Exactly how reflexology might work remains unclear, and several possible explanations have been put forward. One theory is that the body contains an invisible life force, or energy field, that when blocked can result in illness. It is proposed that stimulating nerve endings in the foot can unblock and increase the flow of vital energy to various parts of the body, and promote healing. This account is similar to theories behind other techniques in which mapped points are treated to affect corresponding remote body parts or conditions, such as acupuncture or acupressure.
A different theory is that pressure exerted by reflexologists may release endorphins (compounds that alter pain sensations). Yet another explanation is that compression of specific points ("cutaneo-organ reflex points") stimulates nerves that form connections with other parts of the body, and may have distant effects as part of a reflex arc. Other theories include promotion of lymphatic flow or dissolving of accumulated uric acid crystals via direct stimulation of the feet. Reliable scientific research in these areas is limited.
Reflexologists often take a full client history before examining the bare feet systematically, with the patient lying on a treatment table, couch, or reclining in a chair. During treatment, clients typically remain fully clothed, sitting with legs raised or lying on a treatment table. Unlike massage, which involves a generalized rubbing motion, reflexologists use their hands to apply pressure to specific points of the foot.
Practitioners start by gently massaging the feet, and then begin to apply pressure to selected reflex points on the feet. The strength of pressure used often varies between practitioners, and from patient to patient. This therapy should never be painful.
For lubrication, therapists may use lotion or oils (some which contain aromatherapy products). The reflexologist and client may converse throughout treatment or may remain silent, depending on client preference. Occasionally, practitioners will use instruments on the feet during therapy (for example, sticks of wood, clothespins, combs, rubber balls, rubber bands, tongue depressors, wire brushes, special massagers, hand probes, or clamps). Some reflexology instruction books state that clients may feel a tingling sensation in the part of the body corresponding to the reflex point being stimulated, although this has not been documented scientifically.
Individual reflexology sessions often last from 30 to 60 minutes, and may be part of a 4 to 8 week course of therapy. Practitioners range from those who taught themselves from books to individuals who attended training courses and belong to professional associations. Techniques can be learned and self-administered. No widely accepted regulatory systems exist for reflexology, and there is currently no state licensure or training requirement in the United States.