Holistic Assessment The next step in the

development of Bowen Therapy

Published on May 17, 2013 7:52 am
Holistic Assessment the next step in the development of Bowen Therapy : As Published in
In Touch, the quarterly, in-house journal of the Bowen Therapist Professional Association
(BTPA), U.K. May, 2013
Graham Pennington N.D., Grad Dip (Acupuncture)
Graham is the principal of Warrnambool Natural Medicine Centre in Victoria, Australia. He has
practiced Bowen Therapy, Naturopathy and Acupuncture for more than twenty years. He is the
author of A Textbook of Bowen Technique A Comprehensive Guide to the Practice of Bowen
Therapy.

INTRODUCTION
In 1986, Oswald Rentsch commenced what was to be an amazingly successful campaign to
promote and teach his personal interpretation of Tom Bowens approach to therapeutic
bodywork. Although Rentsch has undoubtedly succeeded in placing Bowen Technique on the
map of remedial bodywork, this success has come at a cost. Rentschs interpretation has come to
be viewed as representative of the way Bowen actually worked[1], yet there is ample evidence
that this is not so.
Whether or not Rentschs systematised, recipe version of Bowen Technique serves to illustrate
the majority of Bowens moves and procedures is debateable but it is certain that the repetitive,
sequential application of learned procedures is not indicative of Bowens approach.
One of the major differences that exists today, between the clinical approach used by Tom
Bowen and those who follow a derivative of Rentschs approach, is that the latter do not apply
the therapy in accordance with a system of holistic assessment. Applying the recipe style of
treatment is a symptomatic approach: no holistic assessment is required and the therapist
administers a similar treatment to each case, regardless of individual presentation.
If we are to remedy this situation the Bowen Therapy profession must embrace holistic
assessment methods. This involves a simple addition to the existing knowledge base an
addition that enables the therapist to customise each treatment according to individual
presentation. In this way, every treatment varies because it is targeted to the needs of each
patient. Of course this approach leads to better clinical outcomes.

BACKGROUND
Tom Bowen left no formal training notes about the type of therapy he practised. To understand
and define it, we must rely on accounts of the people who claim to have watched him work. It is
widely acknowledged that at least six men claim to have done so over the twenty-three years he
was in practice (1959-1982). Interestingly, each of those who observed him developed a
different interpretation of his work. Oswald Rentsch, has taught his interpretation widely, whilst
others have only taught their interpretation of Bowens work to a handful of practitioners.
Consequently, a Bowen industry has emerged where most published authors and treating
practitioners have been exposed to only one individuals interpretation of Bowens work.
At least two of the six men who observed Bowen have publicly rejected the recipe style
approach. Instead, they use a style of Bowen Technique in which treatment is applied based on a

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holistic assessment of the patient and is targeted to specific dysfunction, in accordance with
individual presentation. In addition to making a holistic assessment of each patient, they apply
the Technique in a holistic manner, recognising some of the complex interrelationships existing
within the body. They also use reassessment techniques to measure the effectiveness of their
treatments as they apply them.
Questions are now being posed regarding the basic assumptions of those teaching the popular
recipe style of the technique. Romney Smeeton, a chiropractor, and one of Bowens observers in
the seventies and early eighties, writes
I should state I am at odds with much of the current teachings of Bowens work, primarily
because they lack a system of individual assessment and are nearly all based on a systematized
use of standardised recipes and this was not Bowens approach.
Kevin Ryan, an osteopath, and another of Bowens observers, told the BTFA (Bowen Therapists
Federation of Australia) conference in 1998 that Bowen based his treatment interventions upon
his assessment of the patient and that

Tom Bowen never did a move unless he had an expectation of what effect it would produce.

Interestingly, according to the transcript of proceedings of the Committee of Inquiry into

Osteopathy, Chiropractic and Naturopathy, in 1973, Tom Bowen said, I average 65 patients per
day. This allowed him around five minutes for the treatment of each patient. The recipe style
of treatment widely taught and practiced today simply cannot be applied in this time frame. It is
clear that Bowen did not routinely apply the recipe style approach that currently bears his name.

HOLISTIC ASSESSMENT
Many Bowen Therapists can and do perform assessments of isolated muscle groups or individual
joints, much like a physiotherapist or a myotherapist. These assessments are helpful in providing
a baseline level of function from which to measure progress, but they do not embrace holistic
principles, or encourage therapists to view the body as a complex interrelated whole.

A holistic assessment is one that assesses the body for areas of dysfunction from a systemic
viewpoint. Holistic assessment procedures allow the body to be viewed in its entirety, allowing
the therapist to assess central nervous system (CNS) function, for example, whilst
simultaneously recognising some of the complex interrelationships which might influence it.
Importantly, it allows the therapist to identify primary sites of dysfunction rather than secondary
sites applied in this context, treatments are less symptomatic.

The few Bowen Therapists who do use such an assessment techniques claim it enables the
Bowen treatment to be targeted and goal-directed. Treatment goals can be assessed along the
way, thus the use of holistic assessment procedures can help to achieve better clinical outcomes.

Holistic Assessment Discussion

If the Bowen Technique is a holistic therapy should it not embrace holistic assessment methods?
A holistic profession is one that recognises the body as being more than the sum of its parts. A
holistic profession is one that recognises the importance of complex interrelationships that exist
within the body. Osteopathy is such a profession. We know that Bowen called himself an
osteopath and he did so because he embraced the underlying principles of osteopathy (and these

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are certainly holistic[2]). By utilising the recipe approach to treatment, some Bowen Therapy
practitioners may be ignoring the very principles upon which the technique is founded.
The good news is, holistic assessment techniques can be easily learnt and applied to provide a
more targeted, effective, goal directed Bowen Therapy.

Holistic Assessment Techniques

At the beginning of every treatment Tom Bowen made an assessment of tonal symmetry on each
patient. All Bowen Therapists still do this at the beginning of every treatment although many of
them may not realise they are doing it. A general rule that all therapists learn is that a treatment
should always be commenced with Moves 1 & 2 of the Lower Back Procedure the reason for
this is to assess tonal symmetry.

Tonal asymmetry is an expression of the patients dysfunction[3], so as therapists, our first

objective must be to identify the side of tightness. The tight side is synonymous with the side
of the functional short leg. The functional short leg acts as a signpost pointing the therapist to
the dysfunction that is the source of the patients problem. A simple premise applies here: if we
exert an influence upon that dysfunction, then the short leg will change.

The use of simple tonal assessment methods allows the therapist to identify relationships within
the body and to measure the effectiveness of any therapeutic input. For example, if there is a
functionally short right leg that does not change after the piriformis move, one can assume the
patients dysfunction is not associated with piriformis. If the leg length corrects following the
Temporomandibular Joint (TMJ) Procedure, one can recognise the patients dysfunction was
associated with the TMJ. Indeed, one could use this method of move and re-assess to
determine whether any individual move in the TMJ Procedure (or in any other procedure) had
actually corrected the dysfunction. For the therapist, such a process is both educational and
empowering.

Recognition of Interrelationships
Tom Bowen was, like many good therapists, aware of interrelationships which existed between
different areas of the body. Those who watched him work have claimed he attributed special
significance to a few areas of the spine. The notion expressed is that Bowen placed particular
emphasis on restoring function to the sacroiliac joints, the coccyx, the cervical spine and the
TMJ[4]. Bowen understood that a patients sciatic pain could be related to TMJ dysfunction and
that the patients migraines could be related to coccyx dysfunction[5] etc. The significance of
this for the Bowen therapist is that a patients primary dysfunction can be quite a long way from
the site of symptoms, thus making the need for holistic understanding and assessment even
greater.

Screening Procedures
As therapists, some of these interrelationships can be used to our advantage through the use of
some simple screening procedures. The Cervical Turn Test is one example. Once a functional
short leg is identified, the therapist can have the patient turn their neck to the left and then
reassess the functional short leg. The process can be repeated with the patient turning the neck to

3
the right. If the patients tonal asymmetry is associated with a problem in their neck, turning the
head to one side should result in a correction of leg length. When this test returns a positive
finding the therapist can confidently focus on locating and correcting the problem in the patients
neck this is the case regardless of whether the symptom presentation is idiopathic knee
swelling, headaches or asthma.

There is also a useful screening procedure to indicate sacroiliac joint dysfunction. The Sacroiliac
Joint Test[6] is carried out with the patient prone. The short leg is identified and the patients
knees are flexed to ninety degrees. A positive test result (indicating sacroiliac dysfunction) is
found when the short leg crosses over and becomes the long leg. A positive indication of
sacroiliac dysfunction would then send the therapist in search of the appropriate treatment
(possibilities include piriformis move, sacroiliac procedure, pelvic procedure etc.).
Reassessment could then be used to confirm restored sacroiliac function.

Holistic assessment techniques used in four cases of right sided hip pain
The following case studies serve to illustrate the principle that symptom presentation does not
give a good indication of the source of dysfunction. Dysfunction in one area of the body can
lead to symptoms in another area. These principles were well understood by Bowen.

Case 1: A 62 y.o. male patient presents with a ten day history of right sided hip pain.
This patient reports significant discomfort in his right hip following recent gardening activities.
Lying prone the patient is assessed and the right leg is found to be functionally shortened.
Moves 1 & 2 of the LBP are performed and the right paraspinal tissue is found to be tighter than
the left. Screening demonstrates a positive Derifield finding. The therapist administers a move to
the left piriformis muscle to assess its tenderness (using this as a control) and then the same
move is applied to the right piriformis. The patient reports increased tenderness on the right
side. Immediate reassessment indicates a return to almost equal leg length. A two-minute wait
is applied followed by reassessment. Tonal symmetry has returned and leg lengths are now
equal. There is no longer a positive Derifield finding. Follow up in one week reveals the patient
was significantly improved following the treatment and has been completely pain free for the last
5 days. Assessment at follow-up reveals tonal symmetry indicating no further treatment is
necessary.

Case 2: A 22 y.o. male patient (a football player) presents with a five week history of recurrent
right sided hip pain which is worse with exertion and gets better with rest.
Moves 1 & 2 of the LBP are performed and reveal elevated tension in the paraspinal tissue on the
left side. Tonal asymmetry is assessed revealing a functionally short left leg. Screening reveals
a positive Cervical Turn Test. Realising the patient has a primary issue affecting his cervical
spine the therapist moves quickly through the Lower & Upper Back Procedures (no waiting
necessary) and turns the patient. Tactile assessment of the neck reveals significant spasm on the
right side from the level of C1 C4. Moves of the Neck Procedure are used to address this
spasm and a two-minute wait is employed. Upon reassessment, tonal symmetry is evident.
Follow up in one week reveals the hip pain has significantly improved following the treatment
and the patient reports he has successfully completed a training session since the treatment.

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Assessment at follow-up reveals minor functional asymmetry which corrects upon cervical
rotation, indicating some further treatment is necessary.

Case 3: A 17 y.o. female patient presents with a two month history of recurrent right sided hip
pain which is worse with exertion and gets better with rest.
Moves 1 & 2 of the LBP are performed and reveal elevated tension in the paraspinal tissue on the
left side. Tonal asymmetry is assessed revealing a functionally short left leg. Screening is
unremarkable. The therapist moves thoroughly through the Lower & Upper Back Procedures
searching for abnormal tensions that may be associated with the presenting asymmetry. No
such tensions are identified and therefore no waiting periods are necessary. Upon turning the
patient, tactile assessment of the neck reveals nothing abnormal. Suspecting an adductor issue,
the therapist compares the tension of the left and right adductors, finding the left to be in a state
of tension. Moves of the Pelvic Procedure are used to address the adductor after which a two-
minute wait is employed. Upon reassessment, the patient demonstrates equal leg length. Further
enquiry reveals the young patient is an avid horse rider who regularly competes in dressage
events. She is counselled on looking after her adductors. Follow up in one week reveals the hip
pain has significantly improved following the treatment but some asymmetry remains. Further
treatment is required.

Case 4: A 40 y.o. female patient presents with a ten day history of right sided hip pain.
This patient reports significant discomfort in her right hip which began several days after
planting 60 trees. Lying prone the patient is assessed and the left leg is found to be functionally
shortened. Screening procedures are negative. Tactile assessment reveals tension and tenderness
of the paraspinal areas on the right side of the first lumbar vertebrae. The therapist administers
Move 1 of the Psoas Procedure[7] to the right paraspinal tissue and immediate reassessment
indicates a return to almost equal leg length. The Psoas Procedure is completed and a two-
minute wait is applied. Upon reassessment tonal symmetry has returned and leg lengths are now
equal. Follow up in one week reveals the patient was significantly improved following the
treatment and has been completely pain free for the last 3 days. Assessment at follow-up reveals
functional symmetry indicating no further treatment is necessary.

FUTURE DIRECTIONS
The recipe system may have placed Bowen Therapy on the map but it is self limiting. As each
patient presents, rather than using our own intelligence to solve their problems, we are urged to
work in robotic fashion, following strict predetermined treatment protocols.
The future of Bowen Therapy lies, not in the repetitive application of learned procedures but in
processes which enable the therapist to identify dysfunction, guide the intelligent application of
treatment and then confirm that the treatment was effective in restoring function. Such processes
must be heavily focused upon holistic methods of assessment.
Thirty years have passed since Tom Bowen left his legacy in our care. It is now time for the
profession of Bowen Therapy to move forward and adopt holistic assessment techniques.

[1] On Rentschs early teaching notes distributed in 1987, the words Bowen Technique an
interpretation by Oswald Rentsch, were printed on each page. Over time these printed words

5
have disappeared and current teaching manuals use the phrase The Original Bowen Technique.
Both phrases acknowledge the existence of other interpretations of Bowen Technique.
[2] The four tenets which underpin osteopathy were laid down by A. T. Still. They are: 1. The
human body functions as an integrated, interrelated, whole unit. 2. Structure and function share
a reciprocal relationship. 3. There exists in the body an innate capacity for self-regulation and
healing. 4. Therapeutic intervention is based upon an understanding of these three points.

[3] The following statement was made by D.D. Palmer, the founder of chiropractic: Life is the
expression of tone. In that sentence is the basic principle of Chiropractic. Tone is the normal
degree of nerve tension. Tone is expressed in functions by the normal elasticity, activity,
strength and excitability of the various organs (and tissues), as observed in a state of health.
Consequently, the cause of disease is any variation of tone.
[4] These sites are significant because they are all associated with dural attachment.

[5] Indeed, Bowen was not alone in recognising these relationships. Osteopaths and chiropractors
have long been aware of these relationships. Sacro Occipital Technique (SOT) is a popular form
of chiropractic which recognises the relationship that exists between structures at opposite ends
of the spine. Many schools of chiropractic refer to the Lovett-Brother relationship which details
this principle.
[6] This screening procedure is derived from the Derifield Test which is commonly used by
chiropractors.
[7] Also known as the Kidney Procedure refer A Textbook of Bowen Technique A
Comprehensive Guide to the Practice of Bowen Therapy

The Bowen Technique Mechanisms for

Action
Published on May 15, 2013 11:25 am
This article is printed with permission: Wilks, J. Bowen technique: Mechanisms for action. It
was published in the Journal of the Australian Traditional Medicine Society. 2013; 19(1):33-35.
Permission from the author has also been obtained.

The Bowen Technique Mechanisms for

Action
John Wilks MA RCST BTAA FRSA, Senior instructor with Bowtech, the Bowen Therapy
Academy of Australia. Web: www.bowentraining.com.au Email: cyma@btinternet.com
ABSTRACT
The efficacy of the Bowen Technique can be explained by its action on a variety of structures in
the body. Bowen moves stimulate several types of intrafascial mechanoreceptors that affect
muscle tonus and increase vagal tone. The type of move used in Bowen also assists the hydration
of fascia, which in turn encourages better vascular and nerve supply.
THE BOWEN TECHNIQUE
The technique developed by Thomas A. Bowen (1916-1982) is unusual in that it affects tissues
in a variety of ways simultaneously. Its effect is not limited to relaxing tight muscles or
increasing hydration in the fascia but it can also be used to increase tonus in the core muscles and
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contractile strength within the fascia and to initiate a lowering of sympathetic tone in the
autonomic nervous system.
To understand how the Bowen Technique works it is useful to examine the varied role of
connective tissue, and particularly fascia, in the body. For example, one of fascias crucial
functions in efficient locomotion is its property of recoil, which depends on good hydration (an
important effect of Bowen work). This can be seen clearly in the thoraco-lumbar aponeurosis,
which is the starting point for a lot of Bowen work. In walking and running, this area of fascia
acts as a kind of bungee and greatly reduces the amount of effort that is needed to exert via the
muscular system. This is demonstrated in the movement of animals such as kangaroos, lemurs
and gazelles as well as humans.[1] Where this recoil property is compromised through a lack of
hydration and reciprocal tension in the fascia, certain movements like running and walking
require more exertion through the muscular system. Change in the quality of the lumbar
aponeurosis is also considered an important factor in lower back pain as this area is highly
innervated with sensory receptors. In fact, fascia is the most richly innervated tissue in the body,
being effectively its largest sense organ, with the highest density of proprioreceptors[2] as well
as being the key tissue addressed in Bowen treatments.[3]
The Bowen Technique has a very specific effect on fascia. Primarily, Bowen moves are made
directly on muscles (although some moves are also performed on tendons, ligaments, joints and
nerves), but because all these structures are surrounded by a network of fascia, it is inevitable
that whatever structure is activated, the fascia that surrounds it (and is integral to it), is affected
at the same time, albeit with slightly different physiological effects. Apart from the sensory
receptors in the skin such as Merkels Discs, Meissners corpuscles and Free Nerve Endings,
there are key intra-fascial mechanoreceptors that are activated during a treatment. These are
largely Golgi, Ruffini and Interstitial receptors. Occasionally, Bowen moves involve a fast
release of pressure, which affects the Pacini receptors (involved in proprioception), but these
types of move are rare. Mostly, Bowen moves involve taking skin slack, applying a challenge (or
gentle push) for a few seconds, and a slow steady move over the structure being addressed.
Bowen moves mostly consist of a type described by Schleip[2] as slow melting pressure. These
types of move strongly affect the numerous Ruffini receptors,which are found in the skin and in
many deep tissues of the body including the lumbar fascia, dural membranes, ligaments and joint
capsules etc. Slow moves over these structures have a lowering effect on the sympathetic
nervous system (SNS)[4] and induce a profound sense of relaxation in the client. Other receptors
that induce a decrease in the SNS and corresponding increase in vagal tone, are the interstitial
receptors, which are found nearly everywhere in the body. Some of these receptors (particularly
the nociceptors) are high-threshold, and known to be involved in chronic conditions, but
interestingly about 50% of these receptors are low-threshold fibres and are sensitive to the kind
of very light touch (similar to skin brushing) that is used in some Bowen moves. This mechanism
explains the deep relaxing effect of Bowen treatments and the crucial healing effect of
increased vagal tone.[5]
On a more structural level Bowen moves affect the Golgi receptors (found in myo-tendinous
junctions, ligaments and the deep fascia) by using slightly more pressure and longer holding
times, and by working close to origins and insertions. It has been suggested that manipulation of
these receptors causes the firing of alpha motor neurons resulting in a softening of related tissues.
This process also seems to happen via gentle stretching of the tissues such as in yoga.[4] Muscles
themselves are stimulated by the challenge in a Bowen move, which activates the muscle
spindles in response to the stretch on the muscle fibres. Much of this response is mediated at the

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level of the spinal cord but some impulses do make their way to various areas of the brain like
the cerebellum, the basal ganglia, the reticular formation and the brain stem, before being co-
ordinated in the thalamus and sent back down the various motor nerve tracts to the muscles or
organs.[3]
It takes around 90 seconds for muscles to respond in this way, so it is interesting that it is normal
practice for Bowen therapists to leave a two minute break (and sometimes longer) between the
various activations or moves. It would appear that by inputting targeted, but minimal sensory
stimulus during a Bowen session without extraneous interference, it allows the body to re-
calibrate. For example Dietz et al6 have shown that the CNS can reset Golgi tendon receptors
and related reflex arcs so that they function as delicate antigravity receptors.[4]
One thing students of the Bowen Technique are taught is always to get clients up at the end of a
treatment so that both feet land on the ground at the same time, thereby stimulating a response in
the many Golgi receptors in the plantar fascia of the feet.
Certain factors are important for a successful Bowen treatment, critically that there is not
excessive stimulation of the CNS by an unnecessary number of moves or distracting the client.
This is particularly important when there is a general sensitization of nerve pathways and tissues
as is the case in chronic pain, which is why a favorite Bowen maxim is less is more. Bowen
also affects the fascia directly through encouraging hydration, as this process is assisted by
gentle stretching, repetitive squeezing and release with pauses, (ie pressure applied and then
waiting) all elements of a Bowen treatment. The waiting time would appear to be essential as
there is a significant increase in hydration after half an hour.[7]
CONTRACTILE PROPERTIES OF CONNECTIVE TISSUE
When looking at possible mechanisms for how the Bowen Technique works, it is important to
differentiate how touch and manipulation affect muscle contraction (or lack of tonus) as opposed
to connective tissue contracture (or in the case of some hyper-mobile clients, a potential lack of
contractile properties in the tissues). Muscle contraction is a high-energy shortening of tissues,
whereas contracture of connective tissue is a slow, (semi) permanent, low-energy, shortening
process, which involves matrix-dispersed cells and is dominated by extracellular events such as
matrix remodeling.[8] For efficient functioning of the human system connective tissues need to
hold certain contractive patterns to maintain stability. In dissection you can see clearly that all
connective tissues are under stress for example dissected nerves and blood vessels have a
length of around 25 30% less than their in situ length.[8]
Myofibroblasts play an essential role in maintaining reciprocal tension networks in the
connective tissues, being a type of fibroblast, the building block cell of fascia, which have the
characteristics of smooth muscle. The constructive tension within the connective tissue is an
essential element of the bodys biotensegrity system[9]. Myofibroblasts are affected in many
kinds of connective tissue disorders such as Dupuytrens and frozen shoulder. Bowen affects
Myofibroblasts directly as they contract and expand slowly in response to factors such as pH and
stress.[2] This occurs over a period of minutes or hours and so expansion or relaxation of
myofibroblast activity will certainly occur during the length of a Bowen treatment (normally
around 45 minutes) as the person relaxes. Soft-tissue techniques such as the Bowen Technique
rely on effecting structural change by directly influencing the biotensegrity aspect of the
connective tissue via their action on myofibroblasts, which is partly why Bowen has such a
powerful and measurable effect on posture.
There is a number of different techniques available to the Bowen therapist that will be used
depending on what outcomes are necessary for a given client in a given situation. For example,
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moves can be done faster or slower, with longer or shorter challenges, deeper of lighter pressure,
medially or laterally, or anteriorly or posteriorly. All these factors will have different effects in
terms of lowering vagal tone, increase or decrease in muscle tonus etc.
Assessment has been, and always will be, an essential and highly individual starting point for
determining how to apply the Bowen Technique with each client. For example, for each client
presenting with similar symptoms of lower back pain there may be a great number of different
reasons for those symptoms. A Bowen treatment will therefore never be the same from client to
client even though they may present with identical symptoms.
The following wise statement from the ancient Chinese poet Lin Yutang should be the mantra of
all holistic therapists: A doctor who prescribes an identical treatment in two individuals and
expects an identical development, may be properly classified as a social menace.
Working with clients in chronic pain is a challenge for any therapist. Prolonged inflammation
has been shown to have a deleterious effect on many structures and mechanisms in the body and
may derive from a variety of causes, such as old injuries, operations, and inflammatory
conditions like endometriosis. It is well known, for example, that inflammation in the gums
(gingivitis) or in the jaw after root canal fillings can affect organs such as the heart and cause
joint and muscle pain. Frequently the original site of the inflammation is asymptomatic but will
have effects elsewhere in the body and is a key factor in chronic pain. Gentle therapeutic
approaches such as Bowen that directly affect the myo-fascial system by gently stimulating the
interstitial receptors and lowering their tendency for hypersensitivity would appear to be the
most obvious choice for clients in chronic pain.
There is considerable interest amongst manual therapists in the concept of fascia as a
communication medium in the body.[10] It has been known for many years that piezoelectric
effects initiated by stressing collagen fibres have a strong healing effect on tissues.[11]
There is no doubt that something of this kind is occurring during a Bowen treatment as the
impulses created by stressing collagen fibres in the challenge and roll of a Bowen move can be
felt clearly with sensitive palpation. These impulses seem to have the effect on the tissues of
freeing areas of fascia that are stuck, or what Deane Juhan[12] refers to as thixotrophic. Scar
tissue that is raised and red responds to Bowen moves by becoming visibly less fibrotic and less
inflamed quite quickly. This means that there is some profound physiological change in the
tissues, specifically in the ratio of type I and type III collagen. This is significant as this ratio is a
crucial element in the make-up of fascia in terms of laxity.
The exquisite images in the DVDs produced by Dr J-C Guimberteau[13] show clearly why
techniques that encourage more fluidity in the fascia, such as Bowen, would have a profound
effect on vascular and nerve supply by freeing up the connective tissues that surround capillaries,
veins, arteries and nerves. The effectiveness of the Bowen Technique in its treatment of a wide
range of conditions is borne out by clinical experience, and although more research needs to be
done in this area it is clear that there are well-researched mechanisms by which the Bowen
Technique can assist in terms of fascial fitness, reducing stress levels, increasing vascular supply
and improving mobility and posture.[14]
References :
1. Kram, R., Dawson, T.J. Energetics and Biomechanics of locomotion of Red Kangaroos,
Comp. Biochem. Physiol.B 1998
2. Schleip, R., Fascia as a Sensory Organ, World Massage Conference Webinar, Nov 2009
3. Wilks, J., The Bowen Technique, the inside story CYMA Ltd 2007

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4. Schleip, R Fascial plasticity a new neurobiological explanation. Journal of Bodywork and
Movement Therapies, 2003, 7(1):11-19 and 7(2):104-116
5. Gellhorn, E., Principles of Autonomic-Somatic Integrations, University of Minnesota Press
1967
6. Dietz, V., Regulation of Bipedal Stance Experimental Brain Research 1992 Vol 89 (1) pp 229
231
7. Schleip, R. & Klingler, W., Fascial Strain Hardening Correlates with Matrix Hydration
Changes Fascia Research, 2007 Elsevier p 51
8. Tomasek, J et al. Myofibroblasts and Mechano-regulation of Connective Tissue Remodelling
Nature Reviews 3 (May 2002) pp349 363
9. Levin, S & Martin, D-C, Biotensegrity. The Mechanics of Fascia. The Tensional Network of
the Human Body Churchill Livingstone, Elsevier 2012 (pp 137 142)
10. Oschmann, J Fascia as a body-wide communication system The Tensional Network of the
Human Body Churchill Livingstone, Elsevier 2012 (pp 103 109)
11. Becker, R., The Body Electric Harper 1985
12. Juhan, D, Jobs Body a Handbook for Bodywork Station Hill Press, NY 2002
13. Guimberteau, J-C., Muscle Attitudes DVD, EndoVivo productions 2010
14. Wilks, J., Understanding the Bowen Technique, First Stone Publishing 2004

Bowen Therapy: A Review of the Profession

Published on February 16, 2013 11:56 am
Bowen Therapy: A review of the profession as published in the Journal of the Australian
Traditional Medcine Society in December, 2012 (JATMS Volume 18, Number 4)
This article is printed with permission: Pennington, K. Bowen therapy.
Journal of the Australian Traditional-Medicine Society. 2012;
18(4):217-220.
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.
ABSTRACT- This article reviews the current profession of Bowen Therapy. It considers the
history of the Bowen technique and the forces which have influenced its development to date.
The article outlines some of the issues relevant to the Bowen Therapy profession as a whole. It
also considers whether there is a philosophical basis underlying the technique and whether
holistic patient assessment processes are relevant to the profession. Future directions and
challenges are outlined.

DEFINITION
Bowen Technique is any therapeutic approach to body work which is based upon the clinical
work of Mr Thomas Ambrose Bowen. It describes an increasing number of approaches, each
based on the conclusions and interpretations of particular individuals who observed Bowen (or
subsequent therapists who had some form of Bowen training). Characteristically, Bowen
Technique involves unique rolling movements over soft tissue, performed at precise locations on
the body. It is said to be effective in bringing relief to musculo-skeletal problems, such as sore
backs[1], necks and limbs.[2] It has also said to be effective in treating internal problems such as
hay fever[3], stress[4] and migraines.[5]

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INTRODUCTION
October, 28, 2012, marked the thirtieth anniversary of the passing of Thomas Ambrose Bowen.
He is said to be the founder of the Bowen Technique, a popular soft tissue therapy which is
known worldwide.[6] This significant anniversary provides an opportune time for the profession
to reflect on its past and make a plan for the future.
At the time of his death, there was no Bowen Technique; Bowen himself was an unrecognised
manual therapist working in his own clinic, using a unique treatment method. The term Bowen
Technique was not coined until several years after his passing.
Bowen Technique has been delivered to us by a handful of therapists, each of whom developed a
personalized interpretation of the methods they saw Bowen apply while observing him in his
clinic. It seems that one of these interpretations alone has so far defined the publics
understanding of Bowens approach to bodywork.

PREVALENCE
Bowen Technique is now practised in thirty countries and taught in more than twenty.[7] There
is a comprehensive network of training facilities and self-accredited teachers and schools, and at
least one government recognised school in Australia.[8] Although known primarily as Bowen
Technique, there is a myriad other names by which variations of the technique are known. Some
of these are Bowen Therapy, Fascial Therapy, Smart Bowen, Fascial Kinetics, Neuro-structural
Integration (NST), Fascial Bowen, Bowenwork and probably other names as well. In 2009 there
were over 26,000 practitioners worldwide.[9] The techniques popularity is probably due to the
fact it is fairly simple to learn, easy to apply and is frequently effective as therapy.

HISTORICAL ASPECTS
Bowen left no formal training notes about the type of therapy he practised. To understand and
define it, we must rely on accounts of the people who claim to have watched him work. It is
widely acknowledged that at least six men claim to have done so over the twenty-three years he
was in practice (1959-1982). Interestingly, each of the men who observed him developed a
different interpretation of his work; perhaps due to differing educational backgrounds, differing
time periods of observation or other unknown factors. One of these men, Oswald Rentsch, has
taught his interpretation widely, whilst others have taught only a handful of practitioners. The
result is that a Bowen industry has emerged but most practitioners have had access to only one of
the interpretations of Bowens work.
Rentsch observed Tom Bowen at work in the mid-seventies. He was also responsible for taking
Bowen Technique to the world at large.[10] Since 1984 he has taught trainees to apply a
systematized recipe version of Bowen Technique. The Bowen industry at large has adopted
Rentschs interpretation; however, other interpretations of Bowens work have not been widely
available. To date, most of the published authors and treating practitioners of Bowen Technique
are using Rentschs approach. On Rentschs early teaching notes that were distributed in 1987,
the words Bowen Technique an interpretation by Oswald Rentsch,[11] were printed on each
page. Over time these printed words have disappeared and current teaching manuals use the
phrase The Original Bowen Technique.[12] Both phrases acknowledge the existence of other
interpretations of Bowen Technique.
At least two of the six men who observed Bowen do not use this recipe style approach. They use
a style of Bowen Technique in which treatment is applied based on a holistic assessment of the
client, and is targeted to specific dysfunction, in accordance with individual presentation. In

11
addition to making a holistic assessment, they apply the Technique in a holistic manner,
involving a recognition of interrelationships existing within the body. They also use
reassessment techniques to measure the effectiveness of their treatments as they apply them.
Questions are now being posed regarding the basic assumptions of those teaching the popular
recipe style of the technique. Romney Smeeton, a chiropractor, and one of Bowens observers in
the seventies and early eighties, writes
I should state I am at odds with much of the current teachings of Bowens work, primarily
because they lack a system of individual assessment and are nearly all based on a systematized
use of standardised recipes and this was not Bowens approach.7
Kevin Ryan, an osteopath, and another of Bowens observers, told the BTFA (Bowen Therapists
Federation of Australia) conference in 1998 that
Tom Bowen never did a move unless he had an expectation of what effect it would produce.
Interestingly, according to the transcript of proceedings on the Committee of Inquiry into
Osteopathy, Chiropractic and Naturopathy, in 1973, Tom Bowen said, I average 65 patients per
day.[13] This allowed him around five or six minutes for the treatment of each patient. The
recipe style of treatment widely taught today cannot be applied in this time frame. It is clear that
Bowen did not routinely apply a recipe approach.

PROFESSIONAL ISSUES
The Australian Traditional Medicine Society has recognised Bowen Therapy as a legitimate
modality of practice for its members, since Dec 2011.[14] Over the last two decades, a number
of Bowen Technique Associations have formed which have different Regulations and Codes of
Ethics and serve their members in various ways, such as through government advocacy and
policy formulation. Health fund rebates are now provided in Australia for treatments offered by
members of recognised Bowen Therapy Associations. It would seem that the Bowen Technique
has matured and grown up! But has it?
1. Lack of Underlying Philosophy:
In regard to various interpretations of the recipe version of Bowen Technique, there seems to be
a lack of basic theory and philosophy which many would consider vital to any profession. The
majority of those who based their professional approach on Bowens work claim he utilised a
holistic approach, not a symptomatic one.
Competence in any profession depends upon an understanding of the theory that underlies it.
[15] For most health professions, underlying philosophy and principles guide clinical practice,
yet this does not appear to be the case with regard to the practice of Bowen Technique. Perhaps
this lack of theory and philosophy, however, is only a problem if we wish to perceive Bowen
Technique as a holistic therapy in its own right, rather than a set of symptomatic treatments. If
the profession is to progress, it needs to clarify its principles and theories in order to guide its
development.
2. Lack of Holistic Assessment:
Many Bowen Therapists can and do perform assessments of isolated muscle groups or individual
joints, like a physiotherapist or a myotherapist. These assessments are helpful in providing a
baseline level of function from which to measure progress, but they do not embrace holistic
principles, or encourage therapists to view the body as an interrelated whole. A holistic
assessment is one that assesses the body for areas of dysfunction from a systemic viewpoint.
The few Bowen Therapists who do use such an approach claim it enables the Bowen treatment to
be targeted and goal-directed.7

12
First principles are the fundamental assumptions on which a particular theory or procedure is
thought to be based. Adopting and applying such principles may help the profession to clarify
the goal of the Bowen Therapist. The profession could consider the following questions: Is
Bowen Technique a holistic therapy in its own right, or is a symptomatic treatment, or is it both,
depending on how it is used? Would embracing a holistic model of patient assessment assist in
obtaining better clinical outcomes?

3. Disintegration:
The growth of the profession over the last thirty years has been characterised by individual
motivation, where portions of the technique have been sectioned off, patented and sold to the
public under differing names. This fragmentation has hindered the ability of the profession to
develop further because each splinter group attempts to create a different identity for the
technique.

DISCUSSION
1. Does an appropriate philosophical framework already exist?
The profession may have already been exposed to a philosophy and basic principles. These
principles to date have not been taught extensively as part of the Bowen Technique education
and this may be to the detriment of the development of the profession. Embracing them will also
help establish the philosophical background and cement the foundation of the treatment
technique as a whole. Guiding principles may also help the therapist when treatment is not
progressing as expected.
These principles are not new; they are borrowed from the osteopathic profession. Bowen
described himself as an osteopath, and sought recognition for the work he did from the
Osteopathic Board at the time.[16] The underlying principles of osteopathy are
1. The human body functions as an integrated, interrelated whole unit
2. Structure and function share a reciprocal relationship
3. There exists in the human body an innate capacity for self regulation and healing
4. Therapeutic intervention is based upon an understanding of these three points[17]

It is clear that Bowen embraced these principles.

2. Are holistic assessment techniques relevant?

In the world of remedial bodywork, regardless of modality, most therapeutic interventions are
applied in response to patient assessment. Across all professions, assessment forms an
invaluable tool to guide treatment selection and application. Most assessment techniques are
generic; they are relevant to all corrective therapy because they provide important information
about the patients condition, as well as the response to treatment. Up to now, most Bowen
therapist have applied a standardised therapy to every patient, independent of holistic
assessment, largely due to a lack of education in this area. Most recently however, the
profession of Bowen Therapy is being challenged to address the inherent lack of holistic patient
assessment. If the Bowen Technique is a holistic therapy should it not embrace holistic
assessment methods?

3. Disintegration

13
The disintegration to so many variations of Bowen Therapy has resulted in the technique itself
being hard to define. The profession itself lacks direction since it cannot agree amongst the
differing parties on basic elements about, for example whether to keep it pure or to progress
and develop with research.

IMPLICATIONS
By utilising the recipe approach to treatment, some Bowen Technique practitioners may be
ignoring the very principles upon which the technique is founded. Applying the recipe style of
treatment is a symptomatic approach: no holistic assessment is required and the therapist
administers the same treatment to each case, regardless of the presenting problem. At least two
people who observed Bowen at work dispute this approach. In their interpretation of his work
they make a holistic assessment first, then, on the basis of their findings, they administer an
appropriate Bowen treatment.

FUTURE DIRECTIONS
This article has outlined some professional issues and problems for the profession to consider. Is
it time to formally adopt a philosophy and embrace a set of guiding principles? Is it time for the
profession of Bowen Therapy to adopt holistic assessment techniques? Is it time for the different
Bowen therapy groups to come together and work for the benefit of the profession as a whole.
Would these changes ultimately help each practitioner achieve better clinical outcomes?
It is clear the Bowen Technique is a treatment technique that is here to stay. Classical
astrologers refer to the Return of Saturn when the planet Saturn has made one orbit around the
earth and returns to the position it was in when that person or idea was born. It is the instigator
of change and a crossroad period when life altering decisions are made. With the first Saturn
return, a person leaves youth behind and enters adulthood. It takes about twenty nine and a half
years to occur.[18]
As we approach the thirtieth anniversary of Bowens passing, is it time these issues were
addressed?

References
[1] Marr M, Lambon N, Baker J. Effects of Bowen Technique on flexibility levels: implications
for fascial plasticity. Journal of Bodywork & Movement Therapies. 2008 Oct; 12(4): 388.

[2] Carter B. A Pilot Study to evaluate the effectiveness of Bowen Technique in the
management of clients with frozen shoulder. Complementary Therapies in Medicine. 2001 Dec;
9(4):208-15.
[3] Bowen for Hayfever. Positive Health Publications. 2008 Jun;(14):7 Available from:
Ebscohost.

[4] Dicker A. Using Bowen therapy to improve staff health. The Australian Journal of Holistic
Nursing 2001 April; 8(1):38-42.

[5] Godfrey J. Case Studies. Positive Health Publications. 2005;108:50-51.Available from

Ebscohost.

[6] Palmquist S. Bowen Technique. Massage Magazine. Jan 2006; (119):78-80.

14
[7] Pennington G. A Textbook of Bowen Technique- A Comprehensive Guide to the Practice of
Bowen Technique. Melbourne: Barker Deane Publishing; 2012.

[8] The Border College of Natural Therapies.[Internet] 2008 [cited 2012 Jun 6] available from
http://www.BCNT.net.au.

[9] Rentsch O. [Internet] 2009 [cited 2012 September 12] available from http://bowtech.com.

[10] Stammers G. Bowen Therapeutic Technique. Journal of the Australian Traditional

Medicine Society.1996 Oct; 2(3):85-86.

[11] Rentsch O. The Bowen Technique an interpretation by Oswald Rentsch, Byaduk

(Australia)1987.

[12] . Rentsch O, Rentsch E. Bowtech The Original Bowen Technique Instruction Manual,
Byaduk (Australia) 2007.

[13] Victorian Government. A Transcript of Proceedings before the Osteopathy, Chiropractic

and Naturopathic Committee. Victorian Government Printer, Melbourne 1973.

[14] Boylan M. ATMS Formally Recognises Four New Modalities. Journal of the Australian
Traditional Medicine Society. 2011 Dec; 17 (4): 255-6.

[15] Boniface G, Seymour A. Using Occupational Therapy Theory in Practice. New Jersey
(USA): John Wiley & Sons; 2012.

[16] Victorian Government Health Department. A Transcript of Proceedings before the

Osteopathy, Chiropractic and Naturopathic Committee. Victorian Government Printer.
Melbourne. 1973.

[17] Still A.T. The Philosophy of Osteopathy. Kirksville: AT Still; 1899.

[18] Arroyo S. Astrology, Karma and Transformation. California: CRCS Publication; 1992.

Book Review May 2013 (BTPA)

Published on May 17, 2013 11:02 pm
15
The following independent review was published in, In Touch, the in-house journal of the
Bowen Therapy Professional Association (BTPA) U.K.

A review of A Textbook of Bowen Technique Graham Pennington

By

David Howells & Kathryn Phillips

When I was first asked to review Grahams book I felt it needed to come not just from me as
someone who has practiced the technique in its various forms since 1994 but also input from a
new convert to the technique. Having been introduced to Kathryn Phillips at a RIG meeting I
thought her views were just as valid as mine and an ideal practitioner to review his book.

I was lucky enough to receive the first copy of this book in the UK as it was delivered to me by
hand from Ron Phelan hot off the press.

A quick review by Kathryn Phillips:

As a relative newbie to Bowen, although not to complementary therapy on which I have been
amassing knowledge for almost two decades, Graham Penningtons book was a welcome
addition to my growing library of resources. I have been avidly trying to absorb as much
information as I can about this very special technique since first being asked by my reflexology
clients to consider adding Bowen to my repertoire: I qualified in 2012, treat 1-2 dozen clients per
week, and am now training in and using NST Bowen in my clinic to extend my knowledge and
understanding yet further.

Within moments of opening it, it was clear that a considerable amount of time had been spent on
ensuring a depth of indexing which most therapy books do not come even close to. As an
information and research specialist of more than three decades this is a key issue for me as I need
to be able to accurately and quickly dip in and out of books to revisit points I remember reading
previously. Even more important when the reason I need to double-check something is because a
client is on the table in the other room and I really want to be able to help them to the best of my
ability right now!

Not only is specific information much easier to find than in many other books in this field, but
also the diagrams, illustrations and narrative are all extremely clear and detailed such that I have
felt confident to carry out new and specific assessments and procedures without having been
formally taught them in a classroom setting. The first one I tried was the psoas procedure which
was an amazing experience for me as the client had been making great progress except in this
one area. My palpation and the clients immediate feedback both coincided, I made the move
without hesitation, deviation or repetition and the client had improved considerably at his next
appointment some weeks later.

16
That most, but not all, established Bowen moves coincide with traditional Chinese medicine
(TCM) acupressure/meridian points, their significance known for thousands of years, had been a
fascination for me from the outset given my pre-existing understanding of reflexology work.
That some moves potentially need a slight adjustment to maximise success is highlighted in this
book with reasons given. As someone who was already feeling for specific reflex points and
monitoring response I had found that Bowen moves did not always give me the feedback I was
used to with reflexology. To me modifying the position of some of the moves slightly, such as
those of the TMJ as described in Grahams book, gave me the responses I had been missing and
increased their efficacy albeit that I accept that the body will frequently read the intent of a
good therapist even if the move is slightly off the mark.

To me Grahams book, coming from the perspective of a Bowen therapist who is also an
acupuncturist, helps to explain and illustrate the significance of this overlap between Bowen and
TCM and in doing so explains much about the consequences associated with the various move
types: the specific direction of rolling moves, the stretching of certain muscles, the use of trauma
to stimulate neural points and so on. That lateral moves typically open up channels, whilst
medial moves block energy, is key to comprehending how Bowen technique works. If a therapist
understands not only what they are doing but more importantly why then they begin to treat more
effectively but even more importantly they can begin to confidently omit or amend moves to suit
the individual being treated.

In summary I found that Grahams book answers many of the questions which for me had been
burning for some time and explains others which I had not yet thought of asking. As someone
new to Bowen this is a book to keep to hand in clinic and curl up with in spare moments as it will
continually remind and inform its index ideal to enable the busy practitioner to dip into
whenever the need arises.

An even quicker review by David Howells:

My first thought on seeing Grahams book was one of great admiration for such a mammoth task
undertaken over many years.

His book is what it says on the cover, A text book of Bowen Technique, a comprehensive guide
to the practice of Bowen and as such it is a great aid to learning for students and experienced
practitioners alike.

I feel he has taken the basic work as we know it and presented it in a way that all students of
Bowen can recognise and relate to immediately. It goes much further and adds in basic
assessment which is required most certainly. One could devote a whole book and workshop to
this area (which Ron Phelan has done). I agree with his comment that in the main students of
Bowen have been taught by route and apply certain basic protocols to everyone. We know that
Tom did not work this way. If we consider his average time with a client was 5 -8 minutes and
he treated 65 clients a day. He assessed, treated and reassessed in a couple of moves. However,
none of us are Tom Bowen although we do try to attain a greater level of understanding and
17
application of the Technique. In fact the Toms of this world only come along once in a lifetime.
That said there has to be a starting point and a process of learning so that students of Bowen can
then go on through further study to improve their assessment and treatment skills. As we look
towards more regulation in this country and abroad we need to take on board Grahams view of
assessment prior to treatment. This I have always advocated and I include basic assessment with
my teaching.

The relevance of Acupuncture to Bowen has been talked about for years. Acupuncturists that
have undertaken Bowen training get very excited when learning the technique. Grahams
knowledge of how Tom studied with Ernie Sanders and that the technique is based on Japanese
Acupoint therapy confirm my own thoughts.

In conclusion it is evident a great deal of thought, research and commitment to Bowen has gone
into this work as Kathryn says the book is coming from the perspective of a Bowen Therapist
who is also an acupuncturist which helps to explain and illustrate the significance of this overlap
between Bowen and TCM. Grahams knowledge of Bowen is unquestionable; he presents it in a
very concise way with great illustrations and a good indexing system.

I would recommend that every student and qualified practitioner read his view on the Bowen
Technique not only is it informative on many levels but challenges opinion and allows for
discussion. Graham is not afraid to link up with other practitioners and cross pollinate ideas and
theories relating to the Technique. This I feel we all need to encompass as every opinion is valid.
I would like to congratulate Graham on producing such a valuable tool that will be of great
benefit to Bowen practitioners who like Tom Bowen have their clients health at heart.

18