Bowen Technique: Case Studies 13 – 18
Case 13 – Recalcitrant inflammation and pain in the knee following arthroscopic meniscectomy:
Maureen is 53years old. She presented to the clinic with longstanding inflammation and pain in her left knee. She explained that the condition had existed for more than 18 months and seemed to progressively be getting worse. It was now affecting her ability to stand at work and to walk anymore than a short distance. She told me that she had had surgery on the knee six months ago where her surgeon removed part of a torn cartilage during the arthroscopy. Since the surgery however, the pain and swelling had become even worse. I questioned her further and found that her surgeon had recently arranged for an MRI scan of the knee. The scan was unremarkable and he was at a loss to explain why she was not making a recovery. She was quite despondent as she had already endured much physiotherapy and had also seen two chiropractors.
The knee was swollen and quite hot and she seemed to flinch at the slightest touch. I asked her to lie prone so I could conduct an assessment. The tonal asymmetry made her left leg appear more than two centimetres shorter than the right. Very gently I flexed her knees to 60 degrees (she wouldn’t let me take them any further) and there was no indication of any change in leg length. Cervical rotation however produced a marked change. With her head turned to the left, the right leg actually became the ‘shorter’ leg (2CTT).
I moved gently through the Lower Back Procedure and then completed the Upper Back moves and I had her turn over. I placed a small pillow under her left knee to ensure she was comfortable and then commenced the Neck Procedure. During the procedure I came across two problems. One was the incredible tension I found in the paraspinal muscles through the right cervical area (C1-C3 level). These muscles were literally rigid and they were very sensitive to pressure. The second problem was that my patient had become quite annoyed that I was working on her neck and not on her knee!
I explained that the surgeon was a very clever man and he couldn’t find a problem with her knee. Neither could the physiotherapist nor the two chiropractors. I suggested that might be because the knee is not the problem. I told her I thought the knee problem was a result of some other issue… that being the problem I had found in her neck. I am quite used to the look she gave me (I see it most days!). She agreed to let me go back to making moves on her neck but remained far from pleased.
Her mood darkened a tiny bit more after I conducted the TMJ Procedure (textbook version) and I knew it was time for a two minute break. I returned about five minutes later and found her neck had released quite well. I asked her to risk having one more treatment with me in a week’s time. She really was shocked now as I hadn’t touched her knee at all!
She returned a week later and told me she could not understand it, but her knee had definitely improved. I repeated the treatment as I found a similar presentation. I asked her to come back once more in two weeks. Significant improvement was evident at that follow up treatment and the swelling was now only 20% of what it had originally been, there was no sign of heat and she reported the pain was 80% better. Importantly, there was no tonal asymmetry evident and the muscles in her neck were quite soft and relaxed. We did another treatment two weeks later and she was still recovering nicely.
In total, I treated Maureen on five occasions over six weeks and she made a full recovery. I never touched her knee!
Comment: This case illustrates the importance of being able to identify and treat the significant issues at the root of a given problem – A classic example of treating the cause, not the symptoms.
Case 14 – Exhaustion, shortness of breath and poor vitality following pulmonary lobectomy:
Margaret was 71 when she presented to the centre in May, 2014. Two years prior she had been diagnosed with lung cancer and had undergone a pulmonary lobectomy followed by chemotherapy for a period of six months. Although the treatment had been ‘successful’, she reported she has experienced chronic exhaustion since. She also suffers extreme breathlessness since the operation and she found it quite difficult to walk from the waiting room to the treatment room (only 15-20 meters). Her husband commented on her chronic listlessness, explaining that “she had lost her spark”.
Assessment showed a 15mm short left leg which corrected on cervical rotation to the left (positive Cervical Turn Test). I completed the Lower Back and Upper Back Procedures noting elevated tension of the paraspinal tissues on the left side. I had her turn over and commenced the Neck Procedure. The right side of her neck felt like it was made of concrete. I applied several short, deep moves to the neck (above and below the area usually addressed by Move 6 of the Neck Procedure) before adding the TMJ Procedure – the right temporalis/lateral pterygoid muscles being very tender and tight.
I treated Margaret weekly over the next 8 weeks. She reported slow but gradual improvement each week. Her neck muscles were gradually softening and she was reporting gradual improvement in her energy levels. By the 8th week the improvement was coming more quickly and I began to lengthen the interval between treatments, first to 3 weeks and then to 6 weeks and then to two months.
In October, 2014, two months after her last visit, she reported that she felt better than she had before she had been diagnosed with the lung cancer. She was walking comfortably for one kilometre several times each day with little breathlessness and her energy was as good as she thought it would get (her husband was smiling as he declared, “she has her spark back and more!”).
Her neck now feels quite ‘normal’ and there is little indication that it used to feel like concrete. Her leg lengths are equal.
Comment: I expect there is much that could be said about this case, particularly the significance of the sphenoid and temporal bones and their dural attachments, as well as the importance of enhancing function in the cervical spine.
There is an acupoint here that is worthy of discussion – one of only a few on the back of the neck. ‘BaiLao’ (M-HN-30) is located in the paraspinal neck muscles at a level that approximates to the 3rd cervical vertebra. The point was first discussed in the Compilation of Acupuncture and Moxibustion (published in 1874) where it was recommended for the treatment of “Scrofula, cough, shortness of breath, Lung consumption and stiffness and pain of the neck”.
Case 15 – Chronic right hip pain with numbness around the left hip:
Jen is 60 years old and has suffered from near constant numbness around her left hip and pain in her right hip for the last 4 years. She has had MRI and CT Scans as well as ultrasound and x-ray investigations and her doctors have advised her that she has significant degeneration of the hip joints as well as bursitis.
Her main symptoms involved constant pain in the right lateral hip area that radiated into the right iliotibial band and persistent numbness of the same region on the left hip. She has had numerous cortisone injections but these have provided little relief. She said she takes analgesic medications but she still has trouble falling asleep at night because of the pain.
Assessment revealed ‘extreme’ tension in both Achilles tendons but worse on the right when her head was in the neutral position. When she turned her head to the right, the right leg remained shorter but when she turned it to the left, the left leg became the shorter leg (Double Positive Cervical Turn).
I completed the Lower and Upper Back Procedures and had her turn over. I finished the Neck Procedure and then released the right temporalis and lateral pterygoid muscles with the TMJ Procedure.
She returned in seven days reporting little change. I repeated the treatment of the previous week but also addressed the Coccyx. I showed her the ‘plates’ exercise and asked her to do it twice daily. She returned the following week reporting that she had had an excellent week! Upon assessment her leg lengths were equal so I just repeated the Basic Relaxation Procedures (1, 2 & 3).
She returned 3 weeks later and reported that she was no longer taking any medication and that she was pain free and had no numbness. She was continuing the exercise and she was now sleeping well and her only complaint was that she was a little stiff in the hips at times. I have assessed her twice at six week intervals since then and she has been asymptomatic now for nearly four months.
Comment: The findings of extreme bilateral Achilles tendon tension suggested the dura was in a state of chronic tension. I always get these patients to do the ‘plates’ exercise several times each day and routinely see excellent results. The exercise is unique in that it stretches and loosens the dural fascia within the spinal column. I attribute the pleasing clinical outcome observed in this case to the use of the ‘plates’ exercise.
Case 16 – Acute lower back pain:
Catherine (43 y.o.) presented to the clinic complaining of ten days of lower back pain and stiffness which radiated across the L5-S1 region and into the area over the left iliac crest.
Assessment revealed a left-sided dural drag that was producing a 10 mm, short left leg. The asymmetry corrected when she turned her head to the right.
I completed the Lower and Upper Back Procedures without observing any waits and had her turn over. I performed the Neck Procedure and noted there was no abnormal tension in the cervical region. I gently palpated the left and right sternocleidomastoid (SCM) muscles and noted significant tension in the muscle on the right side. I made a few moves over the right SCM muscle and the patient commented that the area was quite tender. After a five minute rest I repeated the same moves and noted the muscle held much less tension. I was able to search deeper into the SCM and find (and release) a few more areas of restriction (again, the process was a little uncomfortable for the recipient).
Several minutes later I had her stand and walk around the room and she reported that she could not feel any pain in her lower back. I asked her to lie on the treatment table again so I could reassess her leg length – the leg lengths were completely even and the left sided dural drag had resolved.
At the follow up appointment one week later Catherine reported that the back pain had not returned. She had remained symptom free since the last treatment. Assessment revealed a state of tonal symmetry. I repeated the procedures of the previous week (but in assessment mode) and when I got to the sternocleidomastoid, I was pleased to find a soft, relaxed tissue that required no further treatment.
Comment: In the book and at the workshops, I continually highlight the significance of the sites associated with dural attachment. In this case, the sustaining muscle spasm turned out to be the sternocleidomastoid muscle and in practice, I find this presentation is quite a common one. The muscle attaches to the mastoid process of the temporal bone which is of course, a significant site for dural attachment. SCM release allows dysfunction associated with the temporal bone to resolve. Through the Lovett-Brother relationship, releasing the SCM can have a significant impact on the Ilium.
Case 17 – Sub-acute pain and swelling of the right knee, hay fever and chronic tiredness:
Lynn presented to the clinic complaining of three seemingly unrelated conditions. Her main complaint was pain and swelling in her right knee which had persisted for 10 weeks or so. The symptoms always seemed to worsen following exertion such as going for a long walk. In addition, Lynn was concerned about the hay fever symptoms she had been suffering over the last 4 or 5 months. Finally, she stated that she was also feeling tiredness most of the time.
Assessment showed a short left leg (it was shorter by about an inch, which, for any young readers, is about 25 mm!). The leg lengths became equal once she turned her head to right.
I completed the Lower and Upper Back Procedures without observing any waits and had her turn over. I performed the Neck Procedure and noted there was no significant tension in the cervical region. I gently palpated the left and right sternocleidomastoid (SCM) muscles and noted significant tension in the muscle on the right side (It is worth noting the presentation in this case was very similar to Case 16 but the associated symptomatology was very different).
Both sternocleidomastoid muscles were very tight and tender but the right side was the worst. I treated them several times during the treatment, each time allowing five minutes in between for a response to occur. The procedure was uncomfortable and the patient was quite concerned that I was working on tender areas in the front of her neck when I should have been addressing her knee.
In one of the 5 minute waits between moves I explained how I thought her knee problem was secondary to a more significant disturbance affecting her central nervous system. I explained that I was treating her knee with these moves on the front of her neck. I got the feeling she wasn’t buying my justification so I got my skull model out and showed her how the temporal bone would respond to the treatment and how that would allow the leg lengths to correct and then the knee problem would resolve and it may even help her hay fever and the tiredness etc.. In the end I think she decided I believed in what I was doing and that for her part, she would just wait and see!
I asked her to return in a week but she rang the clinic the next day to thank me. She was already experiencing great improvement in her knee. When she came back the following week, she reported that her knee was 95% better. Her presentation was similar so I repeated the treatment. The SCM’s were much looser and nowhere near as uncomfortable.
She returned the following week and reported her knee had been completely fine and that her hay fever symptoms had improved dramatically. The treatment was repeated and she was asked to return after a further two weeks.
Lynn did return two weeks later and she was very pleased. Her knee had given her no trouble, the hay fever had resolved and her energy was improving.
Case 18 – Acute right buttock and hamstring pain:
Anne described her pain as running from the centre of her right buttock, down the back of her leg to the knee. She said the pain was constant but varied in intensity from “4 out of ten to 6 out of ten” and that it had presented with rapid onset a week prior.
Assessment revealed a short right leg (approximately 15 mm). Screening showed no change on knee flexion but correction was observed upon cervical rotation.
I completed the Lower and Upper Back Procedures without observing any waits and had her turn over. I performed the Neck Procedure and noted there was no significant tension in the cervical region. I gently palpated the left and right sternocleidomastoid (SCM) muscles and noted significant tension in the muscle on the right side (and again, this case was very similar to Case 16 and Case 17 but the associated symptomatology was quite different).
I released the right sternocleidomastoid muscle which was quite tender. The legs lengths immediately corrected and I sent her home asking that she return in one week.
She returned reporting complete recovery but mentioned that she suffered significantly for a few days after the treatment. She explained that she felt better on the day of the treatment but that the pain gradually intensified over the next 48 hours necessitating that she take analgesic medicine. She claimed she was “surprised’ to wake up on the third day after the treatment with absolutely no pain. The pain did not return and assessment at the follow up appointment could find no asymmetry. She had no abnormal tension in any of the tissues that were assessed.
Comment: The last three cases highlight the seemingly random symptomatology of dysfunction associated with the sternocleidomastoid muscle. From pain and swelling of the right knee, hay fever and chronic tiredness, to lower back, buttock and hamstring pain (in the book I also detail a series of cases where facial warts resolved following treatment of the SCM). Each individual presents a unique manifestation of dysfunction.
It is so important to be able to get to the root of any dysfunction. In the case of cervical dysfunction, for example, there may be an endless list of possible symptomatic expressions and the symptom pattern can rarely be relied on to clearly identify its point of origin.
In this regard I am reminded of my early acupuncture training when my teacher tried to share with me an ancient Chinese Medicine axiom. It went something along the lines of, “A single intervention may cure a hundred different conditions whilst any one condition may respond to hundred different interventions”.