What you feel after a Bowen therapy session and which reactions are normal

The day after a session I often get the same question on the phone. “Is it normal to feel like this?” Some people are tired, as if after a long day at work, others drink more water than they have all week, and a few tell me, surprised, that their pain has moved from the back of the neck to between the shoulder blades and that they don't know whether that's a good sign or a bad one.

Here I'll explain which reactions after Bowen therapy are usual, how long they last, what to do in those days and when not to wait any longer.

What you feel in the first days after a session

Many people feel only a deep relaxation. Some fall asleep on the treatment table during the pauses between sets of moves and go home feeling they could sleep for another hour. The reactions my patients describe to me are few and very similar to one another:

• Tiredness and sleepiness, especially on the evening after the session. Many sleep better that night.
• Thirst, greater than usual, on the first day.
• Mild pain, like after exercise, in the area that was worked on or somewhere else, for instance moving from the lower back towards the hip.
• A day when things seem worse, before they settle down.
• Emotions rising to the surface, some light crying or a feeling of being sensitive, in a few people.

All of this we know from what therapists and their patients report, because nobody has counted these reactions for Bowen in a study, and the health guide of the state of Victoria in Australia doesn't even mention them. I touched on them briefly in the article on the contraindications of Bowen therapy as well. Here I'll take them one at a time.

Painful reactions after Bowen therapy

This is the question that worries people most. You came to a therapy so that it would hurt less, and the next day it hurts differently or in another place. From what I see at my practice, mild pain that moves is the most common reaction of this kind, and the feeling of “worse before better” appears in only some patients and usually lasts a day.

The good figures we have are about manual therapies in general. A 2010 review brought together 8 cohort studies and 31 randomised trials and found mild or moderate short-lived reactions in roughly 41% of patients in the cohorts and in 22% in the randomised trials, while serious reactions occurred in roughly 0.13%.

A Swedish study from 2014 of 767 people with back or neck pain went further. Half of those who had at least 3 sessions had such a reaction at least once, most often sore muscles, more pain and stiffness, and women reported them more often than men.

Bowen is gentler than many of the techniques in these studies, because it doesn't manipulate the joints and doesn't press with force. The figures still tell you something useful. A harder day after a manual therapy is common and doesn't mean that something has gone wrong.

How long the reactions last

For Bowen there is no measurement. The closest comes from a Belgian study from 2004 of 465 patients treated with spinal manipulation, in which the reactions usually began within the first 4 hours and generally disappeared within the following 24 hours. Manipulation is much stronger than Bowen, so I take that figure only as a reference point.

At my practice I see reactions appearing within the first 24 to 48 hours and going away by themselves in 1 or 2 days. If 3 days have passed and the pain is the same or worse, please call me.

What to do in the days after a session

The recommendations are simple:

• Drink more water than usual, especially on the first day, because thirst is one of the most common reactions.
• Go for a walk, 20 to 30 minutes on the day of the session or the next day. Sitting or lying still for hours on end doesn't help you.
• Leave heavy exertion for another day, meaning the gym, a long run, carrying heavy loads or a top-to-bottom clean of the house.
• No other manual therapy for a week, meaning no massage, chiropractic or osteopathy, so that we can see clearly what our session did.

The treatment your doctor gave you stays exactly as they prescribed it. Questions about medicines still go to them.

What isn't normal and needs a doctor

A session reaction is mild, eases from one day to the next and brings no new signs. When something appears that you haven't had before, you no longer put it down to the session and you go to a doctor.

• pain that gets worse from one day to the next instead of easing
• a fever, chills or feeling generally unwell
• new numbness, tingling or weakness in an arm or a leg, or in both legs
• changes when you pass urine or open your bowels, or loss of feeling around the genitals
• a swollen, painful and warm leg, especially on one side only
• chest pain or shortness of breath

Why the reactions happen and what isn't known

On many Bowen therapy websites you'll read very confident explanations about fascia being released, toxins being eliminated and the body rebalancing itself after the session. I can't stand behind them. Nobody has measured what exactly causes the tiredness, the thirst or the pain that moves after Bowen, and an explanation that sounds good doesn't become true just because many websites repeat it.

What is known is little. The review carried out by Cochrane Australia in 2024 for the Australian government found very little evidence about the effect of the method, and safety wasn't part of the analysis at all. A 2011 review called the research on Bowen poorly documented. About manual therapies in general we know that reactions are common and short-lived, but even there nobody has worked out why they happen. I'd rather tell you that.

I've put all the studies on Bowen together in the article on whether Bowen therapy actually works.

How many sessions and when you see the effect

Some people feel a change right after the first session, others only after the second or third. How many sessions you need can't be said in advance. For some a few are enough, while an old problem that has lasted for years usually needs more, so I won't give you a number that would create a false expectation.

Sessions are done once a week, 6 or 7 days apart, so that you have time to see what is left of the effect of the previous one. Bowtech România also says on its website that treatments are usually given 7 days apart.

For neck pain there is a randomised trial published in 2023 in Hong Kong, with 8 sessions over 12 weeks in 90 patients whose pain had lasted more than 6 weeks, but with no sham treatment group. I've written at length about the back and the neck in the article on Bowen for back and neck pain. If nothing changes after a few sessions, I'll tell you so openly and we'll look together at what else might make sense.

You'll find how a session goes on the page about Bowen therapy, and the fees page shows what a Bowen therapy session costs.

This article is for information and does not replace a medical consultation. Do not stop or change a prescribed treatment without talking to the doctor who prescribed it.

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