RELAXATION
A Bowen treatment is very relaxing.
It is mostly performed with the person lying on a treatment couch, although Tom Bowen (the originator of the work) provided beds in his clinic, order to encourage a sense of deeper relaxation.
HOLISTIC HEALING
The Bowen Technique embodies a truly holistic approach to healthcare. It is concerned not just with treating specific conditions and symptoms, but also with encouraging a natural potential for health to express itself in every aspect of the patient's life.
TIME OUT

A unique feature of the Bowen Technique is the frequent pauses between each series od moves. These are given to allow the body to respond and integrate what is being done. During these pauses, the therapist will usually leave the room.
This lets the person relax without feeling that they have to keep up a conversation ot that they are being watched.
BOWEN EFFECTS
Bowen therapists sometimes talk about the different effects on posture, particularly 'ascending' and 'descending' influences. The key to effective treatment is to find where the original organising factor in someone's condition is located. For example, a knee injury might be due to a weak toe joint or a pelvic imbalance that is putting undue strain on a knee as that person walks. Similarly, headaches may be the result of an old fall on the tailbone.

Using Bowen Therapy to Treat Chronic Inflammatory Demyelinating Polyneuropathy

Bowtech, the original Bowen Technique, is a gentle form of body work in which very subtle moves performed over the muscles and connective tissue send messages deep into the body, retrieving cellular memory of a preferred, relaxed, balanced way of wellbeing. The technique addresses not only the musculo-skeletal framework, but also the fascia, nerves and internal organs.*1
Because of the nature of CIDP and the effect on the peripheral nervous system, the benefits of the use of fascia in Bowen Therapy to transmit messages to the brain are tantamount to recovery since the normal nerve pathways in a CIDP sufferer are damaged.

Chronic inflammatory demyelinating polyneuropathy (CIDP)

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder, which is sometimes called chronic relapsing polyneuropathy, is caused by damage to the myelin sheath (the fatty covering that wraps around and protects nerve fibres) of the peripheral nerves. Although it can occur at any age and in both genders, CIDP is more common in young adults, and in men more so than women. It often presents with symptoms that include tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart of that acute disease.
Treatment for CIDP includes corticosteroids such as prednisone, which may be prescribed alone or in combination with immunosuppressant drugs. Plasmapheresis (plasma exchange) and intravenous immunoglobulin (IVIg) therapy are effective. IVIg may be used even as a first-line therapy. Physiotherapy may improve muscle strength, function and mobility, and minimize the shrinkage of muscles and tendons and distortions of the joints.
The course of CIDP varies widely among individuals. Some may have a bout of CIDP followed by spontaneous recovery, while others may have many bouts with partial recovery in between relapses. The disease is a treatable cause of acquired neuropathy and initiation of early treatment to prevent loss of nerve axons is recommended. However, some individuals are left with some residual numbness or weakness.*2

Immune cells attack the myelin sheath, a fatty substance which insulates and protects the nerve fibres, and assists with the passage of impulses throughout the nervous system. The myelin sheath speeds up the transmission of signals over long distances. When the myelin sheath is damaged, messages from the brain are slowed or blocked completely. The muscles begin to lose their ability to respond to the brain’s commands; commands that must be carried through the nerve network. The brain also receives fewer sensory signals from the rest of the body, resulting in an inability to feel textures, heat, pain and other sensations. Alternatively (as is the case with CIDP), the brain may also receive inappropriate signals that result in tingling, “crawling skin”, or painful sensations.*3

CIDP is a chronic inflammatory demyelinating condition of the peripheral nervous system (PNS), in contrast to Multiple Sclerosis (MS), which is an inflammatory demyelinating condition of the central nervous system (CNS). There are clinical and pathological similarities between MS and CIDP and, on rare occasions, patients are affected by both conditions.

Axons in the PNS are myelinated by Schwann cells which are covered by a plasma membrane called the neurilemma. Myelinated fibres in the CNS are made up of oligodendrocytes which lack a neurilemma. Because the neurelimma remains intact, for the most part, when nerve fibres are damaged, it plays an important role in regeneration of nerve fibres. This essential difference in the makeup of the two nervous systems seems to be an important factor in the recovery of CIDP patients in comparison to those suffering from MS.

CIDP is a relatively rare condition (only 12 diagnosed cases in Queensland) and little is known about the causes and treatments for it, although pathologies and treatments are similar to those for MS. For this reason, I have researched causes and treatments for MS where they are similar. The estimated prevalence of CIDP in populations from the UK, Australia, Italy, Japan, and the US is 0.8 to 8.9 per 100,000 [9-14].*5

Renewed emphasis has now been placed on diet, particularly fats, as a trigger to the onset of MS. The CNS, that is the brain and spinal cord, is predominately fat. The type of fat that is incorporated into the cells that make up the CNS depends on what we eat. There is now evidence that shows that the cell membranes of people who eat predominantly saturated fats are different from those who eat predominately mono- and poly-unsaturated diets. Importantly, because of the different chemical properties of the fats, that is, their respective melting points, the cell membranes of people who consume mainly unsaturated fats are more fluid and pliable than those who consume saturated fats. If you eat mainly saturated fats your cell membranes are more rigid and inflexible, and more prone to degenerative changes.4 It is known that saturated fat competes with unsaturated fats for uptake into cell membranes and in biological pathways. Saturated fat is tough; it usually wins in these contests, and this seems to be especially so for people with MS. With the increasing knowledge about fats today, we now know that omega-3 fatty acids work to suppress immune system disorders and omega-6s seem to worsen them. MS is infrequent in places where fish (high in omega-3s) is eaten a lot.*4

Aims and Objectives of the Project

The aim of this project is to introduce clients to the prospect of a modality which has a holistic benefit which supports more traditional treatments and to evaluate the effectiveness of the Bowen Technique on CIDP from both a clinical and lifestyle perspective. The client’s perspective of the treatments and results will be determined by regular questioning and a pre and post lifestyle questionnaire.

Research Method/Strategies

Since the number of patients diagnosed with this condition is very small, I have used a qualitative method in my research. The client was interviewed at length with respect to signs and symptoms, pain levels, quality of life and effectiveness of traditional treatments.

Ethical Considerations

Bowen Therapy, its methodology and its effects on the body were explained in detail and written consent for treatments and subsequent publishing of the collected results was received from the client participating.

The Study Sample / Stakeholders

The client used in this project is a female, aged 58 who was normally very active and healthy. She initially suffered a series of TIA’s and was subsequently found to have a cerebral aneurysm. She has had a stent inserted. At this point in time her mobility was still almost normal.
By mid-year 2011 the client noticed the onset of symptoms affecting her mobility and the onset of pain in her feet. In November 2011, the client underwent a Lumbar Puncture and a Nerve Conduction/Electromyography (NCS/EMG) study which suggested a mixed motor-sensory neurogenic pathology. Based on the clinical, NCS/EMG and CSF (cerebrospinal fluid) findings, a diagnosis was made of Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). The CSF Protein levels had risen from 480ppm to 2700ppm where acceptable levels are 150-500. The CSF Protein levels are a usual indicator for the diagnosis of both CIDP and MS. The client was admitted to hospital and given a 5 day loading course of Immunoglobulin (IVIg). The client is now receiving monthly transfusions of IVIg.
A plasma exchange has not been considered at this stage of treatment.

Medications: Endep 10mg (for nerve pain)
  Prednisolene 40mg (immunosuppressant)
  Immunoglobulin (IVIg)
  Frusemide 20mg (fluid retention)
  Panadeine Forte (pain& headaches)
  Endone

Immunoglobulin Treatments

10/11/2011 IVIg 5 day course 5-6 days’ relief from symptoms
10/12/2012 IVIg 5-6 days’ relief
12/1/2012 IVIg no relief
9/2/2012 IVIg no relief
These treatments have continued, but with no apparent relief.

At the start of the Bowtech treatments, Prednisolene was being weaned and has since been ceased.

Symptoms presenting for research:

Feet: walking on glass
Skin: going to split open
Touch: electric shock
Head: beehive
Fingers: numb and tingling
Knee to feet: numb and tingling

The Client says that once she takes her feet off the ground to either sit or lie down, it feels as if she has had a “chinese rope burn” to her ankles.

Bowen Therapy Treatment Plan

Due to the severity of other symptoms, I reintroduced this client to BT slowly to ensure she did not experience an overload. I included an extra procedure at each treatment if no adverse effects from the previous session had been experienced. The extended plan is to treat each area of concern as symptoms arise/continue.

Rehabilitation Plan

The client has been given a copy of stretch and strengthening exercises to undertake daily.
She has been given exercises by the physiotherapy department at the hospital but ceased to do these as she became depressed because she could not feel any difference. She has made an undertaking to at least do the exercises and stretches that I have given her, at least for the duration of her treatments from me. I will encourage her to incorporate the exercises given to her by the physio.
The client has also agreed to embark on an unsaturated fat diet as this has been proven to be effective in the treatment of MS patients. This diet requires that only fats/oils which are liquid at room temperature are consumed. There is no cheese, dairy, deep fried, meat, or commercially made cakes and biscuits to be consumed.

Physical Assessment

Observation: Gait is stinted and client “flops” feet (similar to walking with flippers on) when walking.

Slump Test: This caused no pain, however was not really successful due to the client’s inability to extend legs.

Active Knee: R extension 0° L extension 0°
  R flexion 130° L flexion 130°
Resisted Knee: R extension no resistance L extension no resistance
  R flexion strong L flexion strong
Passive: R extension 0° L extension 0°
  R flexion 130° L flexion 130°
Palpation: Lateral gastrocs are firm on both legs, medial are soft and wasted.

Bowen Therapy Treatment Record

It was found that treatments are required every 3 – 4 days in order to keep pain at a manageable level. Bowen Relaxation Moves (BRM) were given for the first two weeks, along with Head, Ankle, Hammertoe and Bunion moves. This produced the immediate effect of sleeping through the night, stabilized bowel movements, more ease of flexion of the knee, and less “buzzing” in the ears. The client found that pain levels decreased to the extent that she felt that she could “work through the pain” and undertake an increased exercise regime. The client went from minimal mobility, with the use of a walking frame, to being able to complete an 800m circuit over uneven terrain with the use of a walking stick only. Buttock pain also decreased markedly and the client was able to cease taking Endone for pain relief.
By the fourth week, the client’s latissimus dorsi and trapezius muscles had developed conformity and were pliable. Her gluteus maximus muscles were no longer painful when worked on and her gastrocnemius muscles are now showing less wasting and are stronger.
The Coccyx Oblique procedure was then included in two treatments to reduce the tingling in the feet and lower legs, however the client did not feel any further relief from this.
Elbow/Wrist and Forearm Extra procedures were then introduced into the schedule and whilst the tingling in the hands has not decreased, the client now has more flexibility in her hand movements.
At the fourth week, Hamstring and Straight up the Leg procedures were also included to release the IBT and hamstring muscles.
During the eighth week, the client had a fall when attempting to walk along a flooded path and had to take Panamax for a few days. BT again helped her through this and progress is back on track. The Client now reports that although CIDP symptoms are still present, they are no longer progressing. In the eighth week TMJ procedure was also introduced to treat the buzzing in the head.
The client is now on a regular regime of BRM’s, Head, Hamstring, St up Leg, TMJ, Elbow/Wrist, Ankle and Hammertoe & Bunion procedures. This mix is enabling her to lead a more normal life with the minimal need for pain medication.

The client is now awaiting another lumbar puncture to test CSF protein levels.

Data Analysis – Conclusion

Treatments have addressed the main areas of the body affected by CIDP, ie feet, legs, hands and head. Due to the extremely depressed immune levels of these clients, it was important to introduce Bowtech procedures in measured amounts in order to prevent an “overload” of reaction. Bowtech treatments were found to not only address the symptoms of the disease itself, but to counteract the adverse effects of some of the drugs used in its treatment, eg constipation. As stated previously, the manner by which Bowen moves are transmitted throughout the body (by fascia) enables treatments to be effective as the damaged nerves are not a barrier. After five months of treatments, the client still feels that her symptoms have stopped progressing.

Treatments gave immediate relief from discomfort caused by CIDP and the client’s quality of life has improved considerably. The hope is that rather than just ceasing to progress, the symptoms will start to abate. The holistic effect of Bowen Therapy has enabled the client to continue physical exercise that was previously not possible and to counteract the side effects of pharmaceutical treatments being undertaken. The fact that Bowen Therapy transmits data to the brain via the body’s fascia means that the damage incurred by CIDP on the nervous system does not act as a ‘blocker’ and therefore progress is not hampered.

Discussions with Professor George Jelinek (an internationally published MS researcher) have verified the connection between MS and CIDP and the possible similarities in the causes and effects of the two conditions. The Swank diet, which is recommended by Prof Jelinek, advises against the consumption of saturated fats in any form. Consumption of poly and mono unsaturated fats only in the diet is believed to be a successful way of rectifying the breakdown of the fat making up the myelin sheath. Saturated fats are hard and brittle in comparison to unsaturated fats which are pliable. It is believed that a change in diet can create a ‘turn around effect’ within twelve months. Prof Jelinek also recommends the inclusion of Vitamin D from sunlight, Vitamin D3 and Omega 3 supplements, meditation and exercise in the daily regime.

Sharing this knowledge, not only amongst fellow Bowtech practitioners, but with mainstream professionals and, indeed, those suffering from the condition, will help to increase knowledge and hopefully encourage others to look into the causes and effects more thoroughly. I firmly believe that Bowtech practitioners have a place in the successful treatment of CIDP and at the very least in the improvement of the sufferers’ quality of life. The unique means by which Bowen Therapy assists the body to heal itself is the crux its success.


Update

Nerve induction tests undertaken on the client on 2/11/2012 have shown that progression of the disease has ceased in the lower limbs and nerve responses in the upper limbs have improved.

 

 

References:

1. http://bowen.bcnt.net.au/Default.aspx?tabid=73
2. http://www.ninds.nih.gov/disorders/cidp/cidp.htm
3. http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm
4. Jelinek GA. Taking Control of Multiple Sclerosis: natural and medical therapies to prevent its progression. Hyland House Publishing 2005.
5. http://www.uptodate.com/contents/chronic-inflammatory-demyelinating-polyneuropathy-etiology-clinical-features-and-diagnosis

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