BOWEN TECHNIQUE: CASE STUDIES 49 – 54

Case 49: Treatment of a patient complaining of frequent classical migraines

Natalie (54 years old) presented to the clinic six months ago complaining of chronic and recurrent migraines. For about forty years, she had suffered classical migraines that involve the sudden onset of severe head and neck pain, photophobia and visual disturbance, disturbed speech, and occasionally some nausea. She said she experienced an episode, on average, about once per month but there was no specific pattern that would allow her to know when to expect one. The migraines also varied significantly in intensity and about twice a year she would suffer an ‘extreme’ episode that would incapacitate her for several days. Although she had explored various forms of therapy, she had, so far, failed to find any that were effective. A friend had suggested she come and see me.

I enquired about other aspects of her health and found she’d had a lumbar laminectomy about ten years ago. She also told me she suffered from hot feet during the night and that she was often thirsty. Interpreted through the eyes of Traditional Chinese Medicine, these features, along with the classical migraine presentation, all point to an underlying pattern called a ‘Kidney Deficiency’.

Assessment in the prone position revealed a right-sided dural drag of around 8 mm. I began the treatment, as I always do, with the Lower and Upper Back Procedures and then used some of the moves of the Middle Back Procedure to assess the paraspinal region over the Kidneys. I was not surprised to find lots of stiffness and tension bilaterally in this area, and so I checked to see if I could notice any palpable temperature difference between the two sides. In the end, I decided I couldn’t.

I performed a regular right-sided coccyx correction which had the effect of restoring tonal symmetry so I left her for a while to let her body respond to the correction. Upon my return, she was still holding symmetry so I decided I would now apply the Kidney Procedure. Using two or three superior-lateral moves on the paraspinal muscles on each side of the spine around L1-L2, I ‘opened’ both Kidneys and then left her to rest again. After 4 or 5 minutes I came back and ‘closed’ both sides. I had her turn supine and I checked her neck but I found everything felt pretty normal in relation to the upper dural attachments. I concluded the treatment and asked her to return in a week.

Natalie returned the following week saying she had felt “really good” since the initial treatment. She couldn’t describe exactly how she felt “really good” but she said it seemed like she had more energy and more clarity and that she felt less stiffness through her shoulders and back. The assessment showed the tonal symmetry was still holding so I simply applied the Lower Back, Upper Back, and Neck Procedures.  Along the way, I reassessed the tension in the Kidney region and was happy to observe it had improved significantly. I didn’t treat the region however and I asked her to return in three weeks for another session.

She returned three weeks later and she still demonstrated tonal symmetry. I still had nothing to add to the initial treatment. She told me she still felt really good and that she had had no migraines at all. I repeated the second treatment and asked her to return in a month. I have been monitoring her progress with monthly visits and it is now six months since her initial presentation to the clinic. She has had no migraines so far and she cannot remember ever having such a long period without an episode. In addition, she still presents with tonal symmetry each visit and she still says she feels “really good”.

Comment: The Kidney Procedure is probably the most poorly understood part of Bowen’s work. In this instance, it was used, in conjunction with a coccyx correction, to reduce the incidence of classical migraine.
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Case 50: Treatment of atypical absence seizures (petit mal epilepsy) in a 19 y.o. female.

Donna presented to the clinic detailing a history of atypical absence seizures. She described her symptoms as recurrent and frequent episodes during which she would lose consciousness for several minutes at a time. The onset of the episodes was sudden and without warning. Family members had recorded one of the seizures to provide an illustration of her symptoms. In the recording, she appeared to be staring at nothing with a blank expression on her face. She was unresponsive to any communication and when the seizure passed, she had no recollection of the event.

The initial assessment showed she had a right-sided dural drag of around 25 mm. The screening was unremarkable. I applied some basic moves to the lower back region and then the upper back region before turning her supine and checking her neck. The right paraspinal bundle was very tense (compared to the left) and the left sternocleidomastoid muscle was also tense so I targeted my treatment to the pterygoid/temporalis muscles at the right temporomandibular joint. The moves here were obviously uncomfortable as the tissue under my finger was tense and rigid. After a five minute wait, I repeated the moves and then had her turn supine again for reassessment.

The reassessment showed she now had a left-sided dural drag of around 10 mm which I was able to resolve using the reverse coccyx procedure. As we had reached a state of symmetry, I asked Donna to return in two weeks for a follow-up treatment.

Donna returned as scheduled and reported she had experienced three or four seizures since the initial visit. Assessment showed she was still maintaining a state of symmetry. I checked the area over each Kidney and noticed the right side was actually quite hot while the left side was noticeably cooler. After putting in the stoppers, I ‘opened’ both Kidneys (using the superior-lateral moves of the Kidney Procedure) and left her to rest. I checked her after two minutes and the right side was still quite warm so I left her to rest a while longer. After five more minutes, the right side had cooled considerably. I made a pair of medial moves over the paraspinal tissues in the Upper Thoracic area (at approx. T-5) and then ‘closed’ both kidneys (this simply involves making an inferior-medial move over the same site used to open the Kidney). I asked her to return in two weeks for another follow-up treatment.

Donna came back two weeks later and reported that she had had no further episodes since the last visit. I assessed her for tonal asymmetry but everything was good (she showed symmetry). I checked her “Kidneys” and the temperature felt completely normal on each side. I did a few basic moves to assess the tissues in her back and neck but everything felt great so I asked her to return in one month for a follow-up treatment.

Donna returned a month later and everything was great. She still showed no asymmetry and no signs of dysfunction and she reported she had not experienced any seizures at all.

I saw Donna today (it has been six months since her last visit) and I asked how she has been. She said she has had no seizures at all since her second visit and she assured me she will return for more treatment should the seizures return.

Comment: Mr Bowen used specific procedures and protocols for the treatment of epilepsy and these were always applied subject to individual assessment. Many of his treatments in this area involved the use of the Kidney Procedure.

According to Traditional Chinese Medicine, the Kidneys store a precious substance, called the Essence, which serves to nourish the Brain and the central nervous system. Typically, if the Brain is insufficiently nourished by the Essence, the patient may suffer symptoms such as poor concentration and memory, dizziness, loss of consciousness or seizures (epilepsy).

A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behaviour, movements or feelings, and in levels of consciousness. When appropriate, the Kidney Procedure may be used to direct the Kidney Essence to the Brain to nourish and settle it. This involves using the procedure in a very different context to the way it is currently taught by most schools. To use these procedures safely and effectively, it is important therapists develop a detailed understanding of the principles involved as well as competency with regard to assessment and application of the procedures.

Case 51:  Chronic hip pain associated with bursitis in a 71-year-old male

Joe is 71 years old.  He presented to the clinic eight weeks ago complaining of chronic pain in his right hip.  The pain was fairly constant and had been present for at least 18 months.  He described the pain as a constant dull ache which became worse when he sat for any significant length of time.  Medical investigations had identified bursitis as well as tears in his gluteus medius and gluteus maximus.   He had been treated extensively with physiotherapy, as well as with cortisone injections, but had experienced little benefit.  His doctor has prescribed some analgesic and anti-inflammatory medication which did help him deal with the pain.

Assessment in the prone position showed a left-sided dural drag (the left leg appeared about 15 mm shorter) and the screening was unremarkable.  I applied the standard moves to the Lower Back, Upper Back, and Neck and noted all the structures in his neck felt quite normal.  I then applied a reverse coccyx correction, using his left leg as the lever, and reassessed.  Following the coccyx correction, he now showed a short right leg.

I turned him supine and applied a couple of moves to his adductors.  Both adductors were tight and tender but after the moves, which were borrowed from the Pelvic Procedure, he showed symmetry.  I concluded the treatment and asked him to return in a week for a follow-up session.

At the second treatment, Joe reported that he had felt significant improvement and was enjoying periods where he could no longer feel the constant ache in his hip.  The assessment showed he was still holding symmetry so I simply used the basic relaxation procedures and, once again, released his adductors.

The third treatment was performed a week later.  He presented as he had on the first visit, showing a short left leg, and my therapeutic intervention followed the same pattern as his first visit – I applied a reverse coccyx correction and then released his adductors.  On this occasion, however, his adductors felt quite loose and he noticed the moves were nowhere near as tender as they had been previously.

The fourth visit took place two weeks later and Joe reported that he had not experienced any pain between the treatments.  He had begun a gentle daily walking regime and had stopped taking any anti-inflammatory and analgesic medication.  The assessment showed that he still maintained symmetry.  After a few basic relaxation moves, I asked him to return in a month for a final follow-up.

Yesterday, Joe returned for the final check-up.  He has been completely pain-free.  He is walking three or four kilometres each morning and is no longer taking any medication.  I told him he only needs to return if he experiences a return of any symptoms.

Comment:  Over the last few years, I have shared many cases outlining successful treatment of hip pain/bursitis.  It is a common condition and one I see almost every day in the clinic.  On most occasions, these cases are associated with chronic coccyx dysfunction.  Assessment and treatment of the coccyx are central to the effective practice of Bowen therapy and yet I believe it is an area that is poorly understood and poorly presented in most people’s basic training.  I have been told repeatedly that Mr Bowen checked the coccyx on almost every one of his patients, emphasising the importance he placed on this site.   It is essential that we each develop the capacity to assess and correct the coccyx if we wish to align ourselves with the central principles of Mr Bowen’s work.

Case 52: Chronic hip pain associated with congenital hip dysplasia.

Leonie is 32 years old. She presented to the clinic complaining of chronic pain in her right hip. She told me she had experienced an ache or a pain of some sort or another, in her hip, for the past eight years but that one month ago, the pain had become ‘severe’, and she could no longer put up with it.

The pain was like a toothache inside her hip which radiated from the hip itself, down the lateral aspect of her leg, and into her right foot. For the past four weeks, this ache had been quite constant, although she said it had varied in intensity. Leonie was taking analgesic medication but said she tried to avoid taking anti-inflammatory medicines as much as she could. She had tried physiotherapy in the past, and again recently, but it seemed to make her symptoms worse.

During the history taking she mentioned two interesting pieces of information. She told me she was born with ‘dislocated hips’ and that recent x-rays had shown abnormal development of her hip joints (hip dysplasia), although she was unable to provide me with any further detail. When I asked her if any other areas of her body gave her trouble, she replied, “I’ve got a jaw that always clicks but it doesn’t give me much pain”.

Assessment in the prone position was somewhat challenging… Achieving the ‘three straight lines’ that I use in the assessment process wasn’t actually possible because her right femur appeared to protrude a lot more laterally than the left one did (let me try to explain how it looked: the left femoral head looked like it was ‘plugged in’ properly to the left hip joint but the right femoral head looked like it was only ‘plugged’ halfway into the socket). I considered she had an artifact in the form of an abnormally developed hip joint. This matched with her earlier comments about her hip dysplasia, so I simply tried to work around it.

I continued the assessment the best I could and I could clearly see she had a left-sided dural drag. The left leg stayed short when she turned her head to the left but the right leg became the short leg when she turned her head to the right (i.e. she showed a positive Double Cervical Turn Test, +ve 2CTT). This assessment indicates her primary issue is associated with either her coccyx or her sphenoid.

First session: I worked through the Lower Back and Upper Back noting very high tension levels in the paraspinal tissues and then I had her turn supine. I worked on her neck and then applied the Textbook TMJ Procedure. The moves over the pterygoid and temporalis were quite uncomfortable as these tissues were somewhat tense and perhaps even rigid, especially on the right side. I repeated the procedure after a short break and then let her rest a little longer. While she was resting I explained that her ‘clicky’ jaw was very much connected to her hip pain. I told her she was a tough case but that I thought I should be able to help. I asked her to give me three or four treatments to see if I could help.

The second session was a week later and she reported there had been little or no improvement in her symptoms.  The assessment was the same as the previous week, so I repeated the treatment and added the Pelvic Procedure. I can tell you she now had two reasons not to like me much!

The third treatment was another week later and she reported that there had been an improvement in her pain. She no longer felt the pain in her foot and it extended into her leg ‘at times’ but at other times it was confined to just her hip. In general, the pain was less intense and more tolerable. The assessment was the same as the previous sessions except she no longer showed the +ve 2CTT. This time, the screening was unremarkable (i.e. the short leg did not change during any of the screening procedures). I repeated the BRM’s and the Pelvic Procedure but this time, I left her Jaw alone.  I told her I could feel that there was an improvement as the general tension levels in her paraspinal muscles, and in her adductors, was reduced compared to previous weeks. I asked her to return in two weeks’ time, ensuring her body had more time to integrate the changes.

The fourth treatment was pleasing. Leonie reported that she had experienced ten days with no pain at all following the last visit. About three days prior, however, the pain had returned. It was confined to the hip but the ache was quite intense. The assessment was the same: a short left leg with unremarkable screening. On this occasion, I found the coccyx procedure resulted in symmetry. It was just a regular left-sided Coccyx Procedure (Textbook Coccyx, not the generic coccyx procedure most therapists are taught in basic training). I told her we were definitely ‘winning’ but that she should return in one week for another treatment.

The fifth treatment was pleasing as her pain had again resolved. This time, the assessment revealed she still held a state of symmetry. I simply worked through the basic procedures and noted that everything was feeling much looser. I asked her to come back in two weeks.

Leonie presented for the sixth treatment stating that she felt really good. She had had almost no pain at all in her hip and certainly none in her leg or foot. She had not needed any analgesic medication for several weeks and was feeling very grateful for the obvious improvement. Again, she showed symmetry so the treatment was quite basic and I could find no indication of any lingering dysfunction. I asked her to return in a month.

One month later Leonie came in for her seventh treatment. She said she felt great and had experienced no pain at all in her hip. She said this was the first time in eight years she had been pain-free for a sustained period and she wanted to know how long it would last. I assessed her and saw that she still showed symmetry. I also noticed the three straight lines were now ‘straight’. There was no longer any indication of an artifact causing the right femoral head to protrude laterally. I told her I could see no reason why her symptoms would return any time soon. I asked her if her jaw was still ‘clicky’ and she smiled, “It isn’t clicking anymore.”

Comment: Hip dysplasia is the most common cause of hip arthritis in adults before the age of 50.

In the US, it is believed that 10% of all total hip replacements are due to degenerative changes associated with dysplasia. According to the International Hip Dysplasia Institute, “Sooner or later, most people with hip dysplasia need surgery to build better support for the hip. In the early stages of arthritis from hip dysplasia, some of the cartilage surface may be intact and hip preservation surgery is possible to re-align the joint. Re-aligning the joint allows the remaining joint surface to be in a better position for weight-bearing”.

I am constantly amazed at how Bowen therapy can influence the relationship between structure and function. I this instance, I hold the view that it has provided Leonie with a form of ‘re-alignment’ that will afford the joint surface to be in a better position for weight-bearing. I am hopeful it will allow Leonie to function with far less inflammation and therefore slow the degenerative process taking place in her hip. The benefits of this will be significant with regard to the timing of possible future surgery. I hope it will be much “Later”, rather than much “sooner”.
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Case 53: A comparison of two cases of chronic, right-sided shoulder pain and restriction.

One Wednesday morning, 9 weeks ago, I arrived at the clinic to find my first two appointments were both new patients and that each was complaining of chronic, right-sided shoulder pain and restriction. The similarity between these two parallel cases is interesting…

PATIENT A: Georgia is 58 years old and works in an office where she frequently uses a computer. She described chronic, right-sided shoulder pain that has been persistent for almost a year. The pain was mostly in the anterior shoulder region, extending into her clavicle and into the lateral aspect of her neck. She was taking analgesic medications when the pain was bad. She had undergone numerous medical investigations (including ultrasound and x-ray) and had been told by her doctor that she had bursitis. She had undertaken courses of physiotherapy and chiropractic treatment but had enjoyed little improvement. A friend had suggested she come to the clinic.

Physical examination showed restricted range of movement. She could not reach behind her to tuck her shirt in and she could not raise her right arm beyond 90 degrees (reduced abduction).

Tonal assessment in the prone position showed a short right leg (approx. 20 mm short) which did not change on knee flexion or cervical rotation.

Tactile assessment in the supine position revealed great tension in the paraspinal bundle on the right side (i.e. performing move 6 of the neck procedure felt like I was trying to move a thick steel cable). Further palpation showed two other areas that felt quite abnormal. The top third of right sternocleidomastoid muscle held great tension and rigidity. In addition, the soft tissue around the right temporomandibular joint (TMJ) was also rigid and tense.

I made the best moves I could over the tense areas of the sternocleidomastoid and the tissues in front of the TMJ. The patient found the moves quite uncomfortable so I repeated them after a five-minute interval. Once I was satisfied the primary issues had been addressed (I checked for symmetry and this had returned following the moves) I then had her sit up for some shoulder work.

I treated Georgia every week for six weeks. After the first treatment, she thought there was a small improvement but over the next few weeks, she became unsure about whether she was improving. Each week I worked on the sternocleidomastoid and the tissues of the right TMJ.  I could feel continual improvement in these areas, week to week, and I encouraged her to continue. By the fourth visit she reported she was feeling considerably better. She was no longer taking any analgesic medication and she was experiencing much less pain. She also felt she was able to move her shoulder more freely.

On the fourth visit, I noticed her sternocleidomastoid muscle was feeling quite normal (to me). I felt it had regained a normal move signature and so I focused on the tissues associated with the right TMJ. These tissues were still tender and tense.

As I assessed her at the beginning of her sixth visit, I noticed she showed perfect symmetry. This was the first time she had done so throughout the course of the treatments. She told me the improvement had continued over the previous weeks and that she no longer had any pain in her shoulder, just some ‘crunchy’ noise and still some restriction (although not as much as before).

I moved her to fortnightly and I have seen her twice since then. She has maintained symmetry for the last month and all the tissues I had previously worked on feel soft and fluid as I move them. I can no longer feel any tension or rigidity. The range of movement has also continued to improve and she can now raise the arm to around 120 degrees and she can certainly tuck in her shirt without a problem. She says the ‘crunching’ sound only happens occasionally now and that in her estimation she is 95% better.

PATIENT B: The second patient was Luke, a 47 year old engineer, complaining of several years of right-sided shoulder pain and significant restriction of movement. He was unable to remember any event associated with the origin of his shoulder pain but noted the problem has been continuous for several years and seemed to be getting slowly worse with the passage of time. On abduction, he could only raise his arm to 100 degrees and he felt significant restriction in the right shoulder when he tried to reach behind his back.

Tonal assessment in the prone position showed a short left leg (approx. 15 mm) which resolved when he turned his head to the right side (i.e. a positive Cervical Turn Test).

Tactile assessment in the supine position revealed increased tension in the paraspinal bundle on the right side (i.e. move 6 of the neck procedure). Further palpation showed two other areas that felt quite abnormal. The left scalene region was tight and ‘hard’ between C2 and C4 and the right sternocleidomastoid muscle was very tense and rigid. The left and right sternocleidomastoid muscles made quite a dramatic contrast – one soft and pliable and moving freely and the other feeling like a very thick, tense rope joining the two attachment sites. The comparison of these two muscles was also interesting for Luke who had never noticed this striking difference.

I explained that we needed to release these sites and that it would be a little uncomfortable… Luke said he was happy to proceed and after several sets of targeted moves I reassessed him for tonal asymmetry. The asymmetry had resolved following the intervention so I was confident we had addressed his primary dysfunction.

I treated Luke weekly for five weeks. By the end of that time, the scalene region on the left side and the sternocleidomastoid muscle on the right had both returned to a normal healthy state. Luke reported significant improvement in his shoulder too. He told me he felt he was about 80% better because his pain had resolved and his range of movement had improved. He did still experience some intermittent episodes of pain but these were only occasional and usually followed a strenuous activity such as cutting firewood. Tonal assessment in the prone position showed a sustained state of symmetry.

I told Luke we could still do better. The next couple of treatments (spaced fortnightly) were focussed on releasing specific localised tension through his biceps, deltoid and infraspinatus. When I saw him last week he told me he feels his shoulder is about 90% better.

Comment: These two people presented on the same day with a similar complaint.

Successful outcomes were obtained for each patient by targeting treatment to their primary dysfunction.

In both instances the sternocleidomastoid muscle was involved. This is common in chronic shoulder issues due to two factors:

1. The tension in that muscle disturbs the position and movement of the temporal bone generating a state of elevated dural tension that emanates from the cranial base (this will impact the shoulder).

2. The sternocleidomastoid attaches to the medial third of the clavicle. The clavicle serves to position the shoulder and support it through its motion. If the clavicle becomes disturbed in relation to its position and movement, this may impact the function of the shoulder resulting in pain and dysfunction.

In addition to the sternocleidomastoid issue common to both patients, one had chronic TMJ dysfunction and the other had chronic dysfunction associated with the cervical vertebrae. In each case, these relevant issues were targeted and released to promote an environment that would allow the shoulder to heal.

Case 54: Idiopathic inflammation of the ankle in a 69-year-old male

As Kevin (69 y.o.) limped down the corridor to the treatment room, I could see how much pain he was in – he could barely walk and each step seemed to cause severe discomfort. Once inside the room, Kevin began to describe his symptoms in order of severity.

“I have severe pain in my right hip. It goes into my back and it runs down my leg toward my knee. If I try to walk, it hurts like hell. I think it must be sciatica.”

“Every step is so painful and now I think I’ve got gout in my foot. My right foot has blown up. It’s hot and swollen and every time I put weight on it, it hurts as well.”

Kevin said he couldn’t recall any incident associated with the onset but the hip pain had started first, about ten days prior, and it had been getting steadily worse. The foot/ankle had become noticeably swollen and hot and sore about four days ago. Prior to the onset of the hip pain, he felt well. He told me he needed to be fit and healthy because he was going away on a cruise in two weeks’ time.

I assessed Kevin in the prone position and saw that he showed significant tonal asymmetry. His left leg appeared at least 25mm shorter than the right. I conducted a few screening procedures but all were unremarkable. His right foot was indeed very hot and very swollen.

I commenced the treatment with the Lower Back and Upper Back moves before turning him supine. I used the moves of the Neck Procedure to assess the state of the upper dural attachments. The paraspinal bundle on the right side of the neck was quite tense so I gently checked the sternocleidomastoid muscles for tension. The left sternocleidomastoid was tight and so I became confident I would find my target in the muscles associated with the right TMJ. I released the right pterygoid/temporalis region and let him rest awhile.

After a short break, I rechecked his neck and found the tension in the paraspinal bundle on the right side had greatly diminished and the tissues associated with the TMJ had softened significantly. I had Kevin turn prone again and conducted a quick reassessment. The presentation had changed significantly. He still showed a short left leg but now it was only about 5mm shorter.

Using the left leg as the fulcrum, I performed a regular coccyx procedure and observed further improvement. I left him to rest for a few minutes. Upon return, the presentation was one of symmetry. I asked him to get up and try walking around the room. He did and he said he felt a lot less pain coming from his hip and back so I asked him to return in four days’ time.

As Kevin walked in, four days later, it was clear he was moving much better. He still had a slight limp but he was smiling. He told me he was feeling lots better but for the fact that he had developed a headache the day after the treatment. I assessed him and saw that he was still holding symmetry. I asked him about his foot and he said he thought the swelling was less because it didn’t feel as tight or sore, and it certainly wasn’t as hot. After conducting my assessment, I told Kevin I wasn’t going to treat him today. I asked him to return for the follow-up treatment in three or four days.

Kevin returned three days later, one week after his initial treatment. He walked smoothly into the treatment room and he was beaming. He said he felt one hundred percent better. He had no pain anywhere at all. His hip and beck felt good and his foot had returned to normal. I asked about the headache and he said it had lasted about three days in total before it gradually faded away.

A quick assessment showed genuine symmetry but the really interesting thing was that his foot had almost returned to normal as well. I performed a few moves in assessment mode and then sent him off to pack his case for the cruise.

Comment: There are many comments that could be made about this case. Some will no doubt be concerned that I performed both the TMJ and the Coccyx Procedure on the very first visit.  Some may point to the headache as a consequence.  From my perspective, however, the inflammation in the ankle joint was the most interesting symptom in this case.

I deliberately did not touch or treat him below the knee.  I was quite sure that the idiopathic swelling and inflammation was associated with his global pattern of dysfunction.  I frequently observe great results using such an approach in the treatment of knee and ankle inflammation when the onset is idiopathic and the joint affected is on the long-leg side.