Case 25 – Recalcitrant Bell’s Palsy in a 73 y.o. male
Barry (73 y.o.) presented to the clinic on 28th April, 2016 detailing a history of over 18 months of chronic left-sided facial paralysis that had been diagnosed as Bell’s Palsy. He had diminished sensation especially on the upper branch of the facial nerve but also on the other branches too. Quite notably, since the onset of the condition, he had not regained the ability to ‘wrinkle’ his forehead and he still showed very little strength in the muscles under the eye that are associated with the middle branch of the nerve. He had read on the internet that Bowen therapy could help the nerves and so he had come to the clinic to ‘give it a try’.
Assessment of tonal asymmetry revealed that one leg appeared more than an inch shorter than the other. Screening was unremarkable however the paraspinal tissue on the right side of his neck was terribly tight, as was the left sternocleidomastoid. As I worked on him he commented that he had read on the internet that Bowen was ‘gentle’ and ‘painless’ (but that wasn’t how he was experiencing it!). Naturally, those areas of long-standing stagnation were quite tender to move.
Releasing the sternocleidomastoid and the lateral pterygoid/temporalis produced an immediate response. The tonal asymmetry completely resolved during that treatment (and it hasn’t returned since). His paraspinal neck muscles melted during the treatment and his jaw actually straightened. I told him he had a big issue with his jaw and he then relayed details of several traumatic injuries that he had received including a past history of fracture.
On the third visit he stated that he had been noticing some interesting sensations in the affected areas and that he could feel ‘things happening‘ in his face and so he was very keen to continue with the treatment. I was particularly interested when he also stated that he was feeling ‘ten years younger’ because he felt he could move about with more agility and balance and much less stiffness. I reassessed and treated the primary sites but they were still responding nicely – the tissues were becoming softer and more elastic with the passage of time.
He presented again today (35 days after initial presentation) and stated that he was very pleased with the progress because he could feel some movement returning to his face. I asked him to try wrinkling his forehead. The tissue that had previously been non-responsive was now quite wrinkled, indicating that neuromuscular function was returning.
Comment: Bell’s palsy is the term used to describe facial paralysis when the cause is ‘unknown’. As an acupuncturist, I get to see quite a lot of it (because it generally responds really well to acupuncture). I tend to approach the treatment of this condition with two considerations… First, I want to know if there is any ‘structural issue’ having an effect on the nerve… The facial nerve has to run along the cranial base and then through a narrow passage in the temporal bone. If there is any state of dysfunction involving the temporal bone or the sphenoid bone then this can significantly impact the nerve so I will always address that with Bowen before I do anything else (I believe Mr Bowen always based his treatments on his understanding of the relationship between structure and function. I always assess each patient to see if there is any tonal asymmetry resulting from cranial bone issues. In many cases of Bell’s palsy there is, and so I lead with some Bowen treatment).
In some cases however, the problem is that the function of nerve has been impaired due to a non-structural issue. For example, prolonged exposure to cold wind (We see this a bit with farmers who drive through the fields checking their stock, with the car window open and the heater on… one side of their face is warm while the other is very cold). In these cases I am inclined to use acupuncture as the treatment of choice.
Case 26 – Involuntary muscle movements in a 16 y.o. female with ataxic cerebral palsy
Connie is 16 years old and she suffers from ataxic cerebral palsy. Her mother brought her to the clinic because she had noticed a gradual but significant deterioration in her gait and told me she believed one of the Connie’s legs had become considerably longer than the other. Connie had previously enjoyed Bowen treatments with a therapist near her home in Melbourne but had been encouraged to come to see me by a friend of the family who lived in my town.
Assessment of leg length (performed prone and during dorsiflexion of the feet) revealed a short right leg which appeared at least five centimetres shorter than the left (Yes – 5 centimetres!). In response to cervical rotation to the right side, the legs became equal in length.
I performed the Lower and Upper Back procedures and then checked the coccyx for tenderness (there was none). I had her turn over and began working on her neck. There were a number of issues but the primary tension was clearly associated with the area over the lateral pterygoid on the right side. It was quite ‘hard’ and very tender to touch.
Connie’s home was a little over 300km away. I did not expect that she would be returning for another treatment anytime soon and I really wanted to release the lateral pterygoid while I had the chance. I applied as ‘deep’ a pressure as I felt she could tolerate and then made the move. I was sure I had affected the release I was after but Connie was not impressed (and after that she didn’t smile at me again!).
I asked her to walk around the room and she certainly appeared to be walking noticeably better. I asked her to lie prone again so I could see if her leg lengths had corrected. They now appeared perfectly equal and unaffected through knee flexion and neck rotation.
The ‘follow-up’ appointment is what makes this case interesting…
Connie returned to the clinic for a second treatment eight months later. Her mother told me Connie’s response to the initial treatment had been remarkable. Her leg length issue seemed to have resolved itself ‘permanently’ following the first treatment and her gait had improved accordingly. The most striking change however, had been to the involuntary, jerky movements which were characteristic of her condition. Since the first treatment these involuntary, jerky movements had become far less prevalent. Previously they had always gotten lots worse in the evenings but since the treatment they had been vastly improved. She had noticed a slight regression over the last month so they had come back to get another treatment.
Assessment of leg length showed the right side appeared about five millimetres shorter than the left and this corrected on cervical rotation. I put in the stoppers, completed the Upper Back Procedure and then got her to turn supine so I could work on her neck. I was surprised to find the pterygoid region was soft and not at all tender. Her primary issue this time was the right sternocleidomastoid, which I released, and this restored the tonal symmetry.
Comment: Ataxic cerebral palsy is caused by damage to the cerebellum. It accounts for about 5-10% of diagnosed cerebral palsy cases and is different from the other two forms, which are spastic cerebral palsy (damage to cortical motor areas and underlying white matter) and athetoid cerebral palsy (damage to basal ganglia).
The Cerebellum is the part of the brain responsible for activating and coordinating muscle movements. Patients with ataxic cerebral palsy experience problems in muscle coordination, specifically in their arms, legs, and trunk (the word ‘ataxia’ means ‘loss of control of bodily movement’).
The most common manifestations of ataxic cerebral palsy include jerky and uncoordinated muscle movements and tremors. In this case, involuntary movement was also common. The initial Bowen treatment focussed primarily on releasing tension in the lateral pterygoid and temporalis which resulted in the subsequent resolution of a severe dural restriction that was emanating from the right side of the cranial vault.
The attachments of the lateral pterygoid and temporalis include the sphenoid and temporal bones and these bones constitute a large part of the cranial base. It would seem the release of these tissues impacted dural and cranial structures and had the effect of significantly reducing some of the symptoms associated with ataxic cerebral palsy.
Mr Bowen was well known for running a special clinic for people with disabilities such as cerebral palsy. He used his techniques to reduce their symptoms and to improve their quality of life. As we gain a greater understanding of the technique and its influence on dural and cranial structures, we can hope to replicate his approach and his success in these areas.
Case 27 – Chronic neck pain and headaches
Sandra is 31 years old. She presented to the clinic complaining of chronic neck pain and stiffness and frequent headaches. She could not recall any specific event associated with the onset of her symptoms but she had been suffering for more than four years. Over this time, she had been receiving ongoing chiropractic and physiotherapy treatment which provided some relief. She was referred to our clinic by a work colleague.
Initial tonal assessment revealed a left-sided dural drag represented by a leg length discrepancy greater than one inch. The leg lengths moved back to symmetry upon head rotation (positive Cervical Turn Test). Her upper back and shoulders were very tight but her neck was even tighter with the paraspinal muscle bundle on the left side feeling extremely tense. I treated her with emphasis on the left lateral pterygoid and temporalis muscles.
One week later she returned for her second visit reporting only slight improvement. I repeated the treatment as her presentation was similar.
On the third visit (one week later) she reported that she had been experiencing even more neck pain than usual and some bad headaches. Assessment revealed a short left leg but this time, there was no change when she turned her head. Screening was unremarkable so I assessed her coccyx and found it to be very tender and deviated to the left. I treated her with a left-sided coccyx correction.
She returned the next week and her neck pain had significantly improved. The presentation of tonal asymmetry was identical to the previous week and I again assessed and treated her coccyx (left-sided). This time, the coccyx tenderness was far less.
She returned for her fifth visit stating she was feeling considerably improved. Assessment revealed a state of tonal symmetry. The coccyx was no longer tender and did not seem to be deviated. As I treated her neck, I noticed how much looser the paraspinal neck muscles felt.
On the sixth visit (two weeks later) she reported further improvement in the symptoms. She had not had a headache for the last three weeks and her neck was pain-free with only minimal stiffness.
Treatment was concluded two weeks later at the seventh visit when she reported she had been symptom-free since the last treatment. Her neck muscles felt quite “normal” and they moved easily. She had again presented with tonal symmetry.
Comment: In the first few visits I did not address the coccyx because the screening had indicated cervical dysfunction. In retrospect, I do believe I may have got a faster resolution for the patient if I had addressed the coccyx from the very beginning of the treatment.
Once I did address the coccyx, the neck muscles began to loosen and the headaches lessened. I would attribute this response to the fact that the filum terminal anchors the dura mater at the coccyx and that resolving dysfunction at this site benefits the dura as a whole and particularly at the Lovett Brother site (the sphenoid).
In recent times I have (on a quite a number of occasions) been able to use a coccyx correction to clear the presentation of a positive Cervical Turn Test.
Case 28 – A comparison of the treatment of three patients that presented with vertigo
During the last month, I had three patients present to the clinic complaining of vertigo. Each described significant bouts of dizziness that included severe ‘spinning’ of the room. Each reported the symptoms were associated with postural changes (for example, on sitting up after lying down) and with particular head movements.
Each patient was individually assessed (using assessment of tonal symmetry) and in each case, treatment was targeted to their own specific issue. In all three instances, the vertigo was vastly improved after the first session and, following the second session, the symptoms completely resolved. All three patients received just three treatment sessions.
The comparison of the three treatments is interesting because, although their symptoms were basically the same, in each case therapy was targeted to a different tissue.
Table 1 – Clinical findings in three patients with vertigo
|Tonal asymmetry evident
Right-sided dural drag
|Positive Cervical Turn Test
|Tension associated with left-sided
|Left side temporalis & lateral pterygoid|
80 y.o. female
|Tonal asymmetry evident
Left-sided dural drag
|Positive Cervical Turn Test
|Tension evident in scalene on the right
30 y.o. female
|Tonal asymmetry evident
Left-sided dural drag
|Positive Double Cervical Turn Test
|Chronic tension evident in the sternocleidomastoid
Muscle on the right
Comment: In the developed world, vertigo accounts for about 2–3% of all emergency department visits. In the clinic it is also quite a common presentation. It is common for people to associate ‘balance issues’, and symptoms such as dizziness and vertigo, with issues affecting the ear (or more precisely, the vestibular system) but in many cases vertigo can result from disturbance associated with the balance centres of the CNS including the brainstem and cerebellum.
As Bowen therapists, we are primarily interested in the relationship that exists between function (of the nervous system) and structure (particularly the structures that house and support the nervous system). In these cases, we should be particularly interested in soft-tissue dysfunction that can influence the bones of the cranial vault and of the upper cervical vertebra.
Patient A experienced a resolution to his symptoms once the temporalis and lateral pterygoid were addressed. The mechanism involved likely relates to the impact these structures have on the temporal bone and the sphenoid and on branches of the fifth cranial nerve.
Patient B’s treatment was targeted to the upper scalenes on the right side and subsequently her symptoms began to resolve. The mechanism here likely involves the impact this intervention had on the upper cervical vertebra.
Patient C’s treatment was targeted to the sternocleidomastoid on the right side. This tissue attaches to the mastoid process of the temporal bone (and to the occiput) and so it has the capacity to impact the inner ear and various structures of the CNS.
In all three cases, the release of the target tissues resulted in immediate benefit to the CNS and this was evidenced by the correction of the tonal asymmetry and a rapid resolution of the symptoms of dizziness and vertigo.
Case 29 – Chronic numbness of the thumb in a 37 y.o. male
A remedial massage therapist presented to the clinic complaining of constant numbness in his left thumb (similar to Case 22). The numbness had been constant for 3 months although it had been intermittent for three months before it became constant.
In addition to the constant numbness of the thumb, the fellow also described periods of numbness in the left arm during the night, where the sensation often radiated into the left shoulder and up to the back of his neck. The numbness was impacting his capacity to work and he was worried it might get worse. He had had medical investigations including MRI and nerve conduction tests but these were unremarkable. He had tried physiotherapy and had multiple chiropractic treatments however he had received no benefit to the constant numbness. His doctor had suggested he try acupuncture and so he had come to the clinic to see me. I asked if I could assess him to see for myself that there were no structural issues affecting his neck and shoulder.
Assessment of tonal asymmetry (prone) revealed a right-sided dural drag of approximately 1 inch. There was no change in leg-length on knee flexion but head turning certainly changed the picture. Head turning to the left made no difference to the short right leg, but head turning to the right caused the left leg to become almost 1 inch short. I noted the cervical involvement as what I term, a “Reverse” Double Cervical Turn Test.
I asked if I could do some soft-tissue work instead of the acupuncture as I felt there were issues that needed addressing. He agreed and I commenced the Bowen treatment. When I palpated his neck (using the Neck Procedure as described in the book) I found severe tension in the paraspinal bundle on the right side. I made a few deep medial moves on the paraspinal tissue up around C-2 and C-1 (as this area felt very rigid) and I also released the lateral pterygoid and temporalis on the right side using the textbook TMJ procedure.
At the end of the treatment I reassessed the patient in the prone position. The right leg was short but there was no change on turning the head to either the left or the right. I applied a right sided coccyx treatment which the patient said was quite tender. A few moments later there was a presentation of tonal symmetry.
The patient was treated over the next five weeks with Bowen. The target areas for each treatment were the Neck, TMJ and Coccyx Procedures. By the fourth visit, treatment was simply confined to the neck and TMJ as the screening presentation had changed to show a simple positive cervical turn test.
By the fourth treatment the patient reported significant improvement in the numbness stating that he was experiencing periods that were free of any numbness and when the symptom was present, it was far less noticeable. The nightly episodes of numbness extending into the shoulder and neck had abated. Most noticeable for me was the progressive softening of the paraspinal bundle on the right side, around C-1 and C-2.
The treatments were weekly, except for the fifth treatment that was two weeks after the fourth. At that session, the patient reported that he had been totally symptom-free for more than a week. Tonal assessment revealed perfect symmetry and no change at all with head turning. Palpation of the right paraspinal bundles revealed similar tone on both sides. Treatment was concluded.
Comment: Some Bowen therapists avoid treatment of the Coccyx and the TMJ in the same session. Indeed, many avoid addressing either of these sites during the first visit. I always address whatever issues the body presents and I have no hesitation treating both sites in the same session.
One of the most rewarding aspects of using an assessment of tonal asymmetry to guide each treatment is that it allows the therapist to view the body’s issues as “layers”. The presenting tonal asymmetry relates to the structural issue that is most bothering the nervous system at that moment. Once that issue is resolved, the body will then reveal the next layer of dysfunction. In this way, the therapists can apply treatment to the current layer and observe the body response.
The following case also illustrates this point…
Case 30 – Severe sciatic pain in a 76 y.o. male patient
Alan came into the clinic in severe discomfort, complaining of a recent aggravation of his chronic (but usually low-grade) sciatic issue. His pain originated from the lumbar region and referred down his right leg. He was having great difficulty walking. Initial assessment showed a left-sided short leg of about 10 mm. Screening procedures showed a return to symmetry upon head turning.
I applied treatment in the form of the Lower and Upper Back Procedures before checking his coccyx which seemed unremarkable. I turned the patient over and assessed his neck. I spent the next ten minutes addressing the severe spasm and tension I found on the right side of his neck (I took several two-minute waits as I progressively released this tension). When I was happy that his neck was fine I asked him to get up and walk around the room.
As he walked around the room, he reported that he was still in significant pain but this time, rather than feeling lumbar pain, it seemed to centre around the right sacroiliac joint. He felt shooting pain there on movement and could feel the sciatic pain associated with this shooting sensation.
I asked him to return to the prone position so I could reassess him. This time he showed a short RIGHT leg of about 15 mm. There was no change on head turn but knee flexion caused the right leg to become longer. I checked his coccyx again but it was still unremarkable. I made a few moves over the paraspinal tissue on the left side between the first and third lumbar vertebra. This tissue was in severe spasm and was very uncomfortable to move. I released the area applying multiple moves interspersed with a few two-minute waits (these moves are basically the same as what was traditionally known as the Kidney Procedure). From the first application it was evident that the leg-length had corrected. When he stood up and walked around the room at the end of the treatment he walked freely and had no pain and no shooting sensations. He told me one week later that he had remained completely pain-free since those final moves.
Comment: This patient presented with two separate issues which may be viewed as “layers” of dysfunction. Following the findings of the tonal symmetry assessment the body indicated there were cervical issues that needed to be addressed. Once these were addressed, the symptom pattern changed somewhat and another layer of dysfunction was revealed. This allowed the identification and correction of a longstanding state of dysfunction associated with the paraspinal tissues in the upper lumbar spine. Resolving these issues allowed the pelvis to move to a functional, symmetrical state and the patient’s pain to resolve.
Although body dysfunction can be complex, addressing the issues one at a time (taking away one layer of dysfunction at a time) allows the process to become much less complex. Treatment applied in this way is ‘guided’ and ‘targeted’ and the body’s issues are addressed in order of importance.