BOWEN TECHNIQUE: CASE STUDIES 61 – 66
Case 61: Treatment of atypical absence seizures (petit mal epilepsy) in a 19 y.o. female.
Donna presented to the clinic detailing a history of atypical absence seizures. She described her symptoms as recurrent and frequent episodes during which she would lose consciousness for several minutes at a time. The onset of the episodes was sudden and without warning. Family members had recorded one of the seizures to provide an illustration of her symptoms. In the recording, she appeared to be staring at nothing with a blank expression on her face. She was unresponsive to any communication and when the seizure passed, she had no recollection of the event.
The initial assessment showed she had a right-sided dural drag of around 25 mm. The screening was unremarkable. I applied some basic moves to the lower back region and then the upper back region before turning her supine and checking her neck. The right paraspinal bundle was very tense (compared to the left) and the left sternocleidomastoid muscle was also tense so I targeted my treatment to the pterygoid/temporalis muscles at the right temporomandibular joint. The moves here were obviously uncomfortable as the tissue under my finger was tense and rigid. After a five-minute wait, I repeated the moves and then had her turn supine again for reassessment.
The reassessment showed she now had a left-sided dural drag of around 10 mm which I was able to resolve using the reverse coccyx procedure. As we had reached a state of symmetry, I asked Donna to return in two weeks for a follow-up treatment.
Donna returned as scheduled and reported she had experienced three or four seizures since the initial visit. Assessment showed she was still maintaining a state of symmetry. I checked the area over each Kidney and noticed the right side was actually quite hot while the left side was noticeably cooler. After putting in the stoppers, I ‘opened’ both Kidneys (using the superior-lateral moves of the Kidney Procedure) and left her to rest. I checked her after two minutes and the right side was still quite warm so I left her to rest a while longer. After five more minutes, the right side had cooled considerably. I made a pair of medial moves over the paraspinal tissues in the Upper Thoracic area (at approx. T-5) and then ‘closed’ both kidneys (this simply involves making an inferior-medial move over the same site used to open the Kidney). I asked her to return in two weeks for another follow-up treatment.
Donna came back two weeks later and reported that she had had no further episodes since the last visit. I assessed her for tonal asymmetry but everything was good (she showed symmetry). I checked her Kidneys and the temperature felt completely normal on each side. I did a few basic moves to assess the tissues in her back and neck but everything felt great so I asked her to return in one month for a follow-up treatment.
Donna returned a month later and everything was great. She still showed no asymmetry and no signs of dysfunction and she reported she had not experienced any seizures at all.
I saw Donna today (it has been six months since her last visit) and I asked how she has been. She said she has had no seizures at all since her second visit and she assured me she will return for more treatment should the seizures return.
Comment: Mr Bowen used specific procedures and protocols for the treatment of epilepsy and these were always applied subject to individual assessment. Many of his treatments in this area involved the use of the Kidney Procedure.
According to Traditional Chinese Medicine, the Kidneys store a precious substance, called the Essence, which serves to nourish the Brain and the central nervous system. Typically, if the Essence is insufficient, the patient may suffer symptoms such as poor concentration and memory, dizziness, loss of consciousness or seizures (epilepsy).
A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behaviour, movements or feelings, and in levels of consciousness. When appropriate, the Kidney Procedure may be used to direct the Essence to the Brain to nourish and settle it. This involves using the procedure in a very different context to the way it is currently taught by most schools. To use these procedures safely and effectively, it is important therapists develop a detailed understanding of the principles involved as well as competency with regard to assessment and application of the procedures.
Case 62: Treatment of life-long headache and severe migraines in a 9 y.o. boy
Sam is nine years old. He presented to the clinic two months ago with numerous complaints. He has lived with a constant headache his whole life. He touched his forehead, just above the inner aspect of his left eye, and told me he can’t remember a time when it didn’t ache at this point. A little over a year ago, he had developed migraine headaches that involved recurrent episodes of severe pain, nausea, vomiting, and epistaxis (nosebleeds). These episodes were initially once a month but more recently their frequency had become at least once per week.
In addition to the constant headache and the recurrent migraines, Sam also complained of continual exhaustion and constant pain and numbness in soles of his feet. His complexion was pale and he looked listless. I asked his mother about his sleep and she told me he was always hot at night and that he was often wet with sweat when she checked in on him. She also told me he was a breech birth and that as a newborn he suffered for a long time from severe torticollis. Sam was under the care of one of the country’s top paediatricians but she felt frustrated that he missed so much school. One of her friends had urged her to bring Sam to the clinic to see if we could help.
I had Sam jump up on the table and assessed him in the usual way. The presenting tonal asymmetry resolved when he turned his head to one side so I progressed quickly to assessing and treating his neck. Palpation revealed the paraspinal bundle on the right side of his neck was tense and rigid and I could only get small movements at its edge. I told him I needed to work on his jaw and that it would be a little uncomfortable but he was happy for me to proceed. I released the pterygoid/temporalis and with several breaks, I did my best to soften the spasm in his neck. I asked him to return in a week.
The following week Sam returned with some interesting feedback. His symptoms remained unchanged but he had been having vivid dreams every night (he had never remembered any dreams before) and every night these dreams would end with a nose bleed (also something that had never happened before). I repeated the treatment from the previous week and noticed the paraspinal bundle has softened somewhat.
The following week Sam returned and told me he had not had any migraines and that his headache had become very dull. His dreams had settled somewhat and he had not had any nosebleeds since the previous treatment. This treatment was a bit different because he still showed tonal asymmetry after I had completed the neck work (again, I had noted the neck felt significantly better). This time, the tonal asymmetry resolved with the coccyx procedure and I told his mother I thought we were making good progress.
The next week was his fourth visit and again he had not had any migraines or nosebleeds. Again, he noted his constant headache was still very dull. The treatment was the same as the previous week except that a new layer of tonal asymmetry emerged following the neck and coccyx work. This layer resolved with the application of the Kidney Procedure.
When Sam returned for his fifth visit (two weeks later), he was bursting with excitement. He had had no migraines but most importantly, his headache had disappeared. His mother reported that she had been checking him regularly and his night sweats seemed to have stopped. She also noted how much his energy had improved. I treated his neck and his coccyx and noted how much better his neck felt from my perspective.
At the sixth visit (two weeks later), Sam was cheeky. His football team had beaten mine and he let me know it with as much diplomacy a nine year old could manage. His mum told me, “Everything is great. His head is the best it’s ever been. His energy is amazing. His night sweats have stopped. He’s a new person”. The treatment was similar to previous visits and involved neck and coccyx work followed by the Kidney Procedure.
Yesterday was Sam’s seventh visit and he continues to improve. He says his only remaining symptom is the numbness under his feet. He tells me it has slowly changed from unpleasant pain and numbness to a dull sensation of numbness with no discomfort. I repeated the neck and coccyx work and noticed how much better his neck feels. I have moved him to monthly visits now and I will continue to treat him on a monthly basis until his neck feels normal and he presents with symmetry.
Comment: This case was somewhat complex because it involved the coordination of input through several sites and through several ‘layers’. In all instances, however, I simply followed the trail of tonal asymmetry and the information that came through my fingers.
The use of the Kidney Procedure is significant. In traditional Chinese medicine, the Kidney is perceived as the ‘root of life’. It’s meridian originates at KI-1, the only acupoint on the sole of the foot. It stores the Essence that nourishes the Brain. When there is congenital deficiency associated with the Kidney there will often be night sweats and migraines.
Case 63: Treatment of chronic knee inflammation and pain using non-localised treatment
Gerry (74 years old) presented to the clinic 7 weeks ago complaining of a very painful and swollen left knee. He had been experiencing the pain and swelling continually for almost a year and in recent months he had undertaken an extensive course of physiotherapy. When the physiotherapy failed to provide any relief he undertook a course of chiropractic treatment. Unfortunately, the ten sessions of chiropractic treatment didn’t result in any noticeable benefit either. He told me that for the last six months he had been taking analgesic and anti-inflammatory medicines prescribed by his doctor but rather than experiencing any benefit, his condition just seemed to be getting worse and worse. He was on a list to be contacted about a knee replacement but the surgeons weren’t operating due to precautions associated with COVID-19. He came into the clinic on crutches and he told me he had unable to walk without crutches for the past two months. I was surprised when he told me he wanted acupuncture treatment for his knee and that he really didn’t want me to do any physical therapy on it as he felt the recent physical therapy seemed to have caused his condition to worsen.
A recent scan of his knee concluded he had “moderate to severe joint effusion with a ruptured 6 cm Baker’s cyst; moderate medial compartment degenerative change with a partial tear and prominent fraying of the medial meniscus, and moderate patellofemoral joint degeneration”.
Although I would have liked to treat him with Bowen, I agreed with his request and duly provided just acupuncture treatment. I treated him twice a week and after four sessions of acupuncture it was clear that he had not improved at all. Prior to his last acupuncture session, I had him lie prone on the treatment table for a quick tonal assessment (see below). I told him he should let me have a look at the situation from a Bowen therapy perspective and that I would happily treat him without actually touching his knee. He told me he couldn’t see how a treatment that didn’t address the area of inflammation would be able to provide any benefit. I told him it was a ‘party trick’ that I had developed and that I was quite good at. We had developed quite a good rapport over the last few weeks (while I was giving him acupuncture) so he agreed to let me treat him with Bowen, just as long as I didn’t touch his knee.
Assessment showed a short left leg. It remained short when he turned his head to the right but it became a short right leg when he turned his head to the left (2CTT-Reverse). At this point I knew he had two issues – one in his neck and one associated with his pelvis. I applied the moves of the Lower and Upper Back work with as much pressure as I could sustain because he was a large solid fellow and his muscles felt extremely rigid and tense. I then had him turn supine so I could work on his neck.
As I worked on his neck I noticed the scalenes on his left side were made of concrete. I worked over them several times, releasing the tension bit by bit until I felt I had effected sufficient change. I had him turn prone again and saw that he now showed a short right leg which didn’t change at all when he turned his head. This short right leg resolved with some left-sided paraspinal work (using the right leg as the lever). I asked him to return in a week.
He returned for his second Bowen session one week later and he told me he felt there was “maybe” a little less pain and swelling. I worked on his neck again and felt the scalenes were a lot more responsive than the previous week. Once I had released his neck, I had him turn prone again and found a short right leg which didn’t change with any screening. This time, however, addressing the paraspinal tissue made no change to the presenting asymmetry. It did change however, when I applied a reverse coccyx procedure. Again, I asked him to return in a week.
The following week, he walked in with a walking stick, rather than with his crutches and with a big grin on his face. Our rapport had grown considerably and I just looked him up and down and said, “I don’t want to hear about it! Hop up on the bed.” He showed a short left leg which resolved on head turn (+ve CTT) so I worked his neck again (after running quickly through the Lower and Upper Back work). The tissue in his neck was much better and it responded fully to the first few moves. I had him turn prone again and this time, he showed symmetry. Again, I asked him to return in a week.
He walked into the clinic for his fourth Bowen session without any stick or crutch. He did his best to hide it but I noticed he did have a slight limp. He told me the pain was no longer an issue and that the swelling was getting lots better as each day passed. He told me he had stopped his medications as he had been on them for a long time and he felt he no longer needed them. The session followed the pattern of the week before; I worked on his scalenes and I noticed they were now almost back to a normal texture and tone. After the scalene work, he showed symmetry so the treatment was concluded. I told him he should come back in two weeks since things were progressing quite nicely.
I saw him today for his fifth Bowen session. I followed him down the hallway as he was walking to the treatment room and, just to show off, he did a little dance along the way. He told me he was at least 90% better than when we first began the Bowen sessions. He told me he had no pain but that he was aware there was still some swelling in the joint. Apart from this he felt perfectly fine. He told me he still couldn’t believe I could resolve his issue without actually touching it – I told him, his knee wasn’t really the issue; it was simply a consequence of his issue.
Comment: Holistic assessment affords the therapist many valuable insights. Most importantly, it offers a guide for targeted therapy. Both Andrew Taylor Still and Ida Rolf are frequently quoted for the saying, “Where you think it is, it ain’t”. Holistic assessment allows us to target our therapeutic interventions to the underlying cause of a problem, rather than to the symptoms being expressed.
Arthur Schopenhauer stated, “Talent hits a target no one else can hit; Genius hits a target no one else can see”. Holistic assessment allows us to develop the capacity to see what others can’t. I believe Mr Bowen’s work was guided by his great capacity to see the targets no one else could see.
Case 64: Treatment of left shoulder pain extending down the left arm and into the neck
Lynn (67 y.o.) came to the clinic complaining of acute pain in her left shoulder which extended into and down her left arm and also up into her neck. Questioning revealed that the pain had been constant since its onset one week ago and it did not vary with any activity. She said it ached as much in bed at night as it did during the day. She rated the ache running down her left arm as a 6/10 pain, and the pain that radiated up in to her neck (as far as the sub occipital region) she rated about a 3/10. Lynn was unable to recall any incident or event that may have precipitated the onset of the pain although she did say she had been doing lots of gardening for a few days prior to the onset.
I asked her if she had thought about consulting a medical practitioner, or about going to an emergency department, given that she had experienced a sudden onset of pain that radiated into her left arm. She said she had thought about it, but she was pretty confident that it felt more ‘musculoskeletal’. She had tried to get an appointment to see me earlier but I had been heavily booked so she had waited the extra few days. I asked her if she had experienced any other symptoms such as chest pain or tightness, shortness of breath, palpitations, anxiety, etc, but she had not.
I assessed and treated Lynn as per any other patient (although I also assessed her per traditional Chinese medicine assessment too). She was presenting with symmetry and I could find little issue with her back and neck. I had her sit on the side of the table while I did some work on her right shoulder (including the deltoid and the infraspinatus) and then I did the same work on the left side. The left shoulder was stiff and the deltoid moves were a little tight and tender. The infraspinatus, however, was quite tense and I needed to sink my fingers in quite deeply to get a good contact with its edge. At this point it was quite clear it was very painful at this site. I apologised for the pain that would accompany the move and I told her that I was confident I had found the problem. I asked her to drop her shoulder and as she did, I made a deep and somewhat quick move over the lateral margin of infraspinatus. She pulled away instantly but the move had been made. It had been very painful and it had taken her breath away. I apologised again and I reassured her she would feel much better within 24 hours.
I saw Lynn six days later and she told me she had experienced relief within a couple of hours and that she could only feel very slight levels of pain the following day. After that, the pain had completely resolved. I treated her as per the previous visit but the tension and tenderness at the infraspinatus had fully resolved.
Comment: Over more than 30 years of clinical practice I have referred my fair share of patients directly to the nearby emergency department for evaluation of probable cardiac issues. At least six of those referred (over the years) actually received immediate emergency treatment (including heart surgery). In this instance, however, I had no doubt that this patient’s issue was associated with infraspinatus spasm.
This patient’s presentation perfectly illustrates the clinical manifestation of a severe infraspinatus spasm and this is shown clearly in the illustrations in Chapter 22 of the trigger point manual by Travell and Simons (see image).
Case 65: Treatment of left-sided chest pain associated with rib dysfunction
Jennie (76 y.o.) came to the clinic complaining of left-sided chest pain. She explained that the pain and discomfort had been present for three or four months. She experienced the pain in three places; in the paraspinal area immediately adjacent to the 6th thoracic vertebra, on the left lateral chest wall, and in the front of her chest – around the level of the fifth or sixth intercostals space. The pain varied upon movement but it bothered her most in bed at night.
I had her lie on her back on the treatment table and I gently (but firmly) pushed down on one of her ribs, just lateral to the sternocostal attachment. I asked her if she felt any discomfort. I then repeated the procedure on another rib, and another, etc. Applying pressure to one rib in particular caused her to wince in pain. I checked again and I asked her if she could feel the pain radiating anywhere else? She told me she could feel it radiating right around the ribcage to the sore point in her back. Problem found – now all I had to do was fix it…
I applied a regular treatment in which I addressed scalene dysfunction and then applied a coccyx correction. Having reached a happy point of symmetry, I set about treating the affected ribs. I returned to the front of her chest, where I had found the tender sternocostal attachment a few minutes earlier. The tender rib felt elevated compared to the ribs above and below it so I used an activator tool to ‘push’ it in a posterior direction. I let her rest for a few minutes and reassessed the ribs – they were nowhere near as tender now. Satisfied, I asked Jenny to return in a week.
The following week Jenny reported that she felt about 70 % better with regard to the chest pain. I repeated the treatment and asked her to return again in two weeks. She came back two weeks later and she told me she was quite amazed that she had not had any pain or discomfort at all since the last treatment. On assessment, she showed symmetry and I could find no tenderness associated with any of the rib attachments.
Comment: I can honestly say, treating rib ‘displacement’ has never been my forte. In the last ten years, however, I have slowly gotten significantly better at treating this challenging presentation. I find the majority of patients who have this presentation will have both an ‘ascending’ issue and a ‘descending’ issue. Put simply, they have one issue causing irritation of the lower dural attachments and another issue causing irritation of the upper dural attachments (in the clinic, I often find they present showing a Reverse Double Cervical Turn Test). In my mind, I like to think the body is being ‘torqued’ one way by the upper dural irritation and the other way by the lower dural irritation and this leads to a point, somewhere in the thoracic region, where the facet joints become irritated and this may lead to rib displacement (I don’t know whether that really happens but it’s how I visualise it). It is therefore necessary to resolve the dysfunction at the upper and Lower dural attachments.
The next ‘breakthrough’ for me was when I purchased an activator tool. The activator tool allows me to apply an input directly to the rib. Generally speaking, the rib will have moved anterior or posterior and this can usually be palpated. The activator tool allows a controlled input that helps to ‘relocate’ the rib.
Case 66: Treatment of chronic faecal incontinence
Molly 78 y.o presented to the clinic complaining of regular faecal incontinence. The condition began more than twelve months ago and seemed to be getting worse with the passage of time. Two or three times each week she had ‘an accident’ and now she was developing anxiety about leaving her home. Drs recently arranged for her to have a colonoscopy but it was unremarkable so she followed the advice of a friend and came to the clinic seeking dietary advice.
I asked her to lie prone on the treatment table for a quick assessment. Her right leg was significantly short (right-sided dural drag) yet the paraspinal tissue on the left side of her spine was noticeably tense. The screening procedures were unremarkable. I assessed her Kidney region for a difference in temperature and decided the left side felt a little warmer than the right.
I applied the stoppers and the basic Lower Back moves and then ‘opened’ both Kidneys. I made superior-lateral moves over the left Kidney first (using the right leg as a lever) and as I did so I could feel very tense paraspinal tissue under my thumb (if I’m honest, I think it’s fair to say she let out a bit of a groan in response to each move). I then repeated the opening moves on the paraspinal bundles on the right side (using the left leg as the lever) but these moves met little resistance and caused my subject no discomfort. I let Molly rest for a few minutes.
Upon my return, I rechecked the Kidney region for heat and noticed the temperature on the left side now felt quite similar to the right. I closed both Kidneys with inferior-medial moves over the same points on the erector spinae.
I then reassessed her symmetry and it was clear her short right leg had been replaced by a short left leg. Pleased with the response so far, I applied a reverse coccyx correction using her left leg as the lever. Immediately following the procedure Molly commented, “that felt quite intense”. The procedure resulted in a state of symmetry.
The following session (1 week later) I found the presentation very much the same. I repeated the procedures exactly as I had done them on the first session (I noted the tension in the erector spinae on the left side did feel significantly improved).
The third session was performed a week later. Molly presented to that session with symmetry. I asked her if she had experienced any ‘accidents’ in the previous fortnight and she told me she had not. She said everything was working perfectly well. I asked her to come for another visit in two weeks time.
I saw Molly today (two weeks later) and she continues to show symmetry. She has now been a whole month with no symptoms – the condition appears to have completely resolved with the first treatment. I told her to come back if her symptoms returned at any point.
Comment: More common in older adults, faecal incontinence affects around 1 in 3 people.
According to Traditional Chinese Medicine theory, the anal sphincter is under the control of the Kidney. From a Bowen therapy perspective, working to resolve ‘Kidney’ dysfunction and ‘coccyx dysfunction’, where indicated, can help to restore normal sphincter control. This is easily understood from a meridian perspective.
Mr Bowen regularly employed individualised Kidney and coccyx procedures to treat a vast array of symptomatic presentations, all based on his understanding of physiological interrelationships.