Case 37: Facial Neuralgia in an 85 year old male.

Arthur is 85 years old. He presented to the clinic suffering from sub-acute and severe facial neuralgia.  He had been experiencing severe pain through his right jaw for about a month and the pain was frequently shooting up into the right side of his head and temple area (radiating into the upper branch of the trigeminal nerve). He had had a CT scan and an ultrasound but these were unremarkable. He had seen a dental specialist but no dental issues were identified.  Arthur had been receiving Bowen treatment from a very good Bowen therapist for several weeks but his condition was not abating.  The therapist referred Arthur to me for ‘a second opinion’.

Assessment in the prone position revealed a dural drag shortening the right leg by about half an inch.  Screening techniques showed a positive Cervical Turn Test.

I performed the Lower Back and Upper Back Procedure and then had him turn over. Tactile assessment of the paraspinal muscles at the back of the neck allowed me to observe that the tension on the left side was much tighter. My first thought was that this was indicative of a left-sided TMJ issue. I checked the tension in each sternocleidomastoid muscle, expecting the right side to be tighter (this is covered in the TPD class). The right SCM was like concrete and the left had a ‘normal’ tone. This confirmed my suspicion that there was an issue with the left TMJ.

I did some gentle moves over the right TMJ and noted the tissue under the masseter muscle was soft.  As I made the moves on the left side, I noted the guarding tensions in that area.   As I went deeper, to stimulate the pterygoid/temporalis, I saw Arthur grimace. It didn’t stop me from making a good move. He asked me why it was so sore on the left side when that was his good side. I told him that was uncomfortable because that’s actually where the problem was.  It wasn’t on the same side as the facial neuralgia, but I was certain it was the cause of the pain. I asked him to return in three days.

When he returned for a follow-up treatment three days later he was smiling. I asked how he was and he told me he had been REALLY sore for the first day and a half and then, on the second day, he was eating an apple and he noticed he had no pain at all. He had been pain-free for a day and a half and the only time he’d felt any shooting pain was when he opened wide on one occasion to eat a large banana.

Assessment showed tonal symmetry and the neck muscles and jaw muscles showed a nice symmetrical tone.  Amazingly, the right sternocleidomastoid muscle was also soft and relaxed. I told him he would be fine from here – as long as he stayed away from big bananas!


Comment:  The branches of the trigeminal nerve must pass through various foramen of the sphenoid as they exit the skull (foramen ovale, foramen rotundum, and the superior orbital fissure).  Abnormal tension in the tissues attaching to the sphenoid bone (pterygoid & temporalis) can have an impact on the bone’s function and on the cranial nerves that pass by and through it.

This case shows the importance of tactile assessment as well as the value of recognising the common patterns of dysfunction that we see in the clinic.  Arthur’s dysfunction pattern was common but his symptom pattern was unusual, distracting and potentially misleading.  I have encountered several cases of facial neuralgia where the TMJ issue was a ‘silent’ primary on the side opposite the neuralgia.



Case 38: Correction of severe malocclusion in an 11 year old girl.

Rose presented to the clinic complaining of daily bouts of chronic pain in her mid-thoracic and lumbar regions.  The pain presented each night, during her sleep, and would wake her and drive her out of bed.  The pain improved with movement and, once she was up and moving for a while, the pain would resolve.  If she lay still for more than a few hours, the pain would start to return.  She had endured this problem for almost 18 months and had so far found no relief with chiropractic and physiotherapy treatment.

As I conversed with Rose, I noted an extreme deviation of her mandible.  Her jaw was deviated to the right and she had a significant overbite (about 4 mm).  I assessed her in the prone position and found a short right leg (about 8 mm short) which resolved on cervical rotation.   The paraspinal muscles on both sides were very tense.  Following some basic moves, I had her turn supine and I checked her neck.  There was a lot tension in the paraspinal muscles of the neck but it was greater on the left side.  I placed my fingers on either side of her face, just under the zygomatic arch, and then I asked Rose to open and close her mouth.  I was quite shocked by what I felt and by what I heard.

As she opened her mouth, I could feel the movement of the condylar processes was quite asymmetrical but as the mouth opened beyond a centimetre, there was a very loud ‘cracking’ sound and I could feel the mandible shift (almost violently) in accordance with the loud crepitus.  I asked Rose how long her jaw had been ‘cracking’ like that and she said it had started about two years ago but was progressively getting worse.

I told Rose’s mother that Rose had a very significant issue with her jaw and that I believed this issue was the cause of her chronic pain episodes that were waking her each night.  I explained all about the dura mater and the attachment sites and the importance of the pterygoid muscles and the temporalis and I told her that I thought the jaw problem was so severe that they should seek orthodontic opinion as early as possible.  Her mother told me they had already done so and the orthodontist had said that she would need significant work to correct the problem but that he wouldn’t begin any treatment for another two or three years.  She was surprised by my opinion that the jaw issue was associated with the chronic pain Rose was experiencing but she was certainly quite interested in what help I might be able to offer.

I explained that I thought I could improve the situation to a point where she could become pain-free and be able to sleep through the night without waking.  I told her that I didn’t believe the treatment would resolve the malocclusion but I did think it would lessen its severity.

I assessed the tissues in front of the mandibular condyles.  The tissue on both sides was tense and hard but the left side felt like concrete.  I told Rose the moves would be a bit painful and I asked her to allow me to do them.  I applied the pterygoid moves as deeply as I dared and I was satisfied I had achieved a good depth.  I knew the moves were painful but Rose didn’t flinch at all.

I treated Rose at weekly intervals for the first month.  Over this time there was a slow but gradual improvement in her symptoms and by the end of the month she told me she was only waking up once or twice a week.  I could notice some reduction in the tension around the neck and jaw and so I asked her mother if she would be happy to maintain the treatment but take a slower, longer-term approach.  She agreed and I asked her to come back in three weeks.

Three weeks later Rose reported further improvement.  She had not had any pain in the last three weeks.  I was happy with the gradual improvement so I asked her to come again in another three weeks.  At that appointment, I was rewarded with a view of symmetry for the first time.  Not in her jaw, but certainly in relation to her leg-lengths.  I could feel a further reduction in the general tension levels and I told Rose and her mother that I was very pleased with the progress.  Rose chimed in and stated that she was happy, not just to be rid of the pain, but because she had noticed her jaw was no longer cracking when she opened her mouth.

I moved the appointments to monthly and treated her three more times.  Each month, she presented with symmetry and the various improvements continued.  It was at the fourth monthly follow-up appointment that I was shocked by what I found.  Rose presented with symmetry.  I was now treating other members of her family as well so there were several people in the consulting room and I was treating them two at a time.  I was chatting with them as I was working and as I moved my fingers to the paraspinal muscles in her neck, I was surprised how loose they felt, and this drew my immediate attention.  I looked down at my young patient and saw her jaw looked perfectly aligned!  I didn’t really believe what I was seeing because it had been so severely deviated.  I had stopped talking (mid-conversation) and I quickly moved my fingers to her mouth and pulled her lips apart.  I don’t think I have ever done that to anyone before and it only happened because I was in a state of shock.  I looked at her teeth and saw they lined up nicely.  There was no overbite and there was no deviation of the mandible.  I placed my fingers on either side of her face (just under the zygomatic arch) and asked her to open and close her mouth.  The jaw moved smoothly and symmetrically and a quick palpation of the tissue in that region revealed very soft and supple masseter, pterygoid and temporalis.

I was really struggling to accept what I was seeing and feeling.  I looked up at her mother who was beaming from ear to ear.  She said they had noticed the jaw had changed about two weeks prior and that they couldn’t believe it.  They had been waiting to see my response when I noticed.  I have treated her on many more occasions over the last year (ongoing ‘maintenance’ treatments spaced six weeks apart) and she continues to present this state of symmetry and optimum function.

Comment:   This case saw slow and steady improvement over more than six months of management and treatment.

It emphasises the principle that the body has ‘an innate capacity to heal’ if we are able to restore the relationship between structure and function.  It illustrates the significance of the dura mater and it shows the importance of a holistic perspective with regard to assessment and treatment.



Case 39: Treatment of chronic persistent back pain in a 20 year old male.

Toby explained that he had been suffering continual chronic back pain for at least three years.  The pain was always present and affected several regions including his lumbar region and hip, and his upper back and neck.  He couldn’t identify any event that may have caused it.  He told me that he had seen many other therapists including doctors, physiotherapists, chiropractors and osteopaths but so far, he had found little or no lasting relief.

I asked him to lie prone on the treatment table so I could conduct an assessment.  His left leg appeared a full three centimetres shorter than his right and his left buttock sat at least a centimetre higher than his right.  Screening showed positive for cervical dysfunction and negative for SI joint dysfunction.

I treated his Lower and Upper back and then his neck.  Everywhere I worked was tense and rigid and the moves were often quite uncomfortable as I used the pressure necessary to facilitate each move.  His neck was very stiff and tense and as I worked on it, he mentioned that he commonly experienced headaches.  Through palpation, I identified the main area of dysfunction as his right TMJ/sphenoid so I released the pterygoid and temporalis and then reassessed him.  His left leg was still two centimetres short but this time both screening tests were unremarkable.  I applied a coccyx correction from the left side and there was some improvement but the asymmetry did not resolve.  I turned him supine and released his adductors using the pelvic procedure (they were very tense and tender).  I asked him to return for another treatment a week later.

One week later, Toby reported that he had felt no benefit from the treatment and that he was still experiencing persistent pain.  Assessment still showed a massive left-sided dural drag and the left buttock still sat much higher than the right.  I repeated the treatment of the previous week and still found the right TMJ/sphenoid area was the primary issue.  Following the release of the neck and the TMJ, I addressed his adductors and psoas (bilaterally, and from the front).  I explained that it would take some time to bring about the changes necessary for him to become pain-free and I asked him to return the following week.

Toby returned for his third treatment and reported that there seemed to be no noticeable improvement.  I should mention at this point that Toby lived a considerable distance away and each visit to the clinic involved a round-trip journey of more than 300 kilometres.  I assessed him again and I noticed that his left leg only appeared about one centimetre shorter.  I took this as an encouraging sign and I told him I hoped we would soon see some progress.  The left leg became even when he turned his head to one side, so I headed off to address the upper dural attachment sites.  On this occasion I found his right TMJ to be quite improved but his left sternocleidomastoid was very tense and tender.  After I had released it he still showed a short left leg but it no longer changed on head turn.  I then treated his coccyx (from the left) as well as the adductors.  I asked Toby to return for another treatment in two weeks.

Two weeks later Toby reported that he had been feeling significant improvement.  He said it was the first time any treatment had brought any significant relief.  His left leg was still two centimetres shorter and his left buttock still sat (annoyingly!) a full centimetre higher than the right.  I conducted the screening tests and they were both unremarkable.  I used the Lower and Upper back moves to assess him and then progressed to the Neck Procedure.  He felt so much looser and freer at all places and his neck, TMJ and sternocleidomastoids all felt remarkably loose.  I positioned him prone again and addressed his coccyx (this time I used the ‘reverse’ coccyx procedure) and then left him to rest.  When I returned to the room, a glance from the doorway brought a big smile to my face.  His buttocks now sat level for the first time.  I checked his leg-length and he showed symmetry.  I asked him to return in two weeks time.

He returned two weeks later and he presented with perfect symmetry.  His buttocks sat evenly and I could find no abnormal tension anywhere when I worked on him.  The tissues that had previously felt so tense, now felt so loose.  I asked him how he was going with regard to the pain.  He just grinned and replied, “What pain?”  He had experienced no pain at all since his last visit and he told me he couldn’t believe that he had finally found the answer to his back pain.  I told him I would see him again in a month – just so I could enjoy reassessing him again!

Comment:  This is a great case and it illustrates many things.  I should say from the outset, I believe the coccyx was the underlying issue the whole time.  I think his state of dysfunction had become so chronic that many other areas had become dysfunctional and were contributing to his state of distress.  A process of continual holistic assessment allowed me to resolve various layers until eventually the coccyx was the last place that was still dysfunctional.  In that instance, the ‘reverse’ procedure hit the spot and effected the correction.  I believe the case shows, not only that it is important to hit the right spot, but that it is important to do so at the right time.



Case 40:  Chronic and recalcitrant back pain in 38 y.o. female

Joanne was 17 weeks pregnant when she presented to the clinic complaining of severe lumbar and sciatic pain.  She said that she usually experienced some degree of back pain but it had certainly become progressively worse over the past six weeks.

Assessment showed a short left leg which corrected on head turn (positive Cervical Turn Test).  I moved quickly to her neck and found significant contraction in her neck which I released with the moves of the Neck Procedure.  Joanne lived 250km from my clinic and she was just holidaying in my town for a few days so I didn’t expect her to return.

To my surprise, Joanne returned to the clinic nine months later…  She told me she had enjoyed a largely pain-free pregnancy following the treatment I had given her.  She had a natural delivery but since the delivery she had been experiencing quite severe back pain and sciatica.   She had tried various therapies over the past three months but so far they had failed to offer any relief.  Out of desperation, she decided to travel the 250 kilometres to my clinic to see if I could help.

Assessment showed a left-sided dural drag with a positive Double Cervical Turn Test.  The primary issue was not difficult to ascertain.  As I pushed in to the side of the sacrococygeal junction she flinched in pain.  It was a very tender area to touch.  I performed the coccyx procedure and the dural drag resolved.  I asked her to return for a follow-up treatment a week later.

Joanne returned a week later and reported there had been no improvement.  The assessment was the same and this time I applied a reverse coccyx procedure and asked her to return again in a week.  Joanne wasn’t able to return a week later so she came back in two weeks and again reported that there had been no improvement at all.  She was still suffering severe lumbar pain and sciatica.  I worked slowly and thoroughly and all I could find was significant tenderness around the coccyx.

I asked if the pain was worse with sitting and she said it was.  She said she worked from home, on a computer, and that she had recently installed a ‘standing desk’ to work from because sitting made her so much worse.   We talked about the length of the drive (three hours to the clinic and three hours home) and we discussed the detrimental effect sitting could be having before and after each treatment.  I asked her to remember to get out of the car several times, on the journey home, to have a walk around.  I treated her coccyx and I asked her to return again in two weeks and I stated that I hoped we would soon see some relief to her pain.

Two weeks later she returned and reported that there really was no improvement at all.  I carefully and slowly assessed her as thoroughly as I could and once again settled on the fact that her coccyx was certainly the primary issue.  I treated her and asked her to walk as much as possible on the way home.  She told me she had arranged to spend the night in town, with some friends, and that she wouldn’t be driving home until the following morning.  I was hopeful that this might be a beneficial strategy.  I told Joanne that if this treatment didn’t provide significant benefit that she shouldn’t return for more treatment.  I told her she should instead ring me and I would offer some advice regarding a possible referral.  I advised her to walk around a lot during the afternoon and to avoid any unnecessary sitting.

Joanne returned to the clinic for another appointment two weeks later.  I hadn’t heard from her at all and I was surprised to see her.  She had a small gift, in the form of a bottle of wine, sitting on the chair next to her.  She told me she had been fantastic since the last treatment.  She had enjoyed two weeks without any pain or sciatica and that it was an incredible relief after suffering constantly for nearly five months.  I assessed her and she showed perfect symmetry.  I palpated the area on either side of her coccyx and there was no tenderness.  I checked a few other areas and found no problem and so I sent her home (although I suggested she take a break from sitting every 20 minutes, just to be sure).  I asked her to call me in two weeks, just to report in.  She did ring me two weeks later and the news was all good.

Comment:  People often ask me about the ‘rules’ of Bowen Technique and whether I follow them.  One of the rules I do adhere to relates to long periods of sitting following a treatment.  I usually end each consultation with a phrase I must have repeated more than fifty thousand times: “Over the next 24 hours, please remember this: Sitting for prolonged periods is your worst enemy and gentle movement is your best friend.”    This case highlights the importance of that rule, especially when it comes to restoring function to the coccyx.  I am quite convinced the major difference that made the last treatment “hold” was that Joanne had stayed overnight and thereby allowed the body the time necessary to integrate the treatment.

Case 41:  Chronic Bilateral Brachial Neuralgia in a 28 year old computer operator

David presented to the clinic six weeks ago complaining of constant pain in the front of both shoulders which extended into his arms.  The intensity of the pain, and the degree to which it radiated down each arm, varied significantly at different times and were especially aggravated by his work (which primarily involved data entry onto a computer).  The pain had first presented six months prior but it had quickly worsened and had been present constantly for the past four months.  The pain was always much more severe on the right side and this had been attributed to his right-hand dominance along with his occupation.

Initially, David had consulted a physiotherapist but as the condition worsened he was referred to a Neurologist.  MRI scans were conducted on his neck and shoulders but these failed to note any significant pathology.  Nerve conduction tests were then arranged and they too were unremarkable.  David was taking analgesic and anti-inflammatory medicines which did provide some relief and his Neurologist had recently suggested trying bilateral cortisone injections to see if this could relieve the pain.  David had decided he would like to try acupuncture to see if it could help settle the pain and so he made his appointment at our centre.

Assessment in the prone position showed a left-sided dural drag of more than two centimetres.  This asymmetry resolved upon head turn.  I asked David if I could treat him with Bowen therapy rather than acupuncture and after a short pause he reluctantly agreed.

The tissues in the back and side of David’s neck felt quite good but the right sternocleidomastoid was very rigid and tense and was very tender to touch.  I moved it several times and it was quite uncomfortable and David actually commented that he really had come in to try acupuncture and not to be ‘manipulated’.

I reminded David that his primary issue had been diagnosed as an irritation of the brachial nerves.  I explained that these nerves passed through a tight space in the shoulder and that this space was bordered and protected, and held ‘open’, by his collarbone and scapula.  The problem (as I saw it) was that his sternocleidomastoid muscle was in a state of chronic spasm and this was likely due to the positions he worked in.  Since the tense and tender muscle was attached directly onto the collarbone, I believed it was the cause of his pain.  I told him that I thought that releasing the tension in the muscle would allow the collarbone to move into a more functional position and this in turn would resolve the irritation and pain associated with the brachial nerve.  I then told him that if he would be happier I would be willing to simply treat him with acupuncture…  After another short pause, David urged me to do what I thought was necessary and I returned to working on the sternocleidomastoid.

David returned one week later and reported significant improvement.  He said that if his pain levels were seven out of ten prior to the treatment, they had been about three out of ten since.  I assessed him and noted perfect symmetry.  I treated him again and focussed primarily on the right sternocleidomastoid which was tender and tight but nothing like the first time.  I was heading off for a family holiday so I asked David to return in just over a month.

I saw David again, six weeks after his initial presentation.  He presented with symmetry and he reported that he really only experienced very minor levels of discomfort now and only very occasionally (maybe once or twice a week for an hour or so).  He had stopped all medications a week after the last treatment.  I asked him to return again in a month for a follow-up appointment.

At the follow-up appointment, David reported that he had been completely symptom-free for several weeks.

Comment:   According to Wikipedia, the collarbone serves several functions:

It serves as a rigid support from which the scapula and the free limb are suspended; an arrangement that keeps the upper limb away from the thorax so that the arm has maximum range of movement. Acting as a flexible, crane-like strut, it allows the scapula to move freely on the thoracic wall.

It covers the Cervicoaxillary canal, protecting the neurovascular bundle that supplies the upper limb.

The Cervicoaxillary canal is the passageway that extends between the neck and the upper extremities through which the long thoracic nerve and other structures pass.  Its structure is defined by being posteriorly bordered by the scapula, anteriorly by the clavicle, and medially by the first rib. The long thoracic nerve traverses this passageway in addition to axillary blood vessels and the brachial plexus.

In Bowen Therapy, we adhere to the principle that structure and function share an intimate relationship.  We seek to influence bony structures primarily through treating myofascial attachments.  Dysfunction of the sternocleidomastoid muscle may influence the clavicle, the temporal bone, or the occiput and the symptomatic expressions of this may be wide and varied.




Case 42:  Treatment of Temporomandibular Joint pain in two separate patients:

Three months ago, a local dentist referred one of his patients to me to see if I could help her with her persistent right-sided temporomandibular joint (TMJ) pain.  In addition to the TMJ pain, the patient’s jaw was clicking each time she opened her mouth and she was suffering from frequent headaches.  She had been suffering these symptoms for more than twelve months.

Assessment showed a left-sided dural drag that resolved on head turn so I conducted some Lower Back and Upper back moves and had her turn over so I could assess her neck.  To my surprise, her neck felt quite ‘normal’.  I palpated her sternocleidomastoids, as well as the soft tissue around the TMJ, but I could find no issue.

I asked the patient to return to the prone position for reassessment and I found the same presentation as before – a left-sided dural drag that resolved on head turn.  I decided I would treat her coccyx using the Reverse Coccyx Procedure.  As I did so, she let out a small gasp.  I asked her if the move had been too uncomfortable and she said it was more ‘tingly’ than uncomfortable, and that the tingling sensation had surprised her.  I let her rest for about three minutes and when I returned she told me she had felt a very strange movement in her chest while I had been out of the room.  I reassured her that this was a good sign and I reassessed her and noted she was holding symmetry.

One week later, she returned for the follow-up visit and she told me that about 30 minutes after the last treatment, her chronic sinus congestion had spontaneously cleared and it had not returned since.  She said she was feeling a lot better and the pain around the TMJ was much less.  I assessed her and found a short left leg but with no change on any of the screening procedures.  I treated her coccyx again but this time there was no tingling sensations – it was just a little tender.

She returned one week later reporting significant reduction of the TMJ pain and she commented that she hadn’t had any headache at all throughout the week.  Assessment showed she was holding symmetry so I treated her with the basics and asked her to return in a fortnight.  She returned two weeks later stating that she was totally symptom-free except that her jaw was still clicking (albeit not as loudly).  Since she showed symmetry upon the assessment I suggested she come back to see me for a check-up in two months…

…About five weeks ago, the same dentist referred his own daughter to me for treatment of chronic left-sided TMJ pain.  She also experienced a loud cracking noise that emanated from her jaw each time she opened her mouth more than one centimetre.  She was unable to open her mouth wider than about 18 mm.   These symptoms had persisted for over a year, since her bracers had been taken off, and they seemed to be getting worse with the passage of time, rather than better.

Assessment showed a left-sided dural drag around 12 mm which resolved on head turn.  The sustaining muscle spasm was easy to find and was associated with the tissues of the right TMJ (I often find the SMS on the side opposite the symptoms).

I treated her four times over the five weeks and treatment was always targeted to the tissues of the right TMJ.  Over the time, the tissues softened and became far less uncomfortable to move.  By the third visit she was holding symmetry and she continued to hold it going forward.  By the fifth treatment she could open her jaw around 3.5 cm.  She no longer experienced any pain or any clicking or cracking noises and she had been symptom-free for about three weeks.

Comment:   These cases involved two very similar symptom presentations but each was addressed with totally different treatments.   In each case, thanks to the information gained through tonal assessment, the treatment was able to be targeted to the root of the individual’s condition.  In a conversation I had recently with Dr Romney Smeeton, he stated, “…As people are now starting to understand, Bowen treatments should be patient-specific, not condition-specific.”

These cases also illustrate the potential for Bowen therapists to work in conjunction with dentistry.