2.6 Intro BLT/FPR/Stills Flashcards
Who developed BLT
Dr. Sutherland
Dr. Sutherland stated that osteopathic lesions are strains of the tissues of the body. When they involve joints, it is the ligaments that are primarily affected, so he named the dysfunctions what?
Ligamentous articular strain
[note that LIGAMENTS are what we treat, not muscles]
Indications for BLT
SDs of an articular basis
SDs of a myofascial basis
Areas of lymphatic congestion or local edema
Relative contraindications for BLT
Fracture, dislocation, or gross instability in area to be treated
Malignancy, infection, or severe osteoporosis in area to be treated
Biochemical changes secondary to joint immobilization
Microadhesions
Overall loss of collagen
Loss of water
Physiologic changes secondary to joint immobilization
Greatly increased force needed to move immobile joint
After several repetitions, becomes easier
General goal of BLT
Balance articular surfaces or tissues in the directions of physiologic motion common to that articulation
Central principle of BLT (When is tx complete?)
Take that which you palpate as hard and make it soft
When you feel flow come through dysfunctional area, your tx of that area is complete
PE reveals a left PTP at T7 that becomes more symmetrical with the other side in extension and prominent with flexion. What is the position of treatment for BLT?
A. Flexed, RL, SL B. Flexed, RR, SR C. Extended, RL, SL D. Extended, RR, SR E. Neutral, RL, SR F. Neutral, RR, SL
C. Extended RL SL
Who developed FPR
Stanley schiowitz, DO
Define FPR
System of indirect myofascial release treatment. The component region of the body is placed into neutral position, diminishing tissue and joint tension in all planes and an activating force is added
Indications for FPR
SD in virtually all tissues, especially muscle spasticity
Efficacy is only limited by practitioner’s knowledge of functional anatomy
Safe to use on all ages
Contraindications for FPR
Recent wounds or fractures less than 6 wks old
If the patient cannot voluntarily relax or tolerate position
Severe osteoporosis or joint instability
Radicular pain with tx
Fracture or disc herniation in area being treated
PE reveals left PTP at T1-3 that do not change with flexion or extension. Which of the following levels would utilize the associated described position using an FPR technique?
A. T1 N RL SR B. T1 N RR SL C. T2 N RL SR D. T2 N RR SL E. T3 N RL SR F. T3 N RR SL
C. T2 N RL SR
Still technique definition
Characterized as a specific, non-repetitive articulatory method that is indirect, then direct
[attributed to AT Still but term was coined by Richard Van Buskirk, DO, PhD]
T/F: advantages of FPR are the same as advantages for still’s
True
Easily applied, effective, time efficient, good pt satisfaction, thorough
T/F: indications/contraindications are the same for FPR and Stills
True
PE reveals L4 with left PTP that becomes more symmetric with flexion and prominent with extension. What would be the ending position of treatment for L4 using the Still technique?
A. F RL SL B. F RR SR C. E RL SL D. E RR SR E. N RL SR F. N RR SL
D. E RR SR
Primary goal of FPR
Reduce abnormal muscle hypertonicity (superficial and deep) and restore lost motion to restricted articulation
For FPR, spinal facilitation is defined as:
The maintenance of a pool of neurons (premotor, motor, or preganglionic sympathetics) in a state of partial or subthreshold ________; in this state, less afferent stimulation is required to trigger the discharge of impulses. Facilitation may be due to sustained increase in ________ input, abberant patterns of this input, or changes within the affected neurons themselves or their chemical environment.
Excitation; Afferent
Absolute contraindication for FPR
Lack of consent or cooperation
What is the FPR treatment technique for Lumbar, Flexed (type 2), prone?
Flex leg that is ipsilateral the PTP off the table
Apply compression through the femur
Internally rotate and adduct the LE
Hold 3-5 seconds
Return to neutral and reassess
What is the FPR tx technique for lumbar extended, prone?
Add <1 lb compression through TP contralateral to PTP you are monitoring
Abduct the leg ipsilateral the PTP until motion is felt at the monitoring hand
Induce internal rotation of the hip, then extend the leg
Hold 3-5 s
Return to neutral and reasses
Supine Lumbar Still’s technique for extension dysfunction: what forces are applied to the patient?
Flex until movement is felt at the segment and then add abduction
Once motion is felt, back off flexion by extending until motion is felt at segment
Apply ABDUCTION and INTERNAL rotation through segment
[then compressive force is added, hip is brought through adduction and external rotation, then back to neutral supine]
Supine Lumbar Still’s technique for flexion dysfunction: what forces are applied to the patient?
Flex hip and knee until motion is felt at segment
Apply INTERNAL ROTATION and ABDUCTION
[compressive force is then applied, move hip through adduction and external rotation and back into full hip/knee extension]
