2.6 Intro to BLT, Still's and FPR Flashcards
What are the direct OMT techniques? (6)
- MFR- both
- INR- both
- ST*
- MET*
- HVLA*
- Visceral- both
What are the combination OMT techniques? (1)
Stills
What are the indirect OMT techniques? (7)
- MFR- both
- INR- both
- BLT/LAS *
- FPR *
- functional
- visceral - both
- counterstain
What is BLT? What are it’s 3 principles?
Balanced ligamentous tension
Three Principles
- Disengagementof the dysfunctional area
- Exaggerationof dysfunctional pattern
- Balanced tension of ligaments
What article is BLT based on?
Drs. Rebecca and Howard Lipincott published Dr. Sutherland’s ideas as “Osteopathic Technique of William G. Sutherland” (1949)
In BLT, what are primarily involved in the maintenance of the somatic dysfunction and are used in the reduction of the SD?
ligaments
What was Dr. Still’s Lesson to Dr. Sutherland?
A pt who steps on a nail would draw his leg away, causing a membranous strain between fibula and tibia.
What are the indications for BLT? 2
- SD that involve ligamentous articular strains or myofascial basis
- Areas of lymphatic congestion or local edema
What are the contraindications for BLT?
- Fracture, dislocation, instability
- Open wounds
- Soft tissue/bony infections
- Abscesses
- DVT
- Malignancy
What are the side effects of BLT similar to?
post-exercise soreness
What is the type of motion at an articulation determined by?
shape of the joint surface, position of the ligaments, and forces of the muscles acting upon the joint
ligament tension is (more/less) variable than muscles?
LESS because ligaments do not stretch or contract as muscles do
In normal movements, does the total tension within a ligamentous articular mechanism change?
No, only the relationships between the joint’s ligaments and the position of the joint
What are the biochemical changes secondary to immobilization?
- fibrofatty infiltrates in capsular folds and recesses (longer=more infiltrate)
- loss of water and glycosaminoglycans in ground substance
- collagen fiber lubrication associated with maintenance of interfiber distance (must be maintained for smooth movement)
- microadhesions form and new collagen is laid down haphazardly
- immobilization for >12 weeks results in loss of collagen since rate of degradation > rate of synthesis
How much force is needed to move an immobilized joint? After several repetitions?
10 times normal force;
3 times normal force
What are the steps in BLT?
- position in the shifted neutral (indirect) - superior segment or distal structure over inferior segment for balanced ligamentous tension in all planes of motion
- activating force of inherent respiration - respiratory assist: holding breath at position of greatest ease toward air hunger but don’t pass out
- reevaluate for motion improvement
What is FPR?
Facilitated positional release:
combination of neutral positioning, application of an activating force (compression, torsion, or distraction), and placement into position of ease.
Who developed the FPR technique?
Stanley Schiowitz DO
What are indications for FPR? (3)
- Muscle hypertonicity, muscle spasticity
- Virtually all somatic dysfunction: acute or chronic SD
- Time crunch
What are absolute contraindications for FPR? (5)
- unstable fracture
- manifestation of neurological symptoms
- exacerbation of potentially life-threatening: symptomatology by treatment position (EKG changes, drop in O2 sats) in a monitored pt
- wound < 6 wks
- joint instability
What are relative contraindications of FPR?
- treatment is not well tolerated or significant symptoms or signs occur during the process
- comorbidities that place the pt at risk for fracture (severe osteoporosis, malignancy)
- severe joint instability/severe Osteoporosis
- fx/disc herniation/spinal stenosis/nerve root impingement where positioning could exacerbate the condition
When is FPR maximally effective?
When the SD has a primarily myofascial component
What are the steps of FPR?
- setup: monitor SD and put in “neutral” position AKA flatten the curve
- Use a activating force (compression, torsion, or distraction)
- Place in indirect position for greatest ease and HOLD for 3-5 second
- return and re-evaluate: return to the starting position and re-evaluate for the SD
What is the Still Technique?
combined manipulative method using both indirect and direct components.
- Diagnose Somatic Dysfunction
- Move to Position of Ease- indirect
- Apply localized axial force (compression, traction, torsion <5 lbs of pressure
- Articulatory Movement (direct): carry the region toward or through the RB (bump or “click” may be heard)
- End in direct position (anatomic barrier obtained)
- Return to Neutral and Reassess
Who created Still technique?
AT Still through reference work by Richard Van Buskirk DO PhD
What are the indications of Stills? (2)
- All somatic dysfunction
2. Short on time
What are the contraindications for Stills? (1)
recent wounds (surgical or otherwise) or fractures less than 6 weeks old
What are the steps of the Still Technique?
- initial indirect positioning
- add <=5 lb compression/torsion
- move through the restrictive barrier while maintaining the localizing force
- final treatment position: anatomic barrier
- return patient to neutral and reasses for TART
BLT
- Position set up
- activating force
- indirect manner
- Inherent Respiration
- Breathing/respiratory phase associated with greatest ease- Inhalation flattens the spine in the Anterior-Posterior direction
- Exhalation increases AP spinal curves
- Instruct patient to hold until “air hunger”
BLT goal
- balance the articular surfaces’ directions of physiologic motion that are common to that articulation
- 2nd osteopathic tenet: doctor helps body heal itself
A 50-year-old male complains of left hip pain. It started several weeks ago after climbing six flights of stairs at work. The pain is worse in flexion and going up the stairs. The pain radiates from the groin into the left thigh. Rest makes it better. It is worse at the end of the day. Ibuprofen relieves most of his pain but it is now causing him some “stomach burn.”
OSE demonstrates lumbar paraspinalmuscles tight bilaterally, L4 extended, rotated left, and sidebentleft. Which of the following is consistent with a BLT treatment?
A. Waiting for tissue creep
B. Returning slowly to neutral
C. Asking the patient to hold in exhalation
D. Placing the patient into the direct barrier
C. Asking the patient to hold in exhalation (if this is his preference aka increase AP spinal curves) BLT technique
A 22-yo female presents to the family medicine clinic with complaints of mid-back pain after a triathlon. PE reveals a left posterior TP at T7 that becomes more symmetrical with the other side in extension and prominent with flexion. What is the position of treatment for T7 using a BLT technique?
Indirect- T7 E Rl Sl (same as diagnosis)
General overview steps of FPR? (5)
- Position segment in neutral position: Flatten the curve
- Utilize compression
- Place patient in indirect position: Hold for 3-5 seconds
- Return to neutral
- Reassess
General overview steps of FPR? (5)
- Position segment in neutral position: Flatten the curve
- Utilize compression
- Place patient in indirect position: Hold for 3-5 seconds
- Return to neutral
- Reassess
General overview steps of FPR? (5)
- Position segment in neutral position: Flatten the curve, can use pillow
- Utilize compression
- Place patient in indirect position: Hold for 3-5 seconds
- Return to neutral
- Reassess
A 19-yo male presents to your office with complaints of upper back pain after a mid-term exam and admits to cramming all night. PE reveals left posterior TPs at T1-3 that do not change much with flexion or extension.
What is the monitored foci and positioning for OMT using FPR technique?
T2 N RlSr
A 92 year old WWII veteran presents to the VA hospital complaining of generalized pain in his neck and back. You notice extreme hypertonicity in the cervical region.
What is the first step of treating this patient with FPR?
A. Compression B. Indirect positioning C. Neutralize the curve D. Direct positioning E. Traction
C. Neutralize/flatten the curve- can use pillow
Stills
- set-up position
- activating force
- end position
- indirect
- compression
- direct
FPR goal
reduce abnormal hypertonicity and restore lost motion to a restricted articulation
FPR goal
reduce abnormal hypertonicity and restore lost motion to a restricted articulation
What is Dr. William Sutherland’s contribution to indirect techniques?
Cranial techniques (BMT) and BLT
What is Dr. Stanley Schiowitz, DO and Dr. Eileen DiGiovanna, DO contribution to indirect techniques?
1977- FPR
What is Dr. Lawrence H. Jones, DO contribution to indirect techniques?
1955- Strain-counterstrain
What is Dr. Anne Wales, DO contribution to indirect techniques?
First used term “BLT”
