Holistic Assessment The next step in the development of Bowen Therapy

Published on May 17, 2013 7:52 am Holistic Assessment the next step in the development of Bowen Therapy : As Published in In Touch, the quarterly, in-house journal of the Bowen Therapist Professional Association (BTPA), U.K. May, 2013 Graham Pennington N.D., Grad Dip (Acupuncture) Graham is the principal of Warrnambool Natural Medicine Centre in Victoria, Australia. He has practiced Bowen Therapy, Naturopathy and Acupuncture for more than twenty years. He is the author of A Textbook of Bowen Technique A Comprehensive Guide to the Practice of Bowen Therapy. INTRODUCTION In 1986, Oswald Rentsch commenced what was to be an amazingly successful campaign to promote and teach his personal interpretation of Tom Bowens approach to therapeutic bodywork. Although Rentsch has undoubtedly succeeded in placing Bowen Technique on the map of remedial bodywork, this success has come at a cost. Rentschs interpretation has come to be viewed as representative of the way Bowen actually worked[1], yet there is ample evidence that this is not so. Whether or not Rentschs systematised, recipe version of Bowen Technique serves to illustrate the majority of Bowens moves and procedures is debateable but it is certain that the repetitive, sequential application of learned procedures is not indicative of Bowens approach. One of the major differences that exists today, between the clinical approach used by Tom Bowen and those who follow a derivative of Rentschs approach, is that the latter do not apply the therapy in accordance with a system of holistic assessment. Applying the recipe style of treatment is a symptomatic approach: no holistic assessment is required and the therapist administers a similar treatment to each case, regardless of individual presentation. If we are to remedy this situation the Bowen Therapy profession must embrace holistic assessment methods. This involves a simple addition to the existing knowledge base an addition that enables the therapist to customise each treatment according to individual presentation. In this way, every treatment varies because it is targeted to the needs of each patient. Of course this approach leads to better clinical outcomes. BACKGROUND Tom Bowen left no formal training notes about the type of therapy he practised. To understand and define it, we must rely on accounts of the people who claim to have watched him work. It is widely acknowledged that at least six men claim to have done so over the twenty-three years he was in practice (1959-1982). Interestingly, each of those who observed him developed a different interpretation of his work. Oswald Rentsch, has taught his interpretation widely, whilst others have only taught their interpretation of Bowens work to a handful of practitioners. Consequently, a Bowen industry has emerged where most published authors and treating practitioners have been exposed to only one individuals interpretation of Bowens work. At least two of the six men who observed Bowen have publicly rejected the recipe style approach. Instead, they use a style of Bowen Technique in which treatment is applied based on a
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holistic assessment of the patient and is targeted to specific dysfunction, in accordance with individual presentation. In addition to making a holistic assessment of each patient, they apply the Technique in a holistic manner, recognising some of the complex interrelationships existing within the body. They also use reassessment techniques to measure the effectiveness of their treatments as they apply them. Questions are now being posed regarding the basic assumptions of those teaching the popular recipe style of the technique. Romney Smeeton, a chiropractor, and one of Bowens observers in the seventies and early eighties, writes I should state I am at odds with much of the current teachings of Bowens work, primarily because they lack a system of individual assessment and are nearly all based on a systematized use of standardised recipes and this was not Bowens approach. Kevin Ryan, an osteopath, and another of Bowens observers, told the BTFA (Bowen Therapists Federation of Australia) conference in 1998 that Bowen based his treatment interventions upon his assessment of the patient and that Tom Bowen never did a move unless he had an expectation of what effect it would produce. Interestingly, according to the transcript of proceedings of the Committee of Inquiry into Osteopathy, Chiropractic and Naturopathy, in 1973, Tom Bowen said, I average 65 patients per day. This allowed him around five minutes for the treatment of each patient. The recipe style of treatment widely taught and practiced today simply cannot be applied in this time frame. It is clear that Bowen did not routinely apply the recipe style approach that currently bears his name. HOLISTIC ASSESSMENT Many Bowen Therapists can and do perform assessments of isolated muscle groups or individual joints, much like a physiotherapist or a myotherapist. These assessments are helpful in providing a baseline level of function from which to measure progress, but they do not embrace holistic principles, or encourage therapists to view the body as a complex interrelated whole. A holistic assessment is one that assesses the body for areas of dysfunction from a systemic viewpoint. Holistic assessment procedures allow the body to be viewed in its entirety, allowing the therapist to assess central nervous system (CNS) function, for example, whilst simultaneously recognising some of the complex interrelationships which might influence it. Importantly, it allows the therapist to identify primary sites of dysfunction rather than secondary sites applied in this context, treatments are less symptomatic. The few Bowen Therapists who do use such an assessment techniques claim it enables the Bowen treatment to be targeted and goal-directed. Treatment goals can be assessed along the way, thus the use of holistic assessment procedures can help to achieve better clinical outcomes. Holistic Assessment Discussion If the Bowen Technique is a holistic therapy should it not embrace holistic assessment methods? A holistic profession is one that recognises the body as being more than the sum of its parts. A holistic profession is one that recognises the importance of complex interrelationships that exist within the body. Osteopathy is such a profession. We know that Bowen called himself an osteopath and he did so because he embraced the underlying principles of osteopathy (and these
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are certainly holistic[2]). By utilising the recipe approach to treatment, some Bowen Therapy practitioners may be ignoring the very principles upon which the technique is founded. The good news is, holistic assessment techniques can be easily learnt and applied to provide a more targeted, effective, goal directed Bowen Therapy. Holistic Assessment Techniques At the beginning of every treatment Tom Bowen made an assessment of tonal symmetry on each patient. All Bowen Therapists still do this at the beginning of every treatment although many of them may not realise they are doing it. A general rule that all therapists learn is that a treatment should always be commenced with Moves 1 & 2 of the Lower Back Procedure the reason for this is to assess tonal symmetry. Tonal asymmetry is an expression of the patients dysfunction[3], so as therapists, our first objective must be to identify the side of tightness. The tight side is synonymous with the side of the functional short leg. The functional short leg acts as a signpost pointing the therapist to the dysfunction that is the source of the patients problem. A simple premise applies here: if we exert an influence upon that dysfunction, then the short leg will change. The use of simple tonal assessment methods allows the therapist to identify relationships within the body and to measure the effectiveness of any therapeutic input. For example, if there is a functionally short right leg that does not change after the piriformis move, one can assume the patients dysfunction is not associated with piriformis. If the leg length corrects following the Temporomandibular Joint (TMJ) Procedure, one can recognise the patients dysfunction was associated with the TMJ. Indeed, one could use this method of move and re-assess to determine whether any individual move in the TMJ Procedure (or in any other procedure) had actually corrected the dysfunction. For the therapist, such a process is both educational and empowering. Recognition of Interrelationships Tom Bowen was, like many good therapists, aware of interrelationships which existed between different areas of the body. Those who watched him work have claimed he attributed special significance to a few areas of the spine. The notion expressed is that Bowen placed particular emphasis on restoring function to the sacroiliac joints, the coccyx, the cervical spine and the TMJ[4]. Bowen understood that a patients sciatic pain could be related to TMJ dysfunction and that the patients migraines could be related to coccyx dysfunction[5] etc. The significance of this for the Bowen therapist is that a patients primary dysfunction can be quite a long way from the site of symptoms, thus making the need for holistic understanding and assessment even greater. Screening Procedures As therapists, some of these interrelationships can be used to our advantage through the use of some simple screening procedures. The Cervical Turn Test is one example. Once a functional short leg is identified, the therapist can have the patient turn their neck to the left and then reassess the functional short leg. The process can be repeated with the patient turning the neck to
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the right. If the patients tonal asymmetry is associated with a problem in their neck, turning the head to one side should result in a correction of leg length. When this test returns a positive finding the therapist can confidently focus on locating and correcting the problem in the patients neck this is the case regardless of whether the symptom presentation is idiopathic knee swelling, headaches or asthma. There is also a useful screening procedure to indicate sacroiliac joint dysfunction. The Sacroiliac Joint Test[6] is carried out with the patient prone. The short leg is identified and the patients knees are flexed to ninety degrees. A positive test result (indicating sacroiliac dysfunction) is found when the short leg crosses over and becomes the long leg. A positive indication of sacroiliac dysfunction would then send the therapist in search of the appropriate treatment (possibilities include piriformis move, sacroiliac procedure, pelvic procedure etc.). Reassessment could then be used to confirm restored sacroiliac function. Holistic assessment techniques used in four cases of right sided hip pain The following case studies serve to illustrate the principle that symptom presentation does not give a good indication of the source of dysfunction. Dysfunction in one area of the body can lead to symptoms in another area. These principles were well understood by Bowen. Case 1: A 62 y.o. male patient presents with a ten day history of right sided hip pain. This patient reports significant discomfort in his right hip following recent gardening activities. Lying prone the patient is assessed and the right leg is found to be functionally shortened. Moves 1 & 2 of the LBP are performed and the right paraspinal tissue is found to be tighter than the left. Screening demonstrates a positive Derifield finding. The therapist administers a move to the left piriformis muscle to assess its tenderness (using this as a control) and then the same move is applied to the right piriformis. The patient reports increased tenderness on the right side. Immediate reassessment indicates a return to almost equal leg length. A two-minute wait is applied followed by reassessment. Tonal symmetry has returned and leg lengths are now equal. There is no longer a positive Derifield finding. Follow up in one week reveals the patient was significantly improved following the treatment and has been completely pain free for the last 5 days. Assessment at follow-up reveals tonal symmetry indicating no further treatment is necessary. Case 2: A 22 y.o. male patient (a football player) presents with a five week history of recurrent right sided hip pain which is worse with exertion and gets better with rest. Moves 1 & 2 of the LBP are performed and reveal elevated tension in the paraspinal tissue on the left side. Tonal asymmetry is assessed revealing a functionally short left leg. Screening reveals a positive Cervical Turn Test. Realising the patient has a primary issue affecting his cervical spine the therapist moves quickly through the Lower & Upper Back Procedures (no waiting necessary) and turns the patient. Tactile assessment of the neck reveals significant spasm on the right side from the level of C1 C4. Moves of the Neck Procedure are used to address this spasm and a two-minute wait is employed. Upon reassessment, tonal symmetry is evident. Follow up in one week reveals the hip pain has significantly improved following the treatment and the patient reports he has successfully completed a training session since the treatment.
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Assessment at follow-up reveals minor functional asymmetry which corrects upon cervical rotation, indicating some further treatment is necessary. Case 3: A 17 y.o. female patient presents with a two month history of recurrent right sided hip pain which is worse with exertion and gets better with rest. Moves 1 & 2 of the LBP are performed and reveal elevated tension in the paraspinal tissue on the left side. Tonal asymmetry is assessed revealing a functionally short left leg. Screening is unremarkable. The therapist moves thoroughly through the Lower & Upper Back Procedures searching for abnormal tensions that may be associated with the presenting asymmetry. No such tensions are identified and therefore no waiting periods are necessary. Upon turning the patient, tactile assessment of the neck reveals nothing abnormal. Suspecting an adductor issue, the therapist compares the tension of the left and right adductors, finding the left to be in a state of tension. Moves of the Pelvic Procedure are used to address the adductor after which a twominute wait is employed. Upon reassessment, the patient demonstrates equal leg length. Further enquiry reveals the young patient is an avid horse rider who regularly competes in dressage events. She is counselled on looking after her adductors. Follow up in one week reveals the hip pain has significantly improved following the treatment but some asymmetry remains. Further treatment is required. Case 4: A 40 y.o. female patient presents with a ten day history of right sided hip pain. This patient reports significant discomfort in her right hip which began several days after planting 60 trees. Lying prone the patient is assessed and the left leg is found to be functionally shortened. Screening procedures are negative. Tactile assessment reveals tension and tenderness of the paraspinal areas on the right side of the first lumbar vertebrae. The therapist administers Move 1 of the Psoas Procedure[7] to the right paraspinal tissue and immediate reassessment indicates a return to almost equal leg length. The Psoas Procedure is completed and a twominute wait is applied. Upon reassessment tonal symmetry has returned and leg lengths are now equal. Follow up in one week reveals the patient was significantly improved following the treatment and has been completely pain free for the last 3 days. Assessment at follow-up reveals functional symmetry indicating no further treatment is necessary. FUTURE DIRECTIONS The recipe system may have placed Bowen Therapy on the map but it is self limiting. As each patient presents, rather than using our own intelligence to solve their problems, we are urged to work in robotic fashion, following strict predetermined treatment protocols. The future of Bowen Therapy lies, not in the repetitive application of learned procedures but in processes which enable the therapist to identify dysfunction, guide the intelligent application of treatment and then confirm that the treatment was effective in restoring function. Such processes must be heavily focused upon holistic methods of assessment. Thirty years have passed since Tom Bowen left his legacy in our care. It is now time for the profession of Bowen Therapy to move forward and adopt holistic assessment techniques. [1] On Rentschs early teaching notes distributed in 1987, the words Bowen Technique an interpretation by Oswald Rentsch, were printed on each page. Over time these printed words
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have disappeared and current teaching manuals use the phrase The Original Bowen Technique. Both phrases acknowledge the existence of other interpretations of Bowen Technique. [2] The four tenets which underpin osteopathy were laid down by A. T. Still. They are: 1. The human body functions as an integrated, interrelated, whole unit. 2. Structure and function share a reciprocal relationship. 3. There exists in the body an innate capacity for self-regulation and healing. 4. Therapeutic intervention is based upon an understanding of these three points. [3] The following statement was made by D.D. Palmer, the founder of chiropractic: Life is the expression of tone. In that sentence is the basic principle of Chiropractic. Tone is the normal degree of nerve tension. Tone is expressed in functions by the normal elasticity, activity, strength and excitability of the various organs (and tissues), as observed in a state of health. Consequently, the cause of disease is any variation of tone. [4] These sites are significant because they are all associated with dural attachment. [5] Indeed, Bowen was not alone in recognising these relationships. Osteopaths and chiropractors have long been aware of these relationships. Sacro Occipital Technique (SOT) is a popular form of chiropractic which recognises the relationship that exists between structures at opposite ends of the spine. Many schools of chiropractic refer to the Lovett-Brother relationship which details this principle. [6] This screening procedure is derived from the Derifield Test which is commonly used by chiropractors. [7] Also known as the Kidney Procedure refer A Textbook of Bowen Technique A Comprehensive Guide to the Practice of Bowen Therapy

The Bowen Technique Mechanisms for Action

Published on May 15, 2013 11:25 am This article is printed with permission: Wilks, J. Bowen technique: Mechanisms for action. It was published in the Journal of the Australian Traditional Medicine Society. 2013; 19(1):33-35. Permission from the author has also been obtained.

The Bowen Technique Mechanisms for Action

John Wilks MA RCST BTAA FRSA, Senior instructor with Bowtech, the Bowen Therapy Academy of Australia. Web: www.bowentraining.com.au Email: cyma@btinternet.com

ABSTRACT
The efficacy of the Bowen Technique can be explained by its action on a variety of structures in the body. Bowen moves stimulate several types of intrafascial mechanoreceptors that affect muscle tonus and increase vagal tone. The type of move used in Bowen also assists the hydration of fascia, which in turn encourages better vascular and nerve supply.

THE BOWEN TECHNIQUE

The technique developed by Thomas A. Bowen (1916-1982) is unusual in that it affects tissues in a variety of ways simultaneously. Its effect is not limited to relaxing tight muscles or increasing hydration in the fascia but it can also be used to increase tonus in the core muscles and
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contractile strength within the fascia and to initiate a lowering of sympathetic tone in the autonomic nervous system. To understand how the Bowen Technique works it is useful to examine the varied role of connective tissue, and particularly fascia, in the body. For example, one of fascias crucial functions in efficient locomotion is its property of recoil, which depends on good hydration (an important effect of Bowen work). This can be seen clearly in the thoraco-lumbar aponeurosis, which is the starting point for a lot of Bowen work. In walking and running, this area of fascia acts as a kind of bungee and greatly reduces the amount of effort that is needed to exert via the muscular system. This is demonstrated in the movement of animals such as kangaroos, lemurs and gazelles as well as humans.[1] Where this recoil property is compromised through a lack of hydration and reciprocal tension in the fascia, certain movements like running and walking require more exertion through the muscular system. Change in the quality of the lumbar aponeurosis is also considered an important factor in lower back pain as this area is highly innervated with sensory receptors. In fact, fascia is the most richly innervated tissue in the body, being effectively its largest sense organ, with the highest density of proprioreceptors[2] as well as being the key tissue addressed in Bowen treatments.[3] The Bowen Technique has a very specific effect on fascia. Primarily, Bowen moves are made directly on muscles (although some moves are also performed on tendons, ligaments, joints and nerves), but because all these structures are surrounded by a network of fascia, it is inevitable that whatever structure is activated, the fascia that surrounds it (and is integral to it), is affected at the same time, albeit with slightly different physiological effects. Apart from the sensory receptors in the skin such as Merkels Discs, Meissners corpuscles and Free Nerve Endings, there are key intra-fascial mechanoreceptors that are activated during a treatment. These are largely Golgi, Ruffini and Interstitial receptors. Occasionally, Bowen moves involve a fast release of pressure, which affects the Pacini receptors (involved in proprioception), but these types of move are rare. Mostly, Bowen moves involve taking skin slack, applying a challenge (or gentle push) for a few seconds, and a slow steady move over the structure being addressed. Bowen moves mostly consist of a type described by Schleip[2] as slow melting pressure. These types of move strongly affect the numerous Ruffini receptors,which are found in the skin and in many deep tissues of the body including the lumbar fascia, dural membranes, ligaments and joint capsules etc. Slow moves over these structures have a lowering effect on the sympathetic nervous system (SNS)[4] and induce a profound sense of relaxation in the client. Other receptors that induce a decrease in the SNS and corresponding increase in vagal tone, are the interstitial receptors, which are found nearly everywhere in the body. Some of these receptors (particularly the nociceptors) are high-threshold, and known to be involved in chronic conditions, but interestingly about 50% of these receptors are low-threshold fibres and are sensitive to the kind of very light touch (similar to skin brushing) that is used in some Bowen moves. This mechanism explains the deep relaxing effect of Bowen treatments and the crucial healing effect of increased vagal tone.[5] On a more structural level Bowen moves affect the Golgi receptors (found in myo-tendinous junctions, ligaments and the deep fascia) by using slightly more pressure and longer holding times, and by working close to origins and insertions. It has been suggested that manipulation of these receptors causes the firing of alpha motor neurons resulting in a softening of related tissues. This process also seems to happen via gentle stretching of the tissues such as in yoga.[4] Muscles themselves are stimulated by the challenge in a Bowen move, which activates the muscle spindles in response to the stretch on the muscle fibres. Much of this response is mediated at the
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level of the spinal cord but some impulses do make their way to various areas of the brain like the cerebellum, the basal ganglia, the reticular formation and the brain stem, before being coordinated in the thalamus and sent back down the various motor nerve tracts to the muscles or organs.[3] It takes around 90 seconds for muscles to respond in this way, so it is interesting that it is normal practice for Bowen therapists to leave a two minute break (and sometimes longer) between the various activations or moves. It would appear that by inputting targeted, but minimal sensory stimulus during a Bowen session without extraneous interference, it allows the body to recalibrate. For example Dietz et al6 have shown that the CNS can reset Golgi tendon receptors and related reflex arcs so that they function as delicate antigravity receptors.[4] One thing students of the Bowen Technique are taught is always to get clients up at the end of a treatment so that both feet land on the ground at the same time, thereby stimulating a response in the many Golgi receptors in the plantar fascia of the feet. Certain factors are important for a successful Bowen treatment, critically that there is not excessive stimulation of the CNS by an unnecessary number of moves or distracting the client. This is particularly important when there is a general sensitization of nerve pathways and tissues as is the case in chronic pain, which is why a favorite Bowen maxim is less is more. Bowen also affects the fascia directly through encouraging hydration, as this process is assisted by gentle stretching, repetitive squeezing and release with pauses, (ie pressure applied and then waiting) all elements of a Bowen treatment. The waiting time would appear to be essential as there is a significant increase in hydration after half an hour.[7]

CONTRACTILE PROPERTIES OF CONNECTIVE TISSUE

When looking at possible mechanisms for how the Bowen Technique works, it is important to differentiate how touch and manipulation affect muscle contraction (or lack of tonus) as opposed to connective tissue contracture (or in the case of some hyper-mobile clients, a potential lack of contractile properties in the tissues). Muscle contraction is a high-energy shortening of tissues, whereas contracture of connective tissue is a slow, (semi) permanent, low-energy, shortening process, which involves matrix-dispersed cells and is dominated by extracellular events such as matrix remodeling.[8] For efficient functioning of the human system connective tissues need to hold certain contractive patterns to maintain stability. In dissection you can see clearly that all connective tissues are under stress for example dissected nerves and blood vessels have a length of around 25 30% less than their in situ length.[8] Myofibroblasts play an essential role in maintaining reciprocal tension networks in the connective tissues, being a type of fibroblast, the building block cell of fascia, which have the characteristics of smooth muscle. The constructive tension within the connective tissue is an essential element of the bodys biotensegrity system[9]. Myofibroblasts are affected in many kinds of connective tissue disorders such as Dupuytrens and frozen shoulder. Bowen affects Myofibroblasts directly as they contract and expand slowly in response to factors such as pH and stress.[2] This occurs over a period of minutes or hours and so expansion or relaxation of myofibroblast activity will certainly occur during the length of a Bowen treatment (normally around 45 minutes) as the person relaxes. Soft-tissue techniques such as the Bowen Technique rely on effecting structural change by directly influencing the biotensegrity aspect of the connective tissue via their action on myofibroblasts, which is partly why Bowen has such a powerful and measurable effect on posture. There is a number of different techniques available to the Bowen therapist that will be used depending on what outcomes are necessary for a given client in a given situation. For example,
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moves can be done faster or slower, with longer or shorter challenges, deeper of lighter pressure, medially or laterally, or anteriorly or posteriorly. All these factors will have different effects in terms of lowering vagal tone, increase or decrease in muscle tonus etc. Assessment has been, and always will be, an essential and highly individual starting point for determining how to apply the Bowen Technique with each client. For example, for each client presenting with similar symptoms of lower back pain there may be a great number of different reasons for those symptoms. A Bowen treatment will therefore never be the same from client to client even though they may present with identical symptoms. The following wise statement from the ancient Chinese poet Lin Yutang should be the mantra of all holistic therapists: A doctor who prescribes an identical treatment in two individuals and expects an identical development, may be properly classified as a social menace. Working with clients in chronic pain is a challenge for any therapist. Prolonged inflammation has been shown to have a deleterious effect on many structures and mechanisms in the body and may derive from a variety of causes, such as old injuries, operations, and inflammatory conditions like endometriosis. It is well known, for example, that inflammation in the gums (gingivitis) or in the jaw after root canal fillings can affect organs such as the heart and cause joint and muscle pain. Frequently the original site of the inflammation is asymptomatic but will have effects elsewhere in the body and is a key factor in chronic pain. Gentle therapeutic approaches such as Bowen that directly affect the myo-fascial system by gently stimulating the interstitial receptors and lowering their tendency for hypersensitivity would appear to be the most obvious choice for clients in chronic pain. There is considerable interest amongst manual therapists in the concept of fascia as a communication medium in the body.[10] It has been known for many years that piezoelectric effects initiated by stressing collagen fibres have a strong healing effect on tissues.[11] There is no doubt that something of this kind is occurring during a Bowen treatment as the impulses created by stressing collagen fibres in the challenge and roll of a Bowen move can be felt clearly with sensitive palpation. These impulses seem to have the effect on the tissues of freeing areas of fascia that are stuck, or what Deane Juhan[12] refers to as thixotrophic. Scar tissue that is raised and red responds to Bowen moves by becoming visibly less fibrotic and less inflamed quite quickly. This means that there is some profound physiological change in the tissues, specifically in the ratio of type I and type III collagen. This is significant as this ratio is a crucial element in the make-up of fascia in terms of laxity. The exquisite images in the DVDs produced by Dr J-C Guimberteau[13] show clearly why techniques that encourage more fluidity in the fascia, such as Bowen, would have a profound effect on vascular and nerve supply by freeing up the connective tissues that surround capillaries, veins, arteries and nerves. The effectiveness of the Bowen Technique in its treatment of a wide range of conditions is borne out by clinical experience, and although more research needs to be done in this area it is clear that there are well-researched mechanisms by which the Bowen Technique can assist in terms of fascial fitness, reducing stress levels, increasing vascular supply and improving mobility and posture.[14]

References :
1. Kram, R., Dawson, T.J. Energetics and Biomechanics of locomotion of Red Kangaroos, Comp. Biochem. Physiol.B 1998 2. Schleip, R., Fascia as a Sensory Organ, World Massage Conference Webinar, Nov 2009 3. Wilks, J., The Bowen Technique, the inside story CYMA Ltd 2007
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4. Schleip, R Fascial plasticity a new neurobiological explanation. Journal of Bodywork and Movement Therapies, 2003, 7(1):11-19 and 7(2):104-116 5. Gellhorn, E., Principles of Autonomic-Somatic Integrations, University of Minnesota Press 1967 6. Dietz, V., Regulation of Bipedal Stance Experimental Brain Research 1992 Vol 89 (1) pp 229 231 7. Schleip, R. & Klingler, W., Fascial Strain Hardening Correlates with Matrix Hydration Changes Fascia Research, 2007 Elsevier p 51 8. Tomasek, J et al. Myofibroblasts and Mechano-regulation of Connective Tissue Remodelling Nature Reviews 3 (May 2002) pp349 363 9. Levin, S & Martin, D-C, Biotensegrity. The Mechanics of Fascia. The Tensional Network of the Human Body Churchill Livingstone, Elsevier 2012 (pp 137 142) 10. Oschmann, J Fascia as a body-wide communication system The Tensional Network of the Human Body Churchill Livingstone, Elsevier 2012 (pp 103 109) 11. Becker, R., The Body Electric Harper 1985 12. Juhan, D, Jobs Body a Handbook for Bodywork Station Hill Press, NY 2002 13. Guimberteau, J-C., Muscle Attitudes DVD, EndoVivo productions 2010 14. Wilks, J., Understanding the Bowen Technique, First Stone Publishing 2004

Bowen Therapy: A Review of the Profession

Published on February 16, 2013 11:56 am Bowen Therapy: A review of the profession as published in the Journal of the Australian Traditional Medcine Society in December, 2012 (JATMS Volume 18, Number 4) This article is printed with permission: Pennington, K. Bowen therapy. Journal of the Australian Traditional-Medicine Society. 2012; 18(4):217-220. Katrina Pennington BAppSc(Occupational Therapy) MAppSc(Acupuncture) Kate works part time in private practice, using acupuncture and Bowen Therapy in Warrnambool, Australia. She also devotes time to research and development. ABSTRACT- This article reviews the current profession of Bowen Therapy. It considers the history of the Bowen technique and the forces which have influenced its development to date. The article outlines some of the issues relevant to the Bowen Therapy profession as a whole. It also considers whether there is a philosophical basis underlying the technique and whether holistic patient assessment processes are relevant to the profession. Future directions and challenges are outlined. DEFINITION Bowen Technique is any therapeutic approach to body work which is based upon the clinical work of Mr Thomas Ambrose Bowen. It describes an increasing number of approaches, each based on the conclusions and interpretations of particular individuals who observed Bowen (or subsequent therapists who had some form of Bowen training). Characteristically, Bowen Technique involves unique rolling movements over soft tissue, performed at precise locations on the body. It is said to be effective in bringing relief to musculo-skeletal problems, such as sore backs[1], necks and limbs.[2] It has also said to be effective in treating internal problems such as hay fever[3], stress[4] and migraines.[5]
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INTRODUCTION October, 28, 2012, marked the thirtieth anniversary of the passing of Thomas Ambrose Bowen. He is said to be the founder of the Bowen Technique, a popular soft tissue therapy which is known worldwide.[6] This significant anniversary provides an opportune time for the profession to reflect on its past and make a plan for the future. At the time of his death, there was no Bowen Technique; Bowen himself was an unrecognised manual therapist working in his own clinic, using a unique treatment method. The term Bowen Technique was not coined until several years after his passing. Bowen Technique has been delivered to us by a handful of therapists, each of whom developed a personalized interpretation of the methods they saw Bowen apply while observing him in his clinic. It seems that one of these interpretations alone has so far defined the publics understanding of Bowens approach to bodywork. PREVALENCE Bowen Technique is now practised in thirty countries and taught in more than twenty.[7] There is a comprehensive network of training facilities and self-accredited teachers and schools, and at least one government recognised school in Australia.[8] Although known primarily as Bowen Technique, there is a myriad other names by which variations of the technique are known. Some of these are Bowen Therapy, Fascial Therapy, Smart Bowen, Fascial Kinetics, Neuro-structural Integration (NST), Fascial Bowen, Bowenwork and probably other names as well. In 2009 there were over 26,000 practitioners worldwide.[9] The techniques popularity is probably due to the fact it is fairly simple to learn, easy to apply and is frequently effective as therapy. HISTORICAL ASPECTS Bowen left no formal training notes about the type of therapy he practised. To understand and define it, we must rely on accounts of the people who claim to have watched him work. It is widely acknowledged that at least six men claim to have done so over the twenty-three years he was in practice (1959-1982). Interestingly, each of the men who observed him developed a different interpretation of his work; perhaps due to differing educational backgrounds, differing time periods of observation or other unknown factors. One of these men, Oswald Rentsch, has taught his interpretation widely, whilst others have taught only a handful of practitioners. The result is that a Bowen industry has emerged but most practitioners have had access to only one of the interpretations of Bowens work. Rentsch observed Tom Bowen at work in the mid-seventies. He was also responsible for taking Bowen Technique to the world at large.[10] Since 1984 he has taught trainees to apply a systematized recipe version of Bowen Technique. The Bowen industry at large has adopted Rentschs interpretation; however, other interpretations of Bowens work have not been widely available. To date, most of the published authors and treating practitioners of Bowen Technique are using Rentschs approach. On Rentschs early teaching notes that were distributed in 1987, the words Bowen Technique an interpretation by Oswald Rentsch,[11] were printed on each page. Over time these printed words have disappeared and current teaching manuals use the phrase The Original Bowen Technique.[12] Both phrases acknowledge the existence of other interpretations of Bowen Technique. At least two of the six men who observed Bowen do not use this recipe style approach. They use a style of Bowen Technique in which treatment is applied based on a holistic assessment of the client, and is targeted to specific dysfunction, in accordance with individual presentation. In
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addition to making a holistic assessment, they apply the Technique in a holistic manner, involving a recognition of interrelationships existing within the body. They also use reassessment techniques to measure the effectiveness of their treatments as they apply them. Questions are now being posed regarding the basic assumptions of those teaching the popular recipe style of the technique. Romney Smeeton, a chiropractor, and one of Bowens observers in the seventies and early eighties, writes I should state I am at odds with much of the current teachings of Bowens work, primarily because they lack a system of individual assessment and are nearly all based on a systematized use of standardised recipes and this was not Bowens approach.7 Kevin Ryan, an osteopath, and another of Bowens observers, told the BTFA (Bowen Therapists Federation of Australia) conference in 1998 that Tom Bowen never did a move unless he had an expectation of what effect it would produce. Interestingly, according to the transcript of proceedings on the Committee of Inquiry into Osteopathy, Chiropractic and Naturopathy, in 1973, Tom Bowen said, I average 65 patients per day.[13] This allowed him around five or six minutes for the treatment of each patient. The recipe style of treatment widely taught today cannot be applied in this time frame. It is clear that Bowen did not routinely apply a recipe approach. PROFESSIONAL ISSUES The Australian Traditional Medicine Society has recognised Bowen Therapy as a legitimate modality of practice for its members, since Dec 2011.[14] Over the last two decades, a number of Bowen Technique Associations have formed which have different Regulations and Codes of Ethics and serve their members in various ways, such as through government advocacy and policy formulation. Health fund rebates are now provided in Australia for treatments offered by members of recognised Bowen Therapy Associations. It would seem that the Bowen Technique has matured and grown up! But has it? 1. Lack of Underlying Philosophy: In regard to various interpretations of the recipe version of Bowen Technique, there seems to be a lack of basic theory and philosophy which many would consider vital to any profession. The majority of those who based their professional approach on Bowens work claim he utilised a holistic approach, not a symptomatic one. Competence in any profession depends upon an understanding of the theory that underlies it. [15] For most health professions, underlying philosophy and principles guide clinical practice, yet this does not appear to be the case with regard to the practice of Bowen Technique. Perhaps this lack of theory and philosophy, however, is only a problem if we wish to perceive Bowen Technique as a holistic therapy in its own right, rather than a set of symptomatic treatments. If the profession is to progress, it needs to clarify its principles and theories in order to guide its development. 2. Lack of Holistic Assessment: Many Bowen Therapists can and do perform assessments of isolated muscle groups or individual joints, like a physiotherapist or a myotherapist. These assessments are helpful in providing a baseline level of function from which to measure progress, but they do not embrace holistic principles, or encourage therapists to view the body as an interrelated whole. A holistic assessment is one that assesses the body for areas of dysfunction from a systemic viewpoint. The few Bowen Therapists who do use such an approach claim it enables the Bowen treatment to be targeted and goal-directed.7
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First principles are the fundamental assumptions on which a particular theory or procedure is thought to be based. Adopting and applying such principles may help the profession to clarify the goal of the Bowen Therapist. The profession could consider the following questions: Is Bowen Technique a holistic therapy in its own right, or is a symptomatic treatment, or is it both, depending on how it is used? Would embracing a holistic model of patient assessment assist in obtaining better clinical outcomes? 3. Disintegration: The growth of the profession over the last thirty years has been characterised by individual motivation, where portions of the technique have been sectioned off, patented and sold to the public under differing names. This fragmentation has hindered the ability of the profession to develop further because each splinter group attempts to create a different identity for the technique. DISCUSSION 1. Does an appropriate philosophical framework already exist? The profession may have already been exposed to a philosophy and basic principles. These principles to date have not been taught extensively as part of the Bowen Technique education and this may be to the detriment of the development of the profession. Embracing them will also help establish the philosophical background and cement the foundation of the treatment technique as a whole. Guiding principles may also help the therapist when treatment is not progressing as expected. These principles are not new; they are borrowed from the osteopathic profession. Bowen described himself as an osteopath, and sought recognition for the work he did from the Osteopathic Board at the time.[16] The underlying principles of osteopathy are 1. The human body functions as an integrated, interrelated whole unit 2. Structure and function share a reciprocal relationship 3. There exists in the human body an innate capacity for self regulation and healing 4. Therapeutic intervention is based upon an understanding of these three points[17] It is clear that Bowen embraced these principles. 2. Are holistic assessment techniques relevant? In the world of remedial bodywork, regardless of modality, most therapeutic interventions are applied in response to patient assessment. Across all professions, assessment forms an invaluable tool to guide treatment selection and application. Most assessment techniques are generic; they are relevant to all corrective therapy because they provide important information about the patients condition, as well as the response to treatment. Up to now, most Bowen therapist have applied a standardised therapy to every patient, independent of holistic assessment, largely due to a lack of education in this area. Most recently however, the profession of Bowen Therapy is being challenged to address the inherent lack of holistic patient assessment. If the Bowen Technique is a holistic therapy should it not embrace holistic assessment methods? 3. Disintegration
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The disintegration to so many variations of Bowen Therapy has resulted in the technique itself being hard to define. The profession itself lacks direction since it cannot agree amongst the differing parties on basic elements about, for example whether to keep it pure or to progress and develop with research. IMPLICATIONS By utilising the recipe approach to treatment, some Bowen Technique practitioners may be ignoring the very principles upon which the technique is founded. Applying the recipe style of treatment is a symptomatic approach: no holistic assessment is required and the therapist administers the same treatment to each case, regardless of the presenting problem. At least two people who observed Bowen at work dispute this approach. In their interpretation of his work they make a holistic assessment first, then, on the basis of their findings, they administer an appropriate Bowen treatment. FUTURE DIRECTIONS This article has outlined some professional issues and problems for the profession to consider. Is it time to formally adopt a philosophy and embrace a set of guiding principles? Is it time for the profession of Bowen Therapy to adopt holistic assessment techniques? Is it time for the different Bowen therapy groups to come together and work for the benefit of the profession as a whole. Would these changes ultimately help each practitioner achieve better clinical outcomes? It is clear the Bowen Technique is a treatment technique that is here to stay. Classical astrologers refer to the Return of Saturn when the planet Saturn has made one orbit around the earth and returns to the position it was in when that person or idea was born. It is the instigator of change and a crossroad period when life altering decisions are made. With the first Saturn return, a person leaves youth behind and enters adulthood. It takes about twenty nine and a half years to occur.[18] As we approach the thirtieth anniversary of Bowens passing, is it time these issues were addressed? References [1] Marr M, Lambon N, Baker J. Effects of Bowen Technique on flexibility levels: implications for fascial plasticity. Journal of Bodywork & Movement Therapies. 2008 Oct; 12(4): 388. [2] Carter B. A Pilot Study to evaluate the effectiveness of Bowen Technique in the management of clients with frozen shoulder. Complementary Therapies in Medicine. 2001 Dec; 9(4):208-15. [3] Bowen for Hayfever. Positive Health Publications. 2008 Jun;(14):7 Available from: Ebscohost. [4] Dicker A. Using Bowen therapy to improve staff health. The Australian Journal of Holistic Nursing 2001 April; 8(1):38-42. [5] Godfrey J. Case Studies. Positive Health Publications. 2005;108:50-51.Available from Ebscohost. [6] Palmquist S. Bowen Technique. Massage Magazine. Jan 2006; (119):78-80.
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[7] Pennington G. A Textbook of Bowen Technique- A Comprehensive Guide to the Practice of Bowen Technique. Melbourne: Barker Deane Publishing; 2012. [8] The Border College of Natural Therapies.[Internet] 2008 [cited 2012 Jun 6] available from http://www.BCNT.net.au. [9] Rentsch O. [Internet] 2009 [cited 2012 September 12] available from http://bowtech.com. [10] Stammers G. Bowen Therapeutic Technique. Journal of the Australian Traditional Medicine Society.1996 Oct; 2(3):85-86. [11] Rentsch O. The Bowen Technique an interpretation by Oswald Rentsch, Byaduk (Australia)1987. [12] . Rentsch O, Rentsch E. Bowtech The Original Bowen Technique Instruction Manual, Byaduk (Australia) 2007. [13] Victorian Government. A Transcript of Proceedings before the Osteopathy, Chiropractic and Naturopathic Committee. Victorian Government Printer, Melbourne 1973. [14] Boylan M. ATMS Formally Recognises Four New Modalities. Journal of the Australian Traditional Medicine Society. 2011 Dec; 17 (4): 255-6. [15] Boniface G, Seymour A. Using Occupational Therapy Theory in Practice. New Jersey (USA): John Wiley & Sons; 2012. [16] Victorian Government Health Department. A Transcript of Proceedings before the Osteopathy, Chiropractic and Naturopathic Committee. Victorian Government Printer. Melbourne. 1973. [17] Still A.T. The Philosophy of Osteopathy. Kirksville: AT Still; 1899. [18] Arroyo S. Astrology, Karma and Transformation. California: CRCS Publication; 1992.

Book Review May 2013 (BTPA)

Published on May 17, 2013 11:02 pm
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The following independent review was published in, In Touch, the in-house journal of the Bowen Therapy Professional Association (BTPA) U.K. A review of A Textbook of Bowen Technique Graham Pennington By David Howells & Kathryn Phillips When I was first asked to review Grahams book I felt it needed to come not just from me as someone who has practiced the technique in its various forms since 1994 but also input from a new convert to the technique. Having been introduced to Kathryn Phillips at a RIG meeting I thought her views were just as valid as mine and an ideal practitioner to review his book. I was lucky enough to receive the first copy of this book in the UK as it was delivered to me by hand from Ron Phelan hot off the press.

A quick review by Kathryn Phillips: As a relative newbie to Bowen, although not to complementary therapy on which I have been amassing knowledge for almost two decades, Graham Penningtons book was a welcome addition to my growing library of resources. I have been avidly trying to absorb as much information as I can about this very special technique since first being asked by my reflexology clients to consider adding Bowen to my repertoire: I qualified in 2012, treat 1-2 dozen clients per week, and am now training in and using NST Bowen in my clinic to extend my knowledge and understanding yet further. Within moments of opening it, it was clear that a considerable amount of time had been spent on ensuring a depth of indexing which most therapy books do not come even close to. As an information and research specialist of more than three decades this is a key issue for me as I need to be able to accurately and quickly dip in and out of books to revisit points I remember reading previously. Even more important when the reason I need to double-check something is because a client is on the table in the other room and I really want to be able to help them to the best of my ability right now! Not only is specific information much easier to find than in many other books in this field, but also the diagrams, illustrations and narrative are all extremely clear and detailed such that I have felt confident to carry out new and specific assessments and procedures without having been formally taught them in a classroom setting. The first one I tried was the psoas procedure which was an amazing experience for me as the client had been making great progress except in this one area. My palpation and the clients immediate feedback both coincided, I made the move without hesitation, deviation or repetition and the client had improved considerably at his next appointment some weeks later.
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That most, but not all, established Bowen moves coincide with traditional Chinese medicine (TCM) acupressure/meridian points, their significance known for thousands of years, had been a fascination for me from the outset given my pre-existing understanding of reflexology work. That some moves potentially need a slight adjustment to maximise success is highlighted in this book with reasons given. As someone who was already feeling for specific reflex points and monitoring response I had found that Bowen moves did not always give me the feedback I was used to with reflexology. To me modifying the position of some of the moves slightly, such as those of the TMJ as described in Grahams book, gave me the responses I had been missing and increased their efficacy albeit that I accept that the body will frequently read the intent of a good therapist even if the move is slightly off the mark. To me Grahams book, coming from the perspective of a Bowen therapist who is also an acupuncturist, helps to explain and illustrate the significance of this overlap between Bowen and TCM and in doing so explains much about the consequences associated with the various move types: the specific direction of rolling moves, the stretching of certain muscles, the use of trauma to stimulate neural points and so on. That lateral moves typically open up channels, whilst medial moves block energy, is key to comprehending how Bowen technique works. If a therapist understands not only what they are doing but more importantly why then they begin to treat more effectively but even more importantly they can begin to confidently omit or amend moves to suit the individual being treated. In summary I found that Grahams book answers many of the questions which for me had been burning for some time and explains others which I had not yet thought of asking. As someone new to Bowen this is a book to keep to hand in clinic and curl up with in spare moments as it will continually remind and inform its index ideal to enable the busy practitioner to dip into whenever the need arises.

An even quicker review by David Howells: My first thought on seeing Grahams book was one of great admiration for such a mammoth task undertaken over many years. His book is what it says on the cover, A text book of Bowen Technique, a comprehensive guide to the practice of Bowen and as such it is a great aid to learning for students and experienced practitioners alike. I feel he has taken the basic work as we know it and presented it in a way that all students of Bowen can recognise and relate to immediately. It goes much further and adds in basic assessment which is required most certainly. One could devote a whole book and workshop to this area (which Ron Phelan has done). I agree with his comment that in the main students of Bowen have been taught by route and apply certain basic protocols to everyone. We know that Tom did not work this way. If we consider his average time with a client was 5 -8 minutes and he treated 65 clients a day. He assessed, treated and reassessed in a couple of moves. However, none of us are Tom Bowen although we do try to attain a greater level of understanding and
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application of the Technique. In fact the Toms of this world only come along once in a lifetime. That said there has to be a starting point and a process of learning so that students of Bowen can then go on through further study to improve their assessment and treatment skills. As we look towards more regulation in this country and abroad we need to take on board Grahams view of assessment prior to treatment. This I have always advocated and I include basic assessment with my teaching. The relevance of Acupuncture to Bowen has been talked about for years. Acupuncturists that have undertaken Bowen training get very excited when learning the technique. Grahams knowledge of how Tom studied with Ernie Sanders and that the technique is based on Japanese Acupoint therapy confirm my own thoughts. In conclusion it is evident a great deal of thought, research and commitment to Bowen has gone into this work as Kathryn says the book is coming from the perspective of a Bowen Therapist who is also an acupuncturist which helps to explain and illustrate the significance of this overlap between Bowen and TCM. Grahams knowledge of Bowen is unquestionable; he presents it in a very concise way with great illustrations and a good indexing system. I would recommend that every student and qualified practitioner read his view on the Bowen Technique not only is it informative on many levels but challenges opinion and allows for discussion. Graham is not afraid to link up with other practitioners and cross pollinate ideas and theories relating to the Technique. This I feel we all need to encompass as every opinion is valid. I would like to congratulate Graham on producing such a valuable tool that will be of great benefit to Bowen practitioners who like Tom Bowen have their clients health at heart.

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