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 o!en "hera#ist Professional Asso$iation
%"PA&, '()( May, 2013
Graham Pennington *(+(, ,rad +i# %A$u#un$ture&
,raham is the #rin$i#al of -arrnambool *atural Medi$ine .entre in /i$toria, Australia( 0e has
#ra$ti$ed o!en "hera#y, *aturo#athy and A$u#un$ture for more than t!enty years( 0e is the
author of A Textbook of Bowen Technique A Comprehensive Guide to the Prctice of Bowen
Therp!"

INT!"#$TI!N
1n 1234, 5s!ald 6ents$h $ommen$ed !hat !as to be an ama7in8ly su$$essful $am#ai8n to
#romote and tea$h his #ersonal inter#retation of "om o!en9s a##roa$h to thera#euti$
body!or:( Althou8h 6ents$h has undoubtedly su$$eeded in #la$in8 ;o!en "e$hnique9 on the
ma# of remedial body!or:, this su$$ess has $ome at a $ost( 6ents$h9s inter#retation has $ome to
be <ie!ed as re#resentati<e of the !ay o!en a$tually !or:ed=1>, yet there is am#le e<iden$e
that this is not so(
-hether or not 6ents$h9s systematised, re$i#e <ersion of o!en "e$hnique ser<es to illustrate
the majority of o!en9s mo<es and #ro$edures is debateable but it is $ertain that the re#etiti<e,
sequential a##li$ation of learned #ro$edures is not indi$ati<e of o!en9s a##roa$h(
5ne of the major differen$es that e?ists today, bet!een the $lini$al a##roa$h used by "om
o!en and those !ho follo! a deri<ati<e of 6ents$h9s a##roa$h, is that the latter do not a##ly
the thera#y in a$$ordan$e !ith a system of holisti$ assessment( A##lyin8 the re$i#e style of
treatment is a sym#tomati$ a##roa$h: no holisti$ assessment is required and the thera#ist
administers a similar treatment to ea$h $ase, re8ardless of indi<idual #resentation(
1f !e are to remedy this situation the o!en "hera#y #rofession must embra$e holisti$
assessment methods( "his in<ol<es a sim#le addition to the e?istin8 :no!led8e base @ an
addition that enables the thera#ist to $ustomise ea$h treatment a$$ordin8 to indi<idual
#resentation( 1n this !ay, e<ery treatment <aries be$ause it is tar8eted to the needs of ea$h
#atient( 5f $ourse this a##roa$h leads to better $lini$al out$omes(

BA$%G!#N"
"om o!en left no formal trainin8 notes about the ty#e of thera#y he #ra$tised( "o understand
and define it, !e must rely on a$$ounts of the #eo#le !ho $laim to ha<e !at$hed him !or:( 1t is
!idely a$:no!led8ed that at least si? men $laim to ha<e done so o<er the t!enty-three years he
!as in #ra$ti$e %1252-1232&( 1nterestin8ly, ea$h of those !ho obser<ed him de<elo#ed a
different inter#retation of his !or:( 5s!ald 6ents$h, has tau8ht his inter#retation !idely, !hilst
others ha<e only tau8ht their inter#retation of o!en9s !or: to a handful of #ra$titioners(
.onsequently, a o!en industry has emer8ed !here most #ublished authors and treatin8
#ra$titioners ha<e been e?#osed to only one indi<idual9s inter#retation of o!en9s !or:(
At least t!o of the si? men !ho obser<ed o!en ha<e #ubli$ly reje$ted the re$i#e style
a##roa$h( 1nstead, they use a style of o!en "e$hnique in !hi$h treatment is a##lied based on a
1
holisti$ assessment of the #atient and is tar8eted to s#e$ifi$ dysfun$tion, in a$$ordan$e !ith
indi<idual #resentation( 1n addition to ma:in8 a holisti$ assessment of ea$h #atient, they a##ly
the "e$hnique in a holisti$ manner, re$o8nisin8 some of the $om#le? interrelationshi#s e?istin8
!ithin the body( "hey also use reassessment te$hniques to measure the effe$ti<eness of their
treatments as they a##ly them(
Auestions are no! bein8 #osed re8ardin8 the basi$ assum#tions of those tea$hin8 the #o#ular
re$i#e style of the te$hnique( 6omney Bmeeton, a $hiro#ra$tor, and one of o!en9s obser<ers in
the se<enties and early ei8hties, !rites
;1 should state 1 am at odds !ith mu$h of the $urrent tea$hin8s of o!en9s !or:, #rimarily
be$ause they la$: a system of indi<idual assessment and are nearly all based on a systemati7ed
use of standardised re$i#es and this !as not o!en9s a##roa$h9(
)e<in 6yan, an osteo#ath, and another of o!en9s obser<ers, told the "CA %o!en "hera#ists
Cederation of Australia& $onferen$e in 1223 that o!en based his treatment inter<entions u#on
his assessment of the #atient and that

;"om o!en ne<er did a mo<e unless he had an e?#e$tation of !hat effe$t it !ould #rodu$e(9

1nterestin8ly, a$$ordin8 to the trans$ri#t of #ro$eedin8s of the .ommittee of 1nquiry into
5steo#athy, .hiro#ra$ti$ and *aturo#athy, in 1273, "om o!en said, ;1 a<era8e 45 #atients #er
day9( "his allo!ed him around fi<e minutes for the treatment of ea$h #atient( "he re$i#e style
of treatment !idely tau8ht and #ra$ti$ed today sim#ly $annot be a##lied in this time frame( 1t is
$lear that o!en did not routinely a##ly the re$i#e style a##roa$h that $urrently bears his name(

H!&I'TI$ A''('')(NT
Many o!en "hera#ists $an and do #erform assessments of isolated mus$le 8rou#s or indi<idual
joints, mu$h li:e a #hysiothera#ist or a myothera#ist( "hese assessments are hel#ful in #ro<idin8
a baseline le<el of fun$tion from !hi$h to measure #ro8ress, but they do not embra$e holisti$
#rin$i#les, or en$oura8e thera#ists to <ie! the body as a $om#le? interrelated !hole(

A holisti$ assessment is one that assesses the body for areas of dysfun$tion from a systemi$
<ie!#oint( 0olisti$ assessment #ro$edures allo! the body to be <ie!ed in its entirety, allo!in8
the thera#ist to assess $entral ner<ous system %.*B& fun$tion, for e?am#le, !hilst
simultaneously re$o8nisin8 some of the $om#le? interrelationshi#s !hi$h mi8ht influen$e it(
1m#ortantly, it allo!s the thera#ist to identify #rimary sites of dysfun$tion rather than se$ondary
sites @ a##lied in this $onte?t, treatments are less ;sym#tomati$9(

"he fe! o!en "hera#ists !ho do use su$h an assessment te$hniques $laim it enables the
o!en treatment to be tar8eted and 8oal-dire$ted( "reatment 8oals $an be assessed alon8 the
!ay, thus the use of holisti$ assessment #ro$edures $an hel# to a$hie<e better $lini$al out$omes(

Holistic Assessment "isc*ssion
1f the o!en "e$hnique is a holisti$ thera#y should it not embra$e holisti$ assessment methodsD
A holisti$ #rofession is one that re$o8nises the body as bein8 ;more than the sum of its #arts9( A
holisti$ #rofession is one that re$o8nises the im#ortan$e of $om#le? interrelationshi#s that e?ist
!ithin the body( 5steo#athy is su$h a #rofession( -e :no! that o!en $alled himself an
osteo#ath and he did so be$ause he embra$ed the underlyin8 #rin$i#les of osteo#athy %and these
2
are $ertainly holisti$=2>&( y utilisin8 the re$i#e a##roa$h to treatment, some o!en "hera#y
#ra$titioners may be i8norin8 the <ery #rin$i#les u#on !hi$h the te$hnique is founded(
"he 8ood ne!s is, holisti$ assessment te$hniques $an be easily learnt and a##lied to #ro<ide a
more tar8eted, effe$ti<e, 8oal dire$ted o!en "hera#y(

Holistic Assessment Techni+*es
At the be8innin8 of e<ery treatment "om o!en made an assessment of tonal symmetry on ea$h
#atient( All o!en "hera#ists still do this at the be8innin8 of e<ery treatment althou8h many of
them may not realise they are doin8 it( A 8eneral rule that all thera#ists learn is that a treatment
should al!ays be $ommen$ed !ith Mo<es 1 E 2 of the Fo!er a$: Pro$edure @ the reason for
this is to assess tonal symmetry(

"onal asymmetry is an e?#ression of the #atient9s dysfun$tion=3>, so as thera#ists, our first
obje$ti<e must be to identify the side of ;ti8htness9( "he ti8ht side is synonymous !ith the side
of the fun$tional short le8( "he fun$tional short le8 a$ts as a si8n#ost #ointin8 the thera#ist to
the dysfun$tion that is the sour$e of the #atient9s #roblem( A sim#le #remise a##lies here: if !e
e?ert an influen$e u#on that dysfun$tion, then the short le8 !ill $han8e(

"he use of sim#le tonal assessment methods allo!s the thera#ist to identify relationshi#s !ithin
the body and to measure the effe$ti<eness of any thera#euti$ in#ut( Cor e?am#le, if there is a
fun$tionally short ri8ht le8 that does not $han8e after the #iriformis mo<e, one $an assume the
#atient9s dysfun$tion is not asso$iated !ith #iriformis( 1f the le8 len8th $orre$ts follo!in8 the
"em#oromandibular Goint %"MG& Pro$edure, one $an re$o8nise the #atient9s dysfun$tion !as
asso$iated !ith the "MG( 1ndeed, one $ould use this method of ;mo<e and re-assess9 to
determine !hether any indi<idual mo<e in the "MG Pro$edure %or in any other #ro$edure& had
a$tually $orre$ted the dysfun$tion( Cor the thera#ist, su$h a #ro$ess is both edu$ational and
em#o!erin8(


ecognition of Interrelationships
"om o!en !as, li:e many 8ood thera#ists, a!are of interrelationshi#s !hi$h e?isted bet!een
different areas of the body( "hose !ho !at$hed him !or: ha<e $laimed he attributed s#e$ial
si8nifi$an$e to a fe! areas of the s#ine( "he notion e?#ressed is that o!en #la$ed #arti$ular
em#hasis on restorin8 fun$tion to the sa$roilia$ joints, the $o$$y?, the $er<i$al s#ine and the
"MG=H>( o!en understood that a #atient9s s$iati$ #ain $ould be related to "MG dysfun$tion and
that the #atient9s mi8raines $ould be related to $o$$y? dysfun$tion=5> et$( "he si8nifi$an$e of
this for the o!en thera#ist is that a #atient9s #rimary dysfun$tion $an be quite a lon8 !ay from
the site of sym#toms, thus ma:in8 the need for holisti$ understandin8 and assessment e<en
8reater(


'creening Proced*res
As thera#ists, some of these interrelationshi#s $an be used to our ad<anta8e throu8h the use of
some sim#le s$reenin8 #ro$edures( "he .er<i$al "urn "est is one e?am#le( 5n$e a fun$tional
short le8 is identified, the thera#ist $an ha<e the #atient turn their ne$: to the left and then
reassess the fun$tional short le8( "he #ro$ess $an be re#eated !ith the #atient turnin8 the ne$: to
3
the ri8ht( 1f the #atient9s tonal asymmetry is asso$iated !ith a #roblem in their ne$:, turnin8 the
head to one side should result in a $orre$tion of le8 len8th( -hen this test returns a #ositi<e
findin8 the thera#ist $an $onfidently fo$us on lo$atin8 and $orre$tin8 the #roblem in the #atient9s
ne$: @ this is the $ase re8ardless of !hether the sym#tom #resentation is idio#athi$ :nee
s!ellin8, heada$hes or asthma(

"here is also a useful s$reenin8 #ro$edure to indi$ate sa$roilia$ joint dysfun$tion( "he Ba$roilia$
Goint "est=4> is $arried out !ith the #atient #rone( "he short le8 is identified and the #atient9s
:nees are fle?ed to ninety de8rees( A #ositi<e test result %indi$atin8 sa$roilia$ dysfun$tion& is
found !hen the short le8 $rosses o<er and be$omes the lon8 le8( A #ositi<e indi$ation of
sa$roilia$ dysfun$tion !ould then send the thera#ist in sear$h of the a##ro#riate treatment
%#ossibilities in$lude #iriformis mo<e, sa$roilia$ #ro$edure, #el<i$ #ro$edure et$(&(
6eassessment $ould then be used to $onfirm restored sa$roilia$ fun$tion(


Holistic assessment techni+*es *sed in fo*r cases of right sided hip pain
"he follo!in8 $ase studies ser<e to illustrate the #rin$i#le that sym#tom #resentation does not
8i<e a 8ood indi$ation of the sour$e of dysfun$tion( +ysfun$tion in one area of the body $an
lead to sym#toms in another area( "hese #rin$i#les !ere !ell understood by o!en(

$ase ,: A 42 y(o( male #atient #resents !ith a ten day history of right sided hip pain-
"his #atient re#orts si8nifi$ant dis$omfort in his ri8ht hi# follo!in8 re$ent 8ardenin8 a$ti<ities(
Fyin8 #rone the #atient is assessed and the ri8ht le8 is found to be fun$tionally shortened(
Mo<es 1 E 2 of the FP are #erformed and the ri8ht #aras#inal tissue is found to be ti8hter than
the left( B$reenin8 demonstrates a #ositi<e +erifield findin8( "he thera#ist administers a mo<e to
the left #iriformis mus$le to assess its tenderness %usin8 this as a $ontrol& and then the same
mo<e is a##lied to the ri8ht #iriformis( "he #atient re#orts in$reased tenderness on the ri8ht
side( 1mmediate reassessment indi$ates a return to almost equal le8 len8th( A t!o-minute !ait
is a##lied follo!ed by reassessment( "onal symmetry has returned and le8 len8ths are no!
equal( "here is no lon8er a #ositi<e +erifield findin8( Collo! u# in one !ee: re<eals the #atient
!as si8nifi$antly im#ro<ed follo!in8 the treatment and has been $om#letely #ain free for the last
5 days( Assessment at follo!-u# re<eals tonal symmetry indi$atin8 no further treatment is
ne$essary(

$ase .: A 22 y(o( male #atient %a football #layer& #resents !ith a fi<e !ee: history of re$urrent
right sided hip pain !hi$h is !orse !ith e?ertion and 8ets better !ith rest(
Mo<es 1 E 2 of the FP are #erformed and re<eal ele<ated tension in the #aras#inal tissue on the
left side( "onal asymmetry is assessed re<ealin8 a fun$tionally short left le8( B$reenin8 re<eals
a #ositi<e .er<i$al "urn "est( 6ealisin8 the #atient has a #rimary issue affe$tin8 his $er<i$al
s#ine the thera#ist mo<es qui$:ly throu8h the Fo!er E '##er a$: Pro$edures %no !aitin8
ne$essary& and turns the #atient( "a$tile assessment of the ne$: re<eals si8nifi$ant s#asm on the
ri8ht side from the le<el of .1 @ .H( Mo<es of the *e$: Pro$edure are used to address this
s#asm and a t!o-minute !ait is em#loyed( '#on reassessment, tonal symmetry is e<ident(
Collo! u# in one !ee: re<eals the hi# #ain has si8nifi$antly im#ro<ed follo!in8 the treatment
and the #atient re#orts he has su$$essfully $om#leted a trainin8 session sin$e the treatment(
4
Assessment at follo!-u# re<eals minor fun$tional asymmetry !hi$h $orre$ts u#on $er<i$al
rotation, indi$atin8 some further treatment is ne$essary(

$ase /: A 17 y(o( female #atient #resents !ith a t!o month history of re$urrent right sided hip
pain !hi$h is !orse !ith e?ertion and 8ets better !ith rest(
Mo<es 1 E 2 of the FP are #erformed and re<eal ele<ated tension in the #aras#inal tissue on the
left side( "onal asymmetry is assessed re<ealin8 a fun$tionally short left le8( B$reenin8 is
unremar:able( "he thera#ist mo<es thorou8hly throu8h the Fo!er E '##er a$: Pro$edures
;sear$hin89 for abnormal tensions that may be asso$iated !ith the #resentin8 asymmetry( *o
su$h tensions are identified and therefore no !aitin8 #eriods are ne$essary( '#on turnin8 the
#atient, ta$tile assessment of the ne$: re<eals nothin8 abnormal( Bus#e$tin8 an addu$tor issue,
the thera#ist $om#ares the tension of the left and ri8ht addu$tors, findin8 the left to be in a state
of tension( Mo<es of the Pel<i$ Pro$edure are used to address the addu$tor after !hi$h a t!o-
minute !ait is em#loyed( '#on reassessment, the #atient demonstrates equal le8 len8th( Curther
enquiry re<eals the youn8 #atient is an a<id horse rider !ho re8ularly $om#etes in dressa8e
e<ents( Bhe is $ounselled on loo:in8 after her addu$tors( Collo! u# in one !ee: re<eals the hi#
#ain has si8nifi$antly im#ro<ed follo!in8 the treatment but some asymmetry remains( Curther
treatment is required(

$ase 0: A H0 y(o( female #atient #resents !ith a ten day history of right sided hip pain-
"his #atient re#orts si8nifi$ant dis$omfort in her ri8ht hi# !hi$h be8an se<eral days after
#lantin8 40 trees( Fyin8 #rone the #atient is assessed and the left le8 is found to be fun$tionally
shortened( B$reenin8 #ro$edures are ne8ati<e( "a$tile assessment re<eals tension and tenderness
of the #aras#inal areas on the ri8ht side of the first lumbar <ertebrae( "he thera#ist administers
Mo<e 1 of the Psoas Pro$edure=7> to the ri8ht #aras#inal tissue and immediate reassessment
indi$ates a return to almost equal le8 len8th( "he Psoas Pro$edure is $om#leted and a t!o-
minute !ait is a##lied( '#on reassessment tonal symmetry has returned and le8 len8ths are no!
equal( Collo! u# in one !ee: re<eals the #atient !as si8nifi$antly im#ro<ed follo!in8 the
treatment and has been $om#letely #ain free for the last 3 days( Assessment at follo!-u# re<eals
fun$tional symmetry indi$atin8 no further treatment is ne$essary(


1#T#( "I($TI!N'
"he re$i#e system may ha<e #la$ed o!en "hera#y on the ma# but it is self limitin8( As ea$h
#atient #resents, rather than usin8 our o!n intelli8en$e to sol<e their #roblems, !e are ur8ed to
!or: in roboti$ fashion, follo!in8 stri$t #redetermined treatment #roto$ols(
"he future of o!en "hera#y lies, not in the re#etiti<e a##li$ation of learned #ro$edures but in
#ro$esses !hi$h enable the thera#ist to identify dysfun$tion, 8uide the intelli8ent a##li$ation of
treatment and then $onfirm that the treatment !as effe$ti<e in restorin8 fun$tion( Bu$h #ro$esses
must be hea<ily fo$used u#on holisti$ methods of assessment(
"hirty years ha<e #assed sin$e "om o!en left his le8a$y in our $are( 1t is no! time for the
#rofession of o!en "hera#y to mo<e for!ard and ado#t holisti$ assessment te$hniques(
=1> 5n 6ents$h9s early tea$hin8 notes distributed in 1237, the !ords ;o!en "e$hnique @ an
inter#retation by 5s!ald 6ents$h9, !ere #rinted on ea$h #a8e( 5<er time these #rinted !ords
5
ha<e disa##eared and $urrent tea$hin8 manuals use the #hrase ;"he 5ri8inal o!en "e$hnique9(
oth #hrases a$:no!led8e the e?isten$e of other inter#retations of o!en "e$hnique(
=2> "he four tenets !hi$h under#in osteo#athy !ere laid do!n by A( "( Btill( "hey are: 1( "he
human body fun$tions as an inte8rated, interrelated, !hole unit( 2( Btru$ture and fun$tion share
a re$i#ro$al relationshi#( 3( "here e?ists in the body an innate $a#a$ity for self-re8ulation and
healin8( H( "hera#euti$ inter<ention is based u#on an understandin8 of these three #oints(

=3> "he follo!in8 statement !as made by +(+( Palmer, the founder of $hiro#ra$ti$: IFife is the
e?#ression of tone( 1n that senten$e is the basi$ #rin$i#le of .hiro#ra$ti$( "one is the normal
de8ree of ner<e tension( "one is e?#ressed in fun$tions by the normal elasti$ity, a$ti<ity,
stren8th and e?$itability of the <arious or8ans %and tissues&, as obser<ed in a state of health(
.onsequently, the $ause of disease is any <ariation of toneJ(
=H> "hese sites are si8nifi$ant be$ause they are all asso$iated !ith dural atta$hment(

=5> 1ndeed, o!en !as not alone in re$o8nisin8 these relationshi#s( 5steo#aths and $hiro#ra$tors
ha<e lon8 been a!are of these relationshi#s( Ba$ro 5$$i#ital "e$hnique %B5"& is a #o#ular form
of $hiro#ra$ti$ !hi$h re$o8nises the relationshi# that e?ists bet!een stru$tures at o##osite ends
of the s#ine( Many s$hools of $hiro#ra$ti$ refer to the Fo<ett-rother relationshi# !hi$h details
this #rin$i#le(
=4> "his s$reenin8 #ro$edure is deri<ed from the +erifield "est !hi$h is $ommonly used by
$hiro#ra$tors(
=7> Also :no!n as the ;)idney Pro$edure9 @ refer A Textbook of Bowen Technique A
Comprehensive Guide to the Prctice of Bowen Therp!
The Bowen Techni+*e )echanisms for
Action
Published on May 15, 2013 11:25 am
"his arti$le is #rinted !ith #ermission: -il:s, G( o!en te$hnique: Me$hanisms for a$tion( 1t
!as #ublished in the Gournal of the Australian "raditional Medi$ine Bo$iety( 2013K 12%1&:33-35(
Permission from the author has also been obtained(
The Bowen Techni+*e )echanisms for
Action
John Wilks #A $C%T BTAA &$%A' %enior instructor with Bowtech' the Bowen Therp!
Acdem! of Austr(i" )eb* www"bowentrinin+"com"u ,mi(* c!m-btinternet"com
AB'TA$T
"he effi$a$y of the o!en "e$hnique $an be e?#lained by its a$tion on a <ariety of stru$tures in
the body( o!en mo<es stimulate se<eral ty#es of intrafas$ial me$hanore$e#tors that affe$t
mus$le tonus and in$rease <a8al tone( "he ty#e of mo<e used in o!en also assists the hydration
of fas$ia, !hi$h in turn en$oura8es better <as$ular and ner<e su##ly(
TH( B!2(N T($HNI3#(
"he te$hnique de<elo#ed by "homas A( o!en %1214-1232& is unusual in that it affe$ts tissues
in a <ariety of !ays simultaneously( 1ts effe$t is not limited to rela?in8 ti8ht mus$les or
in$reasin8 hydration in the fas$ia but it $an also be used to in$rease tonus in the $ore mus$les and
6
$ontra$tile stren8th !ithin the fas$ia and to initiate a lo!erin8 of sym#atheti$ tone in the
autonomi$ ner<ous system(
"o understand ho! the o!en "e$hnique !or:s it is useful to e?amine the <aried role of
$onne$ti<e tissue, and #arti$ularly fas$ia, in the body( Cor e?am#le, one of fas$ia9s $ru$ial
fun$tions in effi$ient lo$omotion is its #ro#erty of re$oil, !hi$h de#ends on 8ood hydration %an
im#ortant effe$t of o!en !or:&( "his $an be seen $learly in the thora$o-lumbar a#oneurosis,
!hi$h is the startin8 #oint for a lot of o!en !or:( 1n !al:in8 and runnin8, this area of fas$ia
a$ts as a :ind of ;bun8ee9 and 8reatly redu$es the amount of effort that is needed to e?ert <ia the
mus$ular system( "his is demonstrated in the mo<ement of animals su$h as :an8aroos, lemurs
and 8a7elles as !ell as humans(=1> -here this re$oil #ro#erty is $om#romised throu8h a la$: of
hydration and re$i#ro$al tension in the fas$ia, $ertain mo<ements li:e runnin8 and !al:in8
require more e?ertion throu8h the mus$ular system( .han8e in the quality of the lumbar
a#oneurosis is also $onsidered an im#ortant fa$tor in lo!er ba$: #ain as this area is hi8hly
inner<ated !ith sensory re$e#tors( 1n fa$t, fas$ia is the most ri$hly inner<ated tissue in the body,
bein8 effe$ti<ely its lar8est sense or8an, !ith the hi8hest density of #ro#riore$e#tors=2> as !ell
as bein8 the :ey tissue addressed in o!en treatments(=3>
"he o!en "e$hnique has a <ery s#e$ifi$ effe$t on fas$ia( Primarily, o!en mo<es are made
dire$tly on mus$les %althou8h some mo<es are also #erformed on tendons, li8aments, joints and
ner<es&, but be$ause all these stru$tures are surrounded by a net!or: of fas$ia, it is ine<itable
that !hate<er stru$ture is a$ti<ated, the fas$ia that surrounds it %and is inte8ral to it&, is affe$ted
at the same time, albeit !ith sli8htly different #hysiolo8i$al effe$ts( A#art from the sensory
re$e#tors in the s:in su$h as Mer:el9s +is$s, Meissner9s $or#us$les and Cree *er<e Lndin8s,
there are :ey intra-fas$ial me$hanore$e#tors that are a$ti<ated durin8 a treatment( "hese are
lar8ely ,ol8i, 6uffini and 1nterstitial re$e#tors( 5$$asionally, o!en mo<es in<ol<e a fast
release of #ressure, !hi$h affe$ts the Pa$ini re$e#tors %in<ol<ed in #ro#rio$e#tion&, but these
ty#es of mo<e are rare( Mostly, o!en mo<es in<ol<e ta:in8 s:in sla$:, a##lyin8 a $hallen8e %or
8entle #ush& for a fe! se$onds, and a slo! steady mo<e o<er the stru$ture bein8 addressed(
o!en mo<es mostly $onsist of a ty#e des$ribed by B$hlei#=2> as ;slo! meltin8 #ressure9( "hese
ty#es of mo<e stron8ly affe$t the numerous 6uffini re$e#tors,!hi$h are found in the s:in and in
many dee# tissues of the body in$ludin8 the lumbar fas$ia, dural membranes, li8aments and joint
$a#sules et$( Blo! mo<es o<er these stru$tures ha<e a lo!erin8 effe$t on the sym#atheti$
ner<ous system %B*B&=H> and indu$e a #rofound sense of rela?ation in the $lient( 5ther re$e#tors
that indu$e a de$rease in the B*B and $orres#ondin8 in$rease in <a8al tone, are the interstitial
re$e#tors, !hi$h are found nearly e<ery!here in the body( Bome of these re$e#tors %#arti$ularly
the no$i$e#tors& are hi8h-threshold, and :no!n to be in<ol<ed in $hroni$ $onditions, but
interestin8ly about 50M of these re$e#tors are lo!-threshold fibres and are sensiti<e to the :ind
of <ery li8ht tou$h %similar to s:in brushin8& that is used in some o!en mo<es( "his me$hanism
e?#lains the dee# rela?in8 effe$t of o!en treatments and the $ru$ial healin8 effe$t of
in$reased <a8al tone(=5>
5n a more stru$tural le<el o!en mo<es affe$t the ,ol8i re$e#tors %found in myo-tendinous
jun$tions, li8aments and the dee# fas$ia& by usin8 sli8htly more #ressure and lon8er holdin8
times, and by !or:in8 $lose to ori8ins and insertions( 1t has been su88ested that mani#ulation of
these re$e#tors $auses the firin8 of al#ha motor neurons resultin8 in a softenin8 of related tissues(
"his #ro$ess also seems to ha##en <ia 8entle stret$hin8 of the tissues su$h as in yo8a(=H> Mus$les
themsel<es are stimulated by the ;$hallen8e9 in a o!en mo<e, !hi$h a$ti<ates the mus$le
s#indles in res#onse to the stret$h on the mus$le fibres( Mu$h of this res#onse is mediated at the
7
le<el of the s#inal $ord but some im#ulses do ma:e their !ay to <arious areas of the brain li:e
the $erebellum, the basal 8an8lia, the reti$ular formation and the brain stem, before bein8 $o-
ordinated in the thalamus and sent ba$: do!n the <arious motor ner<e tra$ts to the mus$les or
or8ans(=3>
1t ta:es around 20 se$onds for mus$les to res#ond in this !ay, so it is interestin8 that it is normal
#ra$ti$e for o!en thera#ists to lea<e a t!o minute brea: %and sometimes lon8er& bet!een the
<arious a$ti<ations or mo<es( 1t !ould a##ear that by in#uttin8 tar8eted, but minimal sensory
stimulus durin8 a o!en session !ithout e?traneous interferen$e, it allo!s the body to re-
$alibrate( Cor e?am#le +iet7 et al4 ha<e sho!n that the .*B $an reset ,ol8i tendon re$e#tors
and related refle? ar$s so that they fun$tion as deli$ate anti8ra<ity re$e#tors(=H>
5ne thin8 students of the o!en "e$hnique are tau8ht is al!ays to 8et $lients u# at the end of a
treatment so that both feet land on the 8round at the same time, thereby stimulatin8 a res#onse in
the many ,ol8i re$e#tors in the #lantar fas$ia of the feet(
.ertain fa$tors are im#ortant for a su$$essful o!en treatment, $riti$ally that there is not
e?$essi<e stimulation of the .*B by an unne$essary number of mo<es or distra$tin8 the $lient(
"his is #arti$ularly im#ortant !hen there is a 8eneral sensiti7ation of ner<e #ath!ays and tissues
as is the $ase in $hroni$ #ain, !hi$h is !hy a fa<orite o!en ma?im is ;less is more9( o!en
also affe$ts the fas$ia dire$tly throu8h en$oura8in8 hydration, as this #ro$ess is assisted by
8entle stret$hin8, re#etiti<e squee7in8 and release !ith #auses, %ie #ressure a##lied and then
!aitin8& @ all elements of a o!en treatment( "he !aitin8 time !ould a##ear to be essential as
there is a si8nifi$ant in$rease in hydration after half an hour(=7>
$!NTA$TI&( P!P(TI(' !1 $!NN($TI4( TI''#(
-hen loo:in8 at #ossible me$hanisms for ho! the o!en "e$hnique !or:s, it is im#ortant to
differentiate ho! tou$h and mani#ulation affe$t mus$le $ontra$tion %or la$: of tonus& as o##osed
to $onne$ti<e tissue $ontra$ture %or in the $ase of some hy#er-mobile $lients, a #otential la$: of
$ontra$tile #ro#erties in the tissues&( Mus$le $ontra$tion is a hi8h-ener8y shortenin8 of tissues,
!hereas $ontra$ture of $onne$ti<e tissue is a ;slo!, %semi& #ermanent, lo!-ener8y, shortenin8
#ro$ess, !hi$h in<ol<es matri?-dis#ersed $ells and is dominated by e?tra$ellular e<ents su$h as
matri? remodelin8(9=3> Cor effi$ient fun$tionin8 of the human system $onne$ti<e tissues need to
hold $ertain $ontra$ti<e #atterns to maintain stability( 1n disse$tion you $an see $learly that all
$onne$ti<e tissues are under stress @ for e?am#le disse$ted ner<es and blood <essels ha<e a
len8th of around 25 @ 30M less than their in situ len8th(=3>
Myofibroblasts #lay an essential role in maintainin8 re$i#ro$al tension net!or:s in the
$onne$ti<e tissues, bein8 a ty#e of fibroblast, the ;buildin8 blo$:9 $ell of fas$ia, !hi$h ha<e the
$hara$teristi$s of smooth mus$le( "he $onstru$ti<e tension !ithin the $onne$ti<e tissue is an
essential element of the body9s biotense8rity system=2>( Myofibroblasts are affe$ted in many
:inds of $onne$ti<e tissue disorders su$h as +u#uytrens and fro7en shoulder( o!en affe$ts
Myofibroblasts dire$tly as they $ontra$t and e?#and slo!ly in res#onse to fa$tors su$h as #0 and
stress(=2> "his o$$urs o<er a #eriod of minutes or hours and so e?#ansion or rela?ation of
myofibroblast a$ti<ity !ill $ertainly o$$ur durin8 the len8th of a o!en treatment %normally
around H5 minutes& as the #erson rela?es( Boft-tissue te$hniques su$h as the o!en "e$hnique
rely on effe$tin8 stru$tural $han8e by dire$tly influen$in8 the biotense8rity as#e$t of the
$onne$ti<e tissue <ia their a$tion on myofibroblasts, !hi$h is #artly !hy o!en has su$h a
#o!erful and measurable effe$t on #osture(
"here is a number of different te$hniques a<ailable to the o!en thera#ist that !ill be used
de#endin8 on !hat out$omes are ne$essary for a 8i<en $lient in a 8i<en situation( Cor e?am#le,
8
mo<es $an be done faster or slo!er, !ith lon8er or shorter $hallen8es, dee#er of li8hter #ressure,
medially or laterally, or anteriorly or #osteriorly( All these fa$tors !ill ha<e different effe$ts in
terms of lo!erin8 <a8al tone, in$rease or de$rease in mus$le tonus et$(
Assessment has been, and al!ays !ill be, an essential and hi8hly indi<idual startin8 #oint for
determinin8 ho! to a##ly the o!en "e$hnique !ith ea$h $lient( Cor e?am#le, for ea$h $lient
#resentin8 !ith similar sym#toms of lo!er ba$: #ain there may be a 8reat number of different
reasons for those sym#toms( A o!en treatment !ill therefore ne<er be the same from $lient to
$lient e<en thou8h they may #resent !ith identi$al sym#toms(
"he follo!in8 !ise statement from the an$ient .hinese #oet Fin Nutan8 should be the mantra of
all holisti$ thera#ists: ;A do$tor !ho #res$ribes an identi$al treatment in t!o indi<iduals and
e?#e$ts an identi$al de<elo#ment, may be #ro#erly $lassified as a so$ial mena$e(9
-or:in8 !ith $lients in $hroni$ #ain is a $hallen8e for any thera#ist( Prolon8ed inflammation
has been sho!n to ha<e a deleterious effe$t on many stru$tures and me$hanisms in the body and
may deri<e from a <ariety of $auses, su$h as old injuries, o#erations, and inflammatory
$onditions li:e endometriosis( 1t is !ell :no!n, for e?am#le, that inflammation in the 8ums
%8in8i<itis& or in the ja! after root $anal fillin8s $an affe$t or8ans su$h as the heart and $ause
joint and mus$le #ain( Crequently the ori8inal site of the inflammation is asym#tomati$ but !ill
ha<e effe$ts else!here in the body and is a :ey fa$tor in $hroni$ #ain( ,entle thera#euti$
a##roa$hes su$h as o!en that dire$tly affe$t the myo-fas$ial system by 8ently stimulatin8 the
interstitial re$e#tors and lo!erin8 their tenden$y for hy#ersensiti<ity !ould a##ear to be the
most ob<ious $hoi$e for $lients in $hroni$ #ain(
"here is $onsiderable interest amon8st manual thera#ists in the $on$e#t of fas$ia as a
$ommuni$ation medium in the body(=10> 1t has been :no!n for many years that #ie7oele$tri$
effe$ts initiated by stressin8 $olla8en fibres ha<e a stron8 healin8 effe$t on tissues(=11>
"here is no doubt that somethin8 of this :ind is o$$urrin8 durin8 a o!en treatment as the
im#ulses $reated by stressin8 $olla8en fibres in the $hallen8e and roll of a o!en mo<e $an be
felt $learly !ith sensiti<e #al#ation( "hese im#ulses seem to ha<e the effe$t on the tissues of
freein8 areas of fas$ia that are ;stu$:9, or !hat +eane Guhan=12> refers to as thi?otro#hi$( B$ar
tissue that is raised and red res#onds to o!en mo<es by be$omin8 <isibly less fibroti$ and less
inflamed quite qui$:ly( "his means that there is some #rofound #hysiolo8i$al $han8e in the
tissues, s#e$ifi$ally in the ratio of ty#e 1 and ty#e 111 $olla8en( "his is si8nifi$ant as this ratio is a
$ru$ial element in the ma:e-u# of fas$ia in terms of la?ity(
"he e?quisite ima8es in the +/+9s #rodu$ed by +r G-. ,uimberteau=13> sho! $learly !hy
te$hniques that en$oura8e more fluidity in the fas$ia, su$h as o!en, !ould ha<e a #rofound
effe$t on <as$ular and ner<e su##ly by freein8 u# the $onne$ti<e tissues that surround $a#illaries,
<eins, arteries and ner<es( "he effe$ti<eness of the o!en "e$hnique in its treatment of a !ide
ran8e of $onditions is borne out by $lini$al e?#erien$e, and althou8h more resear$h needs to be
done in this area it is $lear that there are !ell-resear$hed me$hanisms by !hi$h the o!en
"e$hnique $an assist in terms of fas$ial fitness, redu$in8 stress le<els, in$reasin8 <as$ular su##ly
and im#ro<in8 mobility and #osture(=1H>
eferences :
1( )ram, 6(, +a!son, "(G( Lner8eti$s and iome$hani$s of lo$omotion of 6ed )an8aroos,
.om#( io$hem( Physiol( 1223
2( B$hlei#, 6(, Cas$ia as a Bensory 5r8an, -orld Massa8e .onferen$e -ebinar, *o< 2002
3( -il:s, G(, "he o!en "e$hnique, the inside story .NMA Ftd 2007
9
H( B$hlei#, 6 Cas$ial #lasti$ity @ a ne! neurobiolo8i$al e?#lanation( Gournal of ody!or: and
Mo<ement "hera#ies, 2003, 7%1&:11-12 and 7%2&:10H-114
5( ,ellhorn, L(, Prin$i#les of Autonomi$-Bomati$ 1nte8rations, 'ni<ersity of Minnesota Press
1247
4( +iet7, /(, 6e8ulation of i#edal Btan$e L?#erimental rain 6esear$h 1222 /ol 32 %1& ## 222
@ 231
7( B$hlei#, 6( E )lin8ler, -(, Cas$ial Btrain 0ardenin8 .orrelates !ith Matri? 0ydration
.han8es Cas$ia 6esear$h, 2007 Llse<ier # 51
3( "omase:, G et al( Myofibroblasts and Me$hano-re8ulation of .onne$ti<e "issue 6emodellin8
*ature 6e<ie!s 3 %May 2002& ##3H2 @ 343
2( Fe<in, B E Martin, +-., iotense8rity( "he Me$hani$s of Cas$ia( "he "ensional *et!or: of
the 0uman ody .hur$hill Fi<in8stone, Llse<ier 2012 %## 137 @ 1H2&
10( 5s$hmann, G Cas$ia as a body-!ide $ommuni$ation system "he "ensional *et!or: of the
0uman ody .hur$hill Fi<in8stone, Llse<ier 2012 %## 103 @ 102&
11( e$:er, 6(, "he ody Lle$tri$ 0ar#er 1235
12( Guhan, +, Gob9s ody @ a 0andboo: for ody!or: Btation 0ill Press, *N 2002
13( ,uimberteau, G-.(, Mus$le Attitudes +/+, Lndo/i<o #rodu$tions 2010
1H( -il:s, G(, 'nderstandin8 the o!en "e$hnique, Cirst Btone Publishin8 200H
Bowen Therapy: A eview of the Profession
Published on Cebruary 14, 2013 11:54 am
Bowen Therapy: A review of the profession @ as #ublished in the Gournal of the Australian
"raditional Med$ine Bo$iety in +e$ember, 2012 %GA"MB @ /olume 13, *umber H&
"his arti$le is #rinted !ith #ermission: Pennin8ton, )( o!en thera#y(
Gournal of the Australian "raditional-Medi$ine Bo$iety( 2012K
13%H&:217-220(
)atrina Pennin8ton A##B$%5$$u#ational "hera#y& MA##B$%A$u#un$ture&
)ate !or:s #art time in #ri<ate #ra$ti$e, usin8 a$u#un$ture and o!en "hera#y in
-arrnambool, Australia( Bhe also de<otes time to resear$h and de<elo#ment(
AB'TA$T5 "his arti$le re<ie!s the $urrent #rofession of o!en "hera#y( 1t $onsiders the
history of the o!en te$hnique and the for$es !hi$h ha<e influen$ed its de<elo#ment to date(
"he arti$le outlines some of the issues rele<ant to the o!en "hera#y #rofession as a !hole( 1t
also $onsiders !hether there is a #hiloso#hi$al basis underlyin8 the te$hnique and !hether
holisti$ #atient assessment #ro$esses are rele<ant to the #rofession( Cuture dire$tions and
$hallen8es are outlined(

"(1INITI!N
o!en "e$hnique is any thera#euti$ a##roa$h to body !or: !hi$h is based u#on the $lini$al
!or: of Mr "homas Ambrose o!en( 1t des$ribes an in$reasin8 number of a##roa$hes, ea$h
based on the $on$lusions and inter#retations of #arti$ular indi<iduals !ho obser<ed o!en %or
subsequent thera#ists !ho had some form of o!en trainin8&( .hara$teristi$ally, o!en
"e$hnique in<ol<es unique rollin8 mo<ements o<er soft tissue, #erformed at #re$ise lo$ations on
the body( 1t is said to be effe$ti<e in brin8in+ relief to mus$ulo-s:eletal #roblems, su$h as sore
ba$:s=1>, ne$:s and limbs(=2> 1t has also said to be effe$ti<e in treatin8 internal #roblems su$h as
hay fe<er=3>, stress=H> and mi8raines(=5>

10
INT!"#$TI!N
5$tober, 23, 2012, mar:ed the thirtieth anni<ersary of the #assin8 of "homas Ambrose o!en(
0e is said to be the founder of the ;o!en "e$hnique9, a #o#ular soft tissue thera#y !hi$h is
:no!n !orld!ide(=4> "his si8nifi$ant anni<ersary #ro<ides an o##ortune time for the #rofession
to refle$t on its #ast and ma:e a #lan for the future(
At the time of his death, there !as no ;o!en "e$hnique9K o!en himself !as an unre$o8nised
manual thera#ist !or:in8 in his o!n $lini$, usin8 a unique treatment method( "he term ;o!en
"e$hnique9 !as not $oined until se<eral years after his #assin8(
o!en "e$hnique has been deli<ered to us by a handful of thera#ists, ea$h of !hom de<elo#ed a
#ersonali7ed inter#retation of the methods they sa! o!en a##ly !hile obser<in8 him in his
$lini$( 1t seems that one of these inter#retations alone has so far defined the #ubli$9s
understandin8 of o!en9s a##roa$h to body!or:(

P(4A&(N$(
o!en "e$hnique is no! #ra$tised in thirty $ountries and tau8ht in more than t!enty(=7> "here
is a $om#rehensi<e net!or: of trainin8 fa$ilities and self-a$$redited tea$hers and s$hools, and at
least one 8o<ernment re$o8nised s$hool in Australia(=3> Althou8h :no!n #rimarily as o!en
"e$hnique, there is a myriad other names by !hi$h <ariations of the te$hnique are :no!n( Bome
of these are o!en "hera#y, Cas$ial "hera#y, Bmart o!en, Cas$ial )ineti$s, *euro-stru$tural
1nte8ration %*B"&, Cas$ial o!en, o!en!or: and #robably other names as !ell( 1n 2002 there
!ere o<er 24,000 #ra$titioners !orld!ide(=2> "he te$hnique9s #o#ularity is #robably due to the
fa$t it is fairly sim#le to learn, easy to a##ly and is frequently effe$ti<e as thera#y(

HI'T!I$A& A'P($T'
o!en left no formal trainin8 notes about the ty#e of thera#y he #ra$tised( "o understand and
define it, !e must rely on a$$ounts of the #eo#le !ho $laim to ha<e !at$hed him !or:( 1t is
!idely a$:no!led8ed that at least si? men $laim to ha<e done so o<er the t!enty-three years he
!as in #ra$ti$e %1252-1232&( 1nterestin8ly, ea$h of the men !ho obser<ed him de<elo#ed a
different inter#retation of his !or:K #erha#s due to differin8 edu$ational ba$:8rounds, differin8
time #eriods of obser<ation or other un:no!n fa$tors( 5ne of these men, 5s!ald 6ents$h, has
tau8ht his inter#retation !idely, !hilst others ha<e tau8ht only a handful of #ra$titioners( "he
result is that a o!en industry has emer8ed but most #ra$titioners ha<e had a$$ess to only one of
the inter#retations of o!en9s !or:(
6ents$h obser<ed "om o!en at !or: in the mid-se<enties( 0e !as also res#onsible for ta:in8
o!en "e$hnique to the !orld at lar8e(=10> Bin$e 123H he has tau8ht trainees to a##ly a
systemati7ed ;re$i#e9 <ersion of ;o!en "e$hnique9( "he o!en industry at lar8e has ado#ted
6ents$h9s inter#retationK ho!e<er, other inter#retations of o!en9s !or: ha<e not been !idely
a<ailable( "o date, most of the #ublished authors and treatin8 #ra$titioners of o!en "e$hnique
are usin8 6ents$h9s a##roa$h( 5n 6ents$h9s early tea$hin8 notes that !ere distributed in 1237,
the !ords ;o!en "e$hnique @ an inter#retation by 5s!ald 6ents$h9,=11> !ere #rinted on ea$h
#a8e( 5<er time these #rinted !ords ha<e disa##eared and $urrent tea$hin8 manuals use the
#hrase ;"he 5ri8inal o!en "e$hnique9(=12> oth #hrases a$:no!led8e the e?isten$e of other
inter#retations of o!en "e$hnique(
At least t!o of the si? men !ho obser<ed o!en do not use this re$i#e style a##roa$h( "hey use
a style of o!en "e$hnique in !hi$h treatment is a##lied based on a holisti$ assessment of the
$lient, and is tar8eted to s#e$ifi$ dysfun$tion, in a$$ordan$e !ith indi<idual #resentation( 1n
11
addition to ma:in8 a holisti$ assessment, they a##ly the "e$hnique in a holisti$ manner,
in<ol<in8 a re$o8nition of interrelationshi#s e?istin8 !ithin the body( "hey also use
reassessment te$hniques to measure the effe$ti<eness of their treatments as they a##ly them(
Auestions are no! bein8 #osed re8ardin8 the basi$ assum#tions of those tea$hin8 the #o#ular
re$i#e style of the te$hnique( 6omney Bmeeton, a $hiro#ra$tor, and one of o!en9s obser<ers in
the se<enties and early ei8hties, !rites
;1 should state 1 am at odds !ith mu$h of the $urrent tea$hin8s of o!en9s !or:, #rimarily
be$ause they la$: a system of indi<idual assessment and are nearly all based on a systemati7ed
use of standardised re$i#es and this !as not o!en9s a##roa$h9(7
)e<in 6yan, an osteo#ath, and another of o!en9s obser<ers, told the "CA %o!en "hera#ists
Cederation of Australia& $onferen$e in 1223 that
;"om o!en ne<er did a mo<e unless he had an e?#e$tation of !hat effe$t it !ould #rodu$e(9
1nterestin8ly, a$$ordin8 to the trans$ri#t of #ro$eedin8s on the .ommittee of 1nquiry into
5steo#athy, .hiro#ra$ti$ and *aturo#athy, in 1273, "om o!en said, ;1 a<era8e 45 #atients #er
day9(=13> "his allo!ed him around fi<e or si? minutes for the treatment of ea$h #atient( "he
re$i#e style of treatment !idely tau8ht today $annot be a##lied in this time frame( 1t is $lear that
o!en did not routinely a##ly a re$i#e a##roa$h(

P!1(''I!NA& I''#('
"he Australian "raditional Medi$ine Bo$iety has re$o8nised o!en "hera#y as a le8itimate
modality of #ra$ti$e for its members, sin$e +e$ 2011(=1H> 5<er the last t!o de$ades, a number
of o!en "e$hnique Asso$iations ha<e formed !hi$h ha<e different 6e8ulations and .odes of
Lthi$s and ser<e their members in <arious !ays, su$h as throu8h 8o<ernment ad<o$a$y and
#oli$y formulation( 0ealth fund rebates are no! #ro<ided in Australia for treatments offered by
members of re$o8nised o!en "hera#y Asso$iations( 1t !ould seem that the o!en "e$hnique
has matured and 8ro!n u#O ut has itD
,- &ac6 of #nderlying Philosophy:
1n re8ard to <arious inter#retations of the re$i#e <ersion of o!en "e$hnique, there seems to be
a la$: of basi$ theory and #hiloso#hy !hi$h many !ould $onsider <ital to any #rofession( "he
majority of those !ho based their #rofessional a##roa$h on o!en9s !or: $laim he utilised a
holisti$ a##roa$h, not a sym#tomati$ one(
.om#eten$e in any #rofession de#ends u#on an understandin8 of the theory that underlies it(
=15> Cor most health #rofessions, underlyin8 #hiloso#hy and #rin$i#les 8uide $lini$al #ra$ti$e,
yet this does not a##ear to be the $ase !ith re8ard to the #ra$ti$e of o!en "e$hnique( Perha#s
this la$: of theory and #hiloso#hy, ho!e<er, is only a #roblem if !e !ish to #er$ei<e o!en
"e$hnique as a holisti$ thera#y in its o!n ri8ht, rather than a set of sym#tomati$ treatments( 1f
the #rofession is to #ro8ress, it needs to $larify its #rin$i#les and theories in order to 8uide its
de<elo#ment(
.- &ac6 of Holistic Assessment:
Many o!en "hera#ists $an and do #erform assessments of isolated mus$le 8rou#s or indi<idual
joints, li:e a #hysiothera#ist or a myothera#ist( "hese assessments are hel#ful in #ro<idin8 a
baseline le<el of fun$tion from !hi$h to measure #ro8ress, but they do not embra$e holisti$
#rin$i#les, or en$oura8e thera#ists to <ie! the body as an interrelated !hole( A holisti$
assessment is one that assesses the body for areas of dysfun$tion from a systemi$ <ie!#oint(
"he fe! o!en "hera#ists !ho do use su$h an a##roa$h $laim it enables the o!en treatment to
be tar8eted and 8oal-dire$ted(7
12
Cirst #rin$i#les are the fundamental assum#tions on !hi$h a #arti$ular theory or #ro$edure is
thou8ht to be based( Ado#tin8 and a##lyin8 su$h #rin$i#les may hel# the #rofession to $larify
the 8oal of the o!en "hera#ist( "he #rofession $ould $onsider the follo!in8 questions: 1s
o!en "e$hnique a holisti$ thera#y in its o!n ri8ht, or is a sym#tomati$ treatment, or is it both,
de#endin8 on ho! it is usedD -ould embra$in8 a holisti$ model of #atient assessment assist in
obtainin8 better $lini$al out$omesD

/- "isintegration:
"he 8ro!th of the #rofession o<er the last thirty years has been $hara$terised by indi<idual
moti<ation, !here #ortions of the te$hnique ha<e been se$tioned off, #atented and sold to the
#ubli$ under differin8 names( "his fra8mentation has hindered the ability of the #rofession to
de<elo# further be$ause ea$h s#linter 8rou# attem#ts to $reate a different ;identity9 for the
te$hnique(

"I'$#''I!N
,- "oes an appropriate philosophical framewor6 already exist7
"he #rofession may ha<e already been e?#osed to a #hiloso#hy and basi$ #rin$i#les( "hese
#rin$i#les to date ha<e not been tau8ht e?tensi<ely as #art of the o!en "e$hnique edu$ation
and this may be to the detriment of the de<elo#ment of the #rofession( Lmbra$in8 them !ill also
hel# establish the #hiloso#hi$al ba$:8round and $ement the foundation of the treatment
te$hnique as a !hole( ,uidin8 #rin$i#les may also hel# the thera#ist !hen treatment is not
#ro8ressin8 as e?#e$ted(
"hese #rin$i#les are not ne!K they are borro!ed from the osteo#athi$ #rofession( o!en
des$ribed himself as an osteo#ath, and sou8ht re$o8nition for the !or: he did from the
5steo#athi$ oard at the time(=14> "he underlyin8 #rin$i#les of osteo#athy are
1( "he human body fun$tions as an inte8rated, interrelated !hole unit
2( Btru$ture and fun$tion share a re$i#ro$al relationshi#
3( "here e?ists in the human body an innate $a#a$ity for self re8ulation and healin8
4. "hera#euti$ inter<ention is based u#on an understandin8 of these three #oints=17>

1t is $lear that o!en embra$ed these #rin$i#les(

.- Are holistic assessment techni+*es relevant7
1n the !orld of remedial body!or:, re8ardless of modality, most thera#euti$ inter<entions are
a##lied in res#onse to #atient assessment( A$ross all #rofessions, assessment forms an
in<aluable tool to 8uide treatment sele$tion and a##li$ation( Most assessment te$hniques are
8eneri$K they are rele<ant to all $orre$ti<e thera#y be$ause they #ro<ide im#ortant information
about the #atient9s $ondition, as !ell as the res#onse to treatment( '# to no!, most o!en
thera#ist ha<e a##lied a standardised thera#y to e<ery #atient, inde#endent of holisti$
assessment, lar8ely due to a la$: of edu$ation in this area( Most re$ently ho!e<er, the
#rofession of o!en "hera#y is bein8 $hallen8ed to address the inherent la$: of holisti$ #atient
assessment( 1f the o!en "e$hnique is a holisti$ thera#y should it not embra$e holisti$
assessment methodsD

/- "isintegration
13
"he disinte8ration to so many <ariations of o!en "hera#y has resulted in the te$hnique itself
bein8 hard to define( "he #rofession itself la$:s dire$tion sin$e it $annot a8ree amon8st the
differin8 #arties on basi$ elements about, for e?am#le !hether to ;:ee# it #ure9 or to #ro8ress
and de<elo# !ith resear$h(

I)P&I$ATI!N'
y utilisin8 the re$i#e a##roa$h to treatment, some o!en "e$hnique #ra$titioners may be
i8norin8 the <ery #rin$i#les u#on !hi$h the te$hnique is founded( A##lyin8 the re$i#e style of
treatment is a sym#tomati$ a##roa$h: no holisti$ assessment is required and the thera#ist
administers the same treatment to ea$h $ase, re8ardless of the #resentin8 #roblem( At least t!o
#eo#le !ho obser<ed o!en at !or: dis#ute this a##roa$h( 1n their inter#retation of his !or:
they ma:e a holisti$ assessment first, then, on the basis of their findin8s, they administer an
a##ro#riate o!en treatment(

1#T#( "I($TI!N'
"his arti$le has outlined some #rofessional issues and #roblems for the #rofession to $onsider( 1s
it time to formally ado#t a #hiloso#hy and embra$e a set of 8uidin8 #rin$i#lesD 1s it time for the
#rofession of o!en "hera#y to ado#t holisti$ assessment te$hniquesD 1s it time for the different
o!en thera#y 8rou#s to $ome to8ether and !or: for the benefit of the #rofession as a !hole(
-ould these $han8es ultimately hel# ea$h #ra$titioner a$hie<e better $lini$al out$omesD
1t is $lear the o!en "e$hnique is a treatment te$hnique that is here to stay( .lassi$al
astrolo8ers refer to the ;6eturn of Baturn9 !hen the #lanet Baturn has made one orbit around the
earth and returns to the #osition it !as in !hen that #erson or idea !as born( 1t is the insti8ator
of $han8e and a $rossroad #eriod !hen life alterin8 de$isions are made( -ith the first Baturn
return, a #erson lea<es youth behind and enters adulthood( 1t ta:es about t!enty nine and a half
years to o$$ur(=13>
As !e a##roa$h the thirtieth anni<ersary of o!en9s #assin8, is it time these issues !ere
addressedD

6eferen$es
=1> Marr M, Fambon *, a:er G( Lffe$ts of o!en "e$hnique on fle?ibility le<els: im#li$ations
for fas$ial #lasti$ity( Gournal of ody!or: E Mo<ement "hera#ies( 2003 5$tK 12%H&: 333(

=2> .arter ( A Pilot Btudy to e<aluate the effe$ti<eness of o!en "e$hnique in the
mana8ement of $lients !ith fro7en shoulder( .om#lementary "hera#ies in Medi$ine( 2001 +e$K
2%H&:203-15(
=3> o!en for 0ayfe<er( Positi<e 0ealth Publi$ations( 2003 GunK%1H&:7 A<ailable from:
Lbs$ohost(

=H> +i$:er A( 'sin8 o!en thera#y to im#ro<e staff health( "he Australian Gournal of 0olisti$
*ursin8 2001 A#rilK 3%1&:33-H2(

=5> ,odfrey G( .ase Btudies( Positi<e 0ealth Publi$ations( 2005K103:50-51(A<ailable from
Lbs$ohost(

=4> Palmquist B( o!en "e$hnique( Massa8e Ma8a7ine( Gan 2004K %112&:73-30(
14

=7> Pennin8ton ,( A "e?tboo: of o!en "e$hnique- A .om#rehensi<e ,uide to the Pra$ti$e of
o!en "e$hnique( Melbourne: ar:er +eane Publishin8K 2012(

=3> "he order .olle8e of *atural "hera#ies(=1nternet> 2003 =$ited 2012 Gun 4> a<ailable from
htt#:PP!!!(.*"(net(au(

=2> 6ents$h 5( =1nternet> 2002 =$ited 2012 Be#tember 12> a<ailable from htt#:PPbo!te$h($om(

=10> Btammers ,( o!en "hera#euti$ "e$hnique( Gournal of the Australian "raditional
Medi$ine Bo$iety(1224 5$tK 2%3&:35-34(

=11> 6ents$h 5( "he o!en "e$hnique @ an inter#retation by 5s!ald 6ents$h, yadu:
%Australia&1237(

=12> ( 6ents$h 5, 6ents$h L( o!te$h @ "he 5ri8inal o!en "e$hnique 1nstru$tion Manual,
yadu: %Australia& 2007(

=13> /i$torian ,o<ernment" A "rans$ri#t of Pro$eedin8s before the 5steo#athy, .hiro#ra$ti$
and *aturo#athi$ .ommittee( /i$torian ,o<ernment Printer, Melbourne 1273(

=1H> oylan M( A"MB Cormally 6e$o8nises Cour *e! Modalities( Gournal of the Australian
"raditional Medi$ine Bo$iety( 2011 +e$K 17 %H&: 255-4(

=15> onifa$e ,, Beymour A( 'sin8 5$$u#ational "hera#y "heory in Pra$ti$e( *e! Gersey
%'BA&: Gohn -iley E BonsK 2012(

=14> /i$torian ,o<ernment 0ealth +e#artment" A "rans$ri#t of Pro$eedin8s before the
5steo#athy, .hiro#ra$ti$ and *aturo#athi$ .ommittee( /i$torian ,o<ernment Printer(
Melbourne( 1273(

=17> Btill A("( "he Philoso#hy of 5steo#athy( )ir:s<ille: A" BtillK 1322(

=13> Arroyo B( Astrolo8y, )arma and "ransformation( .alifornia: .6.B Publi$ationK 1222(

Boo6 eview )ay .8,/ 9BTPA:
Published on May 17, 2013 11:02 #m
15
"he follo!in8 inde#endent re<ie! !as #ublished in, 91n "ou$h9, the in-house journal of the
o!en "hera#y Professional Asso$iation %"PA& @ '()(
A review of ;A Text<oo6 of Bowen Techni+*e Graham Pennington=
By
"avid Howells > %athryn Phillips
-hen 1 !as first as:ed to re<ie! ,raham9s boo: 1 felt it needed to $ome not just from me as
someone !ho has #ra$ti$ed the te$hnique in its <arious forms sin$e 122H but also in#ut from a
ne! $on<ert to the te$hnique( 0a<in8 been introdu$ed to )athryn Philli#s at a 61, meetin8 1
thou8ht her <ie!s !ere just as <alid as mine and an ideal #ra$titioner to re<ie! his boo:(
1 !as lu$:y enou8h to re$ei<e the first $o#y of this boo: in the ') as it !as deli<ered to me by
hand from 6on Phelan hot off the #ress(

A +*ic6 review <y %athryn Phillips:
As a relati<e ne!bie to o!en, althou8h not to $om#lementary thera#y on !hi$h 1 ha<e been
amassin8 :no!led8e for almost t!o de$ades, ,raham Pennin8ton9s boo: !as a !el$ome
addition to my 8ro!in8 library of resour$es( 1 ha<e been a<idly tryin8 to absorb as mu$h
information as 1 $an about this <ery s#e$ial te$hnique sin$e first bein8 as:ed by my refle?olo8y
$lients to $onsider addin8 o!en to my re#ertoire: 1 qualified in 2012, treat 1-2 do7en $lients #er
!ee:, and am no! trainin8 in and usin8 *B" o!en in my $lini$ to e?tend my :no!led8e and
understandin8 yet further(
-ithin moments of o#enin8 it, it !as $lear that a $onsiderable amount of time had been s#ent on
ensurin8 a de#th of inde?in8 !hi$h most thera#y boo:s do not $ome e<en $lose to( As an
information and resear$h s#e$ialist of more than three de$ades this is a :ey issue for me as 1 need
to be able to a$$urately and qui$:ly di# in and out of boo:s to re<isit #oints 1 remember readin8
#re<iously( L<en more im#ortant !hen the reason 1 need to double-$he$: somethin8 is be$ause a
$lient is on the table in the other room and 1 really !ant to be able to hel# them to the best of my
ability ri8ht no!O
*ot only is s#e$ifi$ information mu$h easier to find than in many other boo:s in this field, but
also the dia8rams, illustrations and narrati<e are all e?tremely $lear and detailed su$h that 1 ha<e
felt $onfident to $arry out ne! and s#e$ifi$ assessments and #ro$edures !ithout ha<in8 been
formally tau8ht them in a $lassroom settin8( "he first one 1 tried !as the #soas #ro$edure !hi$h
!as an ama7in8 e?#erien$e for me as the $lient had been ma:in8 8reat #ro8ress e?$e#t in this
one area( My #al#ation and the $lient9s immediate feedba$: both $oin$ided, 1 made the mo<e
!ithout hesitation, de<iation or re#etition and the $lient had im#ro<ed $onsiderably at his ne?t
a##ointment some !ee:s later(
16
"hat most, but not all, established o!en mo<es $oin$ide !ith traditional .hinese medi$ine
%".M& a$u#ressurePmeridian #oints, their si8nifi$an$e :no!n for thousands of years, had been a
fas$ination for me from the outset 8i<en my #re-e?istin8 understandin8 of refle?olo8y !or:(
"hat some mo<es #otentially need a sli8ht adjustment to ma?imise su$$ess is hi8hli8hted in this
boo: !ith reasons 8i<en( As someone !ho !as already ;feelin89 for s#e$ifi$ refle? #oints and
monitorin8 res#onse 1 had found that o!en mo<es did not al!ays 8i<e me the feedba$: 1 !as
used to !ith refle?olo8y( "o me modifyin8 the #osition of some of the mo<es sli8htly, su$h as
those of the "MG as des$ribed in ,raham9s boo:, 8a<e me the res#onses 1 had been missin8 and
in$reased their effi$a$y albeit that 1 a$$e#t that the body !ill frequently ;read the intent9 of a
8ood thera#ist e<en if the mo<e is sli8htly off the mar:(
"o me ,raham9s boo:, $omin8 from the #ers#e$ti<e of a o!en thera#ist !ho is also an
a$u#un$turist, hel#s to e?#lain and illustrate the si8nifi$an$e of this o<erla# bet!een o!en and
".M and in doin8 so e?#lains mu$h about the $onsequen$es asso$iated !ith the <arious mo<e
ty#es: the s#e$ifi$ dire$tion of rollin8 mo<es, the stret$hin8 of $ertain mus$les, the use of trauma
to stimulate neural #oints and so on( "hat lateral mo<es ty#i$ally o#en u# $hannels, !hilst
medial mo<es blo$: ener8y, is :ey to $om#rehendin8 ho! o!en te$hnique !or:s( 1f a thera#ist
understands not only wht they are doin8 but more im#ortantly wh! then they be8in to treat more
effe$ti<ely but e<en more im#ortantly they $an be8in to $onfidently omit or amend mo<es to suit
the individu( bein8 treated(
1n summary 1 found that ,raham9s boo: ans!ers many of the questions !hi$h for me had been
burnin8 for some time and e?#lains others !hi$h 1 had not yet thou8ht of as:in8( As someone
ne! to o!en this is a boo: to :ee# to hand in $lini$ and $url u# !ith in s#are moments as it !ill
$ontinually remind and inform @ its inde? ideal to enable the busy #ra$titioner to di# into
!hene<er the need arises(

An even +*ic6er review <y "avid Howells:
My first thou8ht on seein8 ,raham9s boo: !as one of 8reat admiration for su$h a mammoth tas:
underta:en o<er many years(
0is boo: is !hat it says on the $o<er, IA te?t boo: of o!en "e$hnique, a $om#rehensi<e 8uide
to the #ra$ti$e of o!enJ and as su$h it is a 8reat aid to learnin8 for students and e?#erien$ed
#ra$titioners ali:e(
1 feel he has ta:en the basi$ !or: as !e :no! it and #resented it in a !ay that all students of
o!en $an re$o8nise and relate to immediately( 1t 8oes mu$h further and adds in basi$
assessment !hi$h is required most $ertainly( 5ne $ould de<ote a !hole boo: and !or:sho# to
this area %!hi$h 6on Phelan has done&( 1 a8ree !ith his $omment that in the main students of
o!en ha<e been tau8ht by route and a##ly $ertain basi$ #roto$ols to e<eryone( -e :no! that
"om did not !or: this !ay( 1f !e $onsider his a<era8e time !ith a $lient !as 5 -3 minutes and
he treated 45 $lients a day( 0e assessed, treated and reassessed in a $ou#le of mo<es( 0o!e<er,
none of us are "om o!en althou8h !e do try to attain a 8reater le<el of understandin8 and
17
a##li$ation of the "e$hnique( 1n fa$t the "oms of this !orld only $ome alon8 on$e in a lifetime(
"hat said there has to be a startin8 #oint and a #ro$ess of learnin8 so that students of o!en $an
then 8o on throu8h further study to im#ro<e their assessment and treatment s:ills( As !e loo:
to!ards more re8ulation in this $ountry and abroad !e need to ta:e on board ,raham9s <ie! of
assessment #rior to treatment( "his 1 ha<e al!ays ad<o$ated and 1 in$lude basi$ assessment !ith
my tea$hin8(
"he rele<an$e of A$u#un$ture to o!en has been tal:ed about for years( A$u#un$turists that
ha<e underta:en o!en trainin8 8et <ery e?$ited !hen learnin8 the te$hnique( ,raham9s
:no!led8e of ho! "om studied !ith Lrnie Banders and that the te$hnique is based on Ga#anese
A$u#oint thera#y $onfirm my o!n thou8hts(
1n $on$lusion it is e<ident a 8reat deal of thou8ht, resear$h and $ommitment to o!en has 8one
into this !or: as )athryn says ;the boo: is $omin8 from the #ers#e$ti<e of a o!en "hera#ist
!ho is also an a$u#un$turist !hi$h hel#s to e?#lain and illustrate the si8nifi$an$e of this o<erla#
bet!een o!en and ".M( ,raham9s :no!led8e of o!en is unquestionableK he #resents it in a
<ery $on$ise !ay !ith 8reat illustrations and a 8ood inde?in8 system(
1 !ould re$ommend that e<ery student and qualified #ra$titioner read his <ie! on the o!en
"e$hnique not only is it informati<e on many le<els but $hallen8es o#inion and allo!s for
dis$ussion( ,raham is not afraid to lin: u# !ith other #ra$titioners and $ross #ollinate ideas and
theories relatin8 to the "e$hnique( "his 1 feel !e all need to en$om#ass as e<ery o#inion is <alid(
1 !ould li:e to $on8ratulate ,raham on #rodu$in8 su$h a <aluable tool that !ill be of 8reat
benefit to o!en #ra$titioners !ho li:e "om o!en ha<e their $lient9s health at heart(

18