2.6 Intro BLT/FPR/Stills

Question 1

Who developed BLT

Answer 1

Dr. Sutherland

Question 2

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?

Answer 2

Ligamentous articular strain

[note that LIGAMENTS are what we treat, not muscles]

Question 3

Indications for BLT

Answer 3

SDs of an articular basis
SDs of a myofascial basis
Areas of lymphatic congestion or local edema

Question 4

Relative contraindications for BLT

Answer 4

Fracture, dislocation, or gross instability in area to be treated

Malignancy, infection, or severe osteoporosis in area to be treated

Question 5

Biochemical changes secondary to joint immobilization

Answer 5

Microadhesions
Overall loss of collagen
Loss of water

Question 6

Physiologic changes secondary to joint immobilization

Answer 6

Greatly increased force needed to move immobile joint

After several repetitions, becomes easier

Question 7

General goal of BLT

Answer 7

Balance articular surfaces or tissues in the directions of physiologic motion common to that articulation

Question 8

Central principle of BLT (When is tx complete?)

Answer 8

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

Question 9

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

Answer 9

C. Extended RL SL

Question 10

Who developed FPR

Answer 10

Stanley schiowitz, DO

Question 11

Define FPR

Answer 11

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

Question 12

Indications for FPR

Answer 12

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

Question 13

Contraindications for FPR

Answer 13

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

Question 14

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

Answer 14

C. T2 N RL SR

Question 15

Still technique definition

Answer 15

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]

Question 16

T/F: advantages of FPR are the same as advantages for still’s

Answer 16

True

Easily applied, effective, time efficient, good pt satisfaction, thorough

Question 17

T/F: indications/contraindications are the same for FPR and Stills

Answer 17

True

Question 18

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

Answer 18

D. E RR SR

Question 19

Primary goal of FPR

Answer 19

Reduce abnormal muscle hypertonicity (superficial and deep) and restore lost motion to restricted articulation

Question 20

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.

Answer 20

Excitation; Afferent

Question 21

Absolute contraindication for FPR

Answer 21

Lack of consent or cooperation

Question 22

What is the FPR treatment technique for Lumbar, Flexed (type 2), prone?

Answer 22

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

Question 23

What is the FPR tx technique for lumbar extended, prone?

Answer 23

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

Question 24

Supine Lumbar Still’s technique for extension dysfunction: what forces are applied to the patient?

Answer 24

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]

Question 25

Supine Lumbar Still’s technique for flexion dysfunction: what forces are applied to the patient?

Answer 25

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]