Case 43:  Treatment of chronic neck and arm pain associated with cervical degeneration

Peter (67 years old) presented to the clinic two months ago describing a state of chronic, constant, and severe neck pain which radiated into the whole length of his left arm (from his shoulder to his fingers) and also into his upper back.  In addition to the constant pain, he also experienced some numbness in his hand and fingers.   The onset of his condition had been gradual over a long period of time but he had now been suffering constant pain in the neck and arm for the last eight months.  He was taking analgesic medication several times each day and had been receiving physiotherapy and myotherapy on a weekly basis for the previous eight months but he felt his condition was actually deteriorating.

Peter gave me a copy of a recent MRI report – It was two pages long.  Highlights from that report read as follows:

Desiccation and narrowing of all cervical intervertebral discs.

Mild flattening of the cord at the C4 – C5 levels.

Uncovertebral and facet joint spondylosis at all levels between C2-C7.

Osteophytic encroachment of neural exit foramen at the levels of C4, C5, C6 and C7 with probable impingement on the emerging cervical spinal nerves – This pathology is present bilaterally but is seen to a greater extent on the left side at all levels.

Assessment in the prone position revealed a right-sided dural drag of about 2 centimeters.  This resolved when he turned his head to one side (+ve Cervical Turn Test).

I made some moves on his lower and upper back before turning him supine and assessing his neck using the Neck Procedure described in my book.  The tension through the back of his neck made it quite difficult to move the paraspinal bundles but it was immediately evident that the left side was tighter than the right.  I checked the tension in the sternocleidomastoids and found significant tension on the left side so I released it.

I placed my fingers anterior to the temporomandibular joint and had him open and close his mouth.  His jaw moved in an awkward way and I felt ‘loud’ audible crepitations under my fingers.  I told him his jaw was associated with a big problem contributing to his neck pain and that the moves I was about to make would be uncomfortable.  He nodded agreement and I applied the moves of the TMJ Procedure as described in my book.

Peter wanted to know how his jaw could be related to the issues he was experiencing in his neck and arm and back so I gave him a mini explanation using my skull model.  He then wanted to know what might have caused his jaw to be so problematic.  I told him he should be well aware it was a big problem because it was crooked, it moved crookedly, and it made noises when it moved.  I told him it was a terrible jaw and he should know more about how it got like that than me.  That was the first smile I’d gotten from him.  He nodded again and then said it gave him lots of trouble since he had broken it in an accident many years prior.

I asked Peter to come back in a week for another treatment and I told him I needed to treat him three or four times to see if I could get some response.

Three weeks later Peter came in for his fourth treatment.  Each week I had assessed tonal asymmetry and encountered the same presentation as the first visit.  I had then targeted my treatment to the Upper Back, the Neck, and the Jaw.  He said he still had pain but he thought there might actually be a small improvement.   I told him I could feel a big improvement!  I told him I could move the paraspinal bundles in the back of his neck much more easily now and that his jaw muscles were loosening nicely.  I told him more relief would come soon and that I wanted to see him again in two weeks time.

Peter came to the next appointment with some good news.  A few days after the last visit he had stopped taking his analgesic medication.   Remarkably, he was now only experiencing minor levels of pain.  The assessment was similar to previous times except on this occasion there was no longer a positive response to the Cervical Turn Test – the screening was quite unremarkable.    During this treatment, I addressed his coccyx and this restored the symmetry.

I saw Peter again today, four weeks after his last visit.  He joyfully reported that he had enjoyed a month without pain.  His arm was 100%.  His upper back was 100% and he felt no pain at all in his neck.  For the first time, the tonal assessment showed symmetry.


Comment:  Eight months of constant pain, associated with significant pathology, was resolved through the progressive release of the tension disturbing the sphenoid and the temporomandibular joint.  Simple, focussed treatment. applied over time, can acheive great results.



Case 44 – Chronic shoulder pain and restriction in a 62-year-old female

Annie presented to the clinic three weeks ago, complaining of chronic pain in her right shoulder.  She described pain in the front of the shoulder which extended down the front of her arm, to her elbow, and then down the forearm to her thumb.  This pain had been constant for at least four months.

She provided a recent ultrasound report that detailed subacromial bursitis as well as small tears in supraspinatus and subscapularis.  She told me she had suffered shoulder pain of some description for the better part of the last four years.   She had been given exercises as well as four cortisone injections over that time but had experienced little improvement.  Out of desperation, she followed a friend’s recommendation to come to the clinic.  Physical examination of the shoulder showed she could only abduct the right arm to about 110 degrees.

Tonal assessment revealed a right-sided dural drag of about 15 mm.  The screening was interesting: When she turned her head to the left, her right leg stayed short.  When she turned her head to the right, her left leg became short ( a ‘Reverse Double Cervical Turn Test’ or 2CTT – Reverse ).

This particular screening indicates the patient has two separate issues, one affecting the cervical region of the spine and the other impacting the lower dural attachments.  Although this can be a confusing presentation when we are first starting out, it can be simplified by treating one area first and then addressing the other.

I applied moves to the Lower and Upper Back and had her turn supine.  Using the moves of the Neck Procedure, I assessed the cervical region.  There was obvious tension and rigidity in the scalene on the right side from the level of C5 – C2.  I applied a few deep, slow moves over the area and left her to rest.  I returned a few minutes later and repeated the moves noting that the distorted tissues had already begun to respond.  After another short pause, I had her turn prone so that I could assess and address the issue associated with the lower dural attachment sites.

This time, in the prone position, she showed a short left leg ( approx. 10 mm ) and the screening was now unremarkable.  I used her left leg as a fulcrum to rotated the innominates as I applied pressure to the right side of her coccyx, just inferior to the sacrococcygeal junction (i.e. a Reverse Coccyx Procedure).

After allowing her a few minutes to rest, I could see she had now returned to a state of symmetry.  I had her sit on the side of the bed so I could do some moves on her shoulder – with emphasis on the long head of the biceps.

Annie returned a week later saying she had been quite sore for a few days following the treatment but on the third day, she felt something go “POP” in her shoulder.  “Something moved in there”, she said.  Since then, her shoulder had been feeling “better and better each day”.

Assessment at the second visit showed a left-sided short leg and the screening was unremarkable.  I moved quickly through the Lower and Upper Back moves and applied a psoas release using the left leg as the fulcrum – this resolved the asymmetry.  I had her turn prone and examined her neck.  It all felt really good so there was no need to treat it.  I did a few basic moves on her shoulder and asked her to return in two weeks.

She returned today to tell me she has had no pain at all in her shoulder.  Two weeks ago she started a new job as a house cleaner and, despite this, her shoulder has been completely pain-free.  She said she was amazed and now regrets she didn’t come sooner.  Examination of the shoulder showed she could now abduct the arm to about 145 degrees.  Tonal assessment showed symmetry.


Comment:  A ‘Reverse’ Double Cervical Turn Test  (2CTT – Reverse) is quite a simple presentation.  It says there is one problem to fix at the ‘top’ and then another correction is required to release the lower dural attachments.   A two-step process that sets in motion a significant healing response.



Case 45:  Constant sciatic pain with foot paresthesia in a 60-year-old female.

Helen presented to the clinic complaining of constant pain that extended from her right hip, down the front and side of her leg, to her right foot.  The pain had been persistent for six weeks and she stated that she could feel a constant ‘tingling’ sensation in her right foot.  She described the pain as severe (“ 9 out of 10”) until she began taking Lyrica.  Since she began the Lyrica, the pain had dropped to around 3/10.  In addition to the Lyrica, she was also taking analgesic medication.

Assessment of the patient in the prone position revealed a short left leg of around 20mm. When she turned her head to the right, the leg-length was unchanged but when she turned her head to the left, the right leg became short (positive Double Cervical Turn, 2CTT – Reverse).

I told her she had two problems and one was most certainly in her neck.  I did a few moves as I progressed quickly from the Lumbar region, through the Upper Back region, and then had her turn supine so I could assess and treat her neck.  Palpation (using the moves of the Neck Procedure) allowed me to identify significant tension and restriction in the left scalene.  I released the left scalene using several moves over a five minute period, taking several breaks along the way to allow time for the tissue to respond.  When I was satisfied the tissue had responded, I had her turn prone again for a reassessment.

Reassessment then showed a clear short right leg which did not change on any of the screening procedures. I applied a regular right-sided coccyx correction which resulted in a presentation of tonal symmetry.  I concluded the treatment and asked her to return in a week.

Helen returned a week later with good news… She said she had experienced some aggravation for a day or two and then things had improved significantly. The pain had mostly resolved but she did notice low levels of discomfort still at times (1/10) and she still had some tingling in her foot. What was particularly pleasing was that she had stopped taking the Lyrica altogether and was only taking a very low dose of analgesics.

Assessment showed she had a short right leg and that it didn’t change throughout any of the screening procedures (screening unremarkable).  I repeated the same treatment from the previous week but this time I did the coccyx prior to turning her into the supine position.  The left scalene region felt a lot better but I touched it up anyway.  We finished with symmetry and again, I asked her to come back in a week.

Helen returned two weeks later (she was away interstate the week prior for work) and reported she felt one hundred percent.  She no longer felt any pain, nor any tingling.  Assessment showed perfect symmetry.

Comment:  I thought this was a good case to share because it also shows the value of the Screening presentation 2CTT-Reverse.  At all stages of treatment, the intervention was targeted and the response expected.  I hate to think of how the case may have progressed without the appropriate assessment and treatment.



Case 46:  Acute sciatic pain and numbness of the foot associated with foraminal stenosis

Trevor presented to the clinic four weeks ago complaining of right-sided sciatic pain.  His main symptoms included constant pain in the right calf and a constant ache in the right ankle and heel.  He was also experiencing constant numbness in part of his foot and in his three smallest toes and he was walking with a noticable limp.  He said the symptoms had commenced five weeks prior and that he had recently received the results of a CT scan.

The CT scan identified small disc bulges at L1/2 and L2/3 levels as well as significant pathology at L3/4.  “There is a right-sided bony osteophyte, along with moderate right sided exit foraminal narrowing giving rise to moderate foraminal and extra foraminal stenosis at L3/4, impinging the right exiting L3 nerve root”.

He had been prescribed analgesic medication which was helping to ease the pain but he was taking 8 doses per day in order to get relief.  He told me he was self-employed and worked as a builder and was not able to take any time off work without experiencing significant financial costs.  For this reason, he was still trying to work.  To make things more challenging, he lived abot 120 kilometers away.

I had him lie prone for a tonal assessment.  He showed a clear left-sided drag of around one inch and he tested positive for both sacroiliac involvement and cervical involvement (+ve SIJ test and +ve CTT).  I worked over his lower back and upper back and had him turn supine.  As I assessed his neck (using an improvised version of the neck procedure) where I found the right paraspinal bundles to be very tight.  Assessment of the sternocleidomastoid muscles showed much greater tension on the left side.  Based on these findings I palpated the tissues deep to the masseter and found (as I expected) much greater tension on the right side.  I made a nice deep move over the pterygoid/temporalis region and left him to contemplate the treatment.  Five minutes later I returned to the treatment room and noted he now showed something very close to symmetry.  I checked the paraspinal tissues in the back of his neck and they had begun to soften.  I asked him to return in four days for a follow-up visit.

He returned four days on and told me he had felt some definite improvement.  He felt the pain was less and he reported that he had reduced the analgesic medicine from 8 doses a day to 2.  The presentation and the treatment were the same as the first visit and I repeated the treatment exactly.  I asked him to return in another five days.

He returned as requested and reported even more improvement.  He had stopped taking the analgesic medicine altogether and he described the pain as minimal and intermittent.  He also said the numbness was now only half that which it had been.  I assessed him and found a short left leg, about half an inch short, with a negative Cervical Turn Test and an obvious sacroiliac dysfunction (+ve SIJ test).   His right buttock appeared raised and tense so I performed a reverse coccyx procedure.  In this procedure, the left leg is used as the fulcrum and the pressure is applied to the right lateral margin of the coccyx around the level of the sacrococcygeal hiatus.  The result was an immediate correction of the tonal asymmetry and a leveling of the buttock heights.  I had him turn prone and I checked his neck but everything felt fine so I concluded the treatment.

He returned eight days later reporting that the progress was continuing and that he felt more than 60% better. I assessed him and found a left-sided dural drag of around half an inch.  The only area I found that felt abnormal was his right paraspinal region around the level of the first two lumbar vertebrae.  I performed the kidney/psoas release using the left leg as the fulcrum and this seemed to resolve the tension and resulted symmetry.

Trevor returned eight days later and reported that he had been completely symptom-free for the best part of the week.  He even noted his limp had resolved.  I assessed him and found perfect symmetry.  I let my fingers wander but I could find no issue at all.  My records show it took eighteen days and four short, targeted, treatments to resolve his symptoms and bring his spine and related structures into a sustained state of tonal symmetry.


Comment:  This case is very similar to Case 1.  I have provided Trevor with several ‘monthly’ follow-up treatments and he remains completely symptom-free.  In the last three months, he has referred around six other people to our center for treatment.

Case 47:  Chronic hip pain and distal paresthesia associated with bursitis

Maree (57 years old) described an incident in which she tripped over her dog and fell awkwardly, causing injury to her right hip.  This incident had happened almost three years ago and since then, she has suffered chronic and severe hip pain.  In addition to the chronic pain, she experiences continual numbness and tingling (paresthesia) down the lateral aspect of her right leg (as well as pain too, on occasions).  She told me the pain intensifies when she works or becomes active and so she always has to take frequent breaks and sit for a while.

She has received long-term physiotherapy as well as some chiropractic treatment and although these therapies have helped her to some degree, her condition has steadily deteriorated.  She was taking analgesic and anti-inflammatory medication as these gave her significant relief for short periods of time.  The most recent scans had shown arthritic change and bursitis in the hip.  Maree had come to see me because a relative of her’s had had a positive experience at our center, with a similar condition, and he had convinced Maree to book a session.

Assessment in the prone position showed a left–sided dural drag of about 12 mm.  Turning her head to the left had no effect on the presentation but turning it to the right changed the presentation to a short right leg (i.e. she had a positive 2CTT or Double Cervical Turn Test – classic).  In addition, the screening also showed positive for sacroiliac joint dysfunction (a positive Derifield sign).

I conducted a tactile assessment by working through the basic moves of the Lower Back, Upper Back and Neck Procedures.

The paraspinal bundle on the right side of the neck (move 6 of the Neck Procedure) was very tense indicating significant dural tension was emanating from the cranial vault.  Visual assessment of her jawline showed displacement to the left side, indicating dysfunction associated with the right temporomandibular joint.  I perform a Textbook TMJ Procedure and left her to contemplate the resulting release.

On returning some five minutes later I reassessed her – she showed symmetry with no change during the screening procedures.  I explained that I had reached the end of the treatment and that I was happy that we had found this issue with her jaw.  I explained that it was not really necessary for me to treat her hip or her leg as long as I resolved the cause of the symptoms and I asked her to return in a week for another treatment.

On the second visit, Maree reported she had experienced no improvement at all.  Assessment in the prone position still showed a short left leg and the screening showed a positive for sacroiliac dysfunction.  I conducted the Lower and Upper Back procedures and then tried a left coccyx (which made no difference).  I applied a reverse coccyx procedure (still using the left leg as the fulcrum) and this resulted in symmetry.  Five minutes later, the symmetry was still holding so I turned her over, checked her neck, and concluded the treatment.  I asked her to come back again for a follow-up treatment in one week.

Maree returned for the third visit with some good news…  She said she had experienced a very good week.  The hip pain had reduced to very mild levels so she had not taken any analgesic medicines.  She also noted that the numbness and tingling that had been traveling down her leg seemed to have completely resolved.  Assessment showed that she was holding symmetry so all I did was the Lower Back, Upper Back, and Neck Procedures and all were unremarkable.  I asked her to come for a follow-up treatment in two weeks.

Maree returned to the clinic today for her fourth visit but it had been a full month since the third visit.  I asked her how she was and she told me her wrist was giving her some pain.  I asked how her hip was and she just shook her head and smiled.  “I really can’t believe it.  It’s 100 percent.  I’ve had no pain at all, no numbness or tingling – I just feel ‘normal’.  And I really can’t believe that you never really worked on my hip”.

I smiled and told her today’s treatment would be disappointing – because I was just going to treat her wrist.

Comment:  This case (like many others) raises some important philosophical questions…  How do we determine where our interventions should be targeted?  When should we treat the symptom and when should we just treat the patient who has the symptom?  In today’s complex world of evidence-based medicine, is there a place for unique treatments based on holistic individual presentations?


Case 48: Chronic hip pain and distal paresthesia in a 37-year-old male

Danny (37 years old) presented to the clinic complaining of chronic pain in his left hip and leg. He stated that he had been suffering the hip pain for more than 12 months and that he could not recall any specific trauma that may have been associated with its onset. In addition to the constant hip pain, he noted that the pain often radiates down the back of his leg, even as far as his foot, and he frequently experienced episodes of numbness in his foot. Danny walked with an obvious limp and he said that was just because of the hip pain. Over the past year, he had sought treatment from several other therapists including a physiotherapist, a massage therapist and a chiropractor but he had found very little relief to date. Danny’s sister is a Bowen Therapist and so she encouraged him to come to our clinic to try some Bowen Therapy. I asked him what kind of work he did and he said he was a sales representative for a company and that the job involved driving around 2000 kilometers each week. I asked him whether he took analgesic medications for pain relief and he just smiled and said, ‘Yeah, too much!’

Assessment in the prone position revealed a left-sided dural drag of almost 3 centimeters. Screening was unremarkable (i.e. there was no change in the observed leg-lengths when he turned his head to either side or when I flexed his knees to ninety degrees).

Danny’s body was quite a mess. I worked on quite a number of different places on the first visit. In addition to the Lower Back, Upper Back, and Neck work, I also treated his coccyx, his TMJ, and his psoas. By the end of the first treatment, I had worked through several layers of asymmetry to finally arrive at a state of sustained symmetry. As he walked around the treatment room, I asked him how he felt… “Much the same he replied”. I nodded and asked him to return in a week.

Danny returned one week later and told me he had experienced “a week from hell”. On a more positive note, however, he did say he had been feeling quite good for the past 24 hours. Assessment showed he was still holding symmetry. Note: This is always frustrating for me as a therapist… When patients who have an obviously chronic issue return for their second visit and they are still holding symmetry. I explained to Danny that I had asked him to return too early and that I didn’t really want to treat him today as I felt his body was still integrating the changes we had initiated in the first session. He was happy to reschedule the appointment and come back next week.

So Danny returned for his second treatment, two weeks after his first. He hadn’t noticed any dramatic benefits but he did say he felt things were changing. Assessment showed a short left leg and screening revealed a Double Cervical Turn test (+ve 2CTT) as well as a right-sided derifield sign. I treated him much as I had done on the first session and booked him in for the following week.

At the third session, Danny still showed a short left leg and the screening was unremarkable. I worked through the Lower and upper back and then tried a regular left-sided coccyx correction which resulted in symmetry. I checked his neck and noted the upper dural attachments were all traveling along nicely. I told him we were making good progress and that there should be noticeable improvements evident soon. I asked him to come for his next treatment in two weeks time.

Danny came for his fourth treatment after a two-week break and he told me things were definitely improving. He was having lots of ‘good days’. He said these were days where he had very little or no pain in his hip and he also noted it had been at least three weeks since he had felt any pain in his leg or any numbness in his foot. Again, he presented with short left leg and unremarkable screening and the only significant intervention was to his coccyx (left-sided, regular coccyx procedure).

Yesterday Danny came for his fifth visit. He strode into the room quite boldly and wore a big smile on his face. He told me he felt, and I quote, ‘bloody great’. He had not experienced any symptoms at all since his last visit two weeks ago. It had now been three weeks since he had taken any analgesic medication and he just felt he was ‘fixed’. I told him not to get too excited. After all, he still had a back that needed looking after and I still had kids that need to be fed and clothed and educated.

Assessment showed slight shortness of the left leg which resolved with a reverse coccyx procedure. I checked a few other places but everywhere felt remarkably good. I told him it was remarkable how much his body had changed in the five visits and he just kept smiling. I told him to come in again in a month and we’ll see if he needs any input.


Comment: Danny’s symptom presentation was almost identical to Maree’s (case 47). In each instance, the individual patterning, revealed through the screening process, was unique but in each case, the coccyx was the primary issue.

It’s interesting to note that thousands of years ago, some clever healers in China worked out that DU-2 (the acupoint on the midline at the sacrococcygeal junction) was a good place to stimulate to benefit the lumbar region and hips and to resolve pain and numbness radiating from the lower back into the leg and foot. By design, or by coincidence, the use of the Bowen technique takes this genius to a whole new level with gentle work that is so simple, so brilliant, and so powerful.