When Bowen therapy isn't done and when I ask your doctor first

If you searched for “Bowen therapy contraindications” and found answers that don't match, it isn't your fault. An official list, published by an association of Bowen therapists and valid for everyone, doesn't exist. I looked for one for a long time and didn't find it. What you do find are scattered recommendations, a few common-sense rules and a lot of lists copied from massage.

Below I'll tell you what I found when I looked for it, what I do in my practice instead and which signs mean you go to a doctor, not to a complementary therapy.

Why you can't find an official list

I read what the Bowen therapist organisations in Australia and the United Kingdom publish, plus the health guide of the state of Victoria. The Australian federation answers the question about pregnancy with a firm “yes”, with a single condition: you tell the therapist you're pregnant when you book. The Victorian guide names no contraindication and stops at the advice not to have any other manual therapy for a week after the session.

The studies don't help much more. The review Cochrane Australia carried out 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. An older review published in 2011 said that research on Bowen is poorly documented. When nobody has counted the side effects, nobody can write a list of contraindications backed by data.

That doesn't mean anything goes. It means the list is made by the person working with you, after they have listened to you and found out what treatments you're on, and you have every right to know what each of their rules rests on.

When I postpone a session

The first reason is simple. I don't work with you while you have a fever or an acute infection, because at that point your body has other work to do, and a session meant to calm it has nothing to add. I book you in again once you're through it.

The same goes for a fresh fracture or a recent operation in the area I would need to work on. The tissue has to heal first. The pace isn't set by me but by the surgeon or orthopaedist who operated on you, and I don't start before they say the area can be touched safely.

If your problem is structural, for example a herniated disc or a torn ligament, the technique has nothing to repair there, because it works on the tension in muscles and fascia.

When I talk to your doctor first

There are a few situations in which I don't start without clearance from the doctor who looks after you:

• a cancer diagnosis
• a high-risk pregnancy
• heart disease
• epilepsy
• a pacemaker
• a clotting disorder or anticoagulant treatment
• the period right after an operation
• young children

Bowen therapy is gentle, but it complements medical treatment and doesn't replace it, so your doctor has the first say.

If you have cancer, I don't start until I've spoken with the doctor caring for you, because they know things about your body, your treatment and what comes next that I can't see in a first conversation, however carefully I listen. Their treatment takes priority.

Anticoagulants and any clotting problem also change the way I touch, so besides the clearance I want to know about them from the start. My movements are very gentle. Still, in someone who bruises easily, even light pressure matters.

There's one more case I treat with great care, and that's a swollen, painful and warm leg, especially in a pregnant woman, after an operation or after a long journey. It may be a clot in a deep vein.

In 2020 a case was published of a young woman 25 weeks pregnant who went into cardiac arrest shortly after a leg massage, because she had a clot in a vein that nobody had noticed.

Bowen in pregnancy

The Australian federation answers the question about pregnancy with a firm “yes”. I do work with pregnant women too, but with precautions:

• I avoid the first trimester and don't work on the pelvic and lower back areas.
• The session is shorter and gentler than usual.
• You come with the agreement of the doctor who is following your pregnancy and you tell me you're pregnant when you book, exactly as the federation asks.

If the pregnancy is high-risk, I don't start without that doctor's clearance.

What you may feel after a session

Many people feel only relaxed. Others say they're thirstier than usual, that they're tired that evening or that the treated area aches a little, as after exercise. We know this from what therapists and their patients report, because there are no studies on the subject. It usually passes within 1 or 2 days.

The best figures we have are for manual therapies in general, not for Bowen. A 2010 review gathered 8 cohort studies and 31 randomised trials and found mild or moderate passing reactions in about 41% of patients in the cohorts, and serious reactions in about 0.13%.

Bowen is gentler than many of the techniques in the review, but the figure tells you that a harder day after a session is normal, not a sign that something has gone wrong.

What isn't normal is pain that gets worse from one day to the next, a fever or new weakness in an arm or a leg. For any of them you call me and go to a doctor, without waiting for the next session.

I'll ask one more thing of you, a small one. In the week after the session don't have massage, chiropractic or any other manual therapy, so that it's clear what our session did and what it didn't.

The signs that mean a doctor, not Bowen

The English NICE NG59 guideline on back pain asks doctors to rule out first the causes that have nothing to do with muscles, such as cancer, an infection, an injury or an inflammatory disease. On the patient side, the British health service says when you need urgent help.

You'll also find these signs in the other article on back pain, but I'll repeat them, because this is where they matter most:

• numbness, tingling or weakness in both legs
• loss of feeling in the genital area or around the anus
• changes in passing urine or stools, for example you can't urinate or can't control it
• back pain that started after an accident or a serious fall
• chest pain
• back pain together with a fever, chills or feeling generally unwell
• very severe pain that came on suddenly, or pain that is getting worse quickly
• weight loss you can't explain

Why I'm writing a list that doesn't officially exist

It would have been easier to copy a long list from a massage website and give the impression that it's the rule of the method. It wouldn't have been honest, because those lists aren't written for Bowen and aren't backed by data on Bowen.

What I can give you instead is the way I work. I'm a doctor before I'm a Bowen therapist, so the first conversation is about what you have, what treatments you're on and what tests you've had.

Only after that do we decide together whether a session makes sense, whether we postpone it or whether your problem is solved somewhere else. How a session goes, how long it lasts and what it costs are on the page about Bowen therapy.

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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