Autumn Issue 2004 No. 108
The Bowen Technique - Treatment of shoulders
by Julian Baker
There can be little more generalised in terms of a diagnosis as 'Frozen Shoulder.' The term is often enough to strike dread into the hearts of even the most experienced physical therapist, encompassing as it does so many possibilities, both in terms of aetiology as well as treatment.
Blacks Medical dictionary defines a frozen shoulder as "a painful complaint of the shoulder, accompanied by stiffness and considerable limitation of movement....". It continues in this vein, coming to the conclusion that spontaneous remission is the general outcome, "although this might take in excess of 18 months."!
As it stands, Bowen therapists tend to like the presentation of a classic frozen shoulder, as it often gives a faster outcome than other, even apparently more simple, cases. The key to why Bowen is so effective lies in the principles of how Bowen differs from many other approaches and it's worth outlining what Bowen is all about before continuing.
The Bowen Technique is named after Australian body worker Tom Bowen. An untrained therapist who worked out of a house in Geelong, Victoria, Tom Bowen was credited with treating upwards of 12,000 patients per year and referred to himself as an osteopath. He showed few others his methods, but six men were given access to some of his work, and after Bowen's death in 1982 the teaching of some of his techniques began.
The work is very subtle, using fingers and thumbs to work over soft tissue and applying very little pressure. The effect of the Bowen move is to create a gentle disturbance in the underlying fascia, which in turn prompts a central nervous system response.
There are many variations of Bowen's approach that have sprung up over the years, some of which apply a great deal more pressure than others, but many of the principles remain the same. The move itself involves the movement of 'skin slack' prior to the application of pressure to the structure. The move is then made in opposition to the direction of the skin slack and is a rolling type of action, made with sufficient pressure to create the disturbance, but without allowing the muscle to flick.
Another feature of the technique is the addition of breaks in between sets of moves, where the practitioner leaves the room (where appropriate) and allows the work to start the process. This is an important feature which has a big effect on the outcome of the work, and enables the experienced therapist to vary the moves being performed according the changes that are taking place.
Although most of the moves are performed with patients either prone or supine, a significant number, the shoulder amongst them, are performed with the client sitting or standing. There are many approaches that the skilled Bowen therapist can take with a shoulder condition, but pretty much all of them start with the very simple deltoid moves, which will be described later.
From the perspective of the Bowen therapist there are three considerations when working with a shoulder. The first is the presentation of a specific shoulder problem, where a therapist can work locally in the region of the shoulder very simply and usually to good effect. For this approach to be as effective as it should be, it is important to establish that there are no other causes or reasons as to why the shoulder is restricted or in pain.
Imbalances or problems in the Temporo Mandibular Joint, whiplash, or other cervical problems might lead to this state of affairs and even issues involving the diaphragm or respiratory system will have an effect on shoulder and ROM.
For the most part we are referring here to chronic conditions of the shoulder, which have probably been treated previously with traditional techniques, possibly even surgery but which have not responded fully.
In the case of an acute shoulder injury, this is where Bowen really comes into its own. It is rare that we need to spend more than two or three sessions, one week apart with an acute shoulder, providing rest is given and there is no tearing.
It is widely felt among existing converts to the technique, that Bowen is probably the most effective tool currently available for acute injuries, especially given that due to its gentleness, treatment can be offered immediately following injury.
Typical sporting injuries Grade 1 or 2 sprain in the acromioclavicular joint or even the glenohumeral joint can be treated immediately and to excellent effect and experience has suggested that the early treatment of these conditions, reduces the incidence of future dislocation.
The second element is the consideration of the shoulder in treating other areas of the arm, neck and shoulder. The brachial plexus is a major element in this area and conditions such as carpal tunnel, and even tennis elbow can be effectively helped prior to localised treatment by working the shoulder area.
Brachial plexus is a nerve bundle all too often overlooked when addressing shoulder and arm conditions and yet, in my experience, provides the solution to a lot of referred problems.
The third is the concept of fascia[ connections through and over the shoulder area and down the level of the pelvis and hips, thereby affecting knees on the opposite side to the presenting shoulder. This idea of the fascia) connection has been explored brilliantly by Tom Myers, in his book Anatomy Trains.
The initial Bowen treatment for a shoulder problem will involve addressing many of these areas through the initial basic procedures. The patient will be laid prone and a series of moves made through both the lower and upper back.
An important focus for the practitioner will be ensuring the release of levator scapula. It can often be all too easy to be drawn into working specific areas of pain, but it's worth remembering that the deltoid only functions in harmony with the normal movement of the scapula.
With its attachment to the superior medial angle of the scapula and with the role of elevating and rotating the scapula, working the levator gives the rest of the structure the opportunity to re-establish normal movement.
Another standard Bowen move is over the supraspinatus, a small muscle which provides a huge amount of power to the deltoid and which is innervated by a branch of the brachial plexus. Two medial Bowen moves from its lateral aspect, can have a big effect on the pain that is often felt into the middle of the deltoid on abduction.
Once the surrounding areas of the shoulder have been addressed, the actual shoulder itself is then treated, with the patient either standing or sitting. The classical shoulder move varies from most of the other moves in the Bowen repertoire, as it is made with the arm in movement.
Traditionally and preferably, the move is made with the assistance of another person, who will hold and carry the arm across the body, whilst the therapist is concentrating on the movement at the posterior border of the deltoid. This however is often impractical and the move can easily be adapted to a single-handed technique.
The first move is found by following the line of the axillary crease posteriorly until a dip is found at the back of the shoulder. Accuracy is very important here, as the margin for error when working the shoulder is very small.
The position of this move is a major muscular junction for the shoulders and upper body and, if in the right place, takes in not only the deltoid, but also the long head of the triceps, infraspinatus and teres minor.
If working with an assistant, the move is made with the thumbs, whilst the assistant carries the arm across the body, ensuring that the arm is as relaxed as possible. The solo move requires a lot of concentration from the operator, to not only ensure that the move is made properly, but that the client is relaxed and that the arm is in the correct position, 450 from the body, with the elbow at chest or breast height.
The arm is pushed towards the opposite shoulder, creating a tension through the entire shoulder girdle, at which point the therapist jars the mid deltoid area with the heel of his or her hand. This creates a reverberation through the structure and also jars the axillary nerve.
The arm is then carried carefully back to its original position, where again it is checked to ensure it is relaxed. A move across the anterior border of the deltoid, still following the line of the axillary crease is made with fingers or thumbs. This move not only works the deltoid, but on a deeper level subscapularis and coracoacromial ligament.
Once perfected, these moves take only a few seconds to perform after which the standard rest time of three to five minutes is given before re-assessing the shoulder.
The moves can be performed a second time, but care needs to be taken so as not to further inflame the shoulder. The results can often be quite startling, with even long standing 'frozen' shoulders responding within five or ten minutes.
In one case a gentleman who volunteered to be demonstrated on, had 100% relief from a very restricted shoulder, which had been present for over eight years.
A study into the effect of The Bowen Technique for 'Frozen' Shoulders looked at 100 volunteers with nonspecific, gradual onset shoulder pain.
They were each given four treatments with half the group being given Bowen and the other half a specific hands on placebo treatment. The groups were not told which was which, but the treated group reported considerably greater improvement than the placebo.
Average improvement for abduction was 40% and horizontal abduction 28% percent. Overall 67% of the treatment group improved with their degree of improvement 'statistically significant.'
It's worth pointing out that this study gave no form of exercises and adhered strictly to a proscribed set of moves, irrespective of other factors already mentioned, which might have impacted on their condition as compliance and other factors would have impacted greatly on the outcomes.
The Bowen Technique was introduced to the UK only eleven years ago, and yet in that short space of time has had a big influence in the field of soft tissue therapies. Regarded originally as a complementary therapy, it is fast becoming the therapy of choice for many physiotherapists.
Annie Sewart a private physiotherapist based in Bristol, has been using Bowen for over six years. As well as practicing reflexology and aromatherapy she claims that she has received the best results using Bowen estimating an overall success rate of 80%.
There are of course hundreds of additions to even this one procedure and it is important to remember that Bowen is not simply a series of procedures, but a system of bodywork, with a set series of principles, but literally millions of variations. We simply have to decide'Where do we start?'
Autumn Issue 2004 No. 108
by Julian Baker