Case Studies                                 

Positive Health magazine –     July 2008   

A shoulder / hand mystery solved with the Bowen Technique 

A. was a fit and healthy 55 year old man who held down a very responsible, physically demanding job which he loved.  He had been off work for the 4 months, since mid-June, due to a problem with his right hand.  

It began with a lack of movement in fingers and wrist.  He had some chiropractic treatments and the chiropractor said there was a lump in his right posterior shoulder.  Blood tests were all clear.  

After a lengthy wait to see a consultant, he had an x-ray, which revealed a lump on the bone and an MRI scan which showed swelling on the tendons in the shoulder.  His right hand had been getting more and more swollen, painful and restricted since July with points of pain if he clenched his fist.   

The consultant did not know what was wrong but wanted to give a cortisone injection into the shoulder but A. refused this treatment.  A. then went to a rheumatologist, privately, and he diagnosed rheumatoid (inflammatory) arthritis and wanted A. to take methotrexate.  Methotrexate can reduce inflammation but one of its actions is to reduce the activity of the immune system and many advise that it be used only to treat the life-threatening stages of cancer due to its negative side effects.  A. was advised that taking this drug would mean he would have to give up his physically demanding job and that he would also have to give up driving.  Not a welcome prognosis for an active and fit 55 year old.    

A. arrived to try Bowen Technique treatment on 22 October, having read a short article about Bowen in a local magazine.  For his first Bowen treatment, I decided to begin with the minimum amount of moves and to have longer breaks between them to gauge his response.  

When I came back into the room after a 5 minute break about 2/3 of the way through the treatment, A. reported that he had been experiencing very substantial involuntary twitches and jerks of his shoulders and arms, very predominantly on the right side.  I observed this for a bit and did not interfere by giving more treatment at this stage but allowed A.’s body to continue its spontaneous reaction until it naturally began to quiet down after some 10 minutes.  

During the break after another small set of Bowen moves, A.’s whole body began to undulate from head to toe in a very gentle wave-like pattern.  Again, this went on for approximately 5 – 10 minutes and his reaction was, first of all, amazement and secondly, he couldn’t help but laugh out loud, which he said felt very good.  

After this spell of whole-body movement, his teeth began to chatter, which again continued for some minutes and included some very forceful leg movements, like running.    Throughout these most extraordinary responses, he experienced no pain.  Indeed, the predominant feeling was one of relief and release.  And then these responses all stopped as if someone had snapped their fingers and A. was utterly relaxed on the bed, all muscles quiet.  

When he got up from the treatment, he felt “infinitely better”, with only a small twinge discernable between his shoulder blades.      

Over the next week, before his second Bowen, he experienced varying degrees of involuntary twitching and jerks, especially in his right shoulder and arm.  These were accompanied by episodes of stinging and itching in his right wrist, hand and fingers, with his right hand at one point feeling hot internally but not externally.  

A. had Bowen treatments at weekly intervals on 29 October, 4 and 11 November.   Between treatments, he continued to have a variety of twitches, spasms, itches and stiffness in his right arm, hand, shoulder and neck.  However, these were usually experienced upon waking and wore off increasingly quickly each day as he got up and moved around.  He was feeling fit and well enough to return to his work on 18 November, after 5 months off.    

The swelling in his hand was decreasing during this period as well, to the point that at his treatment on 2 December, only the top knuckle on his index finger still showed a small degree of swelling.  In January, he reported that all swelling in the right arm/hand/fingers was gone and he had good function in all parts of it.  

A. continued to come for Bowen treatments once every 3 weeks for some time, always experiencing some degree of the involuntary muscle twitching, jerks or waves, but never again as spectacular or prolonged as during his first two or three treatments.  

A. wanted to have a Bowen treatment every three weeks for about two years after this primary resolution of his original problem, as he felt it kept him in peak form and was obviously still working with the releases necessary as indicated by his muscle activity.  

As of writing, A. has felt so well and confident that he has had only four Bowen treatments in the last year:  February, May, August and November.    Was the consultant correct in diagnosing A.’s problem as rheumatoid arthritis?  Who knows, but it didn’t matter with the gentle, non-invasive Bowen treatment.  

One of the main guidelines of Bowen is that we do not diagnose a condition, but treat the body as a whole, without referral to a named disease.  

A. had a problem, a real mystery of a problem and needed something to help.  His recovery from the symptoms he was suffering was a very welcome resolution of the mystery – and a very different one than might have been expected if he had taken a very powerful medication and resigned from his job due to disability.  

The body is a self-repairing mechanism and Bowen, in common with other therapies, is able to encourage this self-healing ability.      

About the Author Janie Godfrey Cert ECBS VTCT MBTER is a Bowen Technique practitioner covering the Frome, Somerset area.  

She trained in The Bowen Technique with the European College of Bowen Studies and has been in practice since 1998.    She also holds a certificate in Clinical Pastoral Education and is a full member of the professional regulating body for accredited Bowen therapists, the Bowen Therapists' European Register  - www.bter.org, and is a member of the NHS Directory of Alternative and Complementary Therapists.  

Contents provided by the European School of Bowen Studies (ECBS)   

For further details about the Bowen Technique please contact Karen on 01954 260 982 / 07714 995 299 or email [email protected]

In Touch             

The Journal of the Organisation of Chartered Physiotherapists in Private Practice  

AUTUMN ISSUE 2004  No. 108   

The Bowen Technique ~ Treatment of shoulders   

Julian Baker
 
There can be little more generalised in terms of a diagnosis as ‘Frozen Shoulder.’  The term is often enough to strike dread into the hearts of even the most experienced physical therapist, encompassing as it does so many possibilities, both in terms of aetiology as well as treatment.   

Blacks Medical dictionary defines a frozen shoulder as “a painful complaint of the shoulder, accompanied by stiffness and considerable limitation of movement….”.  It continues in this vein, coming to the conclusion that spontaneous remission is the general outcome, “although this might take in excess of 18 months.”!   

As it stands, Bowen therapists tend to like the presentation of a classic frozen shoulder, as it often gives a faster outcome than other, even apparently more simple, cases.  

The key to why Bowen is so effective lies in the principles of how Bowen differs from many other approaches and it’s worth outlining what Bowen is all about before continuing.  

The Bowen Technique is named after Australian body worker Tom Bowen.  An untrained therapist who worked out of a house in Geelong, Victoria, Tom Bowen was credited with treating upwards of 12,000 patients per year and referred to himself as an osteopath.  

He showed few others his methods, but six men were given access to some of his work, and after Bowen’s death in 1982 the teaching of some of his techniques began.   

The work is very subtle, using fingers and thumbs to work over soft tissue and applying very little pressure.  The effect of the Bowen move is to create a gentle disturbance in the underlying fascia, which in turn prompts a central nervous system response.  

There are many variations of Bowen’s approach that have sprung up over the years, some of which apply a great deal more pressure than others, but many of the principles remain the same.  

The move itself involves the movement of ‘skin slack’ prior to the application of pressure to the structure.  The move is then made in opposition to the direction of the skin slack and is a rolling type of action, made with sufficient pressure to create the disturbance, but without allowing the muscle to flick.   

Another feature of the technique is the addition of breaks in between sets of moves, where the practitioner leaves the room (where appropriate) and allows the work to start the process.  This is an important feature which has a big effect on the outcome of the work, and enables the experienced therapist to vary the moves being performed according the changes that are taking place.   

Although most of the moves are performed with patients either prone or supine, a significant number, the shoulder amongst them, are performed with the client sitting or standing.  There are many approaches that the skilled Bowen therapist can take with a shoulder condition, but pretty much all of them start with the very simple deltoid moves, which will be described later.   

From the perspective of the Bowen therapist there are three considerations when working with a shoulder.  The first is the presentation of a specific shoulder problem, where a therapist can work locally in the region of the shoulder very simply and usually to good effect.  For this approach to be as effective as it should be, it is important to establish that there are no other causes or reasons as to why the shoulder is restricted or in pain.  

Imbalances or problems in the Temporo Mandibular Joint, whiplash, or other cervical problems might lead to this state of affairs and even issues involving the diaphragm or respiratory system will have an effect on shoulder and ROM.   For the most part we are referring here to chronic conditions of the shoulder, which have probably been treated previously with traditional techniques, possibly even surgery but which have not responded fully.    

In the case of an acute shoulder injury, this is where Bowen really comes into its own.  It is rare that we need to spend more than two or three sessions, one week apart with an acute shoulder, providing rest is given and there is no tearing.  

It is widely felt among existing converts to the technique, that Bowen is probably the most effective tool currently available for acute injuries, especially given that due to its gentleness, treatment can be offered immediately following injury.   

Typical sporting injuries Grade 1 or 2 sprain in the acromioclavicular joint or even the glenohumeral joint can be treated immediately and to excellent effect and experience has suggested that the early treatment of these conditions, reduces the incidence of future dislocation.   

The second element is the consideration of the shoulder in treating other areas of the arm, neck and shoulder.  The brachial plexus is a major element in this area and conditions such as carpal tunnel, and even tennis elbow can be effectively helped prior to localised treatment by working the shoulder area.  Brachial plexus is a nerve bundle all too often overlooked when addressing shoulder and arm conditions and yet, in my experience, provides the solution to a lot of referred problems.   

The third is the concept of fascial connections through and over the shoulder area and down the level of the pelvis and hips, thereby affecting knees on the opposite side to the presenting shoulder.  This idea of the fascial connection has been explored brilliantly by Tom Myers, in his book Anatomy Trains.

The initial Bowen treatment for a shoulder problem will involve addressing many of these areas through the initial basic procedures.  The patient will be laid prone and a series of moves made through both the lower and upper back.  

An important focus for the practitioner will be ensuring the release of levator scapula.  It can often be all too easy to be drawn into working specific areas of pain, but it’s worth remembering that the deltoid only functions in harmony with the normal movement of the scapula.  With its attachment to the superior medial angle of the scapula and with the role of elevating and rotating the scapula, working the levator gives the rest of the structure the opportunity to re-establish normal movement.   

Another standard Bowen move is over the supraspinatus, a small muscle which provides a huge amount of power to the deltoid and which is innervated by a branch of the brachial plexus.  Two medial Bowen moves from its lateral aspect, can have a big effect on the pain that is often felt into the middle of the deltoid on abduction.   

Once the surrounding areas of the shoulder have been addressed, the actual shoulder itself is then treated, with the patient either standing or sitting.  The classical shoulder move varies from most of the other moves in the Bowen repertoire, as it is made with the arm in movement.   Traditionally and preferably, the move is made with the assistance of another person, who will hold and carry the arm across the body, whilst the therapist is concentrating on the movement at the posterior border of the deltoid.  This however is often impractical and the move can easily be adapted to a single-handed technique.   

The first move is found by following the line of the axillary crease posteriorly until a dip is found at the back of the shoulder. Accuracy is very important here, as the margin for error when working the shoulder is very small.  

The position of this move is a major muscular junction for the shoulders and upper body and, if in the right place, takes in not only the deltoid, but also the long head of the triceps, infraspinatus and teres minor.   If working with an assistant, the move is made with the thumbs, whilst the assistant carries the arm across the body, ensuring that the arm is as relaxed as possible. The solo move requires a lot of concentration from the operator, to not only ensure that the move is made properly, but that the client is relaxed and that the arm is in the correct position, 45º from the body, with the elbow at chest or breast height.   The arm is pushed towards the opposite shoulder, creating a tension through the entire shoulder girdle, at which point the therapist jars the mid deltoid area with the heel of his or her hand.  This creates a reverberation through the structure and also jars the axillary nerve.   The arm is then carried carefully back to its original position, where again it is checked to ensure it is relaxed.  

A move across the anterior border of the deltoid, still following the line of the axillary crease is made with fingers or thumbs.  This move not only works the deltoid, but on a deeper level subscapularis and coracoacromial ligament.   Once perfected, these moves take only a few seconds to perform after which the standard rest time of three to five minutes is given before re-assessing the shoulder.  The moves can be performed a second time, but care needs to be taken so as not to further inflame the shoulder.  

The results can often be quite startling, with even long standing ‘frozen’ shoulders responding within five or ten minutes.  In one case a gentleman who volunteered to be demonstrated on, had 100% relief from a very restricted shoulder, which had been present for over eight years.   

A study into the effect of The Bowen Technique for ‘Frozen’ Shoulders looked at 100 volunteers with non-specific, gradual onset shoulder pain.  They were each given four treatments with half the group being given Bowen and the other half a specific hands on placebo treatment.  

The groups were not told which was which, but the treated group reported considerably greater improvement than the placebo.   Average improvement for abduction was 40% and horizontal abduction 28% percent.  

Overall 67% of the treatment group improved with their degree of improvement ‘statistically significant.’   

It’s worth pointing out that this study gave no form of exercises and adhered strictly to a proscribed set of moves, irrespective of other factors already mentioned, which might have impacted on their condition as compliance and other factors would have impacted greatly on the outcomes.   

The Bowen Technique was introduced to the UK only eleven years ago, and yet in that short space of time has had a big influence in the field of soft tissue therapies.  Regarded originally as a complementary therapy, it is fast becoming the therapy of choice for many physiotherapists.  

Annie Sewart a private physiotherapist based in Bristol, has been using Bowen for over six years.  As well as practicing reflexology and aromatherapy she claims that she has received the best results using Bowen estimating an overall success rate of 80%.   

There are of course hundreds of additions to even this one procedure and it is important to remember that Bowen is not simply a series of procedures, but a system of bodywork, with a set series of principles, but literally millions of variations.  We simply have to decide ‘Where do we start?’  

Contents provided by the European School of Bowen Studies (ECBS)   

For further details about the Bowen Technique please contact Karen on 01954 260 982 / 07714 995 299 or email [email protected]

from Physiotherapy FRONTLINE   April 3 2002           Vol 8 No 7   

NEWS     

Clinical Evidence points to effectiveness of Bowen for frozen shoulder      

The Bowen technique, a complementary therapy developed in Australia during the last century, is gaining popularity with healthcare professionals.  New research suggests it can aid patients with frozen shoulder, reports RACHEL POTTER     

Use of the Bowen technique can lead to a significant improvement in range of movement for frozen shoulder patients, says a new study.  

Bowen is a non-invasive, hands-on treatment gaining popularity with physios wishing to offer a complementary therapy in their professional practice.  The study involved 100 volunteers with non-specific, gradual onset shoulder pain.  Each was given four treatment sessions with an experienced Bowen practitioner.  Half were given the normal Bowen technique for shoulder pain, and the other half received a similar hands-on placebo treatment.  Patients had no idea whether they were receiving the treatment or placebo.  

 
Patient improvement was ‘considerably greater’ for the treatment group, according to the study results. Average improvement for shoulder abduction was 40 per cent for the treatment group, and eight per cent for the placebo group.  Forward flexion improvement was 28 per cent for the treatment group, seven per cent for the placebo group.  And horizontal abduction improvement was 24 per cent for the treatment group, compared to eight per cent for the placebo group.  However, placebo group improvements were higher than expected, with 50 per cent of patients showing some improvement.  

In comparison, 67 per cent of the treatment patients improved, and their degree of improvement was statistically significant.  The study results were ‘extremely encouraging’, conclude authors Julian Baker, director of the European College of Bowen Studies, and sports injury therapist Helen Kinnear.  It also demonstrates the cost-effectiveness of Bowen, as patients showed improvement after only a few basic sessions.  

Anneke Loode is a chartered physiotherapist trained in the Bowen technique, and told Frontline that the new research backs up her own experience.  

The results were very promising, she said, particularly as only basic shoulder moves were used.  ‘When I started the course in the Bowen technique I didn’t expect it to dramatically change the way I work,’ said Anneke, who works at the East Grinstead Physiotherapy Clinic, East Sussex.  ‘But it did.  I was quite amazed by the results.  ‘I can confirm the results from the study into frozen shoulders from my own experience.  In the 11 years I have treated patients in private practice I have never seen a frozen shoulder improve so quickly.  The Bowen technique has definitely made the way I treat patients more complete.’    

Contents provided by the European School of Bowen Studies (ECBS)   

For further details about the Bowen Technique please contact Karen on 01954 260 982 / 07714 995 299 or email [email protected]

Today’s Therapist International Trade Journal   -   Issue 39  Mar Apr 2006    

The Bowen Technique - Frozen Shoulder                                  

The term ‘frozen shoulder’ can strike dread into the heart of even the most experienced physical therapist, as it encompasses so many possibilities, both in terms of aetiology as well as treatment.  

As it stands, Bowen therapists tend to like the presentation of a classic frozen shoulder, as it often gives a faster outcome than other, even apparently simpler, cases.    

There are three considerations when working with a shoulder.  The first is the presentation of a specific shoulder problem, where a therapist can work locally in the region of the shoulder very simply and usually to good effect.  For this to be as effective as it should be, it is important to establish that there are no other reasons why the shoulder is restricted or in pain.  

Imbalances or problems in the temporo mandibular joint, whiplash, or other cervical problems might lead to shoulder problems.  Even issues involving the diaphragm or respiratory system can have an effect on a shoulder.   

Bowen really comes into its own in the case of an acute shoulder injury.  It is rare that we need to spend more than two or three sessions one week apart with an acute shoulder, providing rest is given and there is no tearing. Many feel that Bowen is probably the most effective tool currently available for acute injuries, especially as treatment can be offered immediately following injury because of the gentleness of Bowen.  

Typical sporting injuries can be treated immediately and to excellent effect.  Experience suggests that the early treatment of these conditions reduces the incidence of future dislocation.   

The second element is the consideration of the shoulder in treating other areas of the arm, neck and shoulder.  The brachial plexus is a major element in this area and conditions such as carpal tunnel, and even tennis elbow can be effectively helped prior to localised treatment by working the shoulder area.  

Brachial plexus is a nerve bundle all too often overlooked when addressing shoulder and arm conditions and yet it can provide the solution to a lot of referred problems.   

The third is the concept of fascial connections through and over the shoulder area and down the level of the pelvis and hips, thereby affecting knees on the opposite side to the presenting shoulder.  This idea of the fascial connection has been explored brilliantly by Tom Myers, in his book Anatomy Trains.   

The initial Bowen treatment for a shoulder problem will involve addressing many of these areas through the initial basic procedures.  The patient will be laid prone and a series of moves made through both the lower and upper back.  

An important focus for the practitioner will be ensuring the release of levator scapula.  It can often be all too easy to be drawn into working specific areas of pain, but it’s worth remembering that the deltoid only functions in harmony with the normal movement of the scapula.  With its attachment to the superior medial angle of the scapula and with the role of elevating and rotating the scapula, working the levator gives the rest of the structure the opportunity to re-establish normal movement.   

Another standard Bowen move is over the supraspinatus, a small muscle which provides a huge amount of power to the deltoid and which is innervated by a branch of the brachial plexus.  Two medial Bowen moves from its lateral aspect, can have a big effect on the pain that is often felt into the middle of the deltoid on abduction.   

Once the surrounding areas of the shoulder have been addressed, the actual shoulder itself is then treated, with the patient either standing or sitting.  The classical shoulder move varies from most of the other moves in the Bowen repertoire, as it is made with the arm in movement.   

The results can often be quite startling, with even long standing ‘frozen’ shoulders responding within five or ten minutes.  

In one case a gentleman who volunteered to be demonstrated on, had 100% relief from a very restricted shoulder, which had been present for over eight years.   

A study into the effect of The Bowen Technique for ‘Frozen’ Shoulders looked at 100 volunteers with non-specific, gradual onset shoulder pain.  They were each given four treatments with half the group being given Bowen and the other half a specific hands on placebo treatment.  

The groups were not told which was which, but the treated group reported considerably greater improvement than the placebo.   Average improvement for abduction was 40% and horizontal abduction 28% percent.  

Overall 67% of the treatment group improved with their degree of improvement ‘statistically significant.’   

It’s worth pointing out that this study gave no form of exercises and adhered strictly to a proscribed set of moves, irrespective of other factors already mentioned, which might have impacted on their condition as compliance and other factors would have impacted greatly on the outcomes.   

There are of course hundreds of additions to even this one procedure and it is important to remember that Bowen is not simply a series of procedures, but a system of bodywork, with a set series of principles, but literally millions of variations.  

Contents provided by the European School of Bowen Studies (ECBS)   

For further details about the Bowen Technique please contact Karen on 01954 260 982 / 07714 995 299 or email [email protected]