Chronic obstructive pulmonary disease (COPD) is a term that encompasses chronic bronchitis and emphysema. These two conditions can co-exist, and often do, but also occur independant of one another. In both, however, airways become narrowed and leads to a limitation of flow of air through the lungs leading to debilitating shortness of breath. This limitation is most often non-reversible and usually get worse with time, as opposed to conditions such as Asthma that can be managed more effectively. Those with severe symptoms often need oxygen therapy to maintain a decent quality of life and exercise tolerance is very poor.

Marie is a 78 year old retiree who had been diagnosed with chronic bronchitis 10 years ago and has progressively been experiencing an increased shortness of breath. It has progressed to the point where climbing the 8 steps to her front door causes extreme breathlessness and her mobility is in severe decline. Marie was diagnosed with asthma as a young adult and given a standard asthma puffer to manage her symptoms. She has never been into physical fitness but did walk leisurely with her husband before he fell ill several years back. Currently she reports she is unable to do more than 10-15 meters of walking without falling short of breath. We used her self-reported distance walking, and steps ascended as baseline measures.

History, Observation and Clinical Presentation

Marie was breathless upon entering the clinic, and had to pause to catch her breath just to greet us. Marie has an audible wheeze and has reported in acute exacerbation phases she is productive of yellow-ish sputum. She is a notable mouth breather and also had to frequently pause when talking in longer sentences. Her respiratory rate was quite high.

Marie was not a smoker during her life, but her late husband smoked 2 packs a day for 25 years from the time they met till his mid 40′s when he quit. Second hand smoke may certainly be a contributing factor.

Marie has a standard hyper-inflated (barrel chested) appearance that accompanies many with COPD, and has been using inhalers for the last 10 years progressing to corticosteroid inhaler in the last 3. She usually needs a few “puffs” a day but has said that in winter months this usually increases depending on necessity.

Marie also reports that she suffers from sleep-apnea and this causes her to wake frequently during the evenings.

First Treatment:

Procedures : Spinal Series (Lumbar, Thoracic and Cervical) with Pelvic and Respiratory procedure.

Homecare:
Breathing control strategies, including diaphragmatic breathing, breathing control and pursed lip breathing as well as exercises using a Frolov device were advised.

Second Treatment (5-Days later):

Marie reports that her sleep has improved and she is not waking as often at night, down to a few times from a half dozen or more and only to use the bathroom. She also reports a mild improvement when ascending her 8 stairs to her home, stating that she is not as afraid of having to move often due to her decrease in breathlessness.

Procedure: Spinal Series + Sacrum & Pelvis with TMJ procedure, ending with Advanced Respiratory Procedure.

Homecare:
as before + increase distance walked to 20m 2X daily with rest periods integrating beathing exercises.

Third Treatment (5-Days later):

Marie no longer complains of waking due to sleep apnea, and can ascend her stairs with mild discomfort and breathlessness. She is now tolerable of 2X 20 meters walks per day and has been completing 3 cycles of breathing exercises and reports a decrease in breathlessness with her regular activities and a decreased need to rely on her inhalers.

Procedure: continue as per 2nd treatment.

Homecare:
increased to 3X 20-25 meter walks integrating breathing exercises as outlined in first treatment.

Marie has reported that since the inclusion of the advanced respiratory procedure her chest tightness has diminished and she feels less inhibited with her respiration. While she understands that her symptoms and condition is irreversible, she understands how she may be able to better manage it with relaxed controlled breathing and is no longer afraid of the prospect of doing mild exercise due to increased breathlessness. Marie is continuing with ongoing treatment to maintain her improved condition at a bi-weekly frequency.

Julie is a 35 year old office worker, and mother of two. She also enjoys running 3x a week and doing resistance training at the gym 2x a week. She came to us with what she described as unrelenting neck pain with associated headaches that have been progressively getting worse for the last 3 weeks. At our initial appointment she reported a 7/10 constant level of pain (on the Visual-Analog Scale ((VAS)) which is mildly relieved with over the counter pain medication and rest.

The original source of her symptoms were localized to her neck, but for the last 3 weeks her neck pain is accompanied by unrelenting headaches. Julie did not experience any numbness or tingling sensations in her fingers. She did experience an increase in head pain after sitting for 30 minutes at her computer workstation, and found that doing her daily work tasks were very. At the time of her initial evaluation she  reported a constant 7/10 pain, however found that pain medication and rest relieved her condition to a  3-4/10, however 7/10 pain quickly returned with any subsequent activity and upright sitting.

Observation

Julie has a noteable head-forward posture, with some observable scapular winging present. This is especially present with her sitting posture.  The muscular bulk of her upper trapezius and shoulder musculature is increased.

Cervical Spine ROM Examination

Forward Flexion          55 degrees

Extension                   50 degrees

Left (painful side)            Right

Rotation                     50 degrees with Pain        80 degrees

Side Flexion               45 degrees with Pain        65 degrees

No combined movements were tested as Julie was pain-provocative with left rotation and side-bending.

Shoulder / Scapular ROM Examination

Julie presents with adequate ROM in her shoulder, with no provocation or increase in her head/neck pain

Neurovascular Testing

No abnormalities found

Manual Muscle Strength Testing

Julie has decreased strength present upon resisted testing in Side-flexion and Rotation in her Cervical Spine, primarily left side greater than right.

Special Tests

Julie is negative with Vertebrobasilar Insufficiency Test (VBI) Test.

Clinical Presentation

Neck pain when left untreated causing chronic headaches.

First Treatment:

Procedures : Spinal Series (Lumbar, Thoracic and Cervical)

Re-test: C-Spine ROM  Flexion/Extension – 60;  Left Rotation – 70, Right Rotation – 85; Left Side-Bending -55, Right Side-Bending – 65.

Manual muscle strength testing improved with pain-reduction.

Homecare: Deep Neck Flexor (DNF) exercise demonstrated and prescribed in supine position.

Second Treatment (One week later):

Procedure: Spinal Series + Sacrum + TMJ procedure

Re-Test: Full functional ROM restored.

C-Spine ROM  Flexion/Extension – 60;  Left Rotation – 85, Right Rotation – 85; Left Side-Bending -65, Right Side-Bending – 65. No pain.

Manual Muscle testing 5/5 in all ranges, no pain.

Homecare: Modify DNF and continue  in sitting position

Complete Resolution of symptoms with VAS 0/10 and full ROM with pain-free return to full daily and recreational activities.

The pain is localized to the right dominant shoulder. Bill reports no neural symptoms such as numbness, tingling or sharp shooting pain down his right arm or into his fingers. He does, however, have pain at night when he sleeps on his right shoulder which wakes him up. He reports this pain to be about 5/10 in severity and reports he is able to fall back to sleep quickly when he moves positions. Bill does not report any past medical history of shoulder pain, and is on no medications for his pain currently. Bill works as a computer programmer during the day.

Observation

Bill stands with his right shoulder approximately 2cm lower than his left shoulder, and a very mild scoliotic curve is noted in his spine, with some noted atrophy present in his rotator cuff musculature primarily of the infraspinatus in the infraspinous fossa.

Shoulder / Scapular ROM Examination

Winging is present in the right scapula, greater than in the left, with active range of motion into abduction and return from abduction indicating weakness in his scapular stabilizers.

ROM                          Left Shoulder                   Right Shoulder (Injured)

Forward Flexion          180 degrees                   135 degrees

Abduction                   180 degrees                   130 degrees

External Rotation         90 degrees                     45 degrees

Internal Rotation          60 degrees                    35 degrees

Neurovascular Testing

Bill has intact reflexes of his biceps, triceps and brachioradialis bilaterally, as well as intact light touch sensations.

Manual Muscle Strength Testing

Bill had a complete 5/5 for testing of his unaffected left arm, with a 4/5 rating in flexion and abduction of the right arm and a 3/5 strength rating in external rotation with the arm abducted to 90 degrees. Resisted Flexion, Abduction and External Rotation of the right arm reproduced Bill’s pain symptoms.

Special Tests

Bill was positive with Neers Impingment Test , and Hawkins Kennedy test.

Clinical Presentation

Secondary Shoulder Impingement with rotator cuff muscle weakness and strength imbalance causing scapular movement impairment and lost range of motion.

First Treatment:

Procedures : Spinal Series (Lumbar, Thoracic and Cervical) + Standard Shoulder Sequence

Re-test: ROM of right arm in Flexion – 160; Abduction – 150; ER – 50 and IR – 35

Resisted overhead movement still produce pain, but dropped from 7/10 to 5/10 on the VAS.

Manual muscle strength testing remained a strong 4/5 with all directions previously tested.

Neers and Hawkins Kennedy still positive for pain.

Second Treatment (5 days later):

Procedure: Spinal Series + Sacrum + Advanced Shoulder sequence

Re-Test: ROM of right arm in Flexion – 170; Abduction 170; ER – 70; IR – 45

Resisted Overhead activities down to a 3-4/ 10 on the VAS

Manual Muscle testing 5/5 in Flexion and Abduction

Neers and Hawkins Kenedy (-)

Homecare: Stretch for IR muscle group + strengthen scapular stabilizers (Serratus Anterior)

Third and Final Treatment (two weeks from initial treatment):

Procedures: Spinal Series, Sacrum, Advanced Shoulder and TMJ balance

Re-Test: ROM of right arm in Flexion: 175; Abduction 180; ER – 80; IR – 60

5/5 muscle strength in all directions

(-) for special tests performed

VAS 1/10 with resisted activities and Bill reported that he could return to Tennis and was pain-free after training.

Did Tom Bowen follow recipes?

Are we stuck at one man’s development?

These are not all easy questions to answer, however I can say that the first question is undoubtedly a “YES”, and the second question is also undoubtedly “NO”.

For the third, it depends on which man we are talking about. If we’re talking about Tom, it’s debatable as to whether or not any of us have reached that level. What I do know is that he was constantly developing his technique as evidenced by the fact that students had different representations of the work at various time periods when they visited him.

If these students took the same inquisitive approach as Tom did, and understood the underlying mechanisms at work, then they wouldn’t ever be stuck at any level of development as they would have continued to grow. On the other hand, if these students did what they saw, and only what they saw, they might have gotten stuck at a certain level of development.

It depends what level of development you want to reach.

Do you want to be stuck in rote recipe mode, or do you want to learn how to flow and intuitively and critically learn where to place the “move” precisely where each of your clients need it?

If you answered “yes” to the latter, then we’d love to share with you a process for unfolding this.

Bowen Therapy is dynamic and not a static system. Therefore learning recipe’s serves a temporary but very useful purpose. It teaches you how to apply the move, and how to apply the move for specific conditions but it doesn’t teach you how to splice the work so that you can apply Bowen Therapy as needed, individually. For this to happen you need a very specific and detailed understanding of t. It is, like many other systems, evolving as we continue to gain a deeper understanding of this work.

That’s the essence of our work. When one says, “this is not the original Bowen Therapy.

In continuing to experiment with the work, a process begins to unfold and a deeper insight is gained.