Tag Archives: pain

Bowen Therapy – Addressing the Missing Piece in Pain Treatments

Toronto naturopathic doctors - pain

This post is the outcome of being asked repeatedly how Bowen Therapy works, either by patients skeptical of gentle pressure effectively reducing symptoms of chronic pain, or shocked by the fact that gentle pressure successfully relieved their chronic pain where more aggressive treatments did not.

It draws primarily on a really great article on the concept of “central sensitization” as a cause for chronic pain by Paul Ingrham, referenced below.

Presently, dominant pain theory, and as a result, almost all pain treatments, focus on the tissue affected by injury/having pain (e.g., the joints in a person having arthritis, the neck of a person having whiplash), but ignore the role the brain plays in the experience of pain.

Although the impetus for pain occurs in the tissues (e.g., touching a hot pan), pain itself is experienced because your brain is “telling you” there is a “danger” at your hand (“Move your hand!”).

Central sensitization is not a theory, it is a physiological fact, operating by a known mechanism (neuroplasticity), explaining the way in which chronic pain modifies your brain and spinal cord in such way that it begins to signal “danger”, in the form of pain, inappropriately.

Basically, chronic pain “teaches” your brain that danger is a constant presence. It responds by giving you a constant “be gentle/careful” signal in the form of pain.

Central sensitization is the mechanism by which:

  • Pain may remain long after the tissue has recovered from the original injury (e.g., a person may experience muscle aches years after an auto collision).
  • Relatively minor pains may develop into a state of chronic pain (e.g., the development of chronic muscle aching, without any identifiable trauma).
  • Persons may experience pain more intensely than the stimulus suggests they should (e.g., the pain fibromyalgia sufferers experience from gentle pressure; persons having relatively minor joint damage experiencing debilitating joint pains).

How “Brain Pain” is Treated

As I wrote above, almost all pain treatments focus on the tissue where the pain is felt – anti-inflammatories for inflammation at the joints, chiropractic manipulation for misalignment of the spine, etc.

Based on what is known, the general guidelines for treating centralized pain are:

  1. Rule-out, or if present, address trauma at the painful tissue (i.e., if you have a broken bone, the brain is correctly reporting a threat – it must be addressed before the pain can subside).
  2. Minimize aggravation of the pained area (including aggressive treatments) which may reinforce the brain’s assessment of threat.
  3. Re-train your brain to understand that stimulation of the tissue in question is not a danger by “… exposing yourself to the pain, gently and cautiously challenging the body, probably mainly with activity and exercises in a baby-steps way. Other kinds of stimulation are potentially useful as well …”
  4. Being “kind” to your nervous system – essentially manage stress and allow the nervous system to be in a state that it is able to respond to stimuli calmly rather than “freaking out” at every trigger.
  5. Increase “plasticity” of the brain to foster “re-training” of the central nervous system out of it’s “pain habit”.

Bowen Therapy is a method of “gently and cautiously challenging the body”.

Although when Tom Bowen developed Bowen Therapy in the 1950’s, the concepts of central sensitization of pain and neuroplasticity did not yet exist, Bowen Therapy treatments and self-care he recommended to support treatments, reflects closely what is known about treatment of centralized pain today.

Bowen Therapy treatments are comprised of gentle pressure challenging muscles in areas of pain, followed by pauses integrated into the treatments to allow the brain to become comfortable with and understand that it is “safe” – no harm will occur from stimulus to the area.

The after-care recommendations are to be gentle with your body – engaging in gentle motion (e.g., walking), but avoiding strenuous activity (e.g, challenging exercise, aggressive treatments).

To further support Bowen Therapy treatments, based on what we now know about centralized pain, I might include meditation and intermittent fasting in a patients treatment plan.

You can learn more about Bowen Therapy, including research and more case report findings in treatment of a wide range of health conditions here.

References

Ingraham P. Central sensitization in chronic pain: pain itself can change how pain works, resulting in more pain with less provocation [Internet]. PainScience. Updated 2018 Sep [cited 2018 Oct 10]. Available at: https://www.painscience.com/articles/central-sensitization.php.

Sibille K, Bartsch F, Reddy D, Fillingim R, Keil A. Increasing neuroplasticity to bolster chronic pain treatment: a role for intermittent fasting and glucose administration? The journal of pain : official journal of the American Pain Society. 2016;17(3):275-281. doi:10.1016/j.jpain.2015.11.002.

– Jonah Lusis, ND

 

Posted: 2018 Oct 10

Bowen Therapy – A Case Report of Successful Treatment of Migraine Headaches

Toronto naturopathic doctors - migraine

I’m writing this post to share some research I stumbled across in the course of my day-to-day work, researching treatments for patients having range of health concerns, in this case migraine headaches.

I won’t spend a lot of time here offering background into the nature of migraine headaches: if you suffer from migraine headaches, and you’re reading this post because you’re looking for solutions, then you likely know as much as you need to regarding migraines:

  1. The cause of migraine headaches is poorly understood.
  2. They suck.
  3. Success of conventional treatments is inconsistent.

The below is a published case report – basically a detailed record of one patient’s experience of treatment for their migraine headaches using Bowen Therapy (sometimes also called “Bowen Technique“, or BowenWork, among other descriptions).

If you want to read the report in detail, you can find it here.

The Patient

In this case report, the patient was a 66-year old female who had been having severe (symptoms including vomiting) migraine headaches several times weekly since approximately nine years of age.

She had also sustained severe neck, jaw and temporomandibular joint (TMJ) injuries in two separate automobile accidents.

Additional diagnoses of pain causing conditions included thoracic outlet syndrome (TOS) and degenerative disc changes.

Baseline migraine headache and neck pain levels

The patient was suffering migraine headaches; three to four times weekly; and intense chronic neck pain.

The pain was of an intensity that use of 10 to 12 Ibuprofen 200 mg tablets also necessitated, additionally, use of ice compresses and rest in a dark room until symptoms abated.

Her sleep was disrupted by migraine pain most nights.

On a scale of 0-6, with a rating of “6” representing “As bad as it could be”, she rated:

  1. Migraine = 6
  2. Neck pain = 6
  3. Activity limitation (unable to drive, socialize, etc.) = 5
  4. Well-being = 5

Bowen Therapy treatment process

The patient tracked their progress using the Measure Yourself Medical Outcome Profile version 2 (MYMOP2).

She used no other migraine headache treatment over the course of the study.

Three, once-weekly treatments were administered, and an assessment made, in order to determine if continued treatment was warranted/desired.

Mild improvement was observed after three treatments, and the decision was made to continue treatment.

Subsequent treatments were 45 to 60 minutes in duration, and scheduled every one to two weeks. Each treatment protocol was determined by patient feedback, with protocol combinations reflecting symptoms present at the start of each appointment.

The end-point of treatment was determined to be when the patient reported no occurrence of migraine headaches or neck pain for two consecutive sessions (i.e., two to four weeks in total).

Migraine headache and neck pain outcomes

The treatment end-point of two consecutive sessions without migraine headaches or neck pain after 14 treatments, completed over a period of approximately four months.

Migraine headaches were first absent after four treatments.

Neck pain decreased in a relatively linear pattern between treatments one and nine, after which it was reported as absent for the first time.

After treatment 10 neck pain returned following a severe allergic reaction, but resolved after two more treatments.

At treatment 14, the patient reported not having experienced migraine headaches or neck pain for two consecutive treatments.

At a follow-up appointment 10 months later, the patient reported no  episodes of migraine headaches or neck pain, and no new symptoms.

You can learn more about Bowen Therapy, including research and more case report findings in treatment of a wide range of health conditions here.

References

Gustafson S. Bowenwork for migraine relief: a case report. Int J Ther Massage Bodywork. 2016 Mar;9(1):19-28.

– Jonah Lusis, ND

 

Posted: 2018 Oct 9

 

 

 

 

 

“Where is Your Pain?”

Toronto Naturopathic Doctor

My late teacher, the Japanese Shiatsu Master, Mitsuki Kikkawa, C.S.T., R.M.T., used to torture us repeatedly with brain puzzles like that. Master Kikkawa was a Zen Buddhist, and in keeping with his tradition, he used these seemingly nonsensical or paradoxical statements (called “koans”) as a teaching device to trigger a sudden realization in his students. Zen prizes direct experience over the imperfections of mere words, a strategy that carries a distinct advantage: if the student can be brought to the point where they suddenly comprehend something on their own, nothing more needs to be said. When it works, it’s a very efficient method, but for Western students, who are used to being taught in terms of protocols, procedures and step-by-step instructions, it can be a very frustrating experience!

Master Kikkawa would often begin a class by uttering such statements, and then just stand there, smiling, refusing to say another word until someone had correctly answered the riddle. The point was he wanted us to think for ourselves and come to our own understanding, not simply parrot back what we’d been told.

So, where is your pain?

On the surface, the question, “Where is your pain?” seems quite innocent: Well, if I have back pain, then the pain is in my back (obviously!) Where else would it be? When we hurt our knee, we instinctively rub our knee, not our elbow … so what’s the puzzle here?

Consider another well-known example: phantom-limb pain, the kind of pain experienced by better than 90% of amputees; that is: pain in the part they no longer have. What should we tell them? That their foot pain resides in their non-existent foot, or that they’re just imagining/faking the pain? If you said such a thing, they might slap you, and rightfully so – their pain is real, they’d forcefully assert, and they need some help with it. So the question is not as simple as it first appears.

Indeed, where is your pain?

Let me hint at the answer by asking another question: What part of your body controls the tone of all your muscles, the position and orientation of your bones and joints, and the function of all your organs? Hint: it’s the same part that registers and controls all of your other sensations, including pain.

The answer, of course, is your brain. Am I saying that pain is all in your head? Well, yes and no. Yes, in that pain is an entirely subjective, psychological phenomenon, and no, in that it is certainly not imaginary. As Master Kikkawa used to say, “No brain, no pain.” However, since pain is entirely mental, this partly explains why so many people in pain can have X-rays, etc., taken and yet have nothing show up. That doesn’t mean they’re not in pain – after all, there is no scan for pain – we just assume we will always find a direct, physical correlate to explain it. And if we can’t find one, we often tell people there’s nothing wrong with them, or that they’re just stressed, and then we might prescribe them antidepressants or even accuse them of looking for drugs. Try telling that to an amputee suffering phantom-limb pain (then I’d suggest you duck).

Knowing this, you’d think that everyone in physical medicine would take steps to “treat your brain”, as well as your knee, back, etc. Unfortunately, this just isn’t the case. When you come in with knee pain, we mainly treat your knee. If we’re “integrative”, we might also treat your hip and ankle, and maybe your lower back to help your knee, but your brain? Sorry, no.

Your Pain and Your Brain

Addressing the brain and central nervous system – “the master controller”, in my late teacher’s words – is the missing link in physical medicine. “Missing” in the sense that no one seems to do anything about it. And yet, in the words of Dr. Hance Clarke, Director of the Pain Research Unit at Toronto General Hospital, who I heard interviewed on CBC Radio earlier this year, the best treatments for pain that they’ve found at TGH are “the ones that, first, calm the nervous system”.

If this seems like news, don’t feel bad; taking seriously the central role of the brain in pain management is rare, but now appears to be the cutting edge of pain therapy. The words Dr. Clarke uttered were truly revolutionary. However, we now know that inducing relaxation is the prerequisite to causing neuroplastic change in the brain and nervous system (Dr. Norman Doidge’s books are highly readable primers in these concepts), and when the brain changes, the body changes, too.

The type of work I do (my teacher named the technique he developed, “Suikodo™”, pronounced ‘Swee-KOH-doh’) primarily addresses the brain and central nervous system.

The point is, first, to relax your brain.

Relaxation of the body is a secondary effect, but the one patients notice the most. Master Kikkawa was prompted to develop an alternative to the typically painful Shiatsu (deep pressure) treatments when some of his patients, particularly the most sensitive, weakened or debilitated ones, failed to improve or even got worse. He did something very unusual then: he went back to the proverbial drawing board. Instead, he found that the more gently he worked, the more easily patients could relax. Then, profound physical changes would often ensue, far beyond what he could accomplish using painful deep pressure techniques. This was a huge departure for my teacher, the person who the inventor of Shiatsu (Master Tokojiru Namikoshi) had declared the most talented instructor in the history of the Tokyo Shiatsu Institute, and whom he had sent to “bring Shiatsu to the West” in 1972.

I was prompted to write this article by an encounter I had recently while up North visiting a friend. We went to his parents’ house for dinner, and his sister and brother-in-law were there. His brother-in-law is a paramedic, who had sustained a significant lower back injury many years ago, on which I’d worked at the time. As another paramedic once told me, “No one ever seems to collapse in a convenient position”; first responders often destroy themselves trying to save us.

He’d had eight nerve blocks and two epidurals just in this year alone to try and quell his pain, sadly unsuccessful in the main. Then he asked me, “So when are you opening your own clinic again? You’re the only one who ever made a difference in my pain.” Though I was a bit surprised, after 21 years of treating with Suikodo™, I needn’t have been; I’ve heard similar statements countless times.

What he was saying in effect was that this treatment, designed to relax the brain and nervous system – and thereby all the physical parts they control, including those governing pain perception – was more effective overall than nerve blocks intended to merely numb the pain. That’s a rather striking statement especially coming from a medically trained professional.

What is needed then, I feel, in physical medicine today is a paradigm shift: to move beyond merely hammering away at people’s bodies with increasing amounts of force, or numbing them, and instead toward changing their bodies and their pain, as both Dr. Clarke and my late teacher have said, by first relaxing their brains.

The “Nuts and Bolts”

Treatment involves a thorough assessment and diagnosis, then the use of gentle, relaxing motions of the muscles, joints and points on the skin (nerve-rich areas) to trigger relaxation, first in the brain and central nervous system, and then in the body.

One of the virtues of this approach is that, since your brain controls your body, results can often be seen very rapidly. We almost always see changes in the first visit, so it doesn’t take much time to know if Suikodo™ can help you or not.

It works well on its own, or in conjunction with other traditional therapies, e.g., massage, chiropractic, etc. If you’re in chronic pain, or have some kind of physical dysfunction, particularly the kind that seems resistant to treatment, like back or neck problems, headaches or sciatica, I encourage you to give Suikodo™ a try: you have nothing to lose but your pain.

John MacIntosh, ND, RMT

Posted: 2017 Nov 1

 

 

Bowen Therapy: Help for Pain and Anxiety

Toronto Naturopathic Doctor

A little known, but gentle and effective technique for reducing pain and inflammation, and reducing anxiety: Jonah Lusis, ND introduces you to Bowen Therapy!

 

 

For more great videos on health and wellness, visit our YouTube Channel!

 

Posted: 2017 May 24

Bowen Therapy (Bowen Technique)

Toronto Naturopathic Doctor

Relax, Reset, Rebalance

Bowen Therapy is a gentle, hands-on treatment used primarily to decrease pain and increase mobility, and reduce stress and anxiety.

A much more gentle intervention than many conventional pain treatments (e.g., some forms of chiropractic manipulation or physiotherapy), Bowen Therapy may be an effective alternative for patients having much pain (e.g., severe injury), increased sensitivity to pain (e.g., having fibromyalgia); or simply requiring gentle treatment (e.g., elderly, children).

It addresses an area that most pain therapies ignore, “centralized pain”, “re-training” your brain to “let go” of it’s pattern of experiencing pain, particularly chronic pain, pain that has not responded well to other treatments (e.g., “frozen shoulder”), and pain in persons seeming to be extraordinarily sensitive to pain (e.g., fibromyalgia).

Bowen Therapy may be used as either a primary treatment, or supportive treatment. As a primary treatment, it typically used for chronic conditions affecting the musculoskeletal system (e.g., fibromyalgia, recovery from injury, “frozen shoulder”).

It is used as a supportive treatment in cases where the autonomic (“unconscious”) nervous system appears to be in need of being “re-set” (e.g., constipation, heart palpitation) or for stress management (e.g., management of anxiety).

The goal of treatment using Bowen Therapy is usually complete resolution of pain, or complete return to previous function.

Benefits of Bowen Therapy

Bowen Therapy may be of benefit, in some capacity, the treatment almost any health condition.

A study titled “The Bowen Technique: a study of it’s prevalence and effectiveness”, presented at the University of North Carolina, Chapel Hill found that Bowen Therapy treatment was:

  • 95% effective in the treatment of temporomandibular joint (TMJ) dysfunction
  • 88% effective in the treatment of neck pain
  • 85% effective in the treatment of low back pain
  • 83% effective for the treatment of stress and tension
  • 80% effective for the treatment of fibromyalgia
  • 80% effective for the treatment of hip pain
  • 75% effective for the treatment of non-specific pain conditions

Other research has demonstrated that Bowen Therapy:

  • Improves decreases tremor and improves sleep quality in patients having Parkinson’s disease
  • Reduces heart rate variability (“normalized” heart rate) and slows heart rate in 100% of fibromyalgia patients
  • Increased neck range of motion, and decreased “disability scores” in patients having trapezitis (neck and shoulder pain, and restricted movement) when combined with physiotherapy
  • Improves mobility and function; and reduced pain (on average) from a score of 7/10 to 1/10 in 100% of “frozen shoulder” patients
  • Reduces migraine headache frequency and/or intensity in 80% of patients
  • Improves symptoms of restless legs syndrome in 3/5 patients receiving treatment
  • Completely reduces symptoms of carpal tunnel syndrome in 4/6 patients receiving treatment, with complete resolution of symptoms  in 3/4 of these cases
  • Significantly improves motor function of patients recovering from stroke
  • Improves sleep and a general sense of well-being

A single Bowen Therapy treatment has been demonstrated to:

  • Decrease feelings of depression by 51%
  • Decrease feelings of anxiety by 21%
  • Decrease fatigue by 41%
  • Decrease sense of tension by 62%
  • Decrease feelings of anger by 47%
  • Decrease confusion by 33%
  • Increase flexibility (in hamstrings) by 26-34%

Learn more about the experience of, and results from Bowen Therapy treatment for a range of health conditions at these sites:

  • Details of some of the research described above, including studies on treatment of frozen shoulder, carpal tunnel syndrome and restless leg syndrome
  • Six case reports, including treatment of disc injury
  • Six case reports, including treatment of sciatica, carpal tunnel syndrome and “tennis elbow”
  • Six case reports, including treatment of hip and knee pain, and recovery from knee and lung surgeries
  • Six case reports, including treatment of various neuralgias
  • Five case reports, including treatment of sciatica; and further insight into potential mechanisms of action of Bowen Therapy
  • Four case reports, including treatment of migraine headaches, sciatica and “frozen shoulder; and further insight into potential mechanisms of action of Bowen Therapy
  • Three case reports, including recovery from auto collision
  • 22 case reports, including treatment of children, “frozen shoulder” and sciatica
  • Seven case reports, including treatment of “frozen shoulder”, carpal tunnel syndrome and migraine headaches
  • Two case reports of treatment of Parkinson’s disease
  • A case report of treatment of migraine headaches

What to Expect

Bowen Therapy involves application of gentle pressure to the muscles, tendons and other soft tissues at specific points, and in specific sequence.

Treatments are approximately 30 to 45 minutes long, and performed weekly or bi-weekly for the first four sessions.

Treatment frequency is then individualized to your response to treatment (e.g., if your pain is resolved, but returns after three weeks, treatments will be scheduled at three week intervals).

Improvements in pain levels or function may be experienced after as few as one treatment.

Bowen Therapy at Toronto Centre for Naturopathic Medicine

Bowen Therapy treatments at Toronto Centre for Naturopathic Medicine are performed by Du La, ND and Jonah Lusis, ND, both of who have been certified in Bowen Therapy by the Bowen Therapy Academy of Australia since 2002.

Bowen Therapy treatments provided at Toronto Centre for Naturopathic Medicine are covered by most extended healthcare plans.

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