Bowen Therapy in the Treatment of Chronic Back Pain in patients with identified Disc Injury

Bowen Therapy in the Treatment of Chronic Back Pain in patients with identified Disc Injury – as published in the Journal of the Australian Association of Massage Therapists (AAMT) in November, 2013

This article is printed with permission: Pennington, K.  & Journal of the Australian Association of Massage Therapists

Katrina Pennington

BAppSc (Occupational Therapy), MAppSc (Acupuncture)

Kate works part time in private practice, using acupuncture and Bowen Therapy in Warrnambool, Australia.  She also devotes time to research and development.

This research report presents a case series study looking at the effectiveness of Bowen Therapy in the treatment of chronic back pain in patients with clear and demonstrable pathology.  Patients were selected by fitting the inclusion criteria such as having a Magnetic Resonance Imaging (MRI) report demonstrating disc protrusion or bulge, attending the clinic voluntarily during the six month study period, complaining of chronic back pain and being over the age of eighteen years old.  This was a retrospective audit, whereby patients were assessed before and after treatment.

The treatment outcomes detailed in this study provides some evidence of the overall effectiveness of Bowen therapy.  The research findings provide some quantifying data and background for a hypothesis that can be tested at a later date.

INTRODUCTION

In this age of evidence based medicine there is an increasing need to document our work and prove our worth as complementary health professionals.  Many anecdotal and extraordinary results are obtained in individual clinics but fail to gain wider recognition.  This type of study is one that can help communicate the types of results that complementary health practitioners may obtain.

Many massage therapists are aware of and use Bowen Therapy, a soft tissue therapy utilising cross fibre stimulation of specific areas of the body.  This study used a form of Bowen Therapy whereby treatments are targeted to a specific muscle or group of muscles, after having completed a holistic assessment on the client.  In this way, the Bowen Therapy was individualised to the patient and the presenting problem.  Treatment was not carried out as a set procedure which followed a specific script.  Assessment and reassessment formed an integral part of this approach, with assessment continually being utilised to guide the treatment during the session.

BACKGROUND

This research examines the use of Bowen therapy to treat back pain, a condition most massage and Bowen Therapists are familiar with.   According to Briggs and Buchbinder [1] up to 80%of Australians will experience back pain at some point in their lives and 10% will experience significant disability as a result.  Buchbinder [2] in another study writes that lower back pain and osteoarthritis are now ranked second only to cancer as the leading cause of disease burden in Australia.  She states “the finding confirmed the global burden of lower back pain was much higher than previously estimated and re-allocation of resources for research, treatment and prevention was urgently needed”.   Massage therapists and complementary health practitioners are at the coal face with this problem every day in their clinics.  This study highlights one alternative approach which has anecdotally helped to reduce this burden of care, albeit one that is not well recognised.

LITERATURE SEARCH

There is a paucity of literature regarding the treatment of Back Pain and Bowen Therapy treatments. This is not surprising given the young age of the profession, the lack of research skills within the profession and the general lack of funds available for such fringe therapies.  Although a search on EBSCO Health Watch revealed over 70 entries for Bowen Technique, less than ten articles were specifically on the treatment of back pain and Bowen Therapy.  Stephens [3] and James [4] deal specifically with back pain; one article is a single case study, the other is a case series report on treatment effects (n=49).  Both report that the therapy could have helped but that further research is required.  Other conditions in which Bowen therapy was researched scientifically were hamstring flexibility [5], frozen shoulder [6] and stroke rehabilitation [7].

METHODOLOGY

These patients all attended the clinic voluntarily and paid for the consultations themselves (no third party involved).  The inclusion criteria were: chronic back pain for a period of at least three months, a MRI report stating definite disc bulge/protrusion was evident at a relevant spinal level and subjects were at least over 18 years of age.  These patients all attended the clinic for four treatments, one week apart.  Exclusion criteria were: an acute injury or a history of spinal surgery.

Patients attended and filled in a pain scale (VAS), rating their pain on a scale where 1=pain free and 10=worst pain imaginable, immediate emergency care required. This scale was used to provide three measures in total- the pain being experienced “now”, the worst pain experienced in the last 24 hours, and the worst pain experienced in the last week.   Patients were also asked to rate the “bothersomeness” of their symptoms.  These same questionnaires were used after three treatments, one week apart.

The raw data and results are demonstrated in the following tables:

TABLE 1- RAW DATA

*VAS – Visual Analog Pain Scale, where clients are asked to rate the level of pain they have on a scale of 1=10, where 1= pain free, and 10= worst pain imaginable, emergency care required.  Clients rated their pain 3 times- how it was now, what the worst it was in the last week, and the worst it has been in the last 24 hours

** Adverse effects/comments- clients were asked whether they have noticed anything new or unusual which you think could be due to the Bowen Therapy

TABLE 2- POST  TREATMENT

RESULTS

The results showed that each case subjectively improved after treatment with targeted Bowen Therapy.  On average, using the VAS, scores moved from 8.2/10 to 2.1/10, a 6.1 point improvement for the “now” rating.  The average scores for VAS in the other two areas (worst pain in the last week and the worst pain experienced in the last 24 hours) were also an improvement of 6 points.  All subjects recorded “less bothersome than before” and appeared satisfied with the treatment provided.   This was the most significant improvement, moving an average of 7.2 points.  These results concur with the outcomes anecdotally achieved in the clinical setting.

DISCUSSION

This study and its results bring up several issues for discussion.

A review of the other measurements of clinical findings demonstrates the targeted form of Bowen Therapy was able to achieve its aim of minimising the impact of the disc pathology on the clients’ life.  The comments reveal that the participants were able to re-engage in their life activities.  This is evident by the reduction in the VAS scales on all levels, as well as examining the “bothersomeness” section and the comments section.  One lady cancelled her back surgery and resumed volunteer work, another participant was able to resume work and another said he was “doing everything now”.  These results are indeed helping to reduce the disease burden of back pain in Australian society.

TYPE OF BOWEN THERAPY

Previous Bowen research papers have focused upon the use of predetermined procedures.  This study has focused on patients who have been treated with a style of Bowen Therapy in which treatment is based upon of assessment of tonal symmetry and the use of Bowen Therapy that is targeted to the assessment finding.

INDIVIDUALIZATION

Table 2 demonstrates that the muscle spasms which “hold” the asymmetry  in place [8], was found in different areas of the body, including the cervical spine, the temporomandibular joint, the psoas muscle and the adductor group.  The Bowen Therapy provided for each case was therefore different.  Although it was similar in many ways, the focus and the procedures used varied according to need.  This means the Bowen therapy treatment provided was individualized for the presenting case.  This is problematic for the researcher, who is trying to provide scientific reproducible results.  However, in the massage clinic, each case is treated differently, with a different focus, depending on presentation.  It is precisely this individualization which sets the alternative therapist apart from our western medicine counterparts.

STUDY DESIGN ISSUES

This type of study generally does have inherent weaknesses.  These include a selection bias; since all patients attended the clinic voluntarily it is not representative of the population at large.  There is also a measurement bias, whereby patients may have exaggerated their own results for fear of offending the treating practitioner.  The objectivity of the study is compromised by the therapists own bias for the enthusiasm for the therapy as well [9].

These results show a significant improvement for all five patients.  However with such a small study (n=5), no firm conclusions can be drawn; however, it can be stated that positive outcomes occurred and further carefully designed research is required.

SUMMARY

Bowen Therapy was associated with improvement in Pain scales and a reduction in general “bothersomeness” of five patients with identifiable disc pathology.   These results are encouraging.  As previously mentioned, back pain is a leading cause of disease burden in Australia.  Health care officials and government bodies need to allocate more research funds and expertise to these hands-on manual therapies.

This small study also highlights areas of difficulty for research in a complementary health clinical setting.   These include the difficulties of funding, procuring research expertise, obtaining significant subject numbers for research studies and the difficulty in designing effective studies whereby holism and individualization of treatments can be included.  New research designs which allow for holistic concepts and individual treatment protocols need to be developed and utilised.

REFERENCES

1.  Briggs A, Buchbinder R.Back Pain: A National Health Priority Area in Australia? Med.J.Australia 2009;190(9)499-502
2. Buchbinder, R. Global Burden of Disease Study. The Lancet, 14 Dec 2012
3. Stephens, J  Treating sciatica with Bowen Therapy from The Journal of the Bowen Academy of Australia,2006,  1, 16-17
4. James, L . Case Study: Bowen Technique for Back pain and other conditions. Positive Health, positive Health Publications. Jan 2008, Issue 43 p 38-39
5. Marr M, Baker J, Lambon N, Perry J The effects of Bowen Technique on hamstring flexibility over time: a randomized controlled trial. J Bodyw Mov Ther. 2011 Jul; 15(3);281-90.
6. Carter B A Pilot Study to evaluate the effectiveness of Bowen Technique in the management of clients with frozen shoulder. Complement Ther Med 2001 Dec 9(4); 208-15
7. Duncan B, McHugh P, Houghton F, Wilson C Improved motor function with Bowen Therapy for rehabilitation in chronic stroke: a pilot study. J Prim health Care 2011mar1:3(1);53-7 2011
8. Pennington G A Textbook of Bowen Technique A Comprehensive Guide to the Practice of Bowen Technique Barker Deane Publishing 2012, Melbourne
9. Polgar S, Thomas S. Introduction to Research in the Health Sciences 3^rd Edition Churchill Livingstone Melbourne 1995