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Τετάρτη, 11 Ιουλίου 2012

Are there trigger points on the feet? If YES, could this be why Reflexology works?


In the Orhtopedic Reflexology approach the feet muscles and the way to "approach -treat" them according to Hippocrates "law" on rubbing is fundamental!

Could the "diffuse noxious inhibitory control" theory answer on the given effectiveness of Reflexology?

"By the way Hippocrates was the first to describe this!!!!!"
The following article does not discuss Reflexology nor trigger points on the feet specifacally, none the less, it gives a solid basis to speculate, the "Orthopedic Reflexology" way!

I will comment (in red) to assist readers interested in Reflexology.

(click for full article)
from the original paper:
12. How do these treatments work?
Given that dry needling appears to be as effective as local anaesthetic, but has no convincing benefit over placebo treatment, the mechanism of action of all of these therapies remains to be clarified. The placebo treatments used have varied, but all have still involved the application of a penetrative or non - penetrative but nonetheless noxious stimulus to the skin. (reflexology can be a noxious stimulus) 

Central opioid release is thought to produce a global reduction in pain perception by gating spinal cord pain impulse transmission. This is known as diffuse noxious inhibitory control. Reversal of local anaesthetic-induced analgesia has been observed with the administration of an opioid antagonist (Fine et al., 1988). This implicates the endogenous opioid system, which acts to produce hypoalgesia at a spinal cord level, to at least a partial extent in the reduction of pain seen with this therapy.
This is the system implicated in the production of a runners’high (Koltyn, 2002), and it has been suggested to be important in production of the placebo effect (Grevert et al.,1983).
Beyond these suppositions, there is little hard evidence to date on the mechanisms of action of any of the therapies discussed. It is a notoriously hard area to research due to the interactions of so many systems on both a regional and whole-body level. Stress and the sympathetic nervous system have been shown to increase pain perception, but the effect of these treatments on this system has not been conclusively evaluated. (Reflexology is thought to act on the ANS)

13. Conclusions
Although trigger point related pain is widely recognised by health professionals, reliable clinical evaluation and imaging for diagnosis still eludes us. Many treatments in widespread use are poorly validated and not necessarily more effective than placebo. The application of a noxious stimulus may be the key to obtaining improvements in pain
perception. Less stimulatory interventions, such as laser and ultrasound, have not convincingly been shown to be beneficial. Most stimulatory interventions are able to induce subjective improvements in pain scores, if not objectively measurable improvement. Stretch, TENS(1), injection therapies, and dry needling have all shown benefit. Unfortunately, we have extremely limited data comparing results between different therapeutic approaches, in particular, invasive versus non-invasive from which to draw clinical conclusions.
Studies of invasive treatment utilising a placebo intervention have not found the active treatments to be any more effective. Importantly, the placebo interventions used are themselves, stimulatory. The amount of stimulation required to induce analgesia is currently unknown. Despite EMG evidence of changes in the regions of trigger points, muscle penetration does not seem to be necessary to produce an analgesic effect. The evidence is trending towards the magnitude of the effect being consistent regardless of the therapy chosen, or the depth of needle penetration, as long as some counter-stimulation is involved. The relative contributions of local tissue effects and central pain modulation to these clinical improvements require further investigation.
The choice of therapy can, therefore, be guided by patient specific criteria, the therapist’s experience and qualifications, and patient preference. The discomfort induced by the therapy, the likelihood of post-treatment soreness, and the current functional level of the patient are important to consider. (Put Reflexology on the patients list of treatments to choose") Dry needling may not be appropriate for someone with long standing chronic pain that is known to flare after deep massage treatment, but it may be the treatment of choice for an athlete with a regional pain that has not responded to previous soft tissue work. Needle phobias or other known adverse reactions will limit therapeutic choices.
Regardless of the treatment chosen, it is imperative to remember that trigger points are rarely an isolated phenomenon, and the key to successful long-term outcomes of any treatment regime is addressing the precipitating and predisposing factors for each particular patient. (Right up our "alley"!)


"ANOVA showed that there was a significant increase in pain threshold of the subjects following reflexology when compared with sham TENS control data (F(1,9)=5.68, P<0.05).Thus, for example at 60 min, pain threshold increased from a control mean value (sham TENS) ± s.e. mean of 9.1 ± 1.4 s to 15.5 ± 2.1 s following reflexology (P<0.01). Similarly, there was a significant increase in pain tolerance (F(1,9) = 5.132, P<0.05). Thus, at 60 min, pain tolerance increased from a control mean value ± s.e. mean of 120.2 ± 37.9 s to 171.4 ± 42.0 s (P<0.02).
The results of this study show that reflexology increases both pain threshold and tolerance in human volunteers exposed to acute pain. These findings indicate the possibility of using reflexology in the management of pain."

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