Welcome to the treatment guidelines and advice page.

As practitioners of reflexology we are often presented with clients who have a multitude of different conditions. In this section we have compiled AoR guidelines relating to specific conditions and advice on practising as a reflexologist. It is against the AoR’s Code of Practice and Ethics to contradict a GP’s treatment plan and AoR members are reminded that they must only work within their limits of training and expertise.
 

Topics covered

• AoR Guidelines for Working with Asthma
• AoR Guidelines for Working with Cancer
• AoR Guidelines for Working with Children
• AoR Guidelines for Working with Depression
• AoR Guidelines for Working with Diabetes
• AoR Guidelines for Working with Epilepsy
• AoR Guidelines for Working with Irritable Bowel Syndrome (IBS)
• AoR Guidelines for Working with Fertility Problems
• AoR Guidelines for Working with ME
• AoR Guidelines for Working with Pregnant Clients

AoR Guidelines for Working with Asthma

Almost every AoR member will come across clients who suffer with asthma within their first year of practice, and on a regular basis thereafter. Whilst the condition is reasonably well understood, as are the various medical treatment regimes, it can all too easily be approached in a very generalised manner along the lines of one treatment suits all. This must be guarded against as the severity of asthma varies considerably as does the impact that it can have on each individual’s life. A client, whose asthma is severe and is easily sparked off by cold air or exercise, may find that there are extra stresses placed on their life that they find difficult to deal with. This needs to be taken into account when discussing a treatment plan, and when working on the feet.

There are a number of factors which help us to ensure that each client presenting with asthma is treated very much as an individual. Some of these will depend on your environment and whether or not you are treating your client from your home.

Assessing Environment
Unless you are treating the client from their home, there are certain steps that need to be considered in relation to the treatment room and its surroundings. For some clients, their asthma can be aggravated by allergens e.g. pollen, dust, cats, dogs, strong smells. Whilst there is nothing you can do to control the weather, consider how you can minimise the impact of a high pollen count on a client on a hot summers day, while still keeping them comfortable. Keep your room reasonably dust free. This is of particular importance for those reflexologists using various forms of talc. Keep all pets well out of the way, and do not let them into an area that clients will need to go through. If you have aromatherapy oils being used in your treatment room and you are booking in a client who is sensitive to smells, consider when to book in order to allow sufficient time for smells to disburse.

First Aid
We know that one of the effects that reflexology can have is that symptoms that a client is presenting with can, for a short period of time, become a little worse. Asthma is no exception to this as the toxins released into the body following a reflexology treatment, and in particular the client’s first reflexology treatment, can increase the clients sensitivity to an asthma attack for up to a day afterwards. Very occasionally this reaction can occur during treatment, though it is not known whether this is as a result of a physical change (release of toxins) or an energy change. With this in mind you need to be prepared should your client suffer an attack during the treatment session. Make sure that your first aid is up to date, and that you are familiar with the types of approach that can be used for clients suffering an asthma attack.

Treatment Planning
If one of your client’s aims is to improve their asthma, the accepted method of measuring this is by using a peak flow meter. It would therefore be sensible to ask your client to provide a peak flow meter reading prior to their first session and then at regular intervals thereafter. Whilst it is interesting to assess the difference in peak flow before and after a treatment, the important measurements will be those taken over a period of time as a part of the treatment plan.

Contraindications and Cautions
There are no contraindications for clients with asthma, though the above cautions relating to assessing the environment and first aid apply.

AoR Guidelines for Working with Cancer

Until relatively recently cancer was regarded by many as a contra-indication for reflexology. Indeed for many this is still viewed as the case and a large number of training outlets still list cancer on their list of contraindicated conditions. This is not the case for the Association of Reflexologists.
The idea that we were not able to treat cancer sufferers stemmed from a lack of information and understanding, not only of the condition, but also of how reflexology worked and the effect it could have on cancer sufferers. Some people suggested that reflexology might spread an existing cancer through the body via either the lymphatic or circulatory system. This belief may have been borne out of fear, lack of adequate research and experience. Whilst it is not currently possible to demonstrate through research that reflexology has any effect on cancer, there is no evidence of any kind to even suggest that it could have detrimental effects. Of course having an effect on cancer is not what we, as reflexologists, are aiming to do. We are treating the client as a whole and not the disease in isolation.
What has helped us to understand to a greater extent the part that reflexology can play when treating cancer sufferers, is the enormous number of members who have been working in hospitals, hospices and privately with cancer patients. Many reflexologists opt to give their time both voluntarily and paid, to helping in this area. Amongst those is Lucy Bell MAR, winner of the 1999 Good Practice in Integrated Healthcare Awards who heads up Complementary Therapies within Cancer Services, Hammersmith Hospitals NHS Trust. The complementary therapies team could show that patients who received treatment including reflexology alongside orthodox treatment experienced positive benefits. Treatment with complementary therapies helps combat the stress and anxieties of coming into hospital for orthodox treatment that may be traumatic and helps reduce side effects like nausea. Their use has also significantly decreased palliative drug use.
The project has full support from the current director of cancer services, Professor Charles Combes, who was quoted in the Daily Telegraph (17 September 1999) as saying "My clinical impression is that the team here is improving the quality of life for a large number of patients, and that alone is sufficient to justify its existence." Lucy Bell, the team leader, who is a nurse and a reflexologist, says the team get contacted by other hospitals and centres wishing to introduce similar services.

• It is advisable that you request your client to communicate with all parties involved in their medical treatment plan, that they are choosing to receive reflexology.
• Remember the focus of your treatment plan is to treat your client and not the cancer; help them manage and cope at all stages of their treatment. It should never be suggested that reflexology can cure or have any direct effect on the cancer.
• Cancer sufferers can benefit from reflexology before, during and after medical treatment. The treatment approach, including the length of time spent treating during any one session, needs to be varied depending on the presenting physical, mental and emotional state of the client, and at what stage they are at in their treatment or disease.
• There is no evidence to suggest that you should avoid or focus on the reflex area relating to the site of the cancer; any discomfort or unusual response felt by the client should be immediately assessed and addressed perhaps by adjusting pressure or technique.
• Always work within the levels of your training and experience and never hesitate to seek professional advice or support; it is important to understand the services and options that are in place to support your client, other than reflexology.
• Keep up to date with developments in the field and, if this is an area that interests you, put this high on your list of priorities for further training.

AoR Guidelines for Working with Children

The following guidelines provide information on treating children with reflexology. They have been drawn up by experienced reflexologists, and advice has been taken from the relevant legal bodies regarding the legal issues. The guidelines have been laid out in the format of answering relevant questions on the area. If you are unsure regarding any aspect of treating a child, you should contact the AoR before proceeding.

How long should I work on a child’s feet for?
As with all treatment sessions, whether with adults or children, the treatment length will vary depending on the circumstances of your client. As a general rule, the more physically or emotionally vulnerable the client is on that day, then the shorter the session. This applies in particular to the client’s first one or two sessions. With children the age factor is added into this, i.e. the younger the child the shorter the session. With very young children the session may only consist or a few minutes foot massage. As children tend to have a high healing potential and have less baggage that they have been carrying around for less time, they are usually very responsive to reflexology and frequently need fewer shorter sessions than adults. Often only 2 or 3 short sessions with no ongoing maintenance program is needed. Clearly this very much depends on the individual and their circumstances and the treatment plan for each child needs to take all these factors into account.

Can I treat babies?
Yes, however babies generally only require light massage on, or holding of, the feet for a few minutes. This is an excellent activity for the parents to get involved in, and helps build important links between parent and child and vice-versa.

What age constitutes a child?
Everyone under the age of 18 is legally a child. You are required to gain consent for all clients under this age.

Do I need to have a consent form, and if so what needs to be on the form?
If you are providing reflexology to a child you are required to have a consent form signed by someone with parental responsibility for that child. The mother of the child always has parental responsibility. The father will also have parental responsibility if he and the mother are married. Unmarried fathers do not necessarily have parental responsibility and proof of this would need to be provided either in writing from the mother or from a court.

The consent form should be worded in such a way to make it clear that the person providing consent has parental responsibility for the child and gives consent for the child to receive reflexology from you.

What training can I undertake to help me with providing reflexology to children?
Whilst there are currently no continuing professional development courses accredited by the Association of Reflexologists, there is a fair amount of training within this field advertised and available. If you are interested in attending one of these courses there are some basic rules to help you to ensure that the course that you are going on is of high quality and will provide you with what you are looking for.

1. Write down what you want from a course.
2. Decide how much you can afford and over what length of time.
3. When you are looking at a course or workshop, look carefully to see if it fits in with the above criteria. This stage is particularly important, as it will prevent you from attending the course with unrealistic expectations. It may be that you still decide to attend, but beware of bending the course details to fit what you want, as oppose to what the course is offering.
4. Get recommendations from people who have attended the course, and find out as much as you can from them.
5. Speak to the tutor and have a list of questions to ask them to help you establish a clear picture of the course. Beware of tutors who tell you that their course is better than other courses.
6. Get the information on the course and check the following:
a) Costs – are all costs covered
b) Contract – is there a contract between tutor/provider and student. If there is no contract, you must accept that you will have limited come back if things don’t work out as you hope.
c) Venue – is it accessible to you and what are the costs involved in getting there.
d) Aims and objectives – is it clear what the course is aiming to do, what you will be able to do on completion and at what level?
e) Check to see the level of experience the tutor has both generally and specific to the field. As a guide, to be a Main Course Tutor on an AoR Accredited Course providing a Diploma in Reflexology, they must have 5 years post qualification experience.
f) Check to see if the tutor is registered to work with children.
g) If children are going to be an active part of the course or workshop, check to see what the arrangements are for this. Is there adequate supervision? Will the carers be in attendance?
h) If possible, visit the tutor on a current course, or at least in person. Will you get on with them?

If you put all the above into action, then you have a very good chance of attending a high quality course which will meet your expectations. If everyone does this, then gradually the overall quality of courses will be raised, as will the satisfaction of the people attending them and the delivery of reflexology following them.

Are there any contra-indications relating to children?
The contra-indications for working with children are the same as those for working with adults, though there are some additional issues that need to be taken into account. The Code of Practice and Ethics states in article 17, “A member shall practise only within the limits of his / her professional training and competency. No unqualified advice should be given.” If you feel that you are not sufficiently trained or competent to provide reflexology to children, then you should not treat until you have taken the necessary further training.

Should I always treat children with their carer present?
It is an AoR requirement for all clients under the age of 16 to be accompanied to the appointment by someone with parental responsibility for that child, and to remain on the premises, for the duration of the session. It is advisable for all clients between the ages of 16 – 18 to be accompanied to the session by someone with parental responsibility for that child. In every case you should discuss this with the client to emphasise the importance of having this presence.

How long to I have to keep childrens case notes?
You are required by law to keep all notes on children until the child reaches the age of 21.

AoR Guidelines for Working with Depression

Providing reflexology for a client suffering from depression can be a difficult and challenging area, and one which requires considerable thought before taking the client on. The causes and symptoms of depression are many and varied, and an understanding of the area is crucial prior to providing any reflexology treatment.

Overview
As depression is such a complicated, varied and individual area, it is not possible to provide definitive guidelines for AoR members providing reflexology treatments to clients with this condition. Instead we will look at areas for consideration which, combined with your professional training and experience, will help you to make the necessary decisions regarding the provision of reflexology.

Before treating any client suffering with depression you will need to clarify a number of important issues. These are not always easy to isolate and every client must be treated very much as an individual. Initially you need to establish whether or not you are able to treat. This will depend upon a combination of the client’s situation and your training, qualifications and experience. There will be some circumstances where treatment is contraindicated, though this judgement is something that needs to be made for each individual.

Contraindications and Considerations
As an overall rule, it will be contraindicated to treat a client presenting with depression if the client’s psychologically situation is beyond your training, qualifications and/or experience. If they are not receiving any other form of support e.g. counselling, GP support, family network, it is more likely that you would be contraindicated from treating, as reflexology training does not include the necessary skills required for dealing with psychologically disturbed clients.

If you have not received training in this area it is often not possible for you, as a reflexologist, to be aware of the necessary skills needed to treat a depressive client in a constructive way. In this situation, an approach provided in a sincere and meaningful manner, may have a negative impact on the client. In other words, without having undergone training in counselling or a similar area, we do not know what it is that we do not know. If you are unsure – don’t treat.

Clients suffering with depression are more likely to require long term treatment. This may mean attending for reflexology and another therapy support for years. This clearly has to be taken into account when discussing a treatment plan with your client, and may result in either the client or yourself not going ahead with reflexology.

Your client may come to you seeking reflexology, having been diagnosed by their doctor. They may be on medication as a result. The management of this medication is of paramount importance, and all changes in the levels or frequency of dose are decisions that must be made by the GP in consultation with the client. If the client feels that they want to change their medication, and continue with reflexology, they must discuss this with their doctor first. Should they make changes to their medication without the knowledge of their doctor, then you are contraindicated from continuing to provide them with reflexology.

Your client may not have been diagnosed as being depressed. Indeed the term depression is used and misused on a regular basis and may be interpreted in many different ways. Once again this can prove to be a difficult area, as we must avoid giving any form of medical diagnosis, including a psychological diagnosis. However we do need to assess our clients from a reflexology perspective. If you are unsure regarding the psychological situation of a client, you must refer them to their GP prior to providing them with reflexology.

Further considerations
Once your client is seeing you on a regular basis and has a treatment plan, there are a number of considerations which need to be taken into account at every appointment. As with all clients, care needs to be taken to provide them with the best reflexology treatment that you can provide, at that time, depending on their situation. This will take into account how they are feeling, any developments since the last reflexology session and any other changes. Clients presenting with depression may be feeling mentally or emotionally very vulnerable. If this is the case, changes to the reflexology session need to be considered. You may opt for a shorter session with emphasis on relaxation. You may choose not to focus on any one reflex or group of reflexes. You may, in more extreme circumstances, opt not to treat. Having a variety of techniques at your disposal is very helpful so that you can alter your approach to suit your client at that time.

Clients presenting with depression will often describe it as feeling like they are in a rut and not able to see out, let alone get out of that rut. The medication that they are prescribed by their GP can have the effect of giving them the feeling of being able to see out. This is likely to happen over a period of time, and if they are coming for reflexology during that time, they may well put this change down to the reflexology rather than the medication. Now there is no doubt that reflexology may well be very beneficial for clients, both in terms of helping them to see out of the rut, get out of the rut and develop a meaningful existence once having done so, however it is crucial for the reflexologist to recognise the possible beneficial effects of the medication. An understanding of the prescribed medication and its effects is therefore highly desirable. This understanding will then help you to continually update the client’s treatment plan with them.

Other therapies
Reflexology appears to be most effective in many cases of depression when the client is receiving some level of support from another therapist or practitioner alongside reflexology. Most often this will be a form of counselling. It appears to work along the lines of reflexology providing the client with the opportunity to heal, and counselling helping them to take that opportunity and work with it in a constructive manner. It is also likely that through counselling, the client may need to work through difficult and challenging aspects of their life, and reflexology may be able to help them with the energy required to tackle these issues. Whatever the mechanism, the combination of reflexology and counselling for many clients is very beneficial. There may be some reluctance from your client to the idea of going for counselling and every effort should be made to handle this sensitively and with caution.

Reflexology Support
AoR members are reminded that support for reflexology queries relating to depression, all other conditions and individual clients is available from the AoR on 0870 567 3320.

First printed in March 2004 Reflexions
© COPYRIGHT RESERVED

AoR Guidelines for Working with Diabetes

Overview
In general clients who have diabetes benefit from receiving reflexology however there are a few specific areas where that benefit may be noticed the most. One of the key areas for diabetics is the ability to maintain a stable blood sugar level. This is paramount to leading a fulfilled and active life and reflexology seems to help in sustaining an acceptable level of stability. This probably comes about through a combination of a more easily balanced endocrine and digestive system.

Long-term diabetics have higher incidences of problems with circulatory and nervous systems which can lead to a number of conditions including problems with the feet. Reflexology may well have a positive impact with the maintaining of a healthy circulation, and certainly it is helpful for diabetics to have someone checking their feet regularly for damage or for signs of poor circulation.

Contra-indications
For the most part there are no contra-indications for treating clients with diabetes. The only known contraindicated situations are when the client’s diabetes is unstable on a regular basis, or when the client is unwilling to perform daily blood sugar tests over the first few weeks of reflexology treatments. Most stable diabetics monitor their own diabetes with only the occasional check up with a nurse at a diabetic clinic. There is no requirement to ask for permission from the client’s doctor to provide reflexology. Reflexology can alter diabetic’s insulin requirements and unstable clients can be affected in a dangerous way because of this.

Areas of caution
It is recommended that you require all diabetic clients to monitor their blood sugar levels on a daily basis for their first few weeks of reflexology. This is because diabetics have reported significant changes in blood sugar levels following reflexology treatments. This often means that they may need to reduce the amount of insulin in the following one or two injections. Over a longer period of time the levels of insulin required may change (usually fall) and it is important that the client is aware of this and makes the appropriate adjustments.

Check the feet carefully. Impaired circulation and nervous function may mean a degree of neuropathy, which in turn can reduce sensation in the feet. Occasionally this may mean that the client does not notice damage on the feet resulting in infections or in a worst-case scenario, gangrene. Should you notice any damage on the feet, inform the client and take the appropriate action for the level of damage. This may mean not treating the client on this occasion and referring them to their doctor or chiropodist.

Reations you may expect
All clients are susceptible to a healing crisis following any reflexology treatment, but for the most part this is confined to the first session. For diabetic clients there are no known reactions that are specific to their condition other than the possible altering in blood sugar levels. If, as with any client, you are concerned that someone may be particularly vulnerable either physically or emotionally, then perform a short, light first session without concentrating for any length of time on individual reflexes.
Your client may wish to take a blood sugar reading before and after a session, though whilst this will provide valuable and interesting information, it is not a requirement.

Requirements for treating
Know your subject. This is a requirement of the Codes of Practice and Ethics. If you haven’t treated someone with diabetes before or for a long time, chances are you will have forgotten a certain amount about the condition. Check through your training notes and read up on diabetes in your health encyclopaedia. If you don’t have one of these you are missing out on valuable information. There are a number available, the most commonly used is probably the BMA Complete Family Health Encyclopaedia. Other information can be accessed from Diabetes UK the operating name for the British Diabetes Association. See FURTHER INFORMATION. However no matter how much you find out about the condition, don’t forget to get the client’s perspective on how it affects them and the sorts of ways it impacts upon their lives physically and socially.

Do's and dont's
Do treat the client, not the condition
Do talk to the client about how it affects them
Do check the feet thoroughly
Do ask them to check their blood sugar levels daily
Do know your subject
Do brush up on first aid for diabetics
Do keep accurate records of changes

Don’t forget that lifestyle is important – smoking, obesity and lack of exercise can have a major impact on the health of a diabetic
Don’t treat regularly unstable diabetics
Don’t advise any change in medication – this is a matter for the client and their diabetic nurse/doctor
Don’t suggest that the diabetic may be able to come off insulin in the future

Cautionary Tales
Occasionally horror stories are reported in the press such as the one which described how a complementary practitioner advised a client that they can stop taking their insulin, and that their naturopathy would be a suitable replacement. When the client became unwell, the practitioner said that this was all part of the healing process. Needless to say the client died and the sorry tale became a focus for the medical profession and the press when wishing to castigate complementary medicine in general.

Clearly this is an extreme example of a practitioner who was either unqualified or had gone off the rails, however it is an indication of the power that we as reflexologists can hold over the unsuspecting public. We must use our positions as practitioners in as responsible a manner as possible at all times, with ‘Delivering Excellence in Reflexology’ as our aim. Diabetic clients present an interesting challenge and one which can be very rewarding for client and practitioner alike. Reflexology may be able to help diabetics to live a long, healthy and fulfilled life.

First printed in June 2002 Reflexions
© COPYRIGHT RESERVED
 

AoR Guidelines for Working with Epilepsy

Health and safety
Appropriate first aid skills to assist in the event of a client having a seizure.
It is important that a therapist holds a current first aid certificate, as they will be responsible for the wellbeing of the patient while in their care. It is essential that the therapist’s knowledge of all forms of epilepsy and of actions to take in the case of a seizure is up to date.

If as a result of your initial consultation, or of information provided to you at any time, you feel that there is a reasonable possibility that your client may experience a seizure during a reflexology treatment, the following recommendations apply.
1. Ensure that if the client were to have a seizure, that they would not harm themselves in any way. You will need to consider the treatment couch or chair that you are using and the client’s surroundings. You may opt to treat the client in their home where they can arrange their environment for such an eventuality.
2. Ask to have a carer in the room at all times during the reflexology session. This carer should be someone familiar with the client who can take care of the client during and following a seizure.
3. Ask the carer and the client to sign a declaration stating that should the client experience a seizure during the course of a treatment, that you immediately stop any form of reflexology, and that the duty of care immediately and automatically reverts to the carer until such time that they deem it appropriate for you to continue.
4. Include details of the incident in your treatment write up.

Assessment of client
Make a full assessment of any risks involved
During the consultation process, the therapist should obtain full information on the epilepsy condition as it affects this client, especially the frequency and severity of fits, and ensure that both parties are happy to proceed with the treatment.

One suggestion is to ensure that the client’s condition is stabilised with the cooperation of their GP before beginning a course of reflexology.

Terminology to Avoid
• Illness: epilepsy is a condition, not an illness.
• Fit: an ambiguous word which conjures up pictures of insanity or rage. The term 'seizure' or 'epileptic seizure' is preferred as people with epilepsy do not always experience convulsions.
• An epileptic: it is important to look at the person before the medical condition, therefore it is more appropriate to say 'a person with epilepsy'.
• A victim, sufferer (or similar word suggesting a poor, pathetic creature).
• Grand Mal or Petit Mal: terms previously used to describe types of seizure. In fact, there are many types of seizures so these terms are now considered outdated.

Contra-indications
Prior to providing reflexology for a client presenting with epilepsy, the reflexologist must make an assessment of the client at that time, the circumstances in which they are treating, and their physical and emotional capability of dealing with an epileptic seizure. If, for whatever reason, the reflexologist or the client is not happy about continuing with the session, then treatment is contraindicated. It is the responsibility of the reflexologist to make these assessments and decide whether or not to proceed with the reflexology session.

If a client is not yet stable with medication etc then it may be advisable to wait. In most cases a clients will be very aware of their own patterns etc and lead lives entirely unaffected by their condition. There does not seem to be any evidence to show that reflexology can bring on a seizure by working any specific area too hard, but you need to consider very carefully and inform your client fully before testing this for yourself!

First aid
While the AoR have not been notified by any member of a client experiencing an unexpected seizure during a treatment sessions, members should be aware of what course of action to take should this occur. The following are basic first aid guidelines provided by Epilepsy Action. Members should endeavour to keep their first aid training up to date at all times.

Basic First Aid for Seizures
• Remove any dangerous obstacles.
• Cushion head.
• Do not restrict movement.
• Never put anything in the mouth.
• Once the seizure is over place the person in the recovery position (on his or her side).
• Stay with the person until s/he is fully aware and able to speak to you.

When to Call an Ambulance
• If it is the person's first seizure.
• If the seizure lasts longer than is usual for the person, where this is known.
• If you do not know the person's seizure pattern and the seizure lasts longer than 5 minutes.
• If one seizure is followed immediately by another.
• If injury has been sustained.

Medication
As with any medication, it is not for the reflexologist to suggest or prescribe any changes or new treatment unless they are qualified to do so. If any client has concerns about medication or dosage they should seek advice from their GP or specialist. It is against our code of practice to contradict a GP’s treatment plan.

In cases of severe or unstable epilepsy, reflexology should only be given following consultation with the client’s doctor, and the above recommendations relating to health and safety must be implemented.

AoR Guidelines for Working with Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is one of those diagnoses which covers a multitude of symptoms and which does not quite fall into any other known conditions. It affects people in a variety of ways and there are as many causes as there are sufferers. What is clear is that each client who presents with IBS will bring with them their own pattern of causes for the condition. For some this may be solely a physical issue brought about through consumption of a particular food. For others it may stem from very a lengthy and complicated emotional history. Certainly we are aware that for many clients their IBS is affected by stress. Reflexology is likely to help both with reducing their stress levels and, as a result, improving their IBS symptoms.

Areas of Caution
IBS appears to be increasingly common, however this may partially be as a consequence of an increased understanding of the condition and the factors that can affect it. Although IBS can potentially be a very serious condition, particularly if left unmanaged, it is not always seen as such. The effect of this can mean that some people will make a self diagnosis of IBS without visiting their GP. This usually stems from talking with friends or relatives, or reading an article in a magazine. They feel that they can put a name to their ‘dodgy tummy’ and just accept it as a part of their life. This is clearly a dangerous approach as they may have got the diagnosis wrong and the real cause could even be life threatening. It is therefore essential to establish whether or not your client has seen a doctor and had a medical diagnosis of IBS.

Once you have treated a number of people with IBS and seen some regular patterns emerging, it can sometimes be very easy to fall into the trap of looking for those patterns with every IBS client. This may not always be a conscious decision and one must always try to maintain an openness to the individuality of each client and the conditions with which they present.

As you work with an IBS client, you will get to know and hopefully understand the patterns which present through their feet. The interpretation of these patterns and the explanation of your interpretations must be managed with caution. It is clearly helpful to the client if the causes of the IBS can be understood, however it is difficult to be 100% certain when trying to read and understand reflex patterns alongside lifestyle issues, and there is a fine line between interpreting and diagnosing.

Contra-indications
IBS is one of the conditions which is sufficiently vague to allow for self diagnosis. If a client arrives for an appointment with severe abdominal pain stating they have IBS, and has not seen a GP, it is important to advice them to seek professional medical advice or diagnosis. There is no evidence that treating client's suffering with IBS with reflexology that it should be a contraindication, caution should be applied in terms of replacing conventional treatment when no formal diagnosis has been sought. Many reflexologists report that reflexology can help a client cope with the symptoms of IBS.

Dietary Advice
The client’s diet is clearly very important, and as much detail as possible should be sought at the initial consultation and on subsequent visits. Whilst discussion around diet is encouraged, as per rule 17 of the AoR Codes of Practice and Ethics, ‘A member shall practise only within the limits of his / her professional training and competency. No unqualified advice should be given’. If you have a dietary or nutritional qualification you can provide dietary advise, however it must be made clear to the client that this does not form part of the reflexology session and time should be allocated accordingly.

Food intolerance appears to be an issue for a number of people suffering from IBS. This is likely to be an issue that you and your client will want to discuss, and you should endeavour to keep yourself up to date with developments in this area.

Emotional links
There are many theories regarding the causes for IBS and how it may link to an individual’s emotional background. Many of these appear to be valid, however no one theory will fit all circumstances. Indeed the patterns that your client may exhibit will be very specific to them, their life and the way that they go about dealing with issues. In the same way that we must not make medical diagnoses, we must also be very careful not to make psychological diagnoses too. To help with the development of interpretation skills, members are encouraged to attend workshops, seminars and area group meetings.

Medication
As with all clients, it is not the place of the reflexologist to suggest or prescribe changes to medication. It must also be borne in mind that the client’s doctor or other therapist may have ‘prescribed’ a particular diet. You can provide the client with information to discuss with their doctor or therapist, but as stated, you cannot give dietary advice.
 

AoR Guidelines for Working with Fertility Problems

The AoR believe that reflexology can be of great benefit to clients suffering from infertility. Our understanding based on feedback from members is that on average about 50% of clients seeking help through reflexology for infertility, find themselves pregnant within 6 months of commencing treatment. Indeed some members who specialise in the area report higher levels of success, though of course none of these figures can yet be properly or independently substantiated and there are many variables within a medical diagnosis of infertility.

There are many issues connected with treating a client with infertility and these views aim to address these and provide help and direction for members wishing to treat clients with this condition.

Contra-indications
There are no clear-cut contraindications regarding infertility, however there are many circumstances which clients present with, which may mean that a particular approach is needed. In the most difficult of these this may mean that you opt not to treat the client.

Clients presenting with infertility (either medically or self diagnosed) may be in a very vulnerable state and be coming to you with high level of tension, stress and fear. It may be that reflexology is the last resort, though we are finding more and more that people are opting for reflexology sooner, or prefer reflexology rather than the conventional medicine route. If your client has self-diagnosed, it is advisable to refer them to their doctor so that they not only have an accurate medical diagnosis, but they may also know the reason for the condition. This is important as you can see from the list of possible causes that infertility may be present as a result of another condition.

As an AoR member you are required to discuss the possible outcomes of reflexology and this must include what happens should the client become pregnant during a course of treatment. This area is explored in more depth in the September 2002 edition of Reflexions and is available from the AoR as an offprint.

The main area where we receive many queries is that of “Should I treat a client whilst they are undergoing infertility treatment?”. Reflexology is not known to have any detrimental or negative effect on a client who is undergoing a course of infertility treatment. The drugs, such as clomiphene, which are used to control the hormone cycle and stimulate ovulation do not appear to be affected at all by a client receiving reflexology. Indeed it can be a very stressful time for the client and they may need all the help they can get to deal with what can be a very difficult time for them.

The next most often asked question is “Should I stop treating when the client becomes pregnant?”. For a more comprehensive discussion and for the guidelines on this, please refer to your September 2002 Reflexions, ask for the offprint, or go the the FAQ page within the members area of the website at www.aor.org.uk where issues relating to miscarriage are covered.

Finally within the contraindication section, take very careful note of the client’s psychological state in relation to their condition. Whilst it is imperative not to make a psychological diagnosis of your client, should you feel that your client is presenting in a manner, which is beyond your expertise or training, then you are contraindicated from treating them. They should then be referred on to the appropriate person.

Key Issues– Stress and Hormonal Balance
There is no doubt that stress can play a very significant factor in an individuals ability to conceive. The longer the situation carries on, and the more desperate the person becomes, the greater the stress and a vicious cycle of stress and the inability to conceive can be triggered. From this perspective it is often preferable to focus on the issues of stress for the first few weeks or months. By taking this approach and helping the client with any appropriate lifestyle changes, a significant number of those clients will get pregnant simply because they have been able to reduce their anxieties and improve their health. This reduction in stress is likely to have a positive impact on their endocrine system, though there are a number of techniques which seem to be able to balance the hormones enough to make a difference.

From a reflexology point of view, infertility seems to be often associated with the Kidney Meridian. This connects with ideas of fear, worry, anxiety etc. Working towards a position of relaxation and dealing with stress is often very effective.

Techniques
AoR members who have been specialising in this area report a number of key techniques which appear to help with ovulation problems or balancing hormones in general. At the top of the list are techniques which work into the pituitary gland. These include hooking into the reflex, using knuckling techniques and linking. Reflexologists regularly debate the efficacy of pressure, and whether a firm or lighter pressure on a reflex is better. There is no clear cut answer to this and it seems to depend somewhat on the cause behind the problem. If it is predominately stress related and the client will benefit from being able to cope better with the stress in their lives, then a relaxation orientated approach appears to be very beneficial. However there is a significant body of anecdotal evidence which suggests that firm work into the key endocrine glands, and particularly the pituitary can give excellent results.

The short answer to this debate is that there is no one approach which will be the best for all clients at all times. Indeed it is more usual for each individual client to require a variety of approaches depending on their circumstances at the time of treatment. Only you can decide what is most appropriate based on your experience of your client and what they want. To help to ensure that you are able to provide your client with the best approach, try to broaden your library of techniques through attending workshops, seminars, courses and your local AoR Area Group.

The AoR Recomendations
• Ask your client to visit their GP if they have not already done so
• Always treat your client holistically rather than focussing on the condition
• Consider the client’s current circumstances when implementing your treatment plan
• Ensure that you thoroughly research and understand your subject
• Where you can, develop your techniques through workshops, area groups etc
• Always work within your training and experience
• Be careful not to give your client’s false expectations
• Be careful not to make a psychological diagnosis
• Call the AoR on 0870 567 3320 should you need to talk to someone about a client

Conclusion
Treating a client with infertility requires a very responsible and careful approach. They are often coming to you with tremendous tension, stress and fears stemming from many different circumstances. It is very important that you treat your client holistically so that these issues are incorporated into the clients treatment plan.

Infertility can be a very delicate area and our role as reflexologists is to provide our clients with the opportunity to heal in a holistic manner. This does not include the work that would normally be covered by counsellors or sex therapists. Should you find that you are being asked to give advice or counselling in relation to this, you need to refer your client to the appropriate professional.

AoR Guidelines for Working with ME

The guidelines below have been kindly written for the AoR by Wendy Early MAR who has suffered from ME since 1995. Wendy makes the point that those with ME get very little support from professional bodies such as orthodox medical practitioner. The reflexologist might be the only professional that they see regularly about their condition and so they are a vital support to the sufferer.

Treating Client With ME
The following are a few tips for treating clients who have ME. I speak from personal experience since I was diagnosed with this condition in 1995 and was severely disabled by it. I started having reflexology treatments about four years ago and have continued with weekly treatments ever since. I was so impressed by the improvements I made that I eventually trained to become a professional reflexologist myself. I hope this information will help both you and your clients.

1. Be very delicate with the first treatment, especially if they have never had a treatment before. Your energy could knock them out for a few days and put them off the treatment. I would recommend initially a course of a 30-minute treatment each week. Sitting up for an hour can be exhausting so you could treat them lying down. Expect their feet to be lacking in colour and lifeless.

2. Offer to give treatments in their own home since many people with ME are housebound or even bed-bound. But as they begin to improve they might enjoy a visit out to have their treatments!

3. Depression is a major side effect with ME so be aware of this and give them support. Remind them that ME is a condition that you can improve from and that they will not always feel like they do. Also since it is a condition of the nervous system, they are very delicate, both physically and emotionally, and so treat sympathetically.

4. Reflexology can help in many ways, not just as relaxation but also as a boost to the immune system since they are prone to repeat infections. It will help with pain relief, anxiety attacks, and headaches as well as provide a social event since the condition is very isolating. Be aware that ME affects the whole family, so carers may require a treatment.

5. ME reduces the body’s immunity and also reduces its tolerance to medication. Discuss this with your client and their GP for nonessential medication i.e. the contraceptive pill. Also be aware that other contraceptives can cause repeat infections.

6. Coffee, tea, alcohol, refined foods and stress can make the condition worse and therefore a healthy balanced diet is desirable.

7. Other therapies they may be interested in are acupuncture, which is excellent for pain relief. Also, reiki can give an energy boost. A multi mineral supplement is effective and finally self-treatments can give them back control over their condition (especially the spine, lymph drainage, neck, head and adrenals).

8. And finally remember that ME can be a very different experience from one person to another. ME is essentially a collection of symptoms that the medical establishment cannot explain any other way. Some sufferers may have the condition months whilst others may have it for years. So as a therapist, be patient and do not expect too much too soon.

Wendy Early MAR

Contra-Indications
There are no known contra-indications for ME, however most ME clients will need a very specific approach based on taking your time and building up treatment session time over several weeks.

A Cautionary Tale
Several years ago a lady came to see me suffering from ME. She had seen a reflexologist once one year previously and had experienced a relapse immediately following the treatment. This relapse lasted for 3 months! She was clearly very brave to look to reflexology once more.

Bearing this in mind, and following the taking of a case history, I did 10 minutes of foot massage with the client just to see how they would react. When she returned 1 week later, she said that she had been “completely wiped out” for a whole day, but then recovered and felt better for it. I increased the length of treatment to 15 minutes and gently worked a few reflexes. Same response. It took 6 weeks of building up the length of treatment until I could do a complete 45-minute session without my client suffering any reaction. From this point we were able to make progress in the more usual way.
 

AoR Guidelines for Working with Pregnant Clients

The key question that most members want an answer to is ‘Can I treat a client who is under 3 months pregnant?

There are a number of issues that need to be examined when answering this. Whilst there are risks throughout pregnancy, under 3 months/13 weeks pregnancy there is a higher likelihood of miscarriage. Therefore if you provide reflexology for someone during this period there is statistically a greater chance that they will miscarry than if they were treated later on in the pregnancy. There is no evidence to show that reflexology can bring on a miscarriage. Indeed some Reflexologists claim that reflexology can be used effectively in situations where there has been a history of miscarriage, though once again there is no research evidence to back this up.

If, as is supposed, reflexology works by helping the body to function correctly, then should a miscarriage occur at some point during a course of reflexology treatments, the conclusion could be drawn that this is the body's natural response to a problem with the pregnancy. Once again though, there is no scientific evidence to demonstrate that reflexology does work in this way. Both the client and therapist would need to accept this concept.

Pregnancy is an extremely emotive area, and it is recommended that only Reflexologists with at least 1 years experience should consider treating clients who are under 13 weeks pregnant. To help with developing the skills and judgements required for practising safely in this area, members are recommended to attend one of the growing number of continued professional development (CPD) workshops or courses covering pregnancy and childbirth. If you are going to embark on further training please make sure that the reflexologist who is delivering the course is suitably qualified and experienced. Ideally these courses will be offered by reflexologists who have medical training and who have at least 5 years reflexology experience and 3 years experience in treating pregnant clients. You should also try to find a workshop leader who will give you backup support following the course. The AoR does not have an accreditation system for CPD courses and cannot recommend or comment on individual courses or tutors.

When is treatment contra-indicated?
The following situations are contra-indicated and should not be treated.
• Pre-term labour (less than 37 weeks pregnant) - as it is not counted as normal and she should contact her midwife/GP or hospital.
• Placenta Previa (low lying afterbirth) if Grade II & III and 32 weeks or more - as it can be fatal to mum and baby if the placenta comes off the uterine wall as it grows and stretches causing severe bleeding.
• Hydro amnios (too much water around the baby) if 32 weeks or more - as it can be fatal to the baby if the membranes break and the cord is flushed out.

Other situations
Both reflexologist and client must be completely happy with providing and receiving the treatment respectively, and if there is any doubt in either's mind, then treatment is contra-indicated.

To establish whether the client is happy to receive reflexology, they must be in receipt of all the information and have had an opportunity to discuss the issue with you and have any questions answered to their satisfaction. Only then can the client make an informed choice.

To establish whether you, as the reflexologist, are happy to provide reflexology, you must have provided all the information to the client, discussed their individual circumstances and answered all their questions to both their and your satisfaction. You must also be in the position where, if the client were to miscarry following a reflexology session, you would be able to deal with the client appropriately, and be able to cope emotionally with the inevitable upset and self-questioning that follows.

Students
It is recommended that students who wish to practise on pregnant clients do so only for stable clients over 3 months pregnant, with their tutor’s approval, and the case must be closely monitored by the tutor. Once qualified you can start to build up your experience treating clients over 3 months pregnant until you are sufficiently experienced and confident to extend that to those clients under 3 months pregnant.

Unstable pregnancies
In the past this has always been an area where contra-indication is absolute. However there is some anecdotal evidence that suggests that there may be benefits to treating someone during the first 3 months of pregnancy who has a history of miscarriage or who has a medical diagnosis of unstable pregnancy.

Such is the level of caution required in these circumstances that it is recommended that only reflexologists with a depth of knowledge, understanding and experience in this area, should even contemplate taking on clients in this category. To add to this, it is recommended that your client should contact their doctor to discuss the possibility of providing the client with reflexology. Following this, all the above considerations regarding contra-indications apply, in particular the ability of the reflexologist to cope with any eventuality.

Areas of Caution
These conditions need to be diagnosed and, if appropriate, treated by a midwife or doctor before you commence reflexology. You need to be very honest with yourself about how experienced you are as a reflexologist in having encountered a wide variety of situations and disorders.

• Multiple Pregnancies (twins, triplets,…)
• Vaginal Discharge (can be normal increased physiological discharge, mucous from labour, blood from labour or haemorrhage, liquor from ruptured membranes)
• Uterine Pain (can be the onset of labour, kidney infection, scar pain from a previous caesarean section, bleeding from the placenta)
• Epilepsy as it can get worse during pregnancy and needs monitoring carefully.
• Diabetes “ “ “ “ “ “ “ “ “ “ “
• Any other health problems which might affect your client adversely during her pregnancy e.g. heart, kidney, or liver disorders
• If at any time you don’t feel happy or confident or if any changes occur then the client should contact their doctor

‘Are there any reflex points I should avoid?’
The only point thought to possibly induce miscarriage in acupuncture is Spleen 6. This is on the medial side of the ankle about 2½ finger widths up from the medial maleolus. As this is not a universally recognised reflex point that is part of a regular reflexology session there should be no reason to work on this reflex. Some schools teach that the ovaries, uterus, pituitary and thyroid should be avoided at all times throughout pregnancy. Current information suggests that there is no reason to avoid these reflexes, however neither is it recommended that you specifically work into the areas. Treatment during pregnancy is generally focussed on helping the client to have a healthy and trouble free pregnancy. This involves a fairly standard approach to the treatment session, not focussing on any reflexes in particular other than those which will help the client to manage their health successfully whilst pregnant.

‘Can I use reflexology to induce labour?’
Once again there is some anecdotal evidence to suggest that reflexology can help to bring on labour providing both mother and baby are ready. It is always recommended that those clients who wish to use reflexology for this purpose, begin their reflexology sessions at least 6 weeks prior to their predicted term date ie by 34 weeks pregnant. It is recommended that you do not use labour inducing techniques unless the client has received at least 2 reflexology sessions in the 2 or 3 weeks prior to term and they are past their due date. This area is too large and complicated to go into details here. Should you be interested in developing these techniques it is suggested that you attend a pregnancy and childbirth workshop (see above).

Do’s and Don’ts
Do focus on the client’s health
Do take extra care to ensure client comfort
Do allow extra time between ending the session and the client standing up
Do research and understand your subject
Do attend a CPD workshop/course on pregnancy
Don’t exceed your training and experience
Don’t treat pregnancy as an illness
Don’t lie your client flat in the 3rd trimester during treatment
Don’t have the treatment room too warm

Conclusion
Pregnancy is a very difficult, emotive and individual area, which necessitates a high degree of caution and for which there is no substitute for training and experience. These AoR guidelines have been put together in consultation with very experienced and highly qualified reflexologists and members of the medical profession. Out of necessity some areas are generalised and there may be a number of members who do not fit neatly into the guidelines. If you feel that your training and experience allows you to practise on a particular client where the situation is outside of the guidelines, please contact the AoR on 0870 567 3320 to discuss the case.