Bowen Therapy – all fingers and thumbs
Posted by apgaylard on June 19, 2011
I stumbled across Bowen Therapy (aka Bowen Technique, Bowen Work) a few years ago when the other half decided to give it a try. She found it relaxing and felt it provided a little immediate relief that was soon gone. Essentially, it was worthless as a treatment for what was ailing her.
This therapy was invented by an Australian called Thomas Ambrose Bowen (1916 – 1982). Apparently, he referred to himself as an osteopath before the title became regulated in the 1970s. The therapy that now bears his name involves the gentle manipulation of soft tissue using fingers and thumbs; moving them over muscle, ligament, tendon and fascia.
It’s a fairly common, but definitely second division, complementary therapy. In the UK, Bowen Therapists can register with the pointless Complementary and Natural Healthcare Council (CNHC).
After our experience of Bowen Technique, I decided to try and see what evidence is available for the effectiveness of this therapy. I also decided that it was time to see what claims are being made for it.
A bare cupboard
After having a good look, I don’t think that there is really nothing resembling evidence to support the use of Bowen Therapy for anything. A careful search of PubMed, The Cochrane Database and Google Scholar identified just six relevant references.
Carter (2001) reported the outcome of a pilot study of Bowen Technique (BT) and frozen shoulder. It used a case series of just twenty patients. They were given up to five therapy sessions. Improvements were claimed, but this is an uncontrolled study on a small number of patients.
Just a year later Carter (2002) also reported “the qualitative findings from a larger study … and 20 participants’ experiences of BT”. The author claimed that:
“BT was experienced as being gentle, relaxing and noninvasive and of help with significantly eliminating and improving the symptoms associated with frozen shoulder.”
However, again, it’s a very small study with no control group. Oddly it has exactly the same number of participants as the trial reported the year before. I wonder why a second twenty-patient study was published by the same author within a year. Could it be the same study? If not, why do yet another methodologically weak small study?
Dicker published two investigations during 2005 in the obscure Australian Journal of Holistic Nursing. The first (Dicker, 2005a) documented the effect of offering, “Health Service staff treatments with Bowen Technique.” An evaluation after nine months apparently, “indicated that the provision of Bowen Therapy for staff might be an effective way of reducing Workcover claims.”
I do wonder why a programme run during 2002 and evaluated nine months later took until 2005 to appear in a low-rent CAM journal.
The second publication (Dicker, 2005b), reported a six-week programme of Bowen Therapy, treating, “31 Hospital and Community Health Service staff in a group setting […] to reduce stress and improve physical health.”
“Quantitative and qualitative data indicated that Bowen Technique was successful in reducing pain, improving mobility, reducing stress, and improving energy, well being and sleep.”
Being as this was a small uncontrolled study looking at a set of indicators, many of which are highly susceptible to expectation effects (pain, stress, energy, ‘well being’ and sleep) it really provides no evidence to support any specific effect from Bowen Technique.
More recently Marr and co-workers (2010) have produced an RCT for the effect of Bowen Technique on hamstring flexibility. It was conducted on “120 asymptomatic volunteers”. So, this trial is not actually assessing Bowen technique for anyone with a problem. Therefore, it cannot even say anything about treating hamstring injuries.
This renders the details of the trial moot. However, the volunteers were “were randomly allocated into a control group or Bowen group.” Three flexibility measurements were made over the course of a week. The intervention group received one Bowen treatment. The authors claim that:
“A repeated measures univariate analysis of variance, across both groups for the three time periods, revealed significant within-subject and between-subject differences for the Bowen group. Continuing increases in flexibility levels were observed over one week. No significant change over time was noted for the control group.”
I do wonder whether being ‘treated’ gives people the confidence to be more active, making the hamstring a bit more flexible, and that this is the effect being measured.
At any rate, all this trial has demonstrated is improved hamstring flexibility in people without a hamstring problem, compared to other people with no hamstring problem who are just left to their own devices: unconvincing, to say the least.
Rehabilitation from chronic stroke
Finally, Duncan and colleagues (2011) looked at the use of Bowen Therapy for rehabilitation in chronic stroke. This pilot study was based on a case series of just fourteen “people with chronic stroke” who were offered thirteen Bowen therapy sessions over a three-month period.
The authors reported that:
“Motor assessments of the 13 people who participated showed improvements—gross motor function trended to improvement; SF-36 role-physical, physical health summary scale and total SF-36 scores showed statistically significantly improvements. However, grip strength reduced.”
So, just thirteen patients completed the trial. I count eight outcome measures in the paper:
“Barthel Index, Motor Assessment Scale (MAS), Grip strength, Nine-Hole Peg Test (9-HPT), Timed Up and Go (TUG), Key Pinch Test, Mini-Mental State Examination (MMSE) and the SF-36.”
Only changes in MAS (p= 0.019) and the SF-36 (p=0.034), appear to reach statistical significance. The authors also broke down the SF-36 into its constituent elements. Of the eleven elements, only three reportedly reached statistical significance (Role-Physical (p=0.018), Social Functioning (p=0.047), Physical Component Summary (p=0.023)).
However, if a basic correction for multiple inferences were applied (Bonferroni) none of these results would be statistically significant.
So, it’s a small case series that most likely shows no benefit from Bowen Technique. The authors conclude:
“In this pilot study, Bowen therapy was associated with improvements in neuromuscular function in people with chronic stroke. At this stage of study, it is not possible to conclude that there is definite benefit; however the results suggest that exploration through further research is appropriate.”
And I think that this is overstating the case.
So, the sum total of the formally published evidence base for Bowen technique amounts to this:
- one or is it two (?) small uncontrolled trials for frozen shoulder from a single author (Carter 2001, 2002),
- an uncontrolled intervention to try and reduce staff absence (Dicker, 2005a),
- a small uncontrolled study on a range of issues with strong psychological components (Dicker, 2005b),
- an RCT showing improved hamstring flexibility in people with no hamstring problems (Marr et al 2010) and
- a tiny case series that doesn’t show Bowen technique helps stroke rehabilitation (Duncan et al, 2011).
So, it’s safe to say that there is no evidence that Bowen technique can help with any specific medical condition.
Scraping the barrel
However, there are references on Bowen websites describing other research, though they are typically presented without citations and do not seem to tie in with any papers listed on PubMed. So, they are not credible sources. They are partisan and not even published in the credulousCAMliterature. So this ‘evidence’ is not really the bottom of the barrel, it’s more like the soggy soil underneath.
However, a quick trawl through the low level and web ‘publications’ is instructive.
Developing Research Strategies?
Starting with a low-level publication: the “Developing Research Strategies Conference” – this was summarised by Lewith (2005) and included several contributions from Bowenists.
Wright and Orton talked about plans for testing “… Bowen Neurostructural Integration Technique (NST) for Post treatment Trauma in Cancer Patients” using a pragmatic pilot study and just twenty subjects. Six years on, and I cannot find a trace of this trial.
Nikke Ariff described work on migraine and asthma. This used thirty-nine and twenty-three subjects respectively. The trails appear to be unblinded and uncontrolled, using questionnaires and diaries to record subjective measures. These have not been published anywhere I can find and are too small and methodologically weak to provide meaningful evidence.
The presenter also mentioned, “a new protocol to study pre-menstrual syndrome.” I have not found any evidence of this work being completed either.
Alistair Rattray presented his work on childhood asthma. After claiming success in treating a two-year old child in 1999, he apparently claimed, “Over the past 5 years, with over 100 cases to look back on, the initial hopes have been well rewarded.” Rattray described three cases, which he claimed were “typical.”
Essentially this is a poorly reported small case series. No proper trials have appeared to date.
It’s worth bearing in mind what asthma is. According to asthma UK:
“Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs.
When a person with asthma comes into contact with something that irritates their airways (an asthma trigger), the muscles around the walls of the airways tighten so that the airways become narrower and the lining of the airways becomes inflamed and starts to swell. Sometimes, sticky mucus or phlegm builds up, which can further narrow the airways.
These reactions cause the airways to become narrower and irritated – making it difficult to breath and leading to symptoms of asthma.”
It’s hard to see how gentle superficial soft-tissue manipulation can do anything significant for the muscles around the walls of the airways.
So, comparing these plans with the publications currently available shows no real progress in establishing anything approaching evidence since 2005.
European College of Bowen Studies
The ECBS website boasts that it is, “Europe’s leading Bowen school” and that, “On this site you will find the most comprehensive source of information about Bowen on the web.” If this is true, then it would be reasonable to expect that this site would provide the strongest evidence in support of Bowen Therapy.
Tellingly, it’s a rag-tag collection of unpublished research, unfulfilled hopes and newspaper coverage.
There is an interview with Helen Kinnear and Julian Baker about their “Frozen Shoulder Research Programme”. They apparently undertook a controlled trial with 100 subjects. Various positive results are presented; it’s unfortunate that this doesn’t seem to have been properly reported in a peer reviewed journal. I wonder why. If this work is a good as the authors’ seem to think, why wouldn’t they want to get it published?
The asthma research is a re-print of an article from The Times from November 2003, entitled, “The Bowen Technique: Kick the inhaler into touch” and some claims about a trial in development by Alistair Rattray.
On migraine they claim, “Nikke Ariff recently completed The Bowen Technique National Migraine Research Program” based on thirty-nine participants. Odd that this is the same number of subjects mentioned at the the “Developing Research Strategies Conference” (Lewith, 2005). It sounds like “recently completed” means before 2005? Anyway, it’s not properly published, small, unblinded with no control group.
Under “Lymphoedema” they reproduce an article by Eilish Lund from the British Lymphology Society Newsletter. It’s a scanty report of a number of cases.
Finally, they promise that something is “coming soon” for Fibromyalgia.
And that is that. Not a peer-reviewed journal paper among them.
That doesn’t seem to hold anyone back though …
This lack of evidence doesn’t seem to have held back Bowen Therapists and professional associations from making wild and occasionally dangerous claims.
A decade ago Long, Huntley and Ernst (2001) surveyed the opinion of 223 professionalCAMorganizations, to elicit their opinion on, “Which complementary and alternative therapies benefit which conditions?” Two of the three Bowen organizations consulted responded. At lease one of these identified:
Respiratory problems (incl. asthma)
Skin problems incl. exzema
Irritable Bowel Syndrome (IBS)
It is an outrageous list of claims, given the available evidence, let alone plausibility.
The European College of Bowen Studies claims, under the heading, “What Responds Well to The Bowen Technique?”, that:
“The most common presentation is back pain and here Bowen excels. […]. Frozen shoulders are a particular favourite as are neck pain, hayfever, asthma and migraines. Sports injury is a field of remedial therapy that is becoming very aware of The Bowen Technique. Not only do sportsmen report fewer injuries when treated regularly but they also notice an increase in performance. […].” [emphasis mine]
Which is pretty immodest; claims to be able to treat asthma are downright dangerous. How can rubbing soft tissue with thumbs and fingers help with hayfever?
The Bowen Association UK has an even more impressive list:
“Here is a list of just some of the conditions we have been able to assist with:
Baby and childhood problems
Bladder problems, bedwetting
Headaches (migraine, sinus)
Jaw problems (grinding of teeth, misalignment etc)
Knee and hip restrictions, misalignments
Menstrual and other female problems
Pelvic tilt, leg length, hip imbalance
Repetitive Strain Injury
Skeletal and muscular problems from lumbar to neck
The Bowen Therapy Professional Association is not to be outdone, reproducing an equally ridiculous list:
[…] Bowen is suitable for all ages, from a baby with colic to an elderly person with arthritis, and there are no known contra-indications.
This remarkable technique can be quick and effective in helping the following:
Muscular and skeletal problems in neck, shoulder, hip, knees, ankle and back, including sciatica
Frozen shoulder, tennis and golf elbow, R.S.I. and carpal tunnel
Whiplash and sports injuries
Problems with posture and body alignment
Migraine and recurring headaches
Bell’s Palsy, Multiple Sclerosis, Parkinson’s Disease and the difficulties suffered by stroke victims
Respiratory, bronchial and related conditions such as hayfever and asthma
Digestive problems such as IBS
Hormonal, pregnancy and fertility problems
Stress management, ME, fatigue and sleep problems.
Bowen can be of assistance in many cases of emotional stress, where relaxation is a prime factor in easing pain and anxiety. It is also often a great help in improving the quality of life for those who are terminally ill.”
Worryingly, they have a separate list for children:
“Some conditions which have been reported to respond well to Bowen Therapy include:
Allergies, ADD, ADHD, Autism, Asthma, Bed-wetting, Cerebral Palsy, Chest infections, Clicky Hips, Colic, Constipation, Croup, Dyspraxia, Eczema, Glue-ear, Growing Pains, Headaches, Muscular-Skeletal Issues, Panic Attacks, Psoriasis, Sinusitis and Stress.
It may also aid posture, balance and coordination and the after effects of trauma e.g. difficult birth, accident, family breakdown, death of a loved one.”
Scandalously, Bowenist Alastair Rattray even thinks that Bowen can be used in emergency situations like, major asthma attack, panic attacks and “chest tension in a case of anaphylactic shock.”
(For helpful advice from Asthma UK see:What to do in an asthma attack)
What to make of it?
Despite what Bowen therapists and professional organizations claim, there is no evidence that Bowen Therapy / Technique or Work can help with any medical condition.
I hear that it can be a nice, relaxing experience. As such it might make someone feel a little better for a short while.
The claims made on various Bowen websites are nothing more than wishful thinking, a shared healing delusion. At least now, in theUK, the Advertising Standards Authority (ASA) can have these extravagant claims removed. This could spare people from wasting time and money on this nonsense. It might even save lives.
I try to make sure that what I write is both accurate and fair. If you think that I have got anything wrong please let me know. If you are right I will happily change what I have written.
This is not medical advice. If you need that see a properly qualified and registered doctor.
Carter B. A pilot study to evaluate the effectiveness of Bowen technique in the management of clients with frozen shoulder. Complementary therapies in medicine. 2001 Dec;9(4):208–215. Available from: http://dx.doi.org/10.1054/ctim.2001.0481.
Carter B. Clients’ experiences of frozen shoulder and its treatment with Bowen technique. Complementary therapies in nursing & midwifery. 2002 Nov;8(4):204–210. Available from: http://dx.doi.org/10.1054/ctnm.2002.0645.
Dicker A. Bowen technique–its use in work related injuries. The Australian journal of holistic nursing. 2005 Apr;12(1):31–34. Available from: http://view.ncbi.nlm.nih.gov/pubmed/19175268.
Dicker A. Using Bowen technique in a health service workplace to improve the physical and mental wellbeing of staff. The Australian journal of holistic nursing. 2005 Oct;12(2):35–42. Available from: http://view.ncbi.nlm.nih.gov/pubmed/19175262.
Duncan B, McHugh P, Houghton F, Wilson C. Improved motor function with Bowen therapy for rehabilitation in chronic stroke: a pilot study. Journal of primary health care. 2011 Mar;3(1):53–57. Available from: http://view.ncbi.nlm.nih.gov/pubmed/21359262.
Lewith G. Abstracts of the developing research strategies conference 28 April 2005. Complementary Therapies in Medicine. 2005 Sep;13(3):217–225. Available from: http://dx.doi.org/10.1016/j.ctim.2005.06.006.
Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complementary therapies in medicine. 2001 Sep;9(3):178–185. Available from: http://dx.doi.org/10.1054/ctim.2001.0453.
Marr M, Baker J, Lambon N, Perry J. The effects of the Bowen technique on hamstring flexibility over time: A randomised controlled trial. Journal of Bodywork and Movement Therapies. 2010 Sep;Available from: http://dx.doi.org/10.1016/j.jbmt.2010.07.008.
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