BLT/FPR/Still's Technique Flashcards
Thoracic and Lumbar
BLT Upper Thoracics, Supine
Patient supine. Doc at head of table
- hand ipsilateral to PTP place finger on TP of dysfunctional segment
- contralateral hand supports head
- Move patient to ease of motion until you reach a point of BLT
- assess respiratory phases (hold inhalation or exhalation)
- Reassess
Balanced Ligamentous Tension
position patient indirectly (shifted neutral)
activating force is inherent respiration
*treatment is complete when you feel flow thru dysfunctional area
goal: balance the articular surfaces/tissues in directions of physiologic motion
BLT Relative Contraindications
- Fracture, dislocation or gross instability in area to be treated
- Malignancy, infection or severe osteoporosis in area to be treated
BLT Lower Thoracics Seated
- thumb ipsilateral to PTP contacts the TP of INFERIOR vertebrae of vertebral unit
- contralateral contacts the superior vertebrae
- instruct patient to lean back and slouch forward
- instruct patient to move to ease of motion
- assess respiratory phases (have patient stay like that)
Repeat on average 3 times
BLT Thoracic/Lumbar Prone
patient is prone
- left thumb over left TP (index and 3rd over right of TP of same vertebrae)
- patient inhales and exhales–patient holds what relaxes more
- dr address compression force and releases to mimic flexion and extension
- dr approximates left TP of superior and inferior while simultaneously rotating the superior to the left and inferior to the right
FPR
(modification of indirect myofascial release)
-restricted region of the body is placed into a neutral position to diminish tissue and joint tension in all planes
-addition of activating force (compression or torsion)
primary goal: reduce abnormal muscle hyptertonicity and restore lost motion to a restricted articulation
Relative Contraindications
patient can’t voluntarily relax or tolerate position
severe osteoporosis or joint instability
fracture or disc herniation
Use FPR with Caution
osteoporosis malignancy Rheumatological disorders Congenital Malformations Stenosis Other clinical diseases
Upper Thoracic FPR
Patient seated (Dr. behind) Monitor with 1 hand other hand on top of patient's head 1. instruct patient to extend head to neutralize kyphosis 2. add 1 lb of compression 3. put patient into triplanar position of ease 4. Hold 3-5 seconds 5. Return to neutral and reassess
Lower Thoracic FPR
patient seated (Dr. behind)
Monitor with 1 hand, other hand rests on posterior neck
have patient extend spine to neutralize kyphosis
add 1 lb of compression
put patient into triplanar position of ease
hold 3-5 seconds
return to neutral and reassess
lumbar flex/extend prone: FPR
-patient prone
(pillow under belly to neutralize kyphosis)
-monitor with cephalad hand
-caudad hand moves LE
-add 1 lb of compression thru finger resting off TP of -monitoring hand
-Flex or extend leg off the table
(flex: IR and adduct)
(Extend: Abduct, IR)
-hold 3-5 seconds
Return to neutral and reassess.
Still’s Technique
- Patient is passive the entire time
- Joint gets moved to the position of ease while monitoring
- Exaggerate position
- Apply traction or compression for 3-5 seconds
- Maintain force bring joint thru neutral
- release force and bring joint back to neutral
Contraindication of Still’s Technique
- patient has lost intersegmental motion due to spondylosis, OA, or RA
- moderate to severe joint instability
- acute strain or sprain
Upper/Lower Thoracics-Still’s Technique
- Monitors TP of affected segment
- Other hand moves head/neck
- Extend head to monitor motion of appropriate segment
- induce sidebending and rotation to EASE OF MOTION
- Add compression
- move thru Triplanar restrictive barrier–maintain compression
- Return to neutral and reassess
