour patterns and sedentary lifestyle or physical inactivity can create a disorder or exacerbate a problem. Too much standing, or too much sitting, or any activity in excess, are contributory factors that the reflexologist should always bear in mind. Being overweight can also cause too much pressure in vessels; that is why it can often be a common problem of pregnancy.

It is imperative that if there is any prolonged inactivity, simple stretching exercises are suggested. Even flexing and rotating the feet and wriggling the toes will promote a healthy return of the circulation. Or you can get up and walk around on tiptoes to relax the shoulders, then walk on the heels for the lower back.

Recommending treatment (#ulink_032aa0ad-65ab-5a34-93f9-c850ba7d3522)

Reflexology is beneficial for many of the behavioural problems discussed above, especially vein problems and haemorrhoids, because stimulation encourages the venous return to the heart. It also stimulates the connective tissue and improves circulation generally, and helps disperse oedema, especially if there is swelling in a joint, and alleviates pain in spinal areas, possibly because of increased blood supply so nutritive compounds are transferred to muscles without any overload of toxic lactic acid (which is produced through voluntary muscle contraction). It helps in tissue renewal as it triggers growth hormone release from the pituitary, which stimulates new bone growth, aiding in healing of fractures.

Before commencing treatment, one has to consider many different factors. For instance, is the illness of sudden onset, or chronic? If it is chronic the system would be very depleted. The age of the person is not really important because young and old alike will benefit. Contraindications must always be considered, also the person’s threshold of pain, and their reaction to reflexology during, between and after treatment. A patient should always react positively; if there is any uneasiness during treatment one should always stop and use one of the many relaxation techniques. These can be used to calm, tranquillize, balance or revitalize. The body seems to know when it needs invigorating and when it needs to be restful. When treating patients we have to take into consideration all these many factors.

Contraindications to treatment

Specific factors in a patient’s condition may make it unwise to pursue a reflexology treatment. These can include medication and some illnesses. Reflexology can often be given on the hands when a person is very sick or depleted as this ensures that there are less toxins released into the body. Every practitioner must learn to be able to adapt their pressure and area to work on, according to each of their patient’s individual needs.