BOWEN TECHNIQUE: Case Studies 31 – 36

Case 31: Chronic and debilitating back and neck pain in a 75-year-old male

Barry is 75 years old. Three months ago, he presented to the clinic complaining of a long history of chronic and debilitating back and neck pain. Two years prior, he had fallen and broken his left hip. Although he had surgery to repair it, he feels he has never been the same since. In his words, “my hip never fully healed”. He walked with the aid of a stick and demonstrated an obvious limp. He suffered from constant discomfort and he had a degree of permanent numbness in both feet that extended up his leg to about mid-shin level.

Assessment of tonal asymmetry revealed a shortening of the left leg (about 2 cm). The screening showed positive for Sacroiliac Joint dysfunction and also positive for cervical involvement. I commenced the treatment with the Lower Back and Upper Back procedures and then attempted to resolve the left-sided sacroiliac joint issue. Despite investigating and treating the piriformis, the paraspinals, and the coccyx, I was unable to change the positive SI joint test.

I turned him over and began to treat his neck. Put simply, it was as if his neck was made of concrete. In the patient notes from that session, I recorded my observation that he had “Concrete Neck Syndrome”. He was very tender to touch (especially anywhere around the neck or jaw) and so I progressed slowly and gently with each move, always keeping within the parameters of his tolerance. I asked him to return in one week for a follow-up…

He returned the following week, and the week after that, and each successive week since then… He has now had twelve treatments in twelve weeks.

Since the first treatment, he has been slowly, but progressively, improving. After the sixth, he told me he had regained the feeling in his feet and that the numbness in his legs had resolved. During each treatment, I focussed on trying to restore function to the neck and Jaw and this approach seemed to be bringing benefit. Every week, until his tenth treatment, he continued to show the same presentation of the shortened left leg and a positive test for SI joint dysfunction. Despite the lack of change in these indicators of dysfunction, Barry claimed he was slowly improving, and that he was gradually experiencing less pain and discomfort.

By the tenth treatment, the tissues around his jaw had softened and I was finally able to attempt to move quite deeply and firmly over the area that lies deep to the masseter. For the first time, I felt I had made a good move over the pterygoid/temporalis. He winced and he even complained about the discomfort I had given him, but I explained to him that I had waited nearly three months to be able to do that and I promised I wouldn’t do it again (without warning him).

He returned for his eleventh treatment and I noticed something quite unusual… “Where’s your stick”, I asked? “I don’t need it”, he replied (and the smile on his face, as he said it, was worth a case of Champagne). Assessment revealed a state of tonal symmetry. He no longer showed any shortening of his left leg and his SI joint was functioning normally. Palpation revealed a significant decrease in the tension in the tissues of his neck, too. I repeated the treatment but I didn’t go anywhere near his jaw (after all, I had promised!).

This week, Barry had his twelfth treatment and I watched him as he walked from the waiting room, down the corridor, to the treatment room. He had no stick and he walked with no limp. He presented with symmetry. I remarked that his left hip had finally started to behave itself and that his neck felt normal to me now, and not as if it was made of concrete. He told me he couldn’t believe how much better he was. He said that when he thought about how much he had improved, he felt as if he could cry.

Comment:  This case is interesting for several reasons. It certainly illustrates the interrelationship between the lower dural attachment sites, and the upper. Following the surgery to repair the fractured hip, function had not been restored to the SI joint. Following the release of the tension in the pterygoid and temporalis, the SI joint dysfunction spontaneously resolved (this happens commonly in clinic and it serves to illustrate the complex nature of holistic systems). I often wonder if the processes involved in surgery have a disturbing effect on the muscles attached to the jaw.

Change sometimes comes in very small increments. An understanding of the underlying state of dysfunction, combined with the capacity to recognise tonal abnormalities, and subsequent changes that occur in response to treatment, can be useful in helping us attain our clinical goals. This case demonstrates the importance of tactile recognition in the practice of Bowen therapy.

Finally, it shows the efficacy of Bowen therapy and how patience, knowledge, and persistence can be combined to restore function to the nervous system and to relieve pain and dysfunction, even in very chronic cases.



Case 32 – Chronic and severe lower back and hip pain

Janice (60 y.o.) presented to the clinic complaining of chronic lower back and hip pain. She had suffered with the pain for many years but for the last 10 months it had become constant and quite severe. In addition to the chronic back and hip pain, she was also experiencing a constant pain under the ribcage on the right side which worsened during inspiration. She walked with a slight limp and she described how the condition was severely impacting her ability to function. She had had MRI scans and other investigations and was being treated with anti-inflammatory and analgesic medication and with regular physiotherapy. She believed her condition however, was worsening rather than improving, and so she had followed a friend’s advice to try Bowen therapy.

Initial assessment revealed a left-sided dural drag which caused the left leg to appear half an inch shorter than the right. The drag resolved when she turned her head to one side, indicating her primary issue was associated with the cervical spine. I treated her with some basic Lower and Upper Back moves before turning her supine and checking her neck. The paraspinal muscles in the neck were very tight on the left side. Palpation also revealed significant tension in the muscles anterior to the left temporomandibular joint. I treated her neck as well as the tight pterygoid/temporalis muscles on the left side and I managed to get some release. Immediately following the TMJ work the tonal asymmetry changed significantly.

I had her take a little walk and then lie prone again and I reassessed her to find she now presented with her right leg appearing at least one inch shorter. The short right leg prevailed until I released the left psoas muscle using moves over the rectus abdominis. The release of the psoas brought her to a state of symmetry.

Janice returned for a follow-up treatment one week later, where she reported only minor improvement. The treatment applied in the second session was exactly the same as the first because the presenting tonal asymmetry was unchanged. At the third visit, she again reported only minor improvement and the treatment I applied was also the same. Although there seemed little benefit from the initial treatments, I could feel the target tissues were beginning to change so I was optimistic that significant improvement would soon be evident and I communicated this to Janice.

The fourth visit was interesting. She presented with a short left leg that now appeared a little more than one inch shorter, however, it no longer changed on head turning. I simply focused on treating her psoas (this time I spent some time addressing the right psoas too).

At the sixth visit, Janice reported that her back was now pain-free and that she had not experienced any pain under the ribs for at least two weeks. She stated that her only issue now appeared to be some pain she still experienced in her right hip. She also reported that she had reduced her analgesic medication significantly. She still presented with a short left leg but the psoas release no longer brought about symmetry – at this point it was necessary to release the adductors.

Janice was treated on two more occasions, at fortnightly intervals. On her eighth visit she told me she had been pain-free for the past two weeks and that she was no longer taking any analgesic medication. Assessment revealed a presenting state of tonal Symmetry. I asked her to return on a monthly basis for a while so I could monitor her going forward. I have seen her twice since then and she remains pain-free and so far, she maintains the presentation of symmetry. She has also been able to reduce her anti-inflammatory medicine too.

Comment: This case was interesting because of its ‘chronicity’ and its complexity. Resolving the issues in her TMJ and neck in the early stages of treatment, removed a primary layer of dysfunction. It then became evident that there was another layer of dysfunction that needed to be addressed for symptomatic improvement to occur. Assessment of tonal asymmetry provides a useful framework to identify, prioritize and address multiple layers of dysfunction.



Case 33: Treatment of uterine bleeding in a 34 year old patient with diagnosed placenta previa.

Anne (34 y.o) presented to the clinic one week ago suffering from symptoms associated with placenta previa. At the time of her presentation, she was 32 weeks into her fourth pregnancy. Five weeks prior, Anne had noticed some bleeding and so she visited the local hospital where she was diagnosed with placenta previa and was then hospitalized and confined to bed for four weeks. Her symptoms still included persistent low-grade bleeding, back and hip pain, exhaustion, poor sleep and severe night sweats. A concerned midwife had suggested she come to me for some acupuncture in the hope that it might help her situation.

I assessed Anne from a Traditional Chinese Medicine perspective and concluded that she was suffering from significant ‘Kidney Deficiency’.

I also conducted a structural/tonal assessment with Anne lying on the table in the prone position (this was very comfortable and very easy for her to do since I had constructed ‘a nest’ of pillows to support her in that position). Her left leg was noticeably shortened and failed to respond through any of the screening processes. Some quick palpation of the lumbar region revealed significant spasm and tension in the paraspinal tissues lying over the right kidney area (around L1 – L3).

I applied some moves in the form of the Lower Back and Upper Back Procedures and then applied the Kidney Procedure to the tense tissues on the right side. Immediate reassessment showed this had resolved the tonal asymmetry (following the Kidney Procedure, the legs appeared to be equal in length). I left her to rest for a few minutes and then repeated the moves of the Kidney Procedure (right side only). After another two-minute wait, I applied some ‘closing’ moves and I asked her to turn over. I could feel no problem at all in her neck or jaw (or anywhere else) so I asked her to come back in a week so that we could do some acupuncture. I explained that I wanted to withhold the acupuncture at this point because I wanted to see what changes we could achieve with the Bowen work and she said she was happy with that.

She returned today, one week after the initial treatment, and reported that her bleeding had stopped the next day and that it hadn’t returned. Her back and hip pain had also completely resolved. She reported that she was sleeping really well and that her night sweating was greatly reduced. She told me her face had been burning each day in the afternoon too, but that had also stopped. Her energy was now really good and she told me she really couldn’t believe how much better she felt. She said it was, without a doubt, the best week of her pregnancy. I reconstructed the nest of pillows and asked her to lie prone so that I could reassess her. In the prone position, she showed perfect symmetry and I couldn’t find any tension at all in the paraspinal tissues over the kidney regions. I didn’t give her any treatment at all today. I just asked her to come back if she experienced any problems in the coming weeks.

Comment:  I believe the Kidney Procedure is one of the most misunderstood Procedures in Bowen Therapy. To understand the physiological changes observed in this case, the therapist must have an understanding of some of the most fundamental concepts of Traditional Chinese Medicine.

According to Tradition Chinese Medicine, the Kidneys store the Essence and ‘govern’ the process of reproduction as well as the process of birth, growth, and development. The Essence is stored in the Kidneys and then distributed (by the Kidneys) to the extraordinary channels including the Governing Vessel (Du meridian), the Conception Vessel (Ren meridian), and the Penetrating Vessel (Chong meridian). While the Kidneys store the Essence and govern the reproductive process, these extraordinary channels all have pathways that pass from the Kidney to the Uterus.

In this context, the lateral moves used in the Kidney Procedure take on a specific significance in relation to these meridians and their functions in TCM. The Conception Vessel, for example, originates in the Uterus and is commonly used to address any uterine dysfunction while the Penetrating Vessel plays an important role in regulating the uterus and nourishing the fetus during pregnancy.

I have stated on many occasions that I hold little doubt that the theories and principles of traditional acupuncture have played a major role in the creation and development of Bowen technique. This case helps to illustrate the importance of developing our understanding in this area so we can more fully understand the action and influence of Bowen therapy.



Case 34 – Chronic, multi-regional back pain due to coccyx dysfunction

Sandra (40 years old) presented to the clinic in May 2016. She described chronic and quite severe back pain (affecting the lumbar, mid-thoracic and cervical regions to varying degrees) and stated that these back issues had bothered her for more than ten years. On the initial presentation the pain was worse in the neck and between the shoulder blades and at times, the pain made her nauseous.

Assessment of tonal asymmetry revealed a short right leg of about 1cm which resolved when the patient turned her head to one side. Treatment focussed on the severe tension states in the neck and also on the left temporomandibular joint (TMJ). I discussed these issues with Sandra and explained the tensions in the pterygoid/temporalis region were obviously longstanding and would take some time to resolve. She told me having treatment for her back pain was a normal part of her life and that she had already spent tens of thousands of dollars on chiropractic and osteopathic treatment, massage, and physiotherapy although, so far, the benefits had been minimal.

On the third visit, there had been some symptomatic improvement. The pain had reduced and there was no longer any nausea. The interesting thing, however, was that the short left leg, while still present, no longer resolved in response to head turning. I assessed her coccyx and found it deviated to the right and very tender to any pressure.

I can look back now and see that at that moment, I was quite satisfied that her issues were associated with chronic coccyx/sphenoid dysfunction. I understood that the dysfunction was long-standing and I expected the Bowen treatments would lead to the restoration of function, at those sites, and that her symptoms would fully resolve.

I treated her on a fortnightly basis through June, July, August, September, and October. At times, the results looked like they would materialize as she would have periods of a week or ten days with little or no pain but then she would relapse into a bout of severe back pain, an episode of severe proctalgia, or acute coccydynia.  At no point did the symmetry achieved during the session last any longer than 7 days.

Many significant issues had resolved throughout the course of the treatment. The neck tensions that had been so severe in the beginning had resolved and the tissues associated with the TMJ had returned to a normal tone and texture. The coccyx however, always remained tender to touch and did not seem to want to settle. I should comment that throughout the course of the treatment (which spanned over 5 months) I had repeatedly expressed my frustration at the fact that the coccyx would not settle. I had urged her to consult other therapies if she was inclined but she remarked that the Bowen treatment she was having, whilst not fully effective, was indeed the most effective treatment she had tried.

Finally, at the end of October (more than five months after I had commenced treating her), I urged her to consult a local chiropractor with a view to talking about the possibility of a manual coccyx adjustment. I explained to her that this would involve an internal adjustment (via the rectum) and that I was sure it wouldn’t be a pleasant experience. Reluctantly, Sandra agreed and went off to make the appointment.

Five weeks later, Sandra returned to the clinic and presented me with a big hug and a very special (and expensive) bottle of wine. She had seen the chiropractor who had assessed her and had agreed to perform the internal adjustment. The first adjustment was extremely uncomfortable and painful and the chiropractor commented on the severity of the coccyx misalignment. The follow-up treatment, a few days later, was far less painful and the chiropractor was pleased. Two weeks later, a final internal adjustment was made, after which, the chiropractor referred her back to me for ‘ongoing maintenance’. Since the second internal coccyx adjustment, Sandra had been pain-free for twenty- five days and counting.

I assessed her and she demonstrated tonal symmetry. I had her return for a check-up three weeks later and she was still free of all pain and still showing tonal symmetry. Interestingly, the coccyx was no longer tender to touch and no longer deviated.

Comment:  The coccyx is an important site of meningeal attachment – It is the attachment site for the filum terminale. Through its direct influence on the dura mater, coccyx dysfunction can lead to secondary dysfunction at other sites of dural attachment (including the sphenoid bone, the upper cervical vertebra and the sacroiliac joint).

It is quite clear that the coccyx was a very significant site for Mr Bowen. I have been told by those who observed him that he assessed the coccyx on almost every patient he treated, and that he had specialized procedures to address coccyx issues. This case illustrates how coccyx dysfunction can express itself in the form of complex spinal symptoms.

In this patient’s case, she had been receiving treatment for back pain for more than a decade, and from dozens of professionals, yet no one had ever identified the coccyx as the source of her condition. This emphasizes the need for appropriate assessment tools that enable the therapist to identify the primary sites of dysfunction. Even though I was not the practitioner who eventually ‘corrected’ her coccyx dysfunction, the patient was incredibly grateful that I had been the one who identified it and urged her to consult another therapist for an internal chiropractic adjustment.

This case illustrates the limitations of the technique and shows the value that can be derived from appropriate referral.



Case 35 – A patient experiences a ‘reaction’ following a coccyx correction

Eddy (36 y.o.), presented to the clinic complaining of 6 weeks of pain in his right hip.  He had hoped the problem would resolve of its own accord but over the previous two weeks the pain had become worse.  The assessment revealed a short right leg (about 15mm) which was unresponsive during any screening procedures.  After applying some basic moves to his lumbar and upper back region, I assessed his coccyx.

The coccyx was tender to touch on the right hand side.  I ‘moved’ it by applying pressure to the right lateral margin just inferior to the sacrao-coccygeal junction (the right leg was used as a lever during the move).  Eddy reported a strong sensation from the move and I let him rest for a few minutes.  Re-assessment after a short waiting period revealed equal leg-lengths, and although I did check his neck, no further therapeutic intervention was applied.  I asked Eddy to follow-up with me in a week’s time.

Eddy returned to the clinic two days later (without an appointment).  He said he was experiencing severe stiffness and restriction of movement, as well as some lower back pain, and that he was unable to bend to put his socks on.  The pain in his hip was not really troubling him now but his attention was drawn to the problems he was now experiencing in his lower back.  He felt ‘twisted’ and was unable to stand for long.  I asked Eddy to lie prone on a treatment table so I could assess him.  He did so with a little difficulty and I allowed him a moment or two to get comfortable.  Upon assessment, he demonstrated perfect symmetry.  I explained to Eddy that I considered the treatment was having a “positive effect” on him and that he was experiencing a ‘healing reaction’ that should resolve of its own accord over a few days.  I told him I didn’t want to treat him at that moment but preferred to wait instead and that I would monitor his progress over the next few days.

Two days later, Eddy returned to the clinic again and said that he was ‘less’ stiff and that the pain was subsiding but that he was still not “good”.  I assessed him and again I found a presentation of perfect symmetry.  I asked him if he had experienced any other back problems prior to the onset of the hip pain and he told me he had had chronic lingering lower back and neck issues for several years but that he had been able to put up with them well enough.

I put on my best smile and told him he was lucky I had given him such a good treatment at our first appointment and that I was sure his whole spine was still responding in a positive way to the initial coccyx correction.  I told him to be a little more patient and to keep the follow-up appointment he had made for the seventh day after the initial treatment.  Again, I offered no therapeutic input.

Eddy was quite happy when he came in for the follow-up treatment one week after I had first treated him.  He told me he was now just experiencing some very mild lower back discomfort and stiffness.  He could put his socks on easily and he had no hip pain so he was feeling quite positive.  I asked him to rate the pain levels he had been through (using a score out of ten).  He described his chronic back and neck issues as a 2 or 3 out of ten.  His hip pain had reached a ‘5’ out of ten which had motivated him to seek treatment.  The discomfort and the stiffness he experienced during the first few days following the treatment were ‘disturbing’ and although not strictly a ‘pain’ he would rate it as 6 or 7.  On this morning, however, he felt his discomfort level was only about 1 out of 10.

His right leg seemed marginally shorter than the left (perhaps just 2mm) and I treated him again with some basic lumbar and upper back moves before assessing his coccyx again.  There was still a little tenderness on the right side of the coccyx but it was nowhere near as sensitive as it had been the week before.  I applied a gentle input from the right side again.  I assured him he would not experience a similar reaction from today’s treatment and I asked him to drop by the clinic in a week just to let me know how he was going.

One week later Eddie dropped in and told me he was feeling great.  He had no pain at all and no stiffness either.  He was amazed that a small correction to his coccyx could cause so much ‘drama’.  I took a moment to assess him before he left and he still demonstrated perfect symmetry.

Comment:  This case illustrates several important points.  One of the founding principles of osteopathy (and many other forms of complementary medicine) is that the body has the capacity to self-regulate and heal.  Once the coccyx was ‘moved’, the body was able to initiate a long overdue healing response.   The challenge for the therapist in this situation is to be able to identify the difference between an aggravation and a healing response.  In this instance, the observation of tonal symmetry indicated the nervous system was not being compromised and thus the appropriate action to take was to simply wait.

At other times, I have had instances where patients present a day or two after a treatment with new symptomatology or with severe discomfort and assessment has revealed significant asymmetry.  In those cases I would not hesitate to address the primary presenting issue immediately.  In such cases, I have found an immediate targeted intervention can be very effective to help the patient’s recovery.


Case 36 – Using Bowen to help improve fertility…

Six weeks ago, I treated a young lady (30 y.o.) who had come to the clinic because she wanted help to conceive.  Six and a half months earlier, she had stopped taking the contraceptive pill (she had been on it for the 13 years prior) but her period still had not returned. She had been advised that acupuncture might be of benefit, to get things ‘rebalanced’, so she had come to see me.

Questioning revealed her menstrual cycle had always been ‘normal and unremarkable’ prior to going on the contraceptive pill and that her cycle had always been ‘normal’ while she was on it. I took a thorough history and found she also experienced the following symptoms:

– Headaches over the left temple area at least once or twice a week for the last 8-10 months.

– Low-grade insomnia, frequent vivid dreams, and regular nocturia.

I assessed her for tonal asymmetry. I found she had a short left leg when her head was in the neutral position and that it remained short when she turned her head to the left. When she turned it to the right, her right leg shortened and became about 15mm shorter than the left. She was showing a very obvious “Double Cervical Turn Test (classic)”.

In light of her recent history of temple headaches, I moved quickly through the Lower Back and Upper Back Procedures (no waits) and had her turn over so I could assess her neck. There was a band of tension through the paraspinal tissues on the right side of her neck and so I focused my attention on her TMJ. The soft tissues anterior to the right TMJ were rigid and quite tender and she winced as I moved them.

We discussed the significance of what I had found. I explained that the assessment had shown that her CNS was very ‘unhappy’ and that the main issue that was bothering it was associated with the sphenoid bone at the base of her skull. I have a great model of the cranial bones so I used it to show her how dysfunction associated with the sphenoid bone could generate the temple headaches she was experiencing. I also showed her the sella tursica, which cradles the pituitary gland, and I explained the pituitary’s role in relation to menstruation and also fluid metabolism.

Having addressed this ‘structural issue’, I observed her pulse and tongue. She seemed quite healthy but her pulse was thin and thready and quite weak. I suggested we also do some acupuncture to “nourish the blood and yin” and she agreed.

The following week, she showed a short left leg but it didn’t change with any of the screenings. I repeated the initial treatment and found some slight tension and tenderness around the TMJ but it was nowhere near as tender as the week before. Again, I also did some acupuncture.

On the third, fourth, and fifth visits, she showed symmetry so I did no Bowen Therapy at all, just acupuncture. On the sixth visit, I noticed something had changed. Her pulse had become very large and “slippery”. She had still not had a period. I told her I thought it would be worth having a pregnancy test. She came to the clinic yesterday to tell me she was indeed pregnant.

Comment:   As clinicians, we often find we have competing interests. On the one hand, we want to generate the best possible treatment outcomes for our patients, and on the other hand, we want to learn more and more about our interventions, and their effects, so that we can become better practitioners. One way to learn more is to control the inputs we use but this often competes with the patient’s interest.

In retrospect, I might have liked to only apply the Bowen correction to restore the sphenoid function and then monitor the patient over a few months to observe the effects. Instead, I added another therapy to the mix and so now, I really don’t know if the successful outcome was due to

a). Nothing I did (i.e. it might have happened anyway),
b). The Bowen work I applied initially to restore function to the sphenoid/pituitary,
c). The acupuncture treatments she also received, or
d). A combination of b). and c).

I wouldn’t do things differently in this case because I would always prioritize the patient’s needs rather than my own, but it certainly shows one of the great challenges we all experience when we treat people in the clinic (finding a balance between conducting our own ‘research’ and  helping the patient the best we can).