Positive Health Online

Reprinted with permission from https://www.jenreviews.com/foot-massage/

The many benefits of foot massage include releasing endorphins, lowering heart rate, lowering blood pressure, improving balance, and assisting with mental health problems.

So how does Foot Massage Work?

There are several components to foot massage. The physical aspect of the massage - the manipulation and massage of muscles - provides a therapeutic effect in and of itself.(2) It increases blood flow, lymphatic drainage (the drainage of fluid from blood at its filtration before being put back into the circulatory system), and assists in the reduction of local joint pain.(3)

However studies have found other benefits to foot massage, such as decreasing pain, assisting in keeping blood and heart rate low, and helping with some mental health problems such as anxiety and depression. These benefits result from a combination of the physical effects of massage, and the psycho-social aspect of getting a foot massage.(4)

Most of the benefits above occur with any type of massage, though there are some benefits that are unique to foot massage, including increased balance, increased sensation and range of motion in the feet.(5) Reflexology, a form of massage which we will also examine in this article, also tends to concentrate primarily on the feel.

1. Foot Massage Increases Endorphins

It is no secret that endorphins are good for us. Whether through exercise or eating chocolate, endorphins act as happiness hormones, robbing us of pain and discomfort and leaving happiness in their wake.(6)

So what does massage have to do with endorphins? Several different studies looked at the specific effects that foot massage had on a variety of patients with a range of conditions. They found a marked increase in the release of endorphins across the board.(7,8) This release of endorphins is responsible for some of the effects experienced during foot massage. They include an increased feeling of calmness, a decrease in pain and stress, and assistance with managing anxiety and depression.

Put simply, tissue massage, whether of the feet or otherwise, makes you feel good. Massage activates endorphins which circulate around your body and brain, promoting happiness, muscle relaxation and a decrease in pain.(9)

Take Away: Foot massage prompts the release of endorphins, which in turn promote benefits including decreased stress, increased happiness and assisting with pain management and management of some mental health conditions.

2. Foot Massage Activates Parts of the Brain Associated with Reward and Pain Control

One particular study looked at the effect that foot massage had on healthy adults by putting patients under an MRI scanner before the researches performed twenty seconds of massage. (10) This study found activation of reward centres in the brain. Interestingly, though both hand and foot massage was used, the reward centres were only activated significantly when foot massage was performed.(10) Activation of the reward centres was tied to the participants’ increased feelings of calm and a decrease in reported stress.

Another study noted activation of parts of the cingulate cortex when three different types of massage (Swedish, reflexology based massage and massage with an object) were applied to the foot.(11)

The Cingulate cortex is responsible for many things, including pain moderation and the association between external events and memory and emotion.(12) Thus, activation in this area of the brain suggests that foot massage may be useful when it comes to modifying the body's response to pain, and how it responds to certain stimuli.

Take Away: Foot massage affects the brain, targeting both the brain’s reward centres, as well as parts of the brain responsible for pain moderation.

3. Foot Massage Affects Cortisol Levels (Sometimes) and Stress (Always)

Given the above, it should come as no surprise that massage of all types also influences cortisol levels.(13)

Cortisol is the stress hormone. It causes all sorts of havoc in our bodies - increasing heart rate, blood pressure, and anxiety. Foot massage significantly decreases reported stress levels across many different groups.(14)

It goes without saying that a decrease in stress is a good thing - it enables people to go about their days without worry, leaving them with more room to think and concentrate on other things.

This decrease in stress was not a discrete effect - foot massage was found to prompt a decrease in stress in healthy undergraduate students, women with postpartum depression and middle aged women living in the countryside. This was even when the studies found no significant decrease in cortisol.(15, 16, 17)

The fact that stress decreased in all groups (undergraduate student, women suffering post-partum depression and middle aged women) signifies that while there may be other factors at play, foot massage is still an effective way to decrease stress levels.

Take Away: Foot Massage decreases stress levels. Some studies found only small decrease in cortisol levels associated with this, while some studies found statistically significant decreases in the stress hormone.

4. Foot Massage Affects us Because we are Being Taken Care Of

A study into the effects of foot massage and reflexology looked at whether advanced cancer participants reported changes in mood when foot massage and foot reflexology was incorporated into their treatment and care.(18) Most participants reported significant increases in wellbeing.(18) The same was found in patients who participated in a study on the effects of foot massage in a critical care ward.(19)

Human beings are social creatures, and we do not operate primarily on the basis of hormones and medications. When someone dedicates time to your comfort, it feels good. This feeling in turn prompts a release of hormones in your brain which creates a positive feedback loop. We feel good because we are being cared for. Thus, we get a release of hormones which make us feel good, and then we associate massage with something that is good for us.

As we saw above, foot massage affects the pleasure centres of our brains,(10) our endorphin levels and decreases stress. While some studies showed statistically significant changes in biology due to massage, there is no way to remove the social aspect of foot massage from the studies. Thus, it is highly likely that while foot massage has its own discrete effects, it is even more likely that the social aspect of foot massage is a large part of that.

Take Away: Being taken care of is a social need, and a significant aspect of receiving a foot massage. Given that many studies reported decreases in stress, pain and anxiety, but could not find statistically significant changes in biological markers to explain this, it is likely that the social aspect of foot massage plays a large part.

5. Foot Massage Decreases our Perception of Pain

Pain has many different causes. Ranging from the psychological, to neural, to purely physical, it often combines many of these elements, making it a difficult condition to treat.(20) It is a highly subjective experience, and one person’s agonizing pain will be something that another person lives with day to day.(21) So how does foot massage help with pain?

If we look back at the ways that foot massage effects people, we see both physical effects and psychological effects. It provides social care, an increase in endorphins, and decreased stress levels. So it makes sense that when these things are effected, pain becomes easier to deal with. A study looking at how the perception of pain was affected by foot massage showed marked decreases in postoperative pain - so much so that the use of opioids in patients who received massage decreased when compared to the control groups.(22)

This effect is most likely due to the ability of massage to treat several aspects of pain. We’ve already talked in this article about how massage affects parts of the brain involved in pain modulation,(12) and how it also increases endorphin levels.(9) and decreases stress levels.(13)

Massage also provides a social element. Someone is taking care of you. It also has the potential to address the source of the pain. Deep tissue massage and massage focuses on the joints, looking to immediately effect the cause of the pain.

By combining an element of physical benefit, social benefit and psychological benefit, foot massage is able to effectively address multiple source of pain.

Key Take Away: Pain is a highly complicated phenomenon. As foot massage affects several different aspects of ourselves (physical, social and psychological), foot massage can be used effectively to treat pain.

6. Foot Massage Decreases Nausea and Vomiting

Barring a big night out, nausea and vomiting generally result from an upset stomach (in which case vomiting is probably the best thing for you), morning sickness, and the nausea and vomiting experienced by people in pain and cancer patients.

Nausea and vomiting is driven by specific mechanisms - activation of the vagus nerve, upset of your inner ear (motion sickness), or activating of dopamine receptors (related to stress).(23) While massage is not going to affect your inner ear, there is some theorization in studies that massage may affect the dopamine receptors or the vagus nerve.

Evidence for massage’s effect on nausea and vomiting lies in studies that look at cancer patients. 10 minutes of foot massage was used to positively decrease the nausea and vomiting in cancer patients,(24) with further studies finding the same.(25)

Vomiting, especially if chronic, can cause a multitude of secondary problems, including dehydration and ion imbalances (an imbalance of the salts in your body).(24) This in turn can put someone in serious trouble - ions control nerve impulses, the beating of your heart and the ability of your muscles to contract.(23) By assisting in controlling both nausea and vomiting, foot massage can help increase quality of life.

Take Away: Nausea and vomiting cause significant issues if left unchecked. Even singular episodes can affect quality of life. Foot massage can provide a way to help control and manage these symptoms, in turn leading to a better quality of life for those who experience these symptoms.

7. Foot Massage and Reflexology

Here we look at a specific type of massage, based on the principles of reflexology. Reflexology is based around the concept that by massaging the hands and feet, the masseuse can influence other parts of the body.(26) There are several theories on how this works - one is that pressing points in the feet influences the central nervous system. Another is that energy flows through the body and by addressing points of problem in this flow, reflexology can return the body to its resting state.(26)

While there is some anecdotal evidence for this, much of the evidence regarding reflexology points to it increasing both circulation and lymphatic drainage as its main effect.(26)

The lymphatic system and the circulatory system work together to maintain the water balance in the body, to filter the fluid in the body, and to protect against disease by housing and distributing white blood cells.(23) By increasing the body’s circulation and lymphatic drainage, reflexology and massage of the feet has the potential to assist with fluid balance, and the movement of blood fluid through the body’s own personal inbuilt filtration system.

The practice of reflexology has also shown to have distinct effects that cannot be explained by increased circulation and lymphatic drainage.(27) Such effects include relaxation, a decrease in pain, and a general improvement in quality of life.(27) It is entirely possible, that as explored previously in this article, that this result from things such as the experience of being cared for, the increase in endorphins and the decrease in stress levels, rather than reflexology itself.

Key Take Away: Reflexology is a particular type of massage which focuses on points of tension within the soles of the feet and attempts to influence other body functions by their manipulation. While the evidence for how it works is largely anecdotal, its effects are well measured and include pain control and assistance with anxiety and depression.

8. Foot Massage Helps Maintain Healthy Blood Pressure

Blood pressure is a major measure of a person’s risk of cardiovascular disease.(28) A higher blood pressure makes the heart work harder, resulting in increased stress and strain of cardiovascular muscle.(28) For every extra 20 milligrams of mercury above a systolic pressure of 115 mm HG, a person’s risk of heart disease doubles.(29) Given that heart disease is, in essence, a spectrum of disease spanning from angina to heart attacks, it is important that blood pressure be kept under control.(30)

Blood pressure results from three different things - the force at which blood is expelled from the heart, the number of times it is expelled from the heart (heart rate), and the volume of blood present.(23) Blood volume is a product of the relationship between the lymphatic system, which drains fluid from blood and sifts through it before pumping it back into blood, and the circulatory system. Heart rate is influenced by many things, but stress is a large external factor. The force at which blood is expelled from the heart relies on the size of the heart - an overlarge heart will pump out blood with far more force, driving blood pressure higher. An enlarged heart is generally the result of overworking it - after all, it is a muscle, and muscles grow with extensive use.

Given what we’ve already talked with regards to the effects that massage has on stress, the lymphatic and circulatory systems, it comes as no shock that foot massage also has a positive effect on blood pressure. Evidence for this can be seen in a study on foot massages’ effect in the Japanese community.(31) This study found a statistically significant decrease in systolic blood pressure and anxiety levels.(31) Foot massage can therefore be used, in conjunction with its stress busting abilities, to help control blood pressure, and thus decrease the risk of heart disease.

Key Take Away: Blood pressure is influenced by many factors including stress, heart rate, and blood volume, and foot massage can benefit them all. While not a be all and end all, it can be useful in managing underlying causes of high blood pressure.

9. Foot Massage Helps Maintain a Healthy Heart Rate

Like blood pressure, heart rate is tied to the function of the heart. If the heart beats too fast, several things can occur. In critical situations, the heart does not have enough time to fill with blood, and thus cannot supply an adequate blood supply to the rest of the body.(23) In less critical situations, a sustained increased heart rate can lead to feelings of anxiety, and experiences of dizziness and chest pain.(32)

The same Japanese study that looked at blood pressure also examined the effect that foot massage had on heart rate. It found that foot massage decreased the average heart rate in the participants (31). Another study looked at children in intensive care - children who very obviously have undergone much in the way of stress, and found again that their long term heart rate decreased over several sessions of massage, despite their surroundings and situation.(33)

This decrease in heart rate has very obvious benefits - it removes significant stress from the heart. A heart that works too hard is a heart that enlarges - thus contributing to increased blood pressure and a risk of cardiovascular disease.(34)

Take Away: Foot massage benefits in the area of heart rate - it helps keep it within normal levels. This in turn assists the body in maintaining its normal equilibrium, and decreases the risk of cardiovascular disease.

10. Foot Massage Helps Maintain Balance

Balance is something most people don’t think about until it is a skill they don’t possess. A lack of balance affects people’s ability to move - to stand, to walk, to participate in life.

There are two components to balance - the inner ear and the mechanical parts of balance.(23) Foot massage can assist with the mechanical aspects - a study of those whose balance had been affected by diabetes found that foot massage significantly increased their balance.(35)

A lack of balance also often affects the elderly, and those with conditions such as osteoarthritis. Given that massage also has a positive effect on the pain associated with arthritis,(36) massage acts a multi-benefit therapy, giving people both control over their mobility, and relieving their pain.

Take Away: Balance contributes much to our ability to move and participate in society. Foot massage helps address the mechanical aspects of balance, especially in people who have conditions that affects their balance, such as arthritis and diabetes.

11. Foot Massage Benefits the Skin of our Feet

With increased circulation, foot massage also brings about benefits to the skin on your feet. This may not seem as important as the skin on your face, but feet - like your hands - are the parts of our body that we put under the most pressure. We force them into uncomfortable shoes, walk barefoot, put pressure on our soles for hours.

A study on Thai foot massage found that the act of massage increased both temperature and blood flow to the connective tissue below the skin.(37) Foot massage provides many other benefits to the tissue - such as increased blood flow and increased lymphatic drainage..

Foot massage can also assist with people who suffer from swelling of the feet - a study found significant decrease in swelling in the leg following three months of foot massage.(38) This can generally be attributed to increased lymphatic drainage and increased blood flow. As mentioned before, these two aspects working together control the water balance in our body. Swelling in the feet, known medically as oedema, results from an imbalance in water drainage.

Foot massage can also decrease the appearance of scarring - one study found that in Korean burns victims, skin pliability, circulation and appearance improved following three months of massage.(39)

Take Away: Looking after the skin on our feet is often one of our last priorities - however, given how much we rely on our feet and how much we put them through, it should be out first. Foot massage assists with circulation, lymphatic drainage, swelling of the feet, and scar appearance, allowing us to better look after our skin.

12. Foot Massage Helps to Manage Anxiety

Given that we have already investigated how foot massage decreases stress, increases endorphins, provides a sense of closeness and assists with pain management, it should come as no surprise that foot massage also helps relieve feeling of anxiety.

Anxiety is one of those things that many people experience throughout their lifetime. In childhood, adolescence, and as people age, there are many things to feel anxious about, and most of the time it’s a natural response to circumstances.(40) Anxiety disorders occur when that anxiety is persistent, and occurs in circumstances where such a reaction is not warranted.(41)

Foot massage is not something that will cure anxiety. People should always go and see their health providers. However, given that science does still not have the full picture regarding anxiety, the use of foot massage to relieve both normal and chronic anxiety has much to recommend it.

A Swedish study looking at the effect of massage therapy on women with anxiety found no marked increase in anxiety across the time of the study, but also found significant decreases in many of the markers of anxiety - heart rate, blood pressure, body temperature and respiratory rate.(42) The Japanese study that we looked at earlier also measured anxiety levels while performing foot massage and found a significant decrease in anxiety levels.(31)

Take Away: 1 in 5 people will suffer from a mental illness in their lifetime, with two of the most common problems being anxiety and depression. Foot massage gives us an alternate therapy that can work alongside medicine and talk therapy to address the multiple causes for mental illness.

13. Foot Massage Helps Manage Depression

Depression and anxiety often occur hand in hand - most people who experience a mental illness are also at high risk of experiencing another one.(43) Depression, like anxiety, is only partially understood by medicine - we know that it has to do with serotonin and dopamine levels in the brain, but often the medications used to address this take 6 weeks to work, while the side effects of the medications start immediately.(44)

There is clearly social, physical, cultural, and psychological aspects to depression. Given we have seen that foot massage can influence us physically and psychosocially, it should come as no surprise that here again, foot massage can be useful.

In a study of women suffering from postpartum depression, researchers found that massage significantly decreased reports of depression.(45) Another study of middle aged women experiencing depression found similar results.(46)

If we were to look at the effect that foot massage has on both anxiety and depression and also look at the underlying ways that foot massage has its effect (social bonding, decrease in stress, increase in endorphins), it seems fairly logical that while not a cure, foot massage is a useful tool for people who experience anxiety and depression to add to their tool box.

Take Away: Depression, like anxiety, is a disease that is multifaceted and complicated. With foot massage addressing both biological and social triggers for depression, it presents a useful tool to help in the management of the condition.

14. Foot Massage can Assist with Muscle Soreness

Muscle soreness is generally the thing that people think about first when it comes to massage. As previously mentioned, we humans put our feet through quite a bit of abuse - walking all day in inappropriate shoes, not paying attention to how long we spend on our feet – it is easy to see how muscle soreness develops in the feet.

Massage, by definition, is the process of pressing at muscle and connective tissue to relieve tension.(47) While some forms of foot massage, such as reflexology, look to influence other parts of the body through dispelling tension in the feet, the fact of the matter is that massage aims to use touch to improve the patient's quality of life through manipulation of tissue.(48)

People experience many different types of muscle soreness – the muscle soreness after exercise, the muscle soreness that comes from straining something, and the muscle soreness that comes from tension. Massage helps all of these, providing an easy tool for people to use to relieve tension, heal exercise soreness and decrease injury pain.(49, 50, 51)

A study of people exhibiting day after muscle soreness looked at the effectiveness of massage in relieving their pain. This particular study looked at body builders, and found that massage significantly decreased post exercise pain.(49) Other studies that focused on marathon runners found similar results.(50)

Take Away: Muscle soreness inhibits people’s efforts both in their everyday lives, and their sporting endeavours. By decreasing the amount of pain that results from using our muscles, foot massage allows for rapid recovery.

15. Foot Massage can Help Decrease Joint Pain

Along with muscle soreness, joint pain is one of the main complaints for people that use foot massage as a tool of their daily life. Joint pain can occur for many reasons - from arthritis, to general stiffness, to post injury pain. It is something that affects large populations of people.(36)

Foot massage focuses on areas of tension. By relaxing the muscles around the joints, and massaging the connective tissue that holds these joints in place, foot massage can provide relief. A study of patients experiencing joint pain from osteoarthritis found significant decrease in pain following consistent foot massage with lavender oil and almond oil.(36)

Given that joint pain can be further exacerbated by muscles stiffness, the ability of massage to loosen tension in stiff muscles,(51) is of particular interest. By loosening the stiffness in the surrounding tissue, the tension is taken off of the joints and decreases some of the pain felt due to the inflammation of the tissues in the joints.(36)

Take Away: Joint pain hinders the efforts of people to live normal lives. Joint pain in the feet, especially, can have a significant effect as it makes walking and getting around difficult. Foot massage provides a way to decrease that pain, and thus improve the quality of life of those experiencing it.

16. Foot Massage Helps Manage Insomnia

Insomnia is a complicated beast. Like many issues to do with the brain, it is often multifactorial, having more than one root cause. Some of the causes include different drugs (like caffeine, nicotine, the medication you take for asthma), shift work, stress, depression, and pain. Sometimes we just don’t know the cause behind insomnia.(52)

However, looking at the causes behind insomnia, we can already see how foot massage addresses many of these. If foot massage decreases your levels of stress, you’re more likely to sleep. If it assists with depression, you’re more likely to sleep. If foot massage helps with your pain, including joint and muscle pain, you’re more likely to sleep.

Evidence for this can be found in several studies where insomnia was shown to decrease in incidence and severity when foot massage was provided to women suffering from post-natal depression.(45) By providing a sense of calm, by assisting with depression, stress and pain, foot massage provides a viable therapy in assisting oneself to get asleep.

Take Away: Foot massage addresses many of the causes of insomnia, helping to prevent the problem of not being able to sleep in the first place. It also presents an immediate sense of calm and being cared for - both things which prompt sleep.

17. Foot Massage Helps Decrease the Severity and Length of Headaches and Migraines

Headaches and migraines occur for many reasons - stress, tiredness, infections, illness.(53) Sometimes we have no idea what the cause or trigger is. Thus, therapy is often based on what has worked before for that individual. A lack of light, less sound, certain types of painkillers. Often though people have to work through migraines, using medications that sometimes work, sometimes don’t.

Here foot massage can be of assistance, not necessarily by replacing other therapies, but by working alongside them. We’ve already looked at how foot massage addresses some of the above causes – stress and insomnia. By treating these causes, foot massage is helping to prevent episodes from occurring in the first place.

However, other research has also found that foot massages can decrease the severity and length of headaches and migraines.(54) This is of particular importance - both because it provides relief to the sufferer, but also because it enables other methods - such as darkness, and rest, and rehydration - a better chance of working.

Take Away: Headaches and migraines can be debilitating and extremely difficult to control. While foot massage does not provide the cure for these afflictions it does help in two ways. Firstly, it helps manage some of the causes of migraines and headaches. And secondly, it’s been shown to decrease the severity and length of these migraines and headaches, giving other coping methods a chance to work.

18. Foot Massage Helps with Injury Rehabilitation

Injuries can be debilitating, not only in the immediate, but also in their aftermath. Rehabilitation, building up strength, learning to use muscles and tendons again - it’s not an easy path.

Foot massage helps here by allowing a person to go through with all that they need to do to get back on the road to recovery. As we’ve already seen, foot massage helps address many things that makes rehabilitation difficult – pain, stress, muscle soreness, joint stiffness, fatigue,(36, 51). It also assists in areas of depression and anxiety, things that also often afflict those who are working through injuries.

Foot massage also helps specifically when leg and foot injuries are involved. It addresses not only concurrent stresses and causes of pain, but allows the person to directly target pain in their feet, of the muscles in their legs (which are often connected to the bones of the feet)(36). In this way, foot massage allows a person both the chance to attend rehabilitation activities and strive towards the rehabilitation of their injury, but it also allows the individual to address immediate problems when it comes to their feet and legs.

Take Away: Injuries are never pleasant, and their recovery period can often stretch into the weeks and months. Foot massage offers a way of assisting with that recovery, both by addressing things that make recovery difficult, but also by addressing immediate problems of tension in the feet and legs.

Last Thoughts

Many of the studies and papers examined in this article have looked at more than one type of foot massage - Thai foot massage, Swedish foot massage, reflexology. There appears to be no singular type of foot massage that works better than the others, and all seem to have positive benefits.

Even in studies where there was no empirical evidence that could be measured (and in many cases there were biochemical changes that resulted from the foot massage), researchers acknowledged that foot massage had a positive outcome on the people who used it, and that as an alternative medicine, it has a great many applications alongside traditional medicine.

So with all the benefits to gain, and nothing to lose, why not have a go today? Given that there seems to be no particular type of massage that is any better than any other, there are many paths to choose from. You could go to a professional masseuse, get a partner to have a go, or just do it yourself. Whatever option you choose, you stand to benefit from it.

Acknowledgment Citation

Reprinted with permission from https://www.jenreviews.com/foot-massage/