Diploma of Specialised Bowen Therapy
22006VIC
Research Task – Traditional, Alternative and Scientific Practices in
Medicine
The Use of the Bowen Technique for
Symptomatic Relief of Greater
Trochanteric Pain Syndrome (GTPS)
Michelle Mauro
2013
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Michelle Mauro
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The Use of the Bowen Technique for Symptomatic Relief of Greater
Trochanteric Pain Syndrome
Introduction
Many injuries and conditions, both acute and chronic have well established paths of treatment
that follow western medical interventions; however these treatments may be costly, painful
and invasive. The wider community, including medical practitioners, often have limited
knowledge and information of complimentary, often less invasive, effective treatment
alternatives. This research article will focus on Greater Trochanteric Pain Syndrome (GTPS)
and aims to investigate the effectiveness of the Bowen Technique for the relief of symptoms
associated with this painful condition.
Evolution of Treatment and Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome is (GTPS) is a term used to describe chronic pain
overlying the lateral aspect of the hip. Patients typically present with chronic, persistent pain
in the lateral hip and/or buttock that is exacerbated by lying on the affected side, prolonged
standing or transitioning to a standing position, sitting with the affected leg crossed, climbing
stairs, running or other high impact activities (Williams & Cohen, 2009, p. 1665). The pain
can radiate into the lower buttocks and the lateral aspect of the thigh, but rarely extends into
the posterior aspect of the thigh or below the knee (Geraci et al, 2011, p. 76).
The Greater Trochanter (GT) is the site of confluence of three main bursae, the hip abductor
thigh muscles and the iliotibial tract. Histopathologic findings have shown GTPS results from
both tendinopathy and bursa pathology arising from acute or repetitive trauma (Geraci et al,
2011, p. 75). Acute trauma includes contusions from falls, contact sports and other sources of
impact. Repetitive trauma can include bursal irritation resulting from friction by the iliotibial
band. This repetitive cumulative irritation often occurs in runners but can also be seen in less
active individuals (Geraci et al, 2011, p. 76).
The Greater Trochanter is the site of both tendinous insertions and bursa. The main tendon of
the gluteus medius muscle attaches to the postero-superior aspect of the GT, with the lateral
tendon inserting into the lateral aspect. The gluteus minimus muscle attaches to the anterior
facet of the GT. Consequently, inflammation and tears of either the gluteus medius or
minimus muscles, or their tendinous insertions, from tension imposed by the ITB and/or
frictional trauma from overuse, may result in GTPS (Del Buona et al, 2011, p. )
Literature describes more than twenty bursae in the trochanteric area; however three are the
most representative (Geraci et al, 2011, p. 75). The subgluteus minimus bursa; located
between the gluteus minimus tendon and the anterior facet, the subgluteus medius bursa; lies
deep to the portion of the lateral insetion of the gluteus medius tendon and the trochanteric
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Michelle Mauro
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bursa (or subgluteus maximus bursa); covers the posterior facet, lying deep to the gluteus
maximus muscle extending laterally and distally (Klauser et al, 2013, p. 45). Overuse of the
trochanteric bursa and or an inflammation of the bursa may cause trochanteric bursitis
resulting in pain in the region of the greater trochanter (Geraci et al, 2011, p. 75).
Figure 1. Anatomy of the trochanteric region. a = gluteus minimus muscle, b = gluteus medius muscle,
c = subgluteus minimus bursa, d = subgluteus medius bursa, e = subgluteus maximus bursa, f = zona
orbicularis of hip joint capsule, g = superior neck recess of hip joint, h = inferior neck recess of hip
joint, i = vastus lateralis muscle, k = iliotibial band (Geraci et al, 2011, p. 75).
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Hip pain is present in all age groups but is more prevalent between the fourth and sixth
decades of life (Williams & Cohen, 2009, p. 1663). GTPS is most frequent in women (F:M =
4:1) and affects from 10 – 25% of the general population and up to 35% of patients with leg
length discrepancies and low back pain. Additional risk factors include abnormal hip
biomechanics, ipsilateral iliotibial band (ITB) pain, knee osteoarthritis, obesity and specific
sporting activities (Del Buono et al, 2011, p. 2).
The physical examination of a patient with GTPS characteristically reveals point tenderness
in the posterolateral area of the greater trochanter typically at either the site of the gluteus
medius tendon insertion or the insertion of the gluteus minimus tendon. Pain can also be
reproduced through active resistance to abduction and external rotation and sometimes by
internal rotation of the hip (Williams & Cohen, 2009, p. 1665).
The most valuable diagnostic studies for GTPS include Computed Tomography (CT) and
Magnetic Resonance Imaging (MRI) with partial thickness and complete thickness tears of
the gluteus minimus or medius tendons visible on MRI. X-rays of the hip may show evidence
of associated musculoskeletal conditions, calcifications and irregularities around the greater
trochanter, however they generally have little diagnostic value for GTPS (Geraci et al, 2011,
p. 77)
Conservative treatment measures include rest, anti-inflammatory medication, ice, weight loss,
stretching and strengthening exercises, physical therapy and ultrasound. These interventions
aim to improve flexibility, muscle strength and joint mechanics whilst decreasing pain. When
these interventions fail, bursa or lateral hip injections performed with corticosteroid and local
anaesthetics are performed. For patients who fail to respond, surgical intervention is
advocated with arthroscopic bursectomy and/or ITB release performed (Williams& Cohen,
2009, p. 1668).
The Bowen Technique (also known as Bowtech and Bowenwork) is a dynamic system of
muscle and connective tissue therapy developed by the late Tom Bowen in Geelong
Australia. It is a gentle form of soft tissue therapy used in the relief of many specific injuries
and other health problems, both acute and chronic. (Rentsch 2007 p. vii)
The Bowen Technique addresses the body in a holistic manner. The practitioner delivers
signals to the nervous system via sets of moves at specific locations (muscles, tendons,
ligaments and nerves), then allows the body time to respond with subtle adjustments in
tension, prior to performing the next set of moves (Bowtech, 2009).
The basic Bowen “move” distorts a muscle or tendon that is not under load and then rolls
over it at a precise location without sliding on the skin. As a result, the spindle cells and
Golgi tendon organs down-regulate the muscle’s resting tension level via the central nervous
system. The surrounding fascia becomes less solid and more fluid, allowing greater
movement of blood and lymph through the tissue, and enhancing nutrition to and waste
removal from the site of injury. The lack of distracting skin stimulation and the limited
number of precise moves focus the nervous system’s attention on the essential points.
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Michelle Mauro
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Pausing at certain crucial times in a sequence of such moves allows time for the nervous
system and fascia to respond and begin the healing process (Bowtech, 2009).
Demographic Statistics
This research project was conducted in the Redlands, a Shire of Brisbane, Queensland. The
Redland City Council demographic profile, based on results obtained from the 2011 Census
of population and housing, states a population of 138 670 covering a land area of 537 square
kilometres (Redland City Council, 2010).
The age structure shows that:



34.8% of population is ≥ 50 years of age
32% of population is 25-49 years of age
33% of population is 0-24 years of age
A search of Bowen practitioners on the Bowen Association of Australia and Bowtech
websites found 8 practitioners located within approximately 10 kilometres of Capalaba, a
suburb within the Redland Shire, however only one of these practitioners was listed as
working within the Shire. Four of the eight practitioners were located more than seven
kilometres from Capalaba (Bowtech, 2009 & BAA).
Lack of information, advertising and general knowledge within the community suggests little
knowledge of the Bowen technique and it would appear that the lack of practitioners would
make it difficult for some people to access this modality. There are however ample medical
practitioners and physiotherapists within the Shire. With advice from medical practitioners, I
believe that the vast majority of people would be encouraged to pursue the current medical
recommendations for treatment including physiotherapy and steroid injections.
Aims and Objectives of the Project
The aim of this project is to:

To evaluate the effectiveness of the Bowen Technique for symptom management in
Greater Trochanteric Pain Syndrome (GTPS).
Research Methods/Strategies
Both qualitative and quantitative research methods were used in this study. Subjective
assessment was employed with the client interviewed regarding symptoms and pain levels.
Objective assessment was performed through active, passive and resisted movements
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followed by specialised tests. Pre and post therapy semi-structured interviews of patient,
including personal perceptions of therapy were also conducted.
Study Sample/Stakeholders
This project focussed on the treatment of GTPS in one female client, 44 years of age.
Relevant medical history includes fractured right ilium age 11. The client had experienced
intermittent weakness and pain in the right hip and buttock over the previous 15 years
however no therapy or investigations were conducted. Client has had three problem free, full
term pregnancies.
Client noticed ongoing pain in the right hip approximately 3-4 months prior to presentation
for Bowen Therapy. The pain was continual and was exacerbated when running, walking up
stairs and for long periods of time or lying on the affected side. The pain levels ranged from
4-9 on a pains scale of 1 to 10 and analgesics were required on a regular basis to ensure a full
night’s sleep. Diagnostic x-rays showed no obvious abnormalities and physiotherapy was
recommended by her general practitioner who diagnosed Greater Trochanteric Pain
Syndrome. The GP also suggested corticosteroid injections into the lateral hip should the
condition not respond adequately to physiotherapy. No other treatments were undertaken for
the condition.
The client was recommended Bowen Therapy by a relative who had experienced excellent
results for a different condition. With minimal response to physical therapy, the client had no
therapies for approximately two months prior to presenting for Bowen Therapy.
Ethical Considerations
The client was invited to participate in a research study and was given verbal information on
the research project in addition to a participation information sheet and consent form for their
consideration. Bowen Therapy, its history and effect on the body were discussed at length
and all questions answered to the client’s satisfaction. Information relating to client
confidentiality and publishing of results was also discussed. Please refer to Appendix 1 for
client information sheet and consent form used.
Data Collection – Results
Subjective Assessment
On initial presentation, right hip pain experienced was 9 on a pain scale of 1 to 10. Pain was
radiating down the right lateral thigh with the feeling of weakness present in the right buttock
and hip area. Client had difficulty walking up stairs, could not run or participate in vigorous
exercise and could not walk for any length of time. She was unable to sleep on her right side
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and experienced interrupted sleep due to hip pain. The pain was continual throughout the day
and evening and ranged from 4 to 9 on a pain scale of 1 to 10.
The client initially had no knowledge of the Bowen Technique and had very limited
expectations regarding its effectiveness for the treatment of her condition. She had gained
minimal to no benefit from physiotherapy sessions and felt reluctant to continue with this
modality due to the pain and discomfort experienced during the sessions. At the urging of a
family member she attended Bowen Therapy as she was reluctant to proceed with
corticosteroid injections as recommended by her general practitioner.
The client experienced a full, uninterrupted night’s sleep following the first session, however,
there was minimal improvement in symptoms and the second session was conducted five
days later due to high levels of pain. Following the second session, the client experienced a
gradual but continual decrease in pain and symptoms. By the fifth Bowen Therapy session,
no pain was experienced in the objective testing; the client was experiencing uninterrupted
sleep and had started walking her dog for a half an hour each day – something she had been
unable to do for the previous three months. Increased right leg strength and greater range of
movement in the right hip was noted at the fourth and fifth therapy sessions.
Objective Assessment:
On palpation, from the posterior view, the right iliac crest was noted to be approximately 1.5
– 2cm higher than the left at the first therapy session. Both crests were level at session 5.
No pain was experienced with active lumbar movements. Active movements of the knee were
negative for pain.
Active Testing
Bowen Session
1
2
3
4
5
Hip Supine
Pain Right hip
on abduction
ROM – 20º.
Pain Right hip
on abduction
ROM – 25º.
Pain Right hip
on abduction
ROM – 30º.
Pain Right hip
on abduction
ROM – 40º.
Stop P1
Stop P1
Stop P1
Stop P1
No Pain all
movements.
Abduction
ROM - 40º
Stop R1
Bowen Session
1
2
3
4
5
Hip Supine
No pain in all
movements.
Stopped at S1
No pain in all
movements.
Stopped at S1
No pain in all
movements.
Stopped at S1
No pain in all
movements.
Stopped at
S1/R1
No pain in all
movements.
Stopped at
S1/R1
Passive Testing
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Michelle Mauro
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Resisted Tests
Bowen Session
1
2
3
4
5
Hip Flexion
No pain.
Weakness in
right leg
No pain.
Weakness in
right leg
No pain.
Weakness in
right leg
No pain. Slight
weakness right
leg
No pain. Slight
weakness right
leg
Hip Extension
No pain.
Weakness in
right leg
No pain.
Weakness in
right leg
Slight
discomfort.
Weakness in
right leg
Slight
discomfort.
Slight weakness
right leg
No pain. Slight
weakness right
leg
Hip Abduction
Pain in right
hip. Weak
response right
leg
Pain in right
hip. Weak
response right
leg
Slight
discomfort.
Weakness in
right leg
Slight
discomfort.
Weakness in
right leg
No pain. Slight
weakness right
leg
Hip Adduction
Pain in right
hip. Weak
response right
leg
Pain in right
hip. Weak
response right
leg
Slight
discomfort.
Weakness in
right leg
Slight
discomfort.
Weakness in
right leg
No pain. Slight
weakness right
leg
Special tests conducted included Ober test which showed a slight positive on the right leg and
Thomas test which demonstrated a negative result. No leg length, tibial length or femur
length discrepancy was noted.
Procedures Used
BT Session
1
2
3
4
5
Procedures
Used
BRM 1, 2, 3,
H/S & Head
BRM 1, 2, H/S,
Pelvic, Knee
BRM 1, 2, H/S,
Coccyx, Pelvic,
Knee
BRM 1, 2, H/S,
Coccyx Obl,
Pelvic, Knee
BRM 1, 2, H/S,
Coccyx Obl,
Pelvic, Knee,
Ankle, H/T &
Bun
Client was given Bowen Hamstring and Pelvic exercises following week 2. The client built
up to these slowly and only to her level of comfort.
Data Analysis – Conclusion
The initial Bowen treatment was used to relax and balance the body with subsequent sessions
specifically addressing the muscles and tendons within the pelvic and hip area. It was noted
that the client had an inverted coccyx and the coccyx and coccyx oblique procedures were
used throughout sessions three to five.
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Michelle Mauro
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The client reported immediate relief and a good night’s sleep following the first session
however pain levels increased approximately two to three days following this. Client
interviews demonstrate a continual, gradual decrease in pain and symptoms over Bowen
sessions two to five. This is in line with results of subjective and objective assessment which
indicated a gradual decrease in pain, greater range of movement and increase in strength
through the right buttock and leg. Following the fifth treatment session, the client
experienced no symptomatic pain and was participating fully in everyday activities.
This was a pleasing result for the client considering the negative impact GTPS was having on
her life. The client is convinced that resolution of her symptoms is a result of the Bowen
Technique as she did not change her lifestyle or receive other therapies whilst receiving
Bowen Therapy. She is currently on a maintenance program and attends Bowen sessions once
per month.
Although this study was conducted on a single subject, the results were very positive and
encourage further investigation into the use of the Bowen Technique for symptomatic relief
of GTPS. There are medical practitioners and allied health professionals who are open to
results obtained from case studies in therapies outside their realm of practice, however the
wider healthcare community often require evidence before changes to treatment
recommendations are made. To confirm and establish the Bowen Technique as an effective
therapy for GTPS, further research is required in the form of feasibility studies and controlled
trials to provide an evidence base for changes to current established treatments.
Sharing Knowledge
Many people in the wider community experience lateral hip pain diagnosed as Greater
Trochanteric Pain Syndrome resulting from acute or repetitive trauma. As Bowtech
practitioners, we do not diagnose, however it is valuable to have knowledge of the presenting
conditions experienced by the client. In addition to causes and risk factors, this information
enables us to understand the link between musculoskeletal anatomy and symptoms, allowing
the formulation of a treatment plan that aims to provide the best outcome for the client. It is
the intention of this research article to educate Bowtech practitioners, and subsequently their
clients, on the signs, symptoms, risk factors and treatment options for GTPS and investigate
and share the results obtained from the use of Bowen Therapy as a treatment option.
Appendix 1
PARTICIPANT INFORMATION SHEET
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Michelle Mauro
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1. Invitation
You are invited to take part in a research study. Please take time to read the following
information carefully and to decide if you wish to take part in the study. Feel free to ask if
there is anything that is not clear or if you would like more information.
2. What is the purpose of this clinical research study?
The purpose of this study is to investigate whether the use of the Bowen Technique results in
the relief of symptoms for Greater Trochanteric Pain syndrome (GTPS).
3. What does this study involve?
Participation in Bowen Therapy treatment sessions that include answering questions
regarding your:
 Medical history
 Lifestyle and physical activity & sleep patterns
 Pain level and the effects of GTPS on your everyday activities
 Understanding and perception (if any) of the Bowen Technique.
These questions will take approximately 15 minutes. Your participation in this study is
voluntary and you can withdraw at any time.
4. Treatment
You will meet with your Bowen therapist weekly for 3 consecutive weeks. These
appointments will take approximately 1 hour. The timing and number of follow-up treatments
will be discussed with you and be according to response to treatment. No other therapies are
to be undertaken during the Bowen course of treatment.
5. What are the Possible Benefits from participating in this study?
Possible benefit of participation in this study is reduction or complete resolution of symptoms
associated with GTPS. However benefit is not guaranteed. Other Bowen therapists and
people with GTPS may benefit in the future from knowledge gained from this research study.
6. How will my confidentiality be protected?
Any identifiable information that is collected about you in connection with this study will
remain confidential and will be disclosed only with your permission, or except as required by
law.
7. What will happen with the results of the study?
The results of the study will be presented to Border College of Natural Therapies for review
and presented to peers to share knowledge gained.
8. Further information and contact details
Contact Details
Michelle Mauro
Bowen Therapist
BAA Membership No. 9833
Phone No. 0437 735 708
Appendix 2 - Consent Form
Diploma – Specialised Bowen Therapy
Michelle Mauro
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CONSENT FORM
Participation in a Research Study
The Use of the Bowen Technique for Symptom Relief in Greater Trochanteric Pain
Syndrome (GTPS)
By signing this consent form:
1. I confirm that I have read the Participant Information Sheet for the above study.
I have had the opportunity to consider the information, ask questions and have had
these answered satisfactorily.
2. I understand that my participation is voluntary and that I am free to withdraw at any
time without giving any reason. I understand that relevant information of my medical
history and data collected during the study may be looked at by individuals from
Border College of Natural Therapies and I understand any identifying information
will be kept confidential.
Signature
Clients Name:
Signature:
Date:
Declaration by the Practitioner
I hereby declare that I have discussed the purpose and procedures of this research study with
the client.
Practitioner Name:
Signature:
Date:
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Diploma – Specialised Bowen Therapy
Michelle Mauro
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