Bowen Therapy 2: The Evidence

Actual evidence of the effectiveness of Bowen Therapy is a little scarce on the ground (well, it would be, wouldn't it, if you're arguing for meridians, trigger points, qi, chakras and auras?). The Cochrane Collaboration gives no results. PubMed gives one result, published in the now defunct Australian Journal of Holistic Nursing. Brief details are available on that site, as well as one other article. EoR hesitates to refer to these as studies since it appears they are "evaluations" of Bowen Programs, or reports.

Abstract: A six week program using Bowen Technique treated 31 Hospital and Community Health Service staff in a group setting providing an innovative way 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.

Abstract: A program in Byron Shire in 2002 offered Health Service staff treatments with Bowen Technique. The program was evaluated after 9 months. The evaluation explored the effect of the treatment on work related injuries. The responses indicated that the provision of Bowen Therapy for staff might be an effective way of reducing Workcover claims.

Eor wonders, at the very least, whether there were control groups in either of these reports?

While independent, peer-reviewed studies published in reputable journals are scarce on the ground for Bowen Therapy, powerful studies have been conducted by the bowenists themselves to show the power of this therapy. The same studies tend to get reported on most of the Bowen sites. The European College of Bowen Studies, for example, reports on lymphatic drainage.

I started with those with primary Lymphoedema and lymphovenous oedema. I found that most patients felt better, moved more freely and after an initial feeling of great tiredness, began to feel better. Over a period of months a gradual sustained limb volume reduction was noticed.

This 'study' is clearly a report of various case studies. No controls were provided, nor any blinding. Most of the patients were also undergoing other therapy at the same time.

Migraine is another favourite of the bowenists. In this study 42 volunteers (37 female, 2 male, 3 failed to complete the study) were given Bowen over a two week period, and then observed over the following four weeks. Migraine severity and frequency was self-reported. 31 participants reported a decrease in frequency and/or severity. 11 had no change, and 1 reported an increase. Again, many issues arise with this study: there was no control, the treatment^* group was not blinded, and the effect was self-reported (leading to a possibility of wanting to feel there was an effect, or wanting to please the researchers, however involuntarily). Also, of the three who did not complete the study, one had a "healing crisis" (EoR assumes that means they got worse, in which case they should be included in the adverse affects group) and one failed to return the final questionnaire (again, EoR would hypothesize that a likely reason for this is that the therapy was not working for that person). While the author claims a positive result in 79.5% of participants, 2.5% of participants got worse. EoR feels that anything that caused sick people to get worse in 5 out of every 200 applications (7 out of every 100 if you include the two completion failures) would immediately be denounced by these practitioners as an evil from Big Pharma with terrible side effects that were being ignored just so the commercially oriented therapy could continure to be pushed solely in order to make profits. Vioxx anyone? Of course, alties never sin in this manner.

Another favourite complaint is frozen shoulder.

We also wanted to gather evidence that would clearly address the frequently expressed opinion of the medical profession that complementary medicine works purely as "a placebo".

Actually, the medical profession doesn't argue that. They argue that you have to control for the placebo effect in order to see clearly whether any drug/therapy/intervention (complementary or conventional) has an actual effect. It is, however, pleasing to see the bowenists dragging in yet another woo therapy to describe how Bowen works:

It is often described as physical homoeopathy.

In this study 100 volunteers were randomly assigned to a treatment^* group, or a placebo control group, and were treated^* with Bowen for six weeks (three sessions total). Patients were assessed for six shoulder movements, and also self-reported pain levels. Various graphs are shown indicating a dramatic improvement in shoulder movement in those treated^* with Bowen against those who received only placebo.

This is probably the most promising Bowen study, but certain things need clarification: how many participants received treatment^* as opposed to placebo (EoR assumes 50/50, but this is not stated)? How was therapy/placebo applied and controlled, since this was done by a number of therapists across the UK, not in a single location? EoR had a little trouble reading it, but the only graph that shows a category of "worse" shows something like 8% got worse with Bowen (48% with placebo) - refer to his previous point about therapies that improve some people, but make a lot of others sicker above. EoR would also want to follow up the final point:

Placebo patients were treated with Bowen at the end of the placebo period. This produced unexpected results as, although the patients’ range of motion increased significantly, there was not such a great reduction in pain levels. This was compared to the patients who hadn’t experienced the placebo period first. This could be due to the fact that pain level is a subjective assessment and the fact that the patients had seen no initial improvement may have led to them subjectively assessing the pain to be more than those who got an initial improvement and therefore felt good about the treatment.

It could also be due to something else entirely. Some other effect? No effect at all? Some statistical anomaly? Poor design of the study?

EoR would also like to know how Bowen can treat^* fibromyalgia, but this page states

Further information will be available here very soon......

Various other 'studies' can be found if you go looking for them, but the great majority of them, EoR found, were "ongoing" and "promising".

Wikipedia lists the frozen shoulder study, a study on heart rate variability in fibromyalgia sufferers, and a study in hamstring flexibility as the only three extant studies into Bowen Therapy. Problems are noted with the first two (particularly seriously in the second where methodological bias is apparent), and the third study is yet to be published (though this is the most interesting, since it is claimed to be the "first properly conducted study, with approval from ethics and applying strict methodology").

To conclude (as EoR) began: evidence for Bowen Therapy is rather scarce. Given its "dramatic" potential to improve patients "even after a single treatment^*" (though, to hedge their bets, bowenists follow that amazing claim by usually immediately saying multiple treatments^* may be required, as well as "tune ups") EoR would expect to see a "dramatic" effect across a multitude of conditions. The evidence isn't there yet.

^*Bowen, of course, doesn't "treat" anything - it simply allows the body to "rebalance" and "heal itself".

Bowen Therapy 1: An Introduction