Accelerated Healing Response

Accelerated Healing Response By Dan Amato RRT, CBT, CBTI

In this day and age of HMOs, limited visits and shrinking reimbursements, you want to accomplish as much as possible at each patient visit. The more you can achieve in each of those visits, the further along the patient will be in the healing process before their visits run out. At the same time you do not want to overload the body so much that it increases the chance of re-injury. Since every patient heals differently, the best way to assure both accelerated healing and reduced risk of re-injury is to use the bodies own innate healing system.

The body’s healing system regulates the rate of healing which is based on the extent of the injury and the body’s resources. One of the reasons that rehabilitation can be slow is that things like shock, trauma and stress can lock the sympathetic nervous system (SNS) in an excessive state of stimulation. (References 1-6) Since this involves the survival response, it has top priority. Evolutionarily speaking, if the body is in survival mode, healing does not usually take place until the body is sure of survival. Studies show that when the body is in a hyperactive state of sympathetic innervation, healing is blocked. (References 2,6, ,9) Many Physical Therapists have had to deal with these patients who don’t seem to heal. These patients seem to actually resist healing; their bodies are still locked in SNS innervation so nothing works. They are often told that they will “just have to live with it”. Another interesting fact is that when the body is locked in a hyperactive state of sympathetic innervation, the affected portions of the SNS make exaggerated responses to relatively minor stimuli.(1,5,6,8) Perhaps when the body is locked in SNS innervation, modalities used by the therapist can be interpreted as invasive so that the body tries to neutralize it. This could be why sometimes none of the indicated modalities have any effect.

Another impediment to healing is that the body can work against itself. Muscles are usually thought of as causing motion through contraction, but in muscles that are chronically contracted they can act instead as a brakes by opposing motion. (10) Our sensory-motor systems repeatedly respond to trauma and every day stresses via muscular reflexes. These reflexes can create habitual muscular contractions that we are not able to relax voluntarily (11). In fact, research has shown that this contraction continues uninterrupted even during sleep. (12) Thomas Hanna called this habituated state of involuntary muscle contraction, sensory-motor amnesia (SMA). In order to control our muscular movements we require a continuous input of sensory information. (13) Since the sensory division and the motor division of the CNS are part of the same feedback loop, what affects one affects the other. Hanna stated, “Maturation is the growth of greater and greater cortical learning. This process can continue indefinitely, improving and refining human actions, unless negative conditions force the brain into emergency actions in order to survive. Sustained stress and traumatic accidents are such negative conditions that sidetrack the voluntary cortex from its normal control of the sensory-motor system.” (14)

Working With The Body

Patrik Rousselot, PT, a Physical Therapist since 1980, was looking for a modality to help these patients who resisted healing. He searched alternative therapies for twelve years before he found a remarkably effective tool. This tool not only helped treat these difficult patients, but also significantly reduced rehabilitation time in most of his other patients. “I could not understand how doing so little structural work could have such a deep impact on patients physically, but also often energetically and psychologically” explained Rousselot, an admitted skeptic. This highly effective modality is Bowtechâ, The Bowen Technique. It is a gentle but powerful technique that works by balancing the autonomic nervous system (ANS), which controls over 80% of our bodily functions.

The human body is a massive complex of feedback loops. An example is if you eat a donut, your body digests it and converts it to sugar. The sugar is absorbed into the bloodstream and the body senses the rise in blood sugar. The pancreas responds by secreting insulin to decrease the blood sugar levels. This is just one example of the many thousands of feedback loops in the body. Recent discoveries have shown that the whole nervous system functions like a vast communication network. Feedback is constantly exchanged among all the different parts with the brain acting as a switchboard integrating and coordinating all activities. If you could tap into these feedback loops and add new information you could accelerate the healing. The Bowen Technique does just that.

A Bowen treatment consists of a series of gentle but precise mobilizations performed on muscles, tendons, ligaments or nerve sheaths. These moves are performed using the thumbs or fingers. First, the skin is pulled to the side of the structure (in this example, the muscle). Gentle pressure is then applied to the edge of the muscle to a point of resistance. This challenges the muscle and pushes it out of its’ normal position. Next a gentle rolling move is done over the structure while maintaining gentle pressure on the site, which stimulates the proprioceptors sending information through the nervous system to the brain. The body is sent a message that the emergency is over, and it is now possible to initiate healing. To put it simply, a Bowen treatment resets the body allowing it to heal itself. After each series of Bowen “moves”, there is an important pause to allow the body to respond to new information from the proprioceptors. It is during this pause that the body begins to make changes.

Rousselot cautions, “After a Bowen treatment we usually do not treat a patient again before five days to allow time for the body to respond to the work.” Clinically, therapists see this healing process continue for the next five to seven days and sometimes even longer. It seems that other modalities can neutralize the changes the body is trying to accomplish. It is not yet known exactly why this happens, but it is frequently seen clinically in clients who do not heed the five-day rule. Perhaps any modality performed on the body in the five days following a Bowen session competes for the bodies’ resources and lessens any effects. This is why it is important to wait at least five days after a session before introducing any other modalities.
Increasingly, other Physical Therapists are also finding their way to The Bowen Technique. “I work for a corporation owned practice, and managed care is BIG here, “ says Jennifer Martin-Riggio, PT, staff therapist at On Track Therapy. “The Bowen Technique has made me a much more efficient therapist; I get faster results, especially with acute injury.” Martin-Riggio strongly recommends The Bowen Technique to other Physical Therapists, especially in busy practices where they have to juggle several people an hour.

The Bowen Technique-Proposed Mechanisms of Action

There are many proposed mechanisms of action, but I will only discuss a few of them here. It is known that Bowen balances the ANS taking the body out of its hyperactive state of sympathetic innervation. Dr. Whitaker has shown that The Bowen Technique positively affects the Heart Rate Variability. (15) Heart Rate Variability is a measure of ANS function.

The next proposed mechanism is the Golgi endings, which are located in the tendons. Discharges from these Golgi endings are sent to the spinal cord via dorsal root fibers causing an inhibitory effect, which results in relaxation. (10) Spindle cell receptors are located within the muscle itself. When these spindle cell receptors are stretched they contract; when they are shortened they relax. (10) A Bowen move stretches the muscle and suddenly releases it, which may cause the opposing reflexes of the spindle cells and the Golgi Endings to be triggered almost simultaneously causing them to reset. Since most moves are done on the origin, insertion or belly of muscles, the Golgi endings and the spindle cell receptors are the receptors most likely stimulated. Joint proprioceptors may also be involved. They report joint position and motion, direction of motion and velocity of motion. (10) The moves that are done around joints may stimulate the joint proprioceptors sending feedback to the CNS allowing normalization of joint function. It probable that all of these mechanisms, plus a few others are stimulated each time a Bowen move is performed.

There have been a couple of studies done on The Bowen Technique besides the one above done by Whitaker. In a study done by Seba on patients diagnosed with fibromyalgia, all had various degrees of relief lasting from a few days to several weeks. (16) Another study by Prichard showed that the Bowen Technique reduced levels of anxiety, anger, depression, fatigue and confusion thereby enhancing patient’s positive feelings. (17) Many other studies are underway around the world to study the effectiveness of the Bowen Technique. You can expect to hear a lot more about this therapy in the future.

History of the Bowen Technique

Tom Bowen developed the Bowen Technique almost thirty years ago in Australia. Though he was not formally trained in any modality, Tom Bowen had a genius for distinguishing patterns of muscular dysfunction, which he correlated to specific complaints. This allowed him to create procedures that stimulated the body to heal itself. In a 1975 study conducted by the Australian Government, they determined that Tom Bowen treated 13,000 patients a year. They also documented something even more amazing, his almost 90% success rate with most problems resolved in one or two sessions. In 1974, at a national conference, Tom met Oswald Rentsch. Ossie expressed an interest in Bowen’s work and Tom invited him to study with him in his clinic. Tom had no notes, charts or manuals. It was Ossie, along with his wife Elaine, who organized and documented Tom Bowen’s work. Ultimately, it was on his deathbed that Bowen asked Ossie to teach his technique. Since then, Ossie and Elaine have taken The Bowen Technique to many different countries. The Bowen Technique has only been in this country for about the past ten years, but it is already proving its value to both therapists and clients alike.

Who Can Benefit?

Many types of problems respond well to The Bowen Technique: ankle sprains and strains, carpal tunnel syndrome, repetitive stress injuries, chronic pain syndrome, coccyx pain, concussions, fibromyalgia, hamstring strains, herniated disks, knee pain, loss of joint mobility, pain and limitation post-surgically, pelvic imbalances, migraines and headaches, pregnancy related back pain, rotator cuff injuries, sciatica, shin splints, shoulder adhesive capsulitis, stress, TMJ problems and whiplash injuries. This list is not so surprising if you remember that The Bowen Technique stimulates the body’s self-healing mechanism and balances the ANS, which controls over 80% of our bodily functions.

Rousselot was so impressed with The Bowen Technique he became an instructor; he is currently a Senior Instructor and has been teaching for six years. Recently he was asked to write a chapter on The Bowen Technique for Mosby the highly respected textbook publishing company. It is included in their new textbook “Clinicians Complete Reference to Complementary and Alternative Medicine”, edited by Donald Novey, MD. The textbook was written to educate MD’s and other primary health care practitioners so they could make more informed decisions when referring patients to complementary and alternative modalities. Rousselot does not hesitate to recommend The Bowen Technique as a modality to other Physical Therapists. He cites several reasons. Conditions respond faster with The Bowen Technique than with conventional medicine. Things like increased ROM and decreased pain often happen by the end of the treatment. If relief does not happen by the end of treatment it will usually occur in the following hours or days as the body continues to balance itself. Another advantage is the built in pauses. A therapist, depending on the clinic setup, can easily work on several patients at the same time. In this day and age of HMOs, limited visits and shrinking reimbursements, it is good to have a scenario where everyone benefits, the patient, the institution, the insurance provider and the therapist. It is good to have The Bowen Technique.

Dan Amato RRT, CBT, CBTI, Currently staff therapist at Monadnock Community Hospital in Peterborough, NH
Certified Bowen Therapist practicing in Keene and West Lebanon, NH and Springfield VT
Accredited Instructor of The Bowen Technique

References

Korr, I.M., H.M. Wright and P.E. Thomas. Effects of experimental myofascial insults of cutaneous patterns of sympathetic activity in man. Acta Neuroveg, 23:329-355, 1926.

Vulnerability of the segmental nervous system to somatic insults. The Physiological Basis of Osteopathic Medicine, by The Postgraduate Institute of Osteopathic Medicine and Surgery. The Institute, New York, pp 53-61, 1970

Korr, I.M. The spinal cord as organizer of disease processes: Some preliminary perspectives. JAOA 76: pp 35-45, 1976

Korr, I.M. The spinal cord as organizer of disease processes: The peripheral autonomic nervous system. JAOA 79: pp 82-90, Oct. 1979

Korr, I.M. The spinal cord as organizer of disease processes: Hyperactivity of sympathetic innervation as a common factor in disease. JAOA 79: pp 232-36, Dec. 1979

Hyperactivity of sympathetic innervation: A common factor in disease. Concepts and Mechanisms of Neuromuscular Functions, edited by P.E. Greenman. Springer-Verlag, Berlin, 1-8, 1984

Korr, I.M., H.M. Wright and J.A. Chace. Cutaneous patterns of sympathetic activity in clinical abnormalities of the musculoskeletal system. Acta Neuroveg, 25:589-606, 1964

8, Korr, I.M. Sustained sympathicotonia as a factor in disease. The Neurobiologic Mechanisms in Manipulative Therapy, edited by I.M. Korr. Plenum Press, New York 1978 pgs 229-68.

,9 Korr, I.M. The sympathetic nervous system as mediator between the somatic and supportive processes. The Physiological Basis of Osteopathic Medicine, by The Postgraduate Institute of Osteopathic Medicine and Surgery. The Institute, New York, pp 21-38, 1970

10 Korr, I.M. Proprioceptors and somatic dysfunction. JAOA 74: 638-50, March 1975

11 Hanna, T. Somatics, Reawakening the Mind’s Control of Movement, Flexibility and Health. Addison-Wesley Publishing Company, Inc. 1988 xii-xiii

12 Budzynski, T.H. “Brain lateralization and rescripting.” Somatics 3(2) Spring 1981

13 Hanna, T. Somatics, Reawakening the Mind’s Control of Movement, Flexibility and Health. Addison-Wesley Publishing Company, Inc. 1988, pp. 5-7

14 Hanna, T. Somatics, Reawakening the Mind’s Control of Movement, Flexibility and Health. Addison-Wesley Publishing Company, Inc. 1988, pg. 28

15 Whitaker, J.A: The Bowen Technique: a gentle hands-on healing method that affects the autonomic nervous system as measured by heart rate variability and clinical assessment. Paper presented at the American Academy of Environmental Medicine at La Jolla, CA, December 1997

16 Seba, D. The Bowen Technique, a potential treatment for fibromyalgia. Paper presented at the American Academy of Environmental Medicine, La Jolla, CA. 1997

17 Prichard, A. The Psychophysiological Effects of the Bowen Technique. Submitted as a Psychophysiological Major Research Project, Semester II 1993. Swineburne University, Melbourne, Australia.

First Published Amato, D. (2001). Accelerated healing response. ADVANCE Magazine for Physical Therapists, 12(21), 35-37. Oct. 22, 2001