Introduction
Work-related stress is the biggest occupational health problem in the UK. Over half a million people experience stress at work to a level they believe is making them ill, costing organisations around £3.7 billion every year. On average, each stress-related absence involves 29 working days lost, totalling 13 million days in 1 year.1
Excessive stress, without the opportunity to recover, can cause physical and psychological problems. Acute responses include tension, fatigue, nausea and headache, whereas stress over a period of time exposes the body to risk of infection and the onset of chronic conditions like heart disease, digestive disorders and psychological conditions.2 and 3
Stress can also be related to the prevalence of musculoskeletal disorders, which are the most commonly reported work-related illness, causing long-term absenteeism in the workplace.4 To avoid loss of income and high litigation costs, many UK businesses are now seeking inexpensive and convenient solutions to reduce stress and prevent the onset of illnesses. In doing so they are more likely to benefit from a healthier and happier workforce, lower sickness absence, better performance and improved service and profits.1
A holistic approach to stress management attempts to tackle the underlying causes of stress by addressing the individual's physical, psychological and social factors, rather than treating symptoms alone. With the focus on prevention rather than cure, therapists may advise and support lifestyle and dietary changes to help promote and maintain good health in the long term, thereby maximising the individuals’ capacity for self-healing.5 and 6
Reflexology is the systematic application of pressure to reflex points on the foot or, less frequently, the hand.7 It is widely used in the UK to treat conditions such as back and neck pain, migraine and headaches, chronic fatigue, insomnia, digestive problems and other stress-related disorders.7, 8 and 9 Treatments such as reflexology are also being used within some organisations as part of an integrated stress management programme.5 However, few rigorous studies have been conducted on the efficacy of reflexology and little is known of its effectiveness as a means of managing stress in the workplace.
To date, only one study has been published directly investigating the effect of reflexology on physiological and psychological indicators of stress.10 Thirty healthy participants underwent reflexology and no treatment control in a cross-over experimental design. Reflexology was found to have reduced state anxiety and cardiovascular activity consistent with stress reduction but there was no significant effect on trait anxiety or the stress-related secretion of cortisol and melatonin. The study excluded the influence of a therapeutic relationship as each participant only received one 60-min reflexology treatment; however, this raises the question of whether a single reflexology treatment is sufficient to bring about the change in trait anxiety or stress-related hormones.
A single-blind experiment examined the effects of reflexology and foot massage on the regulation of blood pressure by measuring baroreceptor reflex sensitivity (BRS) in 24 students.11 The group receiving reflexology and foot massage showed a reduction in BRS when compared to the control group but the effect did not achieve statistical significance.
A study using qualitative methods suggested that a sample of women with poor mental health felt less anxious and more relaxed after receiving eight weekly reflexology treatments.12 However, it cannot be assumed that the reported effects were the direct result of reflexology intervention.
A recent pilot study investigated the use of reflexology in the management of musculoskeletal disorders.13Fifteen participants with non-specific lower back pain were randomised to receive either reflexology or foot massage for 40-min once a week for 6 weeks. The results showed that the participants receiving reflexology experienced a consistent reduction in pain throughout the study compared to participants receiving massage, but the difference did not achieve significance. Although the small sample could not provide statistically significant evidence, it presented sufficient data to encourage further investigation.
Other studies suggest reflexology may warrant further investigation as a means of alleviating the sensation of pain,14 increasing joint mobility and improving sleep by relieving tension and encouraging feelings of well-being.8 and 9
To investigate the benefits of using reflexology at work, a preliminary study was conducted in an occupational setting with employees who reported high levels of stress and stress-related symptoms. The aim was to explore the use of reflexology in managing stress in the workplace using a range of outcome measures.