BLT/FPR/Still's Technique

Question 1

BLT: Upper Thoracics, Supine Neutral

go toward SD

Answer 1

1) patient supine, with physician sitting at head of table
2) support patients head with hand and reach under neck, placing pad of a finger of the other hand on the TP of dysfunctional segment
3) position patient in flexion (to move middle segment into neutral), rotation, and sidebending RB
4) instruct patient to hold breath as long as possible in phase that provides best ligamentous balance (make minor adjustments to all 3 planes as needed to maintain balance)
5) step 4 repeated until best motion obtained
6) reasses

Dx: T1-3 N SlRr
Tx: T2 N SlRr

Question 2

BLT: Upper Thoracic, Seated

Go toward SD

Answer 2

1) patient seated with physician seated behind
2) monitor segment being treated with one hand, place the other elbow on patient’s shoulder with hand on top of patient’s head
3) place the patient in an indirect position, using small increments until all 3 planes achieve BLT
4) test respiratory phases and instruct patient to hold breath for as long as possible in phase that provides best BLT
5) repeat until best motion obtained (3x average)
6) Reassess

Dx: T2 F SrRr
Tx: T2 F SrRr

Question 3

BLT: Lower Thoracic, Seated

Go to SD

Answer 3

1) patient seated, with physician seated behind
2) using thumb, contact TP of lower vertebra of dysfunctional unit (use same thumb as side of TP); using other thumb, contact other TP if upper vertebra of dysfunctional unit
3) have patient lean back at hips to establish firm contact
4) instruct patient to sit up straight or slouch forward to localize sagittal plane at dysfunctional unit
5) instruct patient to lean a little to the side and rotate a little to side of SD in small increments until all 3 planes achieve BLT
6) Test respiratory phases and instruct patient to hold breath as long as possible in phase that provides best BLT
7) repeat (3 times)
8) reassess

Dx: T4-T12 N SlRr
Tx: T8 N SlRr

Top thumb on side of sidebending
Bottom thumb on side of rotation

Question 4

BLT: Thoracic/Lumbar, Prone

Answer 4

1) patient prone, physician stands beside table
2) physician places left thumb over left TP of T12 and the index and third finger pads of left hand over right TP of T12
3) physician places right thumb over left TP of L1 and index and third finger pads over right TP of L1
4) patient inhales and exhales, and physician encourages patient to hold more relaxing of the two and follows motion of segments
5) physician adds compression force approximating T12 and L1, and then directs a force downward toward the table to vector it to extension barrier
6) physicians thumb approximate the left TP of T12 and L1, which produces side bending left while simultaneously rotating T12 to the left and L1 to the right
7) when total balance achieved, physician holds position until air hunger
8) repeat as needed
9) Reassess