For Lisa Freemantle, a 53-year-old former teacher, reflexology seemed like the perfect second career. She credits reflexology, the ancient practice of using pressure points in the body to relieve health problems, with easing her migraine headaches. So it was with great enthusiasm that she undertook the more than 200 hours of training as part of the certification process and opened a practice near her Westchester County home 10 years ago. By any measure, the practice has been a success — she has a steady stream of clients and earns as much as she did as a substitute teacher. But increasingly, Ms. Freemantle and other reflexologists are finding their businesses under pressure on two fronts. On one side is the rising number of storefront foot spas that employ practitioners who offer what they call reflexology at less than half the usual cost — sometimes as little as $25 an hour, which can be a quarter of the cost of a trained reflexologist, who might charge as much as $100, depending on the location. In a number of states, including Massachusetts, Maryland, Oregon and Washington, some of these storefront spas have been found to be fronts for human trafficking. On the other side are complicated state laws. Although Ms. Freemantle is fully accredited by the American Reflexology Certification Board, frequently attends continuing education seminars and volunteers her service at hospitals, what she is doing technically violates New York State law. Continue reading the main story That is because in New York, Florida, Hawaii and a number of other states, anyone who wants to practice reflexology must be licensed as a trained massage therapist. This confusing web of state licensing requirements has made it easier for illegitimate reflexology salons to flourish, while it has sometimes made it more difficult for legitimate practitioners to operate. Although similar in some respects, reflexology and massage are very different. While both can reduce anxiety or stress, massage therapy is aimed at soothing or healing the specific part of the body being touched. Reflexology, on the other hand, involves applying pressure to parts of the body, usually the feet, hands or outer ears, that correspond to internal organs and systems, like the digestive system or the circulatory system Research by the National Cancer Institute has shown that reflexology may benefit cancer patients by reducing shortness of breath, a common symptom of breast cancer patients. Another study found that it could reduce preoperative anxiety. As the practice has become more accepted, like acupuncture, the number of reflexologists nationwide has grown. The Reflexology Association of America, a trade organization, has 645 individual members, a number that has grown every year since the organization started in 1995, said Brenda Makowsky, president of the association. That does not include the many reflexologists who have not joined the association. The New York State Education Department, which oversees licensing of massage therapists and the state massage therapists organization, supports the practice of reflexology, but as a specialization under the auspices of massage therapy. “If you want to be a podiatrist, you go to medical school and then specialize in podiatry,” said Nicholas Bodkin, second vice president of the New York chapter of the American Massage Therapy Association. “If you want to do reflexology, you should first get a massage therapists’ license and then do reflexology.” Ms. Freemantle said her objection to getting a massage therapy license was not just the time and expense involved — under New York law prospective massage therapists must take least 1,000 hours of approved instruction and do mandatory continuing education — but also a lack of interest in doing massages. “I am a reflexologist,” she said. “I’ve trained to be one and continue to train. Why should I have to do massage?” To be certified in foot reflexology by the American Reflexology Certification Board, Ms. Freemantle, among other things, passed a 300-question written exam covering anatomy, physiology and ethical business practices and saw 30 clients for three sessions each for at least 45 minutes. Requiring her to learn massage therapy to do reflexology “would be like making me learn to drive a truck because I want to drive a car,” she added. Many massage therapists learn reflexology as part of their training, although usually not as intensively as a certified reflexologist, said Elizabeth Willoughby, vice president of the New York State Reflexology Association. An uncertified reflexologist might have far less training. foshan massage