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An Effective Alternative for Treating Lower Back Pain Wayne State University Health Clinic 5200 Anthony Wayne DriveSuite 115Detroit, MI 48202

An Effective Alternative for Treating Lower Back Pain
Wayne State University Health Clinic 5200 Anthony Wayne DriveSuite 115Detroit, MI 48202

Heliotrope Enterprises
Executive Summary
Lower back pain is a common symptom prompting clinic visits in the University. The standard treatment is pain-relieving medications and rest from exertion but current trends in health care point to the increasing use of complementary and alternative medicine (CAM) in the treatment of lower back pain. The use of CAM is motivated by patients’ desire to avoid the side effects of frequent pain medication use. However, many CAM modalities only result in short-term pain relief which decreases patient satisfaction with these treatments.
The Bowen technique is a promising alternative modality for treating lower back pain. It is deemed effective, especially over time, based on its long use since its development in the 1950s. As such, the Wayne State University Health Clinic commissioned a research project to obtain evidence of Bowen technique efficacy which will be the rationale for adopting the technique as an alternative treatment for patients with lower back pain in the future.
This report presents the results of the study done to establish the efficacy of the Bowen technique based on secondary and primary data. A literature review was undertaken showing that pain relief is experienced in 1-3 treatment sessions and generally is sustained over time. Further, email interviews of 10 randomly selected certified Bowen practitioners in the state were done to see if the treatment is effective specifically for back pain based on their experiences. The main results of the study are as follows:
– There were 428 patients treated for lower back pain in the last year.
– Pain symptoms usually abated within 1-3 sessions in more than 50% of the patients; differences in the number of sessions are due to individual factors.
– Symptom improvement tended to continue over time and majority eventually achieved total lower back pain relief.
– Of those who experienced complete relief from pain, most had no more need of further treatments for lower back pain.
– Slightly more than a third of patients returned for maintenance treatment of lower back pain and is mainly due to reinjury, chronic conditions and noncompliance.
Findings of the primary research corroborate the findings in literature which builds strong evidence for the positive outcomes of the treatment. Thus, the Bowen technique is a safe and effective therapy for lower back pain which should be adopted by the University Health Clinic and combined with patient education to address unrealistic expectations, compliance and prevention of reinjury.

Introduction
Lower back pain is a major health complaint in the U.S. In its latest report, the CDC reveals a 30% incidence among American adults in a 2009 survey (National Center for Health Statistics, 2010). Lower back pain can significantly affect the performance of daily activities including work. It increases the number of sick days which correspond to lost economic productivity. The experience of pain considerably reduces the quality of life. It is no wonder that there is a high demand for effective treatment of lower back pain. Conventional treatments consist mainly of medications which can threaten health especially when taken long term. Hence, alternative techniques are better options. Although people obtain full pain relief from alternative modalities, the major complaint is that pain comes back after awhile. Therefore, there is interest in finding an alternative technique that provides relief over time.
The Bowen technique is one alternative treatment that is widely utilized today. Its popularity among alternative treatment practitioners and patients alike is largely due to the fact that it is not invasive, has no side effects and provides long-term pain relief compared to other treatments (Lofting, 2003). This is beside the other benefits gained from the technique’s holistic approach. The modality was popularized by the internationally-recognized Bowen Therapy Academy of Australia and is represented in our country by the Bowenwork Academy USA. The technique is presently governed by quality standards achieved through training and accreditation, the latter provided by the Academy in Australia (Bowenwork Academy USA, 2011). Currently, there are 369 accredited Bowen practitioners in the U.S. with 72 based in California, 47 in Washington, 28 in Texas, 26 in Michigan, and 26 in Oregon.
This report concerns an evaluation of the Bowen technique in terms of its efficacy in relieving pain for longer periods. It aims to provide first-hand evidence validating its efficacy over time as stated by patients and practitioners. Hopefully, the results will initiate more research interest on this modality and further establish the technique as a treatment for lower back pain. Specifically, this report will discuss the following:
– Development of the Bowen technique and how it works
– The Bowen technique as an alternative and non-invasive treatment
– Efficacy of the Bowen technique for back pain within 1-3 sessions based on case studies in literature and the results of primary research
– Percentage of patients coming back after pain level reach zero is supported by case studies in literature and the results of primary research
– The second research method
– Future directions for research on the Bowen technique
The evaluation is accomplished through a literature review as secondary research. Case studies and reviews on the outcomes of Bowen technique utilization in various patients were searched and retrieved from reputable websites, as well as from the ScienceDirect and EBSCOhost databases. A search of relevant books from the perspective of health care professionals yielded one for reference. Primary research was done through email interviews of Bowen technique practitioners using a randomly selected sample of those affiliated with the Bowenwork Academy.

Section I. Background of the Bowen Technique
The Bowen technique is internationally recognized as a complementary and alternative medicine (CAM) modality. Specifically, it is a type of body manipulation treatment, a category of CAM which utilizes either pressure, touch or movement of parts of the body as techniques (Snyder & Lindquist, 2006). With the persistent problem of back pain in the population and the costs and side effects of using pain relievers, it is important to widen the options of patients regarding treatment. The following discussion describes how the Bowen technique was developed and how it actually works.

Development of the Bowen Technique
The Bowen technique or Bowenwork is a therapeutic modality utilized for pain relief. Its development was undertaken by Tom Bowen, a masseur who had a long history of treating athletes and laborers in Geelong, Australia (Brief history, 2012). The most common complaint of his patients was body pain owing to their strenuous physical activities. Bowen used his expertise in massage therapy to relieve the pain of his patients. In his extensive practice, he noticed that there seemed to be a connection between the pain symptoms arising from musculoskeletal injury, problems involving the nervous system, and various Fig. 1 Tom Bowen other health conditions (Brief history, 2012).

How the Bowen Technique Works
The soft tissues most relevant to the Bowen technique are those that involve the muscles and nerves. Receptors located in these sites relay messages to the brain setting in motion the body’s natural ability to heal by repairing worn out or injured tissues, efficiently using nutrients, eliminating waste, ensuring adequate blood flow, permitting lymph drainage, keeping nerves healthy, and maintaining adequate muscle length (The Bowenwork, 2012). An important outcome of Bowen therapy is deep relaxation, a state of remarkably reduced stress that sets the stage for healing. Therapy, whose duration may range from as short as 15 minutes to as long as one hour, eventually results in decreased muscle tension, improved ranges of motion, reduced inflammation and relief from pain (The Bowenwork, 2012).
The Bowen technique is characterized by rolling movements aimed to slide skin over the soft tissues that lie beneath (Genders, 2006). These moves are accomplished using the fingers along with the application of light pressure to specific parts of the body that have been delineated by Tom Bowen in his decades of practice as the areas that trigger specific body responses (The Bowenwork, 2012). The use of gentle pressure is the hallmark of the Bowen technique setting it apart from massage therapy which uses deep pressure. The pressure used in Bowen treatment is considered a mild stimulus which contributes to its high efficacy. An explanation for this is provided by the Arndt-Schultz law adapted to Bowenwork from the field of medicine. It states that in an individual, only an ideal amount of stimulation can bring about optimal results and usually, it is minimal stimulation that works better than strong stimulation (Knight & Draper, 2008).
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Fig. 2 Different Bowen moves
The moves are followed by a rest period which allows the body to fully respond before the next moves are done (Genders, 2006). Wellness is achieved as treatment draws on the innate power of the body to restore itself leading to an abrupt and often long-term resolution of pain and other symptoms. It also recognizes that individual responses vary so that the practitioner must adjust treatment to accommodate the unique responses of patients and for this reason, patient assessment is done prior to treatment (Marr et al., 2010). Initial therapy usually consists of two sessions held weekly but further sessions may be needed. On the average, it would take three to eight treatment sessions for most health problems to completely resolve (The Bowenwork, 2012). The technique has been noted to be useful in treating more than 60 symptoms and conditions.

Section II. The Bowen Technique as an Alternative Non-Invasive Therapy
Compared to conventional pain therapy, which may be delivered through injections, and other alternative treatments such as acupuncture, the Bowen moves are not invasive. This means that the skin, acting as the body’s major protective barrier from the external environment, is not breached. In contrast, the use of injections to administer medications and the utilization of needles for acupuncture both penetrate the layers of the skin.
When proper infection control procedures are not taken, penetration of the skin can facilitate the entry of harmful microorganisms into the body (Injection safety, 2012). A non-invasive therapy like the Bowen technique has many advantages. First, the possibility of developing infections is zero since the skin is not breached. Second, there is no pain associated with treatment. Third, the likelihood of other complications such as tissue injury is virtually none.

Section III. Literature Review
A search of previous studies on the Bowen technique was done using Cinahl and ScienceDirect journal databases. Search terms used were Bowen technique/therapy/treatment/modality and lower back pain. The studies retrieved describe the efficacy of the Bowen technique specifically for back pain and also the people returning for retreatment due to pain recurrence.

Efficacy of the Bowen Technique for Lower Back Pain
The efficacy of Bowen therapy has been documented in literature. James (2008) documented the case of two older adult patients who benefited from the modality. One had extreme lower back and left hip pain owing to problems with the pelvic bone. He had poor posture and difficulty with movements of his arms and legs. After 30 minutes of initial Bowen treatment, he could stand straight and move with ease minus the pain. The other patient also had chronic lower back pain which limited her activities and subsequently developed depression. After initial treatment, her mood significantly improved along with her pain. Two more treatments totally relieved her pain and stabilized her mood. The study validates the pain-relieving effects of Bowen therapy. These case studies show that Bowen treatment can effect pain relief immediately after the first treatment session and that full resolution of symptoms is achieved during the third treatment.
In her book, Genders (2006) also describes two cases of children with cerebral palsy wherein the Bowen technique was effective. Decreased muscle tone, difficulties with balance and coordination and swallowing problems are some of the physical manifestations of this condition while low attention span, sleep disturbances and delays in speech development are some of the psychological and mental signs. Both children received a series of Bowen treatment sessions which resulted in marked and steady improvements in many of these signs. Most notable is the technique’s capacity to enhance musculoskeletal functioning even among children. The children’s parents were able to notice improvements right after the first treatment, again showing that the effects of Bowen therapy are immediate.

 

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