Bowenwork: A New Concept in Pain Management
Greater understanding in the last ten years about the brain and pain has produced a plethora of data on the role of the autonomic nervous system (ANS) in pain perception and the importance of creating a balance of the sympathetic and parasympathetic systems in pain perception and healing. As our society is dealing with the growing healthcare crisis, especially related to the treatment of chronic pain, a new form of manual therapy has emerged in rehabilitation which directly affects the ANS. This new form of manual therapy, Bowenwork, was developed by the late Tom Bowen in Geelong, Australia in the 1970s and 80s. The treatment technique has been taught internationally since the late 80s and was introduced in the early 90s in the United States.
Bowenwork is a gentle, cross fiber, soft tissue manipulation technique that is performed over specific locations in a specific sequence throughout the body, with pauses after procedures to allow the ANS to respond. The procedures can be administered over clothing, which makes this technique easy to provide in any treatment setting.
I learned about Bowenwork while I was working in a surgical center as an occupational therapist and a certified hand therapist. I was treating patients with shoulder, elbow, wrist and hand injuries, utilizing traditional manual therapy strategies, modalities, and exercise.
After receiving a Bowenwork treatment myself and experiencing the effects, I saw the potential benefits that this could offer my patients, and I began my Bowenwork training. After one year of study and subsequent certification, I began applying this technique to my chronic pain population who were suffering from fibromyalgia, repetitive strain disorders, back pain, neck pain, and complex regional pain syndrome. I was astounded by the rapid and, many times, profound results that I began seeing in my patient population. I began my search to understand how such a minimalistic manual therapy technique could have such profound results on the body.
My curiosity led me on a search to better understand the effects that sensory stimulation and cross fiber, light touch pressure on proprioceptors could have on the nervous and myofascial systems. I began to study the specific sites on the body where Bowen moves are administered, and the particular types of fiber and proprioceptive receptors that are located at those sites.
How does this technique work?
Bowenwork is a gentle but powerful technique that works by balancing the ANS, which controls more than 80 percent of our bodily functions. A Bowen treatment consists of a series of gentle but precise soft tissue mobilizations, cross fiber in nature, performed by the thumbs or fingers on muscles, tendons, ligaments, or nerve sheaths. The technique is unique in the following way. First, the skin is pulled to the side of the structure; gentle pressure is then applied to the edge of a muscle. A gentle, rolling move is then performed over the structure in a perpendicular fashion while maintaining gentle pressure on the site. This stimulates the proprioceptors, sending information via the nervous system to the ANS. A pause is applied after this rolling motion, allowing the nervous system to fully respond and the muscles to reset to their normal tissue tension state.
Many of the Bowen moves are done at the musculotendinous junctions where the golgi tendon organs (GTOs) are found. By stimulating these sites and providing a “wait time” after the stimulation, we observe changes in the tension of the connective tissue. Bowen moves may also affect the spindle cells and the joint receptors, which allow the body to respond by affecting muscle tension and proprioception. Muscle spindles and GTOs are continuously monitoring the degree of muscle contraction and tension within the tendons. Spindle cells detect the length of a muscle and are primarily located in the muscle belly. GTOs, on the other hand, are designed to detect muscle tension and are located at both ends of muscle tendons. GTOs complement the action of spindle cells, and vice versa, continually balancing each other’s actions.
We are learning now through newer fascial research that the stimulation of light touch affects the superficial fascial layer of connective tissue, which directly affects the deep fascial matrix. In his book Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, Myers (2009) has prolifically identified specific fascial lines that run throughout the body. By applying pressure to one part of the body, we can see a direct and profound release in another part of the system. It is this direct fascial connection that begins to make sense of what I see clinically. I can choose to include Bowen moves that affect these fascial lines in various parts of the body and will see the client have a whole body response that balances out the abnormal tensional patterns throughout the whole system. I frequently have clients report after a session that they feel taller, more relaxed, with an increased ease in maintaining postural alignment and subsequently more range of motion and less pain with their functional movement patterns.
Most Bowen treatment plans for particular diagnoses last anywhere between two-eight sessions. The treatments are very gentle and can be performed on children, adults, and the elderly. There are no precautions and contraindications for this form of manual therapy. Because of its gentle approach both on the patient and the therapist, it can easily be incorporated into a standard treatment program that involves patient education, ergonomics, therapeutic exercise, energy conservation, work simplification, and the progression of a home exercise program. Positive preliminary findings about the Bowen technique have been published on improved shoulder function (Carter, 2002), hamstring range of motion (Marr, Baker, Lambon, & Perry, 2011) and heart rate variability changes (Whitaker, Gilliam, & Seba). I anticipate that we will continue to see further positive studies coming out about this technique.
Because of our constant search as health care providers to find low cost, easy to implement techniques that demonstrate measurable functional changes as well as cost savings, I anticipate that we will continue to see Bowenwork successfully incorporated in a number of health care settings, such as schools, rehabilitation hospitals, acute care (Godfrey, 2001), outpatient therapy, skilled nursing facilities, and also in the wellness population.
For further information about Bowenwork and continuing education training opportunities in the United States, contact www.bowenacademyusa.com. Bowenwork is currently available in over 33 countries, and certification can be found internationally through the Bowen Academy of Australia at www.bowtech.com.
{Kelly Clancy, OTR/L, CHT, is the owner of The Seattle Center for Structural Medicine, an integrated health center in Seattle, Washington. She received her certification as a Bowenwork practitioner through the Bowen Academy of Australia. In 2010, she became a North American Bowen instructor through the Bowen Academy USA.}
Carter, B. (2002, November). Clients’ experiences of frozen shoulder and its treatment with Bowen technique. Complementary Therapies in Nursing and Midwifery, 8(4), 204-210. doi:10.1054/ctnm.2002.0645
Godfrey, J. (2001). The Bowen technique: gentle and effective antidote to pain. Nurse2Nurse, 1(12). Retrieved August 27, 2013, from https://www.chisuk.org.uk/ArticleItem-19kSEyxg-The_Bowen_Technique__gentle_and_effective_antidote_to_pain.html
Marr, M., Baker, J., Lambon, N., & Perry, J. (2011). The effects of the Bowen technique on hamstring flexibility over time: A randomised controlled trial. Journal of Bodywork and Movement Therapies, 15, 281-290.
Myers, T. W. (2009). Anatomy trains: Myofascial meridians for manual and movement therapists (2nd ed.).
Whitaker, J., Gilliam, P. P., & Seba, D. B. (n.d.). The Bowen technique: A gentle hands-on healing method that affects the autonomic nervous system as measured by heart rate variability and clinical assessment. Retrieved August 27, 2013, from The Bowen Technique: European College of Bowen Studies: http://www.thebowentechnique.com/Studies/bowen-and-heart-rate-variability.html
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