On the strength of the findings of RLD research projects and case studies, plans are already in place for further research.

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1 Sally Kay Biography Sally Kay is a milti-award winning reflexology practitioner, researcher and provider of specialist training. Since qualifying in 2005 she has worked in Private Practice, Hospice and NHS Hospital Cancer Care, and in 2009 was the resident therapist, at internationally renowned holistic holiday retreat, Atsitsa, Greece. Through clinical practice Sally has developed and researched unique Reflexology Lymph Drainage RLD techniques. In 2007 she enrolled on a BSc(Hons) in complementary therapies, studying part-time while continuing to work. In 2011 she graduated with a First Class Honours degree, winning best dissertation prize. The results of her study were presented to the UK leading heads of CAM at 2012 CAMSTRAND research conference to much acclaim. In 2013 and based on the strength of these results, the Welsh Cancer Charity, Tenovus awarded funding for further RLD research, to be conducted in partnership with Cardiff Metropolitan University. This was completed in 2014 and the results published in the journal Complementary Therapies in Clinical Practice Sally has been a guest speaker at national and international conferences, throughout the UK, Europe and America. She teaches RLD to reflexology practitioners from around the world and has published articles in professional journals, International Therapist and Reflexions. Clinical experience and further evidence from a growing body of case studies suggests RLD may be useful for clients with non-cancer related, auto-immune disorders, e.g., Rheumatoid arthritis, Fibromyalgia, allergies, migraine and many other inflammatory conditions. On the strength of the findings of RLD research projects and case studies, plans are already in place for further research. Reflexology Lymph Drainage DVD is available and her book is coming soon. RLD has attracted national and international awards in recognition of this groundbreaking work: - Winner of 2012 Federation of Holistic Therapists FHT Excellence in Practice Award - Winner of 2015 International Council of Reflexologists ICR Research award - Winner of 2016 Association of Reflexologists AoR Excellence in Research award - Honorary Fellow of the Association of Reflexologists AoR - Fellow of Federation of Holistic Therapists FHT - Expert adviser to the Federation of Holistic Therapists FHT - Honorary Member of National Register of Reflexologists Ireland. Bridging the gap between reflexology practice, and proving its worth, is notoriously difficult. I hope that the initial project may form the cornerstone of future studies, which will contribute to the understanding, and integration of reflexology. SALLY KAY BSc(Hons) For more information see

2 Sally Kay Conference (Sunday 7 May at 9.45 am) Reflexology Lymph Drainage RLD RLD was developed through clinical practice while working in cancer care. Patients who received this treatment experienced less discomfort and swelling and an increase in strength and arm mobility. As a pattern began to emerge in these patients, so did the prospect of measuring the effect of reflexology. This coincided with preparation for my final year dissertation for a BSc(Hons) in Complementary Therapies, and the opportunity to conduct the initial research into RLD. A research proposal was submitted and NHS ethical approval was granted. Six participants were given RLD treatments, once a week for four consecutive weeks and measurements were taken before and after each treatment. In addition to capturing the objective data, participants were asked to describe their concerns and comment about how they felt. This was recorded using a standard outcome measure, MYCaW (Measure Yourself Concerns and Wellbeing) and as part of the consultation and feedback. All of the participants reported feeling movement of fluid during their reflexology treatment. Comments at the end of the study included the following I feel like I ve got my arm back I feel good about myself and it has helped my confidence The sleeves on my clothes feel looser I can make a fist I feel normal again, as well as my arm The pain s gone Aim RLD aims to stimulate the function of the lymphatic system and drain excess lymph away from the damaged area. Lymphoedema, is defined as persistent tissue swelling due to blockage or absence of the lymph drainage channels with accumulation of interstitial fluid. Primary lymphoedema has a genetic predisposition, and secondary lymphoedema is caused by surgery, accident, injury or trauma. Cancer causes of secondary lymphoedema include, surgery, radiotherapy, spread of disease and site of tumour Long term physical side effects of lymphoedema include, pain, distorted limb shape, impaired function, decreased elasticity and mobility of skin, fibrosis, dry skin, acute inflammatory episodes

3 Psychological & psychosocial problems anxiety, loss of confidence, altered body image, uncomfortable wearing certain clothing and altered ability to complete everyday living activities Abstract (European Journal of Integrative Medicine Volume 4, Issue 3, Pages e359- e360, Sept. 2012) Reflexology for the management of secondary lymphoedema in patients affected by treatment for breast cancer: an exploratory study. Authors: Sally Kay, Judith Whatley, Philip Harris Background: Breast cancer is the most common cancer in the UK. Following medical intervention approximately 20% of breast cancer patients suffer lymphoedema. After breast cancer, a person may experience psychological or emotional difficulties due to altered body image, and a swollen limb can exacerbate this (Mackereth & Carter 2006). Research suggests that survivors with lymphoedema are more disabled, and they experience a poorer quality of life and more psychological distress than survivors without lymphoedema, (Bernas et.al.2010, Pyszel et.al. 2006, Ridner 2005). There is a need for more effective interventions and further research into a range of physical therapies for the management of lymphoedema. Reflexology is a physical therapy focusing on the feet. Practitioners use specific pressure with thumb, finger and hand techniques to stimulate these reflexes on the premise that this effects a physical change in the body. Anecdotally, cancer patients suffering from lymphoedema report positive effects on the swollen arm after reflexology treatment. Aims and objectives: To explore the use of the RLD (reflexology lymphatic drainage) technique as a precision treatment for the reduction of lymphoedema, swelling of the arm following treatment for breast cancer. Method As part of an undergraduate project, six participants with unilateral secondary lymphedema were recruited from a South Wales cancer-care organization. The participants received four consecutive weekly reflexology lymph drainage (RLD) treatments. Limb Volume Circumferential Measurement (LVCM) was the primary outcome measure used. This method is widely used for calculating arm volume (NHS 2008). Measure Yourself Concerns and Wellbeing (MYCaW), was used to gather subjective data (Patterson et.al. 2006). LVCM and MYCaW measures were taken at baseline, the intervention stage, and at follow-up (one week post-intervention). Results Positive trends were observed on both outcome measures for all six participants. As a group, the results indicated a statistically significant reduction in arm volume, from baseline to follow-up (t=6.93, df=5, p=0.001) on LVCM. MYCaW mean profile scores from baseline to

4 follow-up, also showed a significant improvement (Z=-2.207, p=0.027). The results were also supported by the qualitative data reported by participants. Conclusion: Findings of this exploratory study suggest that RLD may be helpful in the management of secondary lymphoedema. A more robust research design is needed to test for a causal link between the application of reflexology and possible outcome benefits. Résumé de la différence entre le bras gonflé et non gonflé (n = 6) : In 2013 on the strength of these initial findings, Welsh Cancer Charity, Tenovus awarded funding, 12,263.00, for further RLD research (n=26), to be conducted in partnership with Cardiff Metropolitan University. The intervention phase was completed between January and June Published: January 2016, Clinical Practice in Complementary Therapies Use of reflexology in managing secondary lymphoedema for patients affected by treatments for breast cancer: a pilot study Authors: Judith Whatley, Rachael Street, Sally Kay Philip Harris Abstract Purpose: The aim of this feasibility study was to examine the use of reflexology lymphatic drainage (RLD) in the treatment of breast-cancer related lymphoedema (BCRL) with a view to further research. Methods: An uncontrolled trial was conducted with 26 women who had developed lymphoedema in one arm following treatment for breast cancer. Changes in upper- limb volumes and in participant concerns and wellbeing were measured. Qualitative data were also collected.

5 Results: A significant reduction in the volume of the affected arm was identified at follow-up compared to baseline. This reduction in volume appeared to be maintained for more than six months. Participant concerns were significantly reduced and their wellbeing significantly increased. No serious adverse effects were reported. Conclusions: RLD may be a useful intervention for BCRL although the results could not be attributed to the reflexology intervention because of research design limitations. The main conclusion was, however, that there was sufficient evidence for further research using a randomized controlled trial. Quantitative data - objective arm measurements (LVCM) All 26 participants had reductions in swelling of the affected arm. The average difference between swollen and normal arms before RLD was 348.8ml, and the average amount lost was 36.2% of this (126.3ml). All of the statistical tests run on the before and after volumes showed that all effects were statistically significant (p<.001) Quantitative data - subjective MYCaW scores Subjective scores of participant concerns and wellbeing using MYCaW indicated changes on all three scales to be of clinical significance to the participants. The levels of the primary and secondary concerns were both significantly lower at follow-up when compared to baseline (p<001). And participant wellbeing increased significantly from baseline to follow-up (p<01). Nobody dropped out during the study the attrition rate was zero. An example of quotes from the qualitative data exit interview "...I found the whole thing was one of the top 10 highlights of my life" "...I was really quite sceptical thinking, 'this isn't going to work, but I'll do it anyway, and I was amazed, really totally amazed to see the difference in my hand after the first session was just,...i couldn't get over it" "Its lighter, I haven't got the heaviness, I haven't got the aching in my arm, the swelling has gone down, I can stretch my arm, it just feels a lot better" "I look at myself in the mirror now and I can see there s an actual shape to my arm whereas before it went straight down" "I want to continue because I think its wonderful...i think its the best thing that's happened" "It s absolutely amazing because people do suffer with lymphoedema for years and it s so painful, if something as pleasant as this can do something it s wonderful. It s a wonderful, wonderful thing What else is RLD useful for? Since 2012, I have been teaching RLD to reflexologists throughout the UK and Ireland, while continuing to use it in everyday clinical practice.

6 The research results suggest it is highly probable that RLD causes an effect on the lymphatic system. Surely it follows that RLD may also cause an effect on the immune system. And with an increase in auto-immune disorders, I believe this sequence helps the body respond to inflammatory and auto-immune conditions, for example, rheumatoid arthritis, eczema, hayfever and other allergies, (and much more). Part of the RLD training, involves submission of a case study, not necessarily secondary lymphoedema related. From this, and my own clinical experience, I have a growing body of anecdotal case study evidence of RLD being used to support clients with an extensive range of inflammatory, auto-immune disorders as well as secondary lymphoedema. Bridging the gap between reflexology practice, and proving its worth, is notoriously difficult. I hope that the initial project may form the cornerstone of future studies, which will contribute to the understanding, and integration of reflexology. Sally Kay Summary of difference between the swollen and non-swollen arm (n=26)

7 Each of the above photographs were taken before and after one RLD treatment. Sally Kay

8 Sally Kay Workshop (Sunday 7 May at 2.00 pm) How to use RLD for clients with lymphoedema swelling after treatment for breast cancer. The work shop will be a hands-on practical session 90 minutes. Each reflexologist will learn how to give and then receive a basic RLD treatment. I will guide everyone through the sequence using the DVD for instruction, while giving hands-on guidance for the reflexes. -