Background and Aim: Bowen therapy is a non-pharmacological method for treating a variety of pain conditions, but its effectiveness in treating tension-type headaches is unknown. We compared the effectiveness of Bowen therapy to a sham treatment.
Methodology: In a multi-center randomized controlled trial, the young adults with a tension-type headache were selected from the Neurology Department of DHQ hospital Sargodha and Niazi Medical Complex, Sargodha, with convenient sampling. A priori sample size calculation determined that 44 participants were needed. The participants were randomly assigned to two groups. Bowen Therapy (n=22) and Sham Treatment (n=22) groups were enrolled. The Bowen therapy was devised for two weeks. The measurement was taken at baseline and after two weeks. SPSS 22 was used for data analysis.
Results: At baseline, there was no difference found in the Bowen therapy and Sham treatment groups. We have noticed a significant decrease in the severity of pain and improvement in pain pressure threshold assessed by the visual analogue scale (VAS) and algometer in the Bowen therapy group after two weeks (<0.05). However, no changes in pain intensity were found in the sham therapy group. Furthermore, the headache frequency was also reduced in Bowen therapy compared to the sham therapy group (<0.05) after the study period.
Conclusion: The findings suggest that Bowen Therapy might be a beneficial and effective treatment for a tension-type headache. Further studies are needed using older adult’s participants.
Bowen Therapy is a pleasant, relaxing, and holistic rehabilitative therapy that can be used to treat a variety of health issues, including musculoskeletal disorders1. Although Bowen therapy is widely used for treating musculoskeletal conditions, it has not been studied extensively enough to provide evidence of its effectiveness. Bowen Therapy, also termed Bowen Technique or Bowen Work, is a manual therapy that involves a particular way of manipulating soft tissues. It was named after Thomas Bowen, an Australian manual therapist who worked in Victoria from 1959 to 19822 . Although Bowen Therapy is based on descriptions of Bowen’s work provided by people who were present when he practiced it, the name was not given to the technique until after he passed away3 . It functions by rolling over particular muscle groups to trigger the nervous system’s recognition of muscle tension4 . This rolling helps to lift the fascia, which helps to relieve muscle tension1,5 . Bowen moves are a set of precise, gentle pressure moves performed on specific points of muscles, myofascial tissues, ligaments, and tendons with the thumbs and fingers during a Bowen Therapy session. Two-to-five-minute pauses separate the movements to allow the body to respond3,6. Bowen Therapy is commonly used for treating various musculoskeletal issues conditions as well as suggested gastrointestinal, endocrine, and respiratory problems6,7 .
The most common primary headache in adults is a Tension-type headache. It is also known as a stress headache, a muscle contraction headache, or a psychogenic headache. There are two types of headaches: episodic and chronic. The frequency of episodic headaches may be high or low8. The duration of a headache can range from a few minutes to a week. The intensity is usually mild to moderate, with a band-like sensation around the head9,10,11,12. Two out of three people experience tension headaches at some time in their life. Differences according to gender were significant with a male: female ratio of 4:5 in a tension-type headache12. It has a substantial impact on general life activities, moods, and daily work. Its pathogenesis is not known; however, it is suggested to have linked to peripheral myofascial and central mechanisms2. It is challenging to treat due to unknown pathogenesis; the widely used treatments are physical therapy, medication, Soft tissue manipulations, relaxation, and cognitive therapy13,14.
A randomized controlled trial in a healthy population showed that Bowen Therapy improved flexibility in the hamstrings15 . Similarly, in another study, Bowen therapy significantly improved chronic pain after eight weeks2. However, the effects of Bowen Therapy on the physiological effects are still not well established. There are primarily assertions that it acts by rebalancing autonomic nervous system activity, altered myofibroblast activity, muscle relaxation, and changes in collagen type by normalizing muscle, fascia, and cutaneous sensory receptors. These theories were not yet tested in either healthy or clinical populations2,4,6,15. Currently, there are no high-quality trials that examine the effects of Bowen Therapy on various clinical populations. The effects of Bowen therapy in treating tension-type headaches is unknown. We compared the effectiveness of Bowen therapy to a sham treatment.
In a multi-center randomized controlled trial, the young adults with a tension-type headache were selected from the Neurology Department of DHQ hospital Sargodha and Niazi Medical Complex, Sargodha, with convenient sampling. A priori sample size calculation determined that 44 participants were needed. Participants were recruited having an age range between 18-35 years. They had pain for the last three months and had taken regular analgesic medication. Subjects were advised to use their normal analgesics and avoid any new remedy during the study. Subjects were excluded if they had any significant structural acquired or congenital changes in the spine, were pregnant, had postural changes, or had a significant neurological, musculoskeletal, or cardiac disease.
The subjects were randomly allocated to Bowen therapy (n=22) and the sham treatment groups (n=22). Subjects in the Bowen therapy group and the Sham therapy group received six treatment sessions for two weeks. Each session was comprised of 15-20 minutes. A trained physical therapist performed these sessions on specific points of muscles, myofascial tissues, ligaments, and tendons with the thumbs and fingers (Fig 1).
The investigators who collected the outcome measures were unaware of the groups. Pain intensity, pain pressure threshold was assessed by the visual analogue scale and algometer, respectively. All the measurements were taken before and after two weeks. SPSS 22 was used for data analysis.
The data was presented in mean and standard deviation. After two weeks of treatment sessions, the changes in the Bowen therapy and sham therapy groups were assessed using an unpaired t-test. The <0.05 p-value was set as significant. SPSS (version 22) for Windows was used to conduct the statistical analysis.
During data collection and study protocols, patient confidentiality was maintained. The study obtained ethical approval from the local departmental Ethics Committee of University of Sargodha. Before participating in the study, participants gave written informed consent.
The majority of those who took part in the study were women (60%) as compared to males (40%). Their mean age was 25±3.2. At baseline, there was no difference found in the Bowen therapy and Sham treatment groups in any variable. We observed a significant improvement in the intensity of pain assessed by the visual analogue scale (VAS) in the Bowen therapy group after two weeks (<0.05) (Fig. 2). However, no significant changes in pain intensity were found in the sham therapy group.
Fig. 2: Pain intensity on VAS in Bowen Therapy and sham treatment group at baseline and after two weeks. We observed a significant improvement in the pain pressure threshold assessed by the algometer in the Bowen therapy group after two weeks (<0.05). (Fig 3).
Fig. 3: Pain pressure threshold changes in Bowen Therapy and sham treatment group at baseline and after two weeks. The headache frequency was also reduced in Bowen therapy as compared to the sham therapy group (<0.05) after the study period (Fig. 4).
Fig 4: Pain frequency (Weekly) in Bowen Therapy and sham treatment group at baseline and after two weeks. Outcome measures: Pain intensity, Pain pressure threshold, pain frequency.
The first randomized controlled trial was conducted to investigate the effects of Bowen Therapy on patients with a tension-type headache. The study results revealed that Bowen Therapy could reduce pain severity and frequency of headaches in young adults after two weeks. Headaches are caused by muscular tension. It is frequently caused by poor sleeping habits/positions, bad posture, fatigue, or a high stress level. It has the sensation of a band of pressure around the head, starting at the point of tension and moving upward to cause pain. Bowen therapy relieves this tension, which lessens the severity of headaches9.
Our findings suggested that most of the subjects in the Bowen therapy group reduced pain severity after six sessions comprised over two weeks. In line with our results findings, different studies reported the effectiveness of Bowen therapy in reducing the severity of pain intensity in patients having musculoskeletal pain6. Similarly , in another study, scientists advocated that the short-term application of Bowen therapy can be helpful to improve quality of life, mental function, and wellbeing16,17. Bowen Therapy may help to establish a new proprioceptive benchmark that should be incorporated into the body structure.
Bowen therapy acts on the autonomic nervous system. It is suggested that it inhibit the sympathetic nervous system and activate the parasympathetic nervous system. Following chronic pain treatment, numerous studies have discovered an increase in parasympathetic activity 18, 19. Therefore, it may be speculated that Bowen therapy activates the periaqueductal grey and descending inhibitory pathway2, 20.
Bowen therapy is a gentle stretching of the fascia that can be easily applied to soft tissues with no side effects. Manipulation, on the other hand, can cause tenderness. Previous literature examining the effects of manipulation of the spine demonstrated conflicting results 21-23. Malourries and his fellows observed no effect of cervicothoracic manipulation on pain pressure threshold22,23. However, a substantial benefit was seen in cervical range of motion and headache24. In contrast, Rampazo and colleagues reported an increase in pressure pain threshold in cervical spine after applying manipulation on trigger points21. Likewise, De-Silva and fellows also observed an increase in pain pressure threshold after manipulating cervical spine22. Differential study results could be explained by differences in the intervention and study procedures.
Despite this, the current study finding of a trend toward an improvement in Pain pressure threshold after the application of Bowen Therapy maybe since it has a hypoalgesic effect. Bowen therapy may also help to restore fascial flexibility25,26.
We used a sequence of applications of Bowen therapy on peri-cranial musculatures to standardize the application of Bowen Therapy. Future studies are warranted on large sample sizes and old adults having a tension-type headache.
Bowen Therapy might be a beneficial and effective treatment for a tension-type headache.
- Félix GJ, Black L, Rodrigues M and Silva AG. The acute effect of Bowen therapy on pressure pain thresholds and postural sway in healthy subjects. J Bodyw Mov Ther.. 2017; 21: 804-9.
- Lee K and Lewis GN. Short term relief of multisite chronicpain with Bowen Therapy: A double-blind, randomized controlled trial. J Bodyw Mov Ther. 2020; 24: 271-9.
- Morgan-Jones M, Knott F, Wilcox H and Ashwin C. A pilot study of fascia Bowen therapy for 8-11 year-old boys with developmental coordination disorder. J Bodyw Mov Ther. 2019; 23: 568-74.
- Kage V, Bootwala F and Kudchadkar G. Effect of bowen technique versus muscle energy technique on asymptomatic subjects with hamstring tightness: a randomized clinical trial. IJMRHS. 2017; 6: 102-8.
- Gustafson SL. Bowenwork for migraine relief: a case report. International IJTMB.2016; 9: 19.
- Kopczyńska E, Malak R, Kostiukow A and Samborski W. Bowen Technique for patients with low back pain.WSN. 2018; 93: 68-81.
- Saeedpoor F, Asghari F and Sayadi A. Comparison the effectiveness of Bowen family therapy approach and McMaster’s model on intimacy, cognitive emotion regulation and family function in couples who exposed to divorce. J. Coun. Fam. Ther. 2019; 8: 191-214.
- Stephens G, Derry S and Moore RA. Paracetamol (acetaminophen) for acute treatment of episodic tension‐type headache in adults. Cochrane Database Syst. Rev.2016.
- Shah N and Hameed S. Muscle Contraction Tension Headache. StatPearls [Internet]. 2021.
- Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet. 2015; 386: 743-800.
- Krøll LS, Callesen HE, Carlsen LN, et al. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis. J. Headache Pain. 2021; 22: 1-12.
- Kamonseki DH, Lopes EP, van der Meer HA and Calixtre LB. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disabil. Rehabil. 2020: 1-10.
- Farhad A, Razzaq ZA, Sobia B, Saleem S and Shaheen F. Comparing the effects of cervical traction and cervical mobilization in the treatment of cervicogenic headache. PJR. 2015; 4: 21-5.
- Shah FS. Effects of myofascial release and vapocoolant spray with stretch technique on upper trapezius trigger points. PJR. 2016; 5: 43-8.
- Bimal Kumar J. Effect of Bowen Technique Versus Muscle Energy Technique on Asymptomatic Subjects with Hamstring tightness. IJMRHS, 2018;6 (4):32-36.
- Argenbright CA, Taylor-Piliae RE and Loescher LJ. Bowenwork for symptom management of women breast cancer survivors with lymphedema: a pilot study. Complement Ther Clin Pract. 2016; 25: 142-9.
- Williams SP, Malik HT, Nicolay CR, Chaturvedi S, Darzi A, Purkayastha S. Interventions to improve employee health and well‐being within health care organizations: A systematic review. J. healthc. risk manag. 2018;37(4):25-51.
- Perry J, Green A, Singh S and Watson P. A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP. Manual therapy. 2015; 20: 861-7.
- La Touche R, París-Alemany A, Mannheimer JS, et al. Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain?: a randomized-controlled trial. Clin J Pain. 2013; 29: 205-15.
- Picchiottino M, Leboeuf-Yde C, Gagey O, Hallman DM. The acute effects of joint manipulative techniques on markers of autonomic nervous system activity: a systematic review and meta-analysis of randomized sham-controlled trials. Chiropr. Man. Ther. 2019;27(1):1-21.
- Rampazo ÉP, Telles JD, Schiavon MAG and Liebano RE. Hypoalgesic effects of specific vs non-specific cervical manipulation in healthy subjects: a randomized crossover trial. J Bodyw Mov Ther. 2021; 28: 311-6.
- da Silva ÉPR, Telles JD, Schiavon MAG and Liebano RE. Hypoalgesic effects of specific vs non-specific cervical manipulation in healthy subjects: a randomized crossover tria. J Bodyw Mov Ther.2021;28:311-16.
- Malo-Urriés M, Tricás-Moreno JM, Estébanez-de-Miguel E, Hidalgo-García C, Carrasco-Uribarren A and Cabanillas-Barea S. Immediate effects of upper cervical translatoric mobilization on cervical mobility and pressure pain threshold in patients with cervicogenic headache: A randomized controlled trial. 2017; 40: 649-58.
- Silva AC, Biasotto-Gonzalez DA, Oliveira FH, Andrade AO, Gomes CA, Lanza FD, Amorim CF, Politti F. Effect of osteopathic visceral manipulation on pain, cervical range of motion, and upper trapezius muscle activity in patients with chronic nonspecific neck pain and functional dyspepsia: a randomized, double-blind, placebo-controlled pilot study.eCAM. 2018;48(22):16-20
- Weiss K, Kalichman L. Deep fascia as a potential source of pain: A narrative review. J Bodyw Mov Ther.2021; 28: 82-86.
- Seemal P, Noor R, Riaz S, Afzal H, Anwaar S, Niaz M, Seemal P. Effects of Muscle Energy Technique with and without Bowen Therapy in Text Neck Syndrome. Pak. J. Med. Health Sci. 2022 ;16(06):164-.169.
The Ziauddin University is on the list of I4OA (https://i4oa.org/) & I4OC (https://i4oc.org/).
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0). https://creativecommons.org/licenses/by/4.0/
Conflict of Interest: The author (s) have no conflict.
[i] Assistant Professor, Department Allied Health Sciences University Of Sargodha (0000-0002-3944-0084)
[ii] Lecturer, Department Allied Health Sciences University Of Sargodha (0000-0003-3086-7206)
[iii] Senior Lecturer, Shalamar Institute Of Health Science Lahore (0000-0002-8354-9247)
[iv]Physiotherapist, Aadil Hospital Defense Lahore (0000-0002-4824-2442)