BOWEN TECHNIQUE: CASE STUDIES 55 – 60
Case 55: Treatment of a pregnant patient complaining of frequent classical migraines
Emily (28 years old) was 15 weeks pregnant when she presented to the clinic complaining of frequent and severe migraines. She’d previously suffered from migraines several times a year however, since falling pregnant she had been experiencing severe migraines two or three times a week. During an attack, she experienced visual disturbance and photophobia and her head felt like it would explode. The severe, left-sided stabbing pain seemed to originate at the base of her skull and radiate over it, and through it, to her eyes. She would also experience nausea and, in severe attacks, she would vomit.
In between the migraine attacks, she still experienced a constant, low-grade headache affecting the area over the occiput and frontal bone. In addition, she felt exhausted.
She could recall no incident or trauma that may have led to her condition.
I had her lie prone so I could conduct an assessment. She had an obvious right-sided dural drag. When she turned her head to the left, the short right leg remained unchanged. When she turned her head to the right, the presentation changed so that her left leg was now short (I recorded this as a Reverse – Double Cervical Turn Test or 2CTT-R). This is a common screening pattern that shows she had two separate issues: one issue in her neck and another affecting her pelvis.
I did some basic moves in the Lower and Upper Back and had her turn supine so I could assess her neck. The scalenes on the left side were tense and tender so I released them. After a short break, I had her turn prone again so I could address the next layer of dysfunction. Since she now showed a left-sided dural drag, I applied the Coccyx Procedure from the left side. This immediately resulted in symmetry so I asked Emily to return one week later.
At the follow-up appointment one week later, Emily told me she had not experienced any more migraines. More interestingly, her headache had fully resolved within two hours of the treatment and it hadn’t returned. She still showed symmetry so I simply used the basic relaxation procedures and sent her home for another week.
At the third visit, Emily reported that she had had one mild headache during the week. I assessed her and found a short right leg which resolved on turning her head to one side (a positive Cervical Turn Test). I repeated the initial treatment and this culminated in a state of symmetry. Emily has maintained symmetry for eight weeks since that visit and has experienced no symptoms at all. She is now 25 weeks pregnant and incredibly grateful for her Bowen treatments.
Comment: This case shows the power of accurate holistic assessment coupled with targeted therapy and real-time feedback in the form of dural response. Very few Bowen therapists would have found her primary issue (coccyx dysfunction) and of those who did, few would have addressed it. This case calls into question many of the basic teachings associated with the use of coccyx corrections during pregnancy.
Case 56 – Treatment of severe back pain complicated by multiple artifacts
Tony (65 years old) presented to the clinic six weeks ago. He was helped into the building by a friend as he could not walk without assistance. He complained of severe pain throughout his lumbar region which referred into his right hip and travelled down his right leg to his foot. The condition began four weeks prior when he hurt his back lifting some heavy items on his farm. He told me he had chronic low-grade back pain for many years and he simply lived with that but this recent incident was like nothing he had ever experienced before. He was in great pain despite being heavily medicated, taking a mixture of anti-inflammatory medicines and analgesics, as well as cortisone. Despite being severely incapacitated for the last month, his condition had recently ‘improved’ to the point where he felt he could travel to the clinic for treatment.
His recent MRI report stated the following: “Multilevel disc disease with facet joint arthropathy and bulging discs noted at L1/2, L2/3, L3/4, L4/5, and L5/S1… causing marked neural foraminal narrowing, compression over the cauda equine and canal stenosis.”
To make things even more complicated, while taking his history, he revealed two certain artifacts. He was suffering chronic and severe osteoarthritis in his left knee which was continually swollen and painful. He told me he is on a waiting list for a knee replacement. He also mentioned he had suffered from polio as a child and consequently his left leg was ‘somewhat’ shorter than his right, although he couldn’t say by how much.
It was an effort to get Tony onto the table and positioning him prone was only possible with several pillows placed under his abdomen. In the prone position, his left leg was clearly shorter but I was doubtful as to whether leg-length assessment would be reliable or even helpful in his situation. I decided my treatment would be guided simply by touch and tactile recognition.
I began treating Tony using moves of the Lower and Upper Back Procedures but in some instances, even light pressure was extremely painful for him. I noted severe tension and spasm through the right-sided paraspinal tissues in the lumbar region and I tried to release this. I had him turn supine (that took a few minutes) and I assessed the structures associated with the upper dural attachment sites. The tensions here guided me to his right temporomandibular joint where several deep, and somewhat painful, moves achieved the release I was seeking.
After releasing and balancing the upper dural attachment sites, I used palpation to assess several other tissues. His right adductor was very tense and rigid so that became my next area of interest. Once the adductor had responded, I had him turn prone again and spent several minutes working on the right paraspinal bundles.
Tony came to his second treatment, one week later, with the aid of a walking stick. He said he had improved a little but was still in pain and the pain still extended into his hip and down his leg to his foot. The treatments always followed the same pattern and I would continually assess various structures by feel and address the issues I could identify. Over the next few weeks, I could feel significant change taking place throughout his system. By the third week, the upper dural attachment sites were all free from tension and dysfunction. The treatment was now focused on the pathogenic texture and tone associated with the right adductor and the right paraspinal bundle.
Three weeks ago, he came to the fourth treatment and told me he felt he was about 40% better. At the next visit (two weeks ago) I told him he was at least 70% better. This made him laugh and he asked me how I knew that? I told him I could feel the changes taking place throughout his system. The adductor had almost returned to a normal state and the spasm/tension in the paraspinal bundles had softened significantly and had very much localised to the area beside the first and second lumbar vertebrae. He told me he was experiencing much less pain and that it no longer extended into his leg.
Last week he came to his appointment without his walking stick. He reported that he had reduced his medications and that the only real pain he was feeling was associated with the swelling in his left knee. I asked him if he could feel any pain in his back hip or right leg and he said he had been completely pain free for several days.
I saw him today for his most recent treatment. He had further reduced his medications and he stated he had no complaints at all except for his knee. As I worked on him I marvelled at the changes that had taken place throughout his body over the six weeks he had been receiving treatment.
Comment: As therapists, we are continually offered the potential to develop our sense of touch and tactile recognition. Informed touch allows us to develop the capacity to recognise pathological tissue tension and tone and thereby target our treatment to relevant sites. It also enables us to recognise any local and global response that follows our therapeutic input, thereby facilitating the collection of valuable feedback. Such information can allow us to develop an informed expectation regarding the expected process of change and we can use this to form a prognosis for each case.
In short, an evolved sense of tactile recognition allows us to become more informed and more effective manual therapists.
Case 57 – Treatment of severe dizziness
Barry (59 year old farmer) presented to the clinic complaining of ongoing, severe ‘dizziness’. He had been suffering from dizziness for nine days and was not able to identify any likely cause. In addition to the dizziness, he had also felt stiffness of his neck as well as a constant low-grade feeling of nausea and some mild chest pain around the margins of his sternum. His gait was slightly unsteady and his complexion was somewhat ‘grey’ and it was clear he was in some sort of distress. He had already consulted his family doctor who told him his symptoms would likely pass and that he should stay home and rest until they did (keep in mind this is taking place during the COVID-19 crisis). I took his blood pressure and his pulse and found nothing abnormal (BP: 122/80, pulse regular at 74 bpm).
To conduct a physical assessment, I asked him to lie prone on the treatment table. A visual assessment of his leg lengths showed what appeared to be perfect symmetry. After applying a few moves to his lower and upper back regions, I had Barry turn supine so I could assess his neck.
The paraspinal muscles in the back of his neck felt rigid and tense and I was unable to move the bundle on the right side. His scalene muscles felt normal but his sternocleidomastoids were very tense and tender with the left one feeling somewhat like a steel cable. I released the right lateral pterygoid and temporalis using one move in front of the right temporomandibular joint and then I let him rest for a few minutes.
After the wait, I checked the left sternocleidomastoid muscle and found it to be much softer and ‘looser’ and nowhere near as tender as a few minutes prior. I also found I could get some small movement from both paraspinal bundles in the back of his neck. I told Barry the job was still only half-done and that he needed to turn prone again so I could address the second part of his problem.
In the prone position, a visual assessment of his leg lengths now showed significant asymmetry. His left leg now appeared to be a full 25mm shorter than his right. I applied a quick coccyx correction and let him rest for a minute before reassessing. This time he showed perfect symmetry again. His wife was sitting in a chair beside the table and she had seen the perfect presentation at the start of the treatment. She had also seen the huge leg-length discrepancy that followed the neck work and now she could see the return to symmetry after the coccyx work. Her expression was one of amazement.
I asked Barry to get up and walk around the room for a while. After a few minutes, he told me he felt very different. He felt the nausea and the discomfort in his chest had subsided and the dizziness certainly felt better than before. He also remarked that his neck felt much better. I was pleased to see his complexion looked much more normal. I explained the important role of the cranial bones in relation to his symptoms and I also explained the role his coccyx issue had played in the presentation. I asked him if he had been doing anything unusual on the farm lately and he told me he had been driving his tractor for days on end (this involves sitting for many hours with the head turned up and to one side to see if he was keeping the tractor on course). “That’ll do it”, I told him. I asked Barry to return for a follow-up treatment in six days time.
Barry returned and told me his symptoms had fully resolved following the treatment. His only concern was some stiffness in his lumbar region and a slight discomfort in his shoulder.
Comment: At times, visual assessment of asymmetry can be unreliable. In this instance, two different issues were combined together to create a visual impression of symmetry. Tactile assessment of several key structures (especially the muscles of the neck) provides a clear indication of dysfunction in such cases. This, of course, depends upon the therapist’s capacity for tactile assessment.
When dysfunction affects the structures in the cranial base, this may compromise the function of the cranial nerves leading to symptom presentations that may be many and varied. In this instance, I was interested in influencing the structures associated with the vestibular nerve (part of CN VIII) which supplies the middle ear and is associated with balance. Imbalances in this area can give rise to symptoms such as dizziness and vertigo, nausea and vomiting and abnormal posture. Targeted treatment to the cranial base (using sternocleidomastoid release, TMJ and coccyx work) proved effective in resolving his issues.
Case 58: Unsuccessful treatment of Vertigo & Dizziness
George (80 y.o) presented to the clinic complaining of several months of frequent episodes of vertigo and dizziness. He said he experienced the symptoms at least daily and sometimes several times a day. These symptoms began shortly after he fell over and sustained some mild bruising to the left side of his face. In addition to vertigo and dizziness, he was also troubled by some neck stiffness and some lower back pain which radiated into his left buttock and occasionally extended down his left leg.
Assessment showed a significant left-sided dural drag which remained unchanged when he turned his head to the left but changed sides (to become a right-sided dural drag) when he turned his head to the right (2CTT +). Encouraged by the assessment and screening, I told George that I thought I could help.
During the initial treatment, I found significant tension and distortion in both sternocleidomastoid muscles and also in the tissues associated with the right temporomandibular joint (TMJ). Over several treatments, these tissues improved significantly and by the fourth visit, the presentation had changed. George then showed a short right leg which remained unchanged through all screening tests. The issues in the neck, jaw, and sternocleidomastoids had all resolved and his primary issue had become his coccyx.
For three more treatments, I worked on resolving the coccyx dysfunction. On his seventh treatment (11 weeks after his first visit) George presented with perfect symmetry. His back pain had resolved and he no longer felt any discomfort in his leg or buttock. His neck now moved freely and he felt no stiffness but the vertigo and dizziness had not changed at all.
The changes I could see and feel as I worked on him were quite dramatic compared to his initial presentation. He had held symmetry for the last three weeks, his pain had resolved and his body felt relaxed and I could find no issue in his neck, cranial base or pelvis. I asked him if I could change my approach and treat him with acupuncture – he agreed.
I treated him fortnightly with acupuncture for three sessions and all the points I used were either around his ankles or his wrists. After the first session, he said he experienced several days where he had no dizziness or vertigo. After the second session, the symptoms disappeared and did not return. After the third session, I told him we could take a break from the treatment and he should call me if any symptoms returned. That was two months ago and I haven’t heard from him in that time. I treated his wife yesterday and she told me he is going wonderfully well and that he claims he feels ten years younger.
Comment: This case illustrates an important point that is relevant to all practitioners – much of our work is really just an informed guess. I was quite confident the Bowen treatment would restore the relationship between structure and function and thereby resolve the patient’s vertigo. I was wrong.
In the end, the Bowen treatment did restore that relationship but that didn’t result in a resolution of the vertigo. Onward referral was required and in this case, I was able to change the modality and treat him as an acupuncturist.
The philosopher in me is reminded of a quote by Italian psychiatrist, Roberto Assagioli, who said: “There is no certainty; there is only adventure”.
Case 59: Treatment of pain and numbness in the leg
John (70 y.o.) came to the clinic complaining of two weeks of left-sided sciatic pain, as well as some numbness in the lower region of his left leg. These symptoms had been constant since their onset, two weeks prior, and they worsened if he tried to walk more than a short distance. He had had no medical investigation as his first option was to try some Bowen treatment. When I asked him why he had waited two weeks to come in he told me he had hoped the symptoms would spontaneously resolve if he just gave them some time.
Assessment in the prone position revealed a dural drag (a short left leg) of about 20 mm which returned to a state of tonal symmetry when John turned his head to one side (+ve CTT). I moved quickly through some basic relaxation procedures and had him turn supine so I could assess his neck. One of the scalenes on the right side was rigid and tense so I released it with several moves over a five minute period.
When I was satisfied that the neck muscles had released, I had him turn prone again and repeated the initial assessment. He now showed a short right leg which tested positive for sacroiliac dysfunction. This resolved with a simple Reverse Coccyx Procedure.
I asked John to return for a follow-up treatment but he told me he couldn’t return for three weeks because he was going away on holidays. He did return three weeks later and he told me he had been considerably better but that the sciatic pain and numbness were still present, and they still got worse when he walked more than a short distance.
Assessment showed a short right leg with unremarkable screening. Again, I moved quickly through the basic relaxation procedures and then had him turn supine. His neck felt great. I quickly checked the psoas from the front and found them to be normal so I turned him prone again. The short right leg was still obvious so I tried a regular coccyx procedure – there was no change. I applied the Reverse Coccyx Procedure and this time I felt a small shift at the sacrococcygeal junction. To my surprise, John made the following comment: “What the hell was that? I felt something weird then… it was like my hips just moved!” I told him I was very pleased with the correction and the response.
I told John he should return in a week for a follow-up but he told me he had another holiday planned and that he would return in three weeks (at this point I told him I was very jealous). I treated John today, three weeks after that last treatment. He told me the day after that treatment he had been “very stiff and sore all over” and that he thought something must have gone wrong during the treatment. The next day, however, he woke feeling wonderful and he has felt wonderful every day since. Assessment showed perfect symmetry.
Comment: This was quite a simple case.
The first step was to resolve the cervical dysfunction by releasing the sustaining muscle spasm associated with the scalene.
The second step was to resolve sacroiliac dysfunction through stimulation of the sacrococcygeal junction.
The third step was to let the body do the rest.
Case 60: Chronic coccyx and lumbar pain spanning more than eleven years
Alice (39 y.o.) was referred to the clinic by another therapist for treatment of her chronic coccyx pain. Alice had originally hurt her coccyx eleven years ago, by falling from a ladder and landing on her bottom. The trauma was very significant and was associated with severe pain for months with an inability to sit down without cushions. Gradually, the pain became more bearable but it never fully resolved. The condition had aggravated following her pregnancy and the birth of her only child and then last year she had another fall and reinjured the area. She had an MRI at the time of the original injury, and another recently, and both MRI’s revealed a large hematoma in the region of the coccyx.
In addition to pain around the coccyx, Alice was also experiencing pain across her lumbar region extending up into her right flank. This pain aggravated if she sat for any period of time. Alice expressed a concern that, because her coccyx was so tender and sore, she may not be able to let me treat her in that region. I assured her that I would be considerate and that I would work within parameters she could tolerate.
The assessment showed a short left leg which did not change at all on screening. I performed some moves over the lower and upper back and then tried a gentle left-sided coccyx procedure. The contact I made to the sacrococcygeal region was gentle but firm and the rotation generated by the leg was sufficient to make the necessary ‘connection’ between my pressure at the coccyx and the rotation of the pelvis. Alice informed me that the discomfort caused by my pressure was quite significant but that she could bear it well enough.
Following the left-sided coccyx procedure, I reassessed her and noted that nothing had changed – she still showed a short left leg. I decided to attempt a reverse coccyx procedure using the left leg as the fulcrum. As I applied pressure to the sacrococcygeal junction from the right side, Alice tensed a little and told me it was much more tenderness there than she had felt on the other side. I told her it would be a little more painful than the first move and that I believed we were exactly where we needed to be. She relaxed a little and told me to go ahead with what I needed to do.
Once the connection was established between the two pressures, I could tell Alice was putting up with quite a bit of discomfort. I pushed the leg a little further and held my pressure at the sacrococcygeal junction quite firmly. As I felt the stretch take hold, Alice began to tense. I asked her for just two more seconds and then I released the pressure and she exhaled with relief. “Wow – that was painful”, she said. I let her rest for a minute and then reassessed her. Her leg lengths were even.
I had her turn supine and checked her neck – it was fine. In the supine position, she still held symmetry so I had her get up and walk around the room. She told me she could still feel where my finger had been pressing on her tail bone.
Alice returned for a second treatment one week later. She reported she was feeling significant improvement and was keen to continue with more treatment. The assessment still showed a short left leg and I repeated the treatment of the previous week. The tenderness she experienced as I worked on her coccyx was not quite as severe as the previous week and I was able to get a little more force into the procedure (she still found it quite uncomfortable). Again the procedure resulted in symmetry and again I asked her to return in a week.
Alice rang the clinic the following day complaining of crippling pain in her coccyx region. She was certain something had gone terribly wrong as the pain was so severe she could hardly walk. I reassured her that she shouldn’t be worried. I told her it was a really good sign and that I had actually expected such a reaction after the initial treatment. I told her to ring me the next day and report in.
She didn’t call back the next day but she did keep the next appointment. She told me the pain was terrible for one day and the next day it just seemed to have disappeared. Since then, she was just feeling a little stiffness in the lumbar region but that was surprising because she had been doing lots of physical work on a farm all week. I assessed her and she showed symmetry so I just did some lower back and upper back work before sending her on her way.
Alice returned for a fourth visit five weeks later and reported that she had been absolutely terrific. She had no pain at all and no stiffness, and that she couldn’t believe her coccyx issue had finally been resolved after eleven years of constant pain and dysfunction. Reassessment showed she still held symmetry so I told her she needn’t return unless she felt any issue.
Comment: A simple procedure, a profound healing response.
It sounds so simple but it took me decades of practice to finally understand the coccyx work and to develop competency and confidence in relation to its application. This work is the foundation of Mr Bowen’s approach to bodywork and comparatively, so few therapies are equipped with the tools to address this important site of dural attachment.