Case 19 – Daily episodes of neuralgia in the head and neck:
Jan is 66 years old. She described her symptoms with precision. For the last 3 months, at about 3:00 am or 4:00 am each night she is woken by pain that stems from the top of her left shoulder (acupoint GB-21) and runs up her neck to the base of her skull (acupoint GB-20) and then up the back of her head and over the top to her forehead (acupoint GB-13). The pain is accompanied by a sensation of ‘tightness’ and it causes her to get up and take medication and move around. The odd thing she noted, was that she has very little problem with pain or stiffness at other times during the day.
I explained to Jan that her problem was very easy to understand from a Chinese medicine perspective, as it was a classic example of ‘Yang Rising’, but Jan was quite sure she wanted me to use Bowen Therapy rather than acupuncture to address her complaints.
I suggested we assess her and see if there were any issues in her neck that might be a problem and if not, we could then talk more about the possibility of treating her with acupuncture.
Prone assessment revealed a short leg on the left side – about 2 cm shorter than the right. Screening failed to show any change. I asked her to open her mouth ‘wide’ and hold it open – this caused the legs to return to a state of symmetry. I asked her to ‘grind her teeth’ for a moment or two and this caused the dural drag to return.
While she was lying prone, the only issue I could find was a slight deviation of her coccyx. It was deviated a little to the left but treating it elicited no change in her tonal asymmetry. I had her turn over and commenced the neck work. I noted the left side of her neck was much tighter than the right, but the tension was evenly distributed and constant through the paraspinal tissue from C-6 through to C-1. I palpated the area over the pterygoid/temporalis muscles in front of the condyloid process of the mandible and noted much tension and sensitivity on the left side.
I used the textbook TMJ Procedure to release the tension and left the room. Five minutes later, as I repeated the move, Jan commented that it was much more comfortable this time and that she could feel some unusual but pleasant sensations behind her eyes. I had her walk around then reassessed her leg lengths to find a state of tonal symmetry. I asked her to return in a week.
The following week she reported that she was much improved and hadn’t woken during the night on the last three nights. I repeated the treatment and noted significant improvement. I asked her to return in two weeks. She returned and reported she was symptom free. I provided Jan with two more treatments, two and three weeks apart, before I was satisfied the issue was completely resolved.
Comment: Opening her mouth ‘wide’ and holding it open caused her legs to return to a state of symmetry. This is a simple screening test I sometimes use to see if the jaw is associated with the presenting tonal asymmetry.
Many patients report sensations behind their eyes or even visually in response to the TMJ Procedure. This is likely due to the intimate contact the sphenoid has with the optic nerve which runs through the bone itself (through the optic foramen) and then rests against it in the chiasmatic groove (or optic groove).
Case 20 – Chronic trigeminal neuralgia; ear and face pain:
Kylie came to the clinic six months ago complaining of chronic and severe pain through her face and ear. She outlined a 15 month history that involved right-sided ear pain and a constant burning sensation in her right cheek, face and jaw. She also described a frequent ‘shooting’ pain that ran from her temporomandibular joint, along her mandible, to her chin. She outlined how the symptoms had originally presented in association with a recalcitrant ear infection that had persisted for almost 5 months. The ear had been painful and had discharged continually for several months before the pain spread to her face and jaw. Finally the ear infection had resolved but the neuralgia had remained.
Tonal assessment revealed she had a short leg on the left side (1 inch short). There was no change to this pattern of asymmetry upon knee flexion however significant change was observed in response to cervical rotation. Turning her head to the left made no change to the presenting asymmetry but turning her head to the right resulted in a 1 inch shortening of the RIGHT leg (this pattern is called a ‘double’ Cervical Turn Test and is commonly seen in patients with sphenoid and/or coccyx dysfunction).
Lower and Upper Back Procedures were applied and the coccyx was checked for tenderness and asymmetry. Although the coccyx was tender and deviated to the left side, there was no change in tonal asymmetry in response to treatment of the Coccyx. The patient was asked to turn over and her neck was assessed/treated. The right paraspinal muscles were very tense throughout the length of the cervical spine. Palpation of the masseter and lateral pterygoid muscles revealed a rigid tension of these tissues on the right side. Given the attachment of the lateral pterygoid to the sphenoid bone it was identified as the target tissue. Treatment was applied to the lateral pterygoid and (and temporalis) in the form of the Textbook TMJ Procedure.
The applied procedure was quite painful for the patient and she felt immediate sensations through the right side of her face. The procedure was repeated following a five minute wait and the patient was reassessed for tonal asymmetry. Where she had previously demonstrated a short left leg, she now had symmetry.
Kylie returned for a follow-up appointment a week later reporting only minor signs of improvement. The presentation was the same, as was the treatment. The first four treatments were performed at weekly intervals and each week she reported some improvement. By the fifth treatment Kylie stated that she had stopped taking analgesic medication and felt her pain was about 50% less. Since Kylie was travelling a considerable distance to have the treatment we rescheduled the appointments to a fortnightly program.
I month later Kylie reported the improvement had continued to gain momentum and that she now felt she was 70% better. Although she still presented with some asymmetry, it was relatively minor. The rigidity of the right lateral pterygoid had also reduced notably. I month after that, she reported that the burning pain had fully resolved and that she only experienced minor episodes of the shooting pain on rare occasions.
Kylie’s condition is much improved and has been stable for the last three months. Although she still experiences occasional shooting sensations along her jaw to her chin, she notes that these are quite mild and very occasional (two or three episodes per month). She comes for treatment on a monthly basis now and she is yet to present with symmetry. Hopefully that will come soon.
One of the interesting things about this case has been the presentation of the coccyx from one treatment to the next. On some occasions it is deviated to the left and on others it is deviated to the right. Although the tenderness has reduced, as yet it has not fully resolved.
Comment: This case illustrates the principle that healing often takes place slowly over a prolonged period of time (as Bowen Therapists, many of us put ourselves under pressure with unrealistic expectations. I have heard hundreds of times that people feel they should see results in two or three treatments! This case has been ‘a work in progress’ for the last six months and is ongoing).
It also shows the relationship that exists between the dural attachment sites at opposite ends of the spine (the coccyx and the sphenoid). On two occasions during this treatment program, Kylie presented with the coccyx being the primary issue. It was addressed and the following treatment she would present with the sphenoid/tmj issue being primary again. This is not uncommon.
Case 21 – Scoliosis associated with chronic and severe lower back pain
Julie (74 y.o.) presented to the clinic in May, 2015, complaining of severe pain in the lower back, and at the base of her spine. She hobbled into the treatment room with considerable difficulty, listing to one side – her shoulders were four inches to one side so they did not sit directly above her hips. Julie revealed this chronic state had worsened since its onset over a year ago and that she was never free of the pain. She had tried other therapies over that time with no significant improvement.
I asked her to lie prone on the treatment table but she felt this would be too uncomfortable. I asked her to lie in that position for just a minute or so, so I could assess her, and she agreed.
I have encountered few people with her level of dural tone. Her left leg was 1 inch short (2.5 cm) but this corrected on cervical rotation. Running the length of the spine on the left side was paraspinal tissue that simply resembled steel. The left paraspinal tissue sat half an inch higher than the corresponding tissue on the right side and scoliosis was clearly visible. Dorsiflexing her feet proved to be very difficult, with the left foot being almost completely rigid.
I quickly put in the Lower Back moves and asked how she felt lying on the table (she had been on the table about 2 minutes). She said she was in worse pain in this position and that she really needed to get up and walk around. I left her for a few minutes and she hobbled restlessly around the treatment room until I returned. She lay on the table again and I completed an Upper Back treatment and asked her to turn over.
Her neck simply felt like a crowbar with higher grade steel in the paraspinal tissue on the right side. I kept making a few moves as best I could and then letting her rest. Every time I came back into the room she was up and hobbling around. She would lie down again and I would make a few more moves… The tissue under the masseter on the right side was very tense and painful and I warned Julie the move might be uncomfortable but she urged me to continue.
I moved it twice with a short break in between the moves and also released the left sternocleidomastoid muscle which was very tense and then I asked her to return in a week.
She returned stating there was little improvement and, as the presentation was the same, I repeated the treatment. She still could not lie on the table and I would always find her hobbling around when I came back into the room. On the third visit (one week later) she stated she thought there may be a slight improvement but she couldn’t say for sure. The presentation was the same but I was sure the tension states had reduced a little in intensity.
She returned for her fourth visit and I noticed she walked much better – her shoulders seemed to be only 2 inches ‘off centre’. Julie said the improvement was very significant over the last week and that she was very pleased her pain levels had improved. I followed the same approach as the presentation was the same, albeit the tension was significantly less. It surprised me that she still needed to walk around the room each time I took a break. I was most surprised however when she said she could not afford to return for another treatment for a month.
One month later she told me she had continued to improve and that she now felt only minimal pain. She was walking straighter and this time she could lie on the table for the whole treatment. The tension changes were striking but the right TMJ and the right side of her neck were still the primary area of dysfunction. Sensing her reluctance to continue treatment (due to the cost) I urged her to have one more treatment in another month. She agreed and upon assessment at that session I could see that things had improved further. Her shoulders were actually were they were supposed to be, and she walked normally. The issues were slight and the left leg was only a little shorter than the right. I asked her to attend once more in a month.
At that appointment Julie presented with tonal symmetry. She had no trouble lying on the table and she stated that she had not felt any back pain at all for more than a month. In fact, she was almost finished painting her kitchen which involved lots of work up and down ladders and getting down on the floor! The scoliosis she has presented with had resolved and the paraspinal tensions were the same on both sides.
Comment: I never cease to be amazed by the body’s capacity to restore itself in response to the correct stimulation. At the outset, I never expected Julie’s scoliosis to change so significantly. Indeed, I simply set out with a view to reducing her pain. The resolution of the chronic and severe lower back pain followed the release of the tension affecting the dural tube. The degree of change that followed was truly remarkable – as is the change it has brought to the quality of Julie’s daily life.
Case 22 – Chronic numbness in the thumb and fingers associated with upper back pain
Greg is 55 years old and he arrived at the clinic complaining of numbness in his thumb, index and middle fingers. He reported the numbness had been present for three or four months and was fairly constant. He also complained of upper back pain as well as pain in the right shoulder and elbow.
Greg had seen four other therapists so far for this condition and had experienced no noticeable improvement – he was quite despondent.
I asked him to stand up and I reached behind him and put pressure on his right infraspinatus muscle. As I palpated the tense tissue, Greg looked at me and smiled. After a few seconds of holding pressure against the muscle he told me the numbness was increasing and the local discomfort I was creating was extending into his shoulder and reproducing his shoulder pain. He was apparently happy that I had immediately found “a great spot”.
I assessed him for tonal asymmetry and addressed a couple of issues in his neck after I had completed a Lower Back and an Upper Back Procedure. I had him sit up and then used the infraspinatus move to release the tension at the back of his shoulder blade. I grabbed a text and showed him the pain referral pattern for the infraspinatus trigger points and this helped him to understand how this point was related to his pain and numbness. I repeated the move a few times and although it was very painful, this just seemed to make him more pleased.
He returned a week later saying there was less pain but that the numbness had persisted and was unchanged. I repeated the treatment and asked him to be patient. He returned the following week reporting a significant reduction in the numbness. I moved him to fortnightly treatments and at each visit he detailed continued improvement. I saw him yesterday (exactly two months after his initial visit) and he stated that he had no symptoms at all. Upon palpation, the infraspinatus muscle was no longer tense nor tender.
Comment: Bowen is great at resolving trigger points and the infraspinatus move is invaluable in clinic.
Case 23 – Trigger finger
Moyra (86 years young) presented in May 2014 complaining of a longstanding trigger finger. She showed me how her right ring finger would catch and ‘get stuck’ in one position and she had to use her other hand to move it back to the normal place. She stated there was little pain but that it was very inconvenient.
Assessment revealed a left sided dural drag that resolved when she turned her head to one side. The right side of her neck felt quite like concrete. Using a modified version of the Neck Procedure, I did my best to release the paraspinal muscle tension between C-5 and C-2. I might add, at the time, she didn’t think I was a very nice person!
I also worked the muscles in her upper and lower arm but found nothing particularly interesting.
The following week, Moyra thought her finger may have been a little better but she couldn’t say for sure. I repeated the treatment and sent her away for another week. She returned as scheduled and reported there had certainly been some improvement in her finger. It was catching less and when it did catch, she could sometimes move it out of that position without resorting to the use of her other hand.
Her neck was improving too and now felt much less like concrete and much more like a normal ‘tight’ neck. I treated her four times in total and she reported 85% improvement over that time period.
Nine months later Moyra returned to the clinic seeking treatment for a different issue. She remarked that she had no trouble at all with her finger and that it had continued to improve and was now 100%.
Case 24 – Chronic neck stiffness and pain in a 19 y.o. female
Ashley (19 years old) presented to the clinic in the first week of June, 2015. She described a seven year history of chronic neck tension and pain, headaches and recurrent migraines. She noted the symptoms were worse when she felt ‘stressed”. She explained the onset of the condition was associated with trauma sustained in a motor vehicle accident when she was twelve.
Previous treatments include regular ongoing physiotherapy, massage and occasional chiropractic treatment.
Assessment revealed a short left leg (1 cm). There was no change in leg length on turning her head to the left but when she turned her head to the right, the leg lengths changed so that the right leg became 1 cm shorter (this particular event is an indication of sphenoid/coccyx dysfunction).
I completed the Lower and Upper back procedures and noted elevated tension through the paraspinal tissues on the left side. I had her turn over and commenced work on her neck. Her neck was in a state of high tension and I noted its origin cranially. I used the TMJ Procedure (Textbook version) to release the pterygoids and temporalis in an attempt to influence the sphenoid.
After the treatment I had her walk around the room and then assessed her again, just like I had at the beginning of the treatment… I noted she now had a short right leg with no change upon cervical rotation. I suspected coccyx involvement but decided I would wait until next week to address it.
Ashley forgot her appointment the following week and so I saw her two weeks after the initial treatment. She reported that little had changed and that she was still very uncomfortable in her neck. Assessment showed the same presentation of asymmetry that I had initially observed on the first visit. I decided to assess the coccyx and I found it to be tender and deviated to the right. I felt a small but noticeable movement in the coccyx as I applied pressure to its lateral margin. After letting her rest for a few minutes I reassessed her and noted perfect symmetry with regard to her leg lengths.
I concluded the treatment there and asked her to return in a week for review. She returned saying she felt great. Assessment showed the symmetry had held. I gave her a basic treatment so I could palpate the areas that had been so tense on the first visit and was delighted to find her neck to be relaxed. I asked her to return for review in three weeks which she did. She reported that she had been symptom free for the last month. I reviewed her again yesterday (two months later) and she again presented with symmetry and no symptomatology.
Comment: This case is interesting on so many levels, not the least of which is that the chronic state of dysfunction was able to resolve so rapidly and so completely following the coccyx correction. The Lovett Brother relationship between the coccyx and the sphenoid is a central theme in Bowen Therapy. Bowen Therapy is very capable of addressing dysfunction associated with either structure but to be effective the treatment must be correctly targeted. In this case, assessment of tonal asymmetry was able to show no real benefit from addressing the upper sites of dural attachment. It was also able to provide an immediate demonstration of the effectiveness of the coccyx correction. Although there is more that could be discussed, I would like to point out that this case demonstrates so clearly the holistic nature of the spine and of our interventions.