BLT /FPR/ STILL Lecture and LAB Flashcards
What are some reasons to do indirect treatments?
Patient/practitioner preference
Direct treatments contraindicated
Direct treatment just isn’t working
Who came up with Balanced Ligamentous tension?
Dr. William Sutherland, DO
What are the three principles of BLT?
Disengagement of the dysfunctional area
Exaggeration of dysfunctional pattern
Balanced tension of ligaments
How does inhalation and exhalation effect the spinal curves?
Inhalation flattens the spine in the Anterior-Posterior direction
- Exhalation increases AP spinal curves
Describe Facilitated Positional Release
Make diagnosis Flatten (“neutralize”) the curve Add compression Indirect positioning Hold 3-5 seconds Return to neutral Reassess
What is the MOA of FPR?
Interaction between 1alpha-afferent and gamma-efferent activity
Intrafusal fibers allowed to return to normal length
1alpha-afferent signals decrease
Decreases tension in extrafusal fibers
Muscles achieve normal length and tone
What are some indications of FPR?
Muscle hypertonicity
Virtually all somatic dysfunction
Time crunch
Contraindications of FPR?
Unstable fracture Manifestation of neurologic symptoms Life-threatening symptoms Wounds <6 weeks Joint instability
What are the steps to FPR?
Neutralize (flatten) spinal curve Utilize compression Place patient in shifted neutral - Hold for 3-5 seconds Return to neutral Reassess for TART findings
Stills technique wasn’t published until…
2000
Describe Stills technique
Place dysfunctional segment in shifted neutral position Add localizing force - <5 pounds of compression/traction Move through the restrictive barrier while maintaining localizing force - “Bump” or click may be heard or felt End in direct position - Anatomic barrier is attained Return to neutral Reassess for TART findings
What are some indications for Stills?
Somatic Dysfunction
Muscle hypertonicity
Lymphatic congestion or local edema
What are some contraindications for Stills?
Fracture, dislocation, instability Wounds <6 weeks Soft tissue/bony infections, abscesses DVT/Malignancy Manifestation of neurologic symptoms Deep venous thrombosis
What positions do you use for BLT?
Seated for upper thoracic and mid thoracic
BLT is an indirect or direct treatment?
Indirect
How long does the patient hold breath in BLT?
Air hunger
How to know if they hold inhale or exhale?
Which ever one causes more relaxation of the dysfunction
For prone BLT, how do you make flexion?
Pressure on the superior TP
For prone BLT, how do you make flexion?
pressure on the inferior TP
For prone BLT, physician stands on what side?
Side of the PTP
How much pressure in FPR?
Less than 1 Lb
How to do mid thoracic position for FPR?
Doctor hug, extend to get rid of kyphotic curve
How to do lumbar position for FPR?
Seated. Flex to get rid of lumbar lordotic curve
Stills technique for Upper vrs lower thoracic?
Upper applies force through the head, mid and lower you do a doctor hug and apply force through shoulders.
