BLT, FPR and Still for Thoracic and Lumbar

Question 1

BLT, FPR, and Still Technique

can each be used for __________

Answer 1

Type 1 and Type 2

Question 2

BLT stands for

________

Key things to remember for it (2)

Answer 2

Balanced ligamentous tension

• uses breathing
• indirect (move into ease of motion)

Question 3

BLT Upper Thoracics

Supine

-used to tx type 1

Dx: T1-3 N SL SLRR

Answer 3

Tx: same position; T2 (middle one) NSL, RR

• 1. Support head with one hand
• 2. With hand corresponding to the TP that you are going to treat, find C7–> go to T2 and place fingers on TPs.
     * If; since we are SR, we use our right hand to contact the TP
• 3. Flex pt neck to bring T2 into neutral
• 4. Take patient in SB L–> by translating right
• 5. Take patient into RR, by applying anterior force to the L PTP.
• 6. Have patient inhale and exhale; whichever one the patient likes best, sustain until they feel the need to breathe (hold them in the one they like the best)
     * Ex. If patient likes to exhale best; tell them to exhale until they need to breathe in.
• 7. Repeat until motion is balanced
• REASSESS
  *

Question 4

BLT Lower Thoracic

Seated

-used to tx type 1

Dx: T4-12 N SL RR

Answer 4

Tx: T8, E SL RR

1. Patient is seated
2. Find T8; 1 below the inferior angle of the scapula
3. [Q: what is the PTP: in this case, L]–> Use the ipsilateral thumb (l thumb) and put it on the TP of the vertable below; and other thumb on segment with the dysfunction

–> we are puttint out R thumb on the TP of T9 and L thumb on the TP of T8

4. Have pt sit up straight, SB a little to the L and R a little to the R [AT THAT SEGMENT]
5. Inhale and exhale; find one they like; hold
6. Keep doing until motion is restored
7. REASSESS

Question 5

BLT: Thoracic/ Lumbar: Prone

-type 2-

Dx: T12 ESLRL

Answer 5

• Tx: T12 ESLRL
• 1. Patient lays prone:
• 2. ASK YOURSELF; what is the PTP? In this case–> L, so we stand on their L side
     * Put L hand on the defected segment (T12) and R one on segment below (L1) like a sandwich.
• 3. Extension/flexion
     * Bc extension- we push the two hands together because during extension, our TP are closer together.

-if it was flexion, we would pull them apart

• 4. Rotation (hands go in opp directions)
     * Rotate dysfunctioned segment :
     * Other hand–> rotate right
• Do this together around 3 times until balance is restored

REACCESS

Question 6

What is FPR?

Answer 6

Facilitated positional release–> A modified MFR.

Restricted region is placed in neutral position to reduce tension in all planes.

Then, we add a activating force (compression or torsion).

Question 7

What is the goal of FPR?

Answer 7

Reduce muscle hypertonicity and restore lost motion

Question 8

FPR is direct/indirect

passive/active

Answer 8

INDIRECT- we take into ease: tx is same as Dx

PASSIVE- YOU do everything

Question 9

FPR: Upper Thoracics

Seated.

—-Dx: T2 E RRSR—

Answer 9

Tx: T2 E RRSR

1. Monitor segment w one hand
2. Grab head w other
3. Extend head a little to neutralize kyphosis
4. Rotate R and SB R
5. Add a activating force: compression (relaxes muscle)
6. Hold 3-5 seconds
7. Release

7. Reassess

Question 10

FPR Lower Thoracic (T7-T12)

Seated

Dx: T7 E RRSR

Answer 10

1. Monitor the T7 segment with one hand
2. Go across the back with our other hand and grab their shoulder
3. Put them into extension a little to neutralize the kyphosis in back
4. Rotate them to the R, SB to the R
5. Add a compressive force down for 3-5 seconds,
6. Let go
7. Reaccess

Question 11

FPR Prone

Lumbar Flexed(Type ____)

Answer 11

2

Question 12

Prone FPR,

Lumbar Flexed (Type II)

Dx: L4 F SLRL

Answer 12

TX: L4 FSLRL

Doc will be on side of PTP (in this case, L)

1. Neutralize the curve: Patient lays on stomach with pillow under abdomen, to neutralize the curve
2. Use hand closest to table to monitor PTP
3. Other hand: Flex leg off table–> adduct and internally rotate

5. Add activating force: compress leg inwards towards femur

6. Hold 3-5 seconds- bring patient back to neutral
7. Reass

Question 13

Prone FPR,

Lumbar Extension (Type____)

Answer 13

2

bc extension hellloo

Question 14

FPR Prone

Lumbar Extended (Type II SD)

Dx: L4 ES_LR_L

Answer 14

Doc is on opposite side of the PTP

1. Neutralize the curve: lay down and add pillow underneath tummy
2. With hand closer to their head, monitor the TP. Other hand on distal femur (or ankle)
3. Activating force: internally rotate distal femur to you.
4. Abduct and extend leg
5. Hold 3-5 seconds

Question 15

Still technique

Passive or active

Answer 15

Passive

Question 16

What is the summary of Stills tecqniue

Answer 16

1. Start out in the position of ease (the positions in the given diagnosis), while monitoring the joint
2. Add a compressive force
3. Move through neutral and into their RB (Go to the position OPPOSITE of given).

[Position of ease: T1 E RRSR + compression]–> move through neutral–> [Go into restrictive barrier: T1: F RLSL]

–> go back to neutral; REASSESS

Question 17

How much compression should you add for Stills

Answer 17

5 lbs

Question 18

What might you hear at the end of end of Stills

Answer 18

You may mobilize a joint and hear. a click or pop

Question 19

T1 E RRSR

If this is the diagnosis for stills, what is the tx

Answer 19

Begin at T1 E RRSR–> neutral–> T1 F RLSL

Question 20

Upper Thoracics Still Technique

Seated

T1 E RRSR

Answer 20

1. [Position of ease: T1 E RRSR + compression of head
2. WHILE MONITORING SEGMENT ENTIRE TIME]
3. –> move through neutral
4. –> [Go into restrictive barrier: T1: F RLSL]
5. –> go back to neutral; REASSESS

Question 21

Still Technique: Lower Thoracics (T5-12)

Seated

Dx T6ERLSL

Answer 21

[Position of ease: T6 E RLSL + compressing oppsosite shoulder down WHILE MONITORING SEGMENT ENTIRE TIME]

–> move through neutral

–> [Go into restrictive barrier: T6: F RRSR]

–>passively go to neutral;

REASSESS