BLT Handout UE lab

Question 1

Ligaments- job

Answer 1

regulate and guide the movement in all the articulatory mechanisms of the body. In most joints they act as checks to the voluntary actions of muscles.

The clearest example of this idea occurs in the wrist. There are no muscular forces acting directly upon the carpal bones yet we can flex, extend, circumduct and move our wrists in all sorts of configurations. Each of these movements occurs as a result of small rotations, twistings and turnings of the carpal bones.

Question 2

the carpal ligaments can be viewed as

Answer 2

levers and pulleys and straps guiding the bones and the articular relationships. Dr. Sutherland described this arrangement as a ligamentous articular mechanism.

Question 3

carpal bones vs ligaments

Answer 3

while the positions of the carpal bones may change, the tensions on the carpal ligaments do not. In other words, when the wrist is flexed, the dorsal ligaments are not stretched, nor do the palmar ligaments go slack. As long as the wrist is moved within its physiological range of motion, the tensions within the carpal ligaments remain balanced. Sutherland called this a balanced ligamentous articular mechanism.

Question 4

Examples of ligamentous articular mechanisms

Answer 4

the forearm (radial and ulnar intraosseous membrane), the tibia and fibula (again via the intraosseous membrane) and the foot

According to Sutherland’s model, all of the joints in the body are balanced ligamentous articular mechanisms.

Question 5

ligamentous situation in the foot

Answer 5

While the range of motion is much less than the wrist, the ligaments of the foot are responsible for creating a system, which is capable of weight bearing and mobility. Movements of the forefoot and hind foot are dictated by the ligamentous arrangement.

Question 6

ligaments and proprioception

Answer 6

The ligaments provide proprioceptive information that guides the muscle response for positioning the joint, and the ligaments themselves guide the motion of the articular components.

Question 7

Reciprocal tension

Answer 7

describe the role of ligaments in joints8. According to Sutherland’s model, throughout the physiological range of motion of any given joint, the associated ligaments maintain a constant level of tension. They do not stretch, nor do they become lax.

Question 8

In normal movements as the joint changes position

Answer 8

the relationships between the joint’s ligaments also change, but the total tension within the articular mechanism does not

Question 9

When the joint is affected by injury, inflammation or mechanical forces, etc

Answer 9

the distribution of tension between the ligaments is altered. This is what happens in somatic dysfunction. The distribution and vector of tension within any given ligament will change according to the position of strain in the joint.

Question 10

Application of the principles

Answer 10

the technique combines a fulcrum introduced by the physician with an activating force provided by the patient. The physiological movements and forces generated in the body through position and respiration. The inherent forces within the body can be used as activating forces to assist the physician in the manipulative procedure. This is a very safe and effective method of treatment.

Question 11

Principles of diagnosis

Answer 11

by observing the motion of a given joint during respiration or active motion, the observer can ascertain the position of the articular surfaces. This observation is usually performed through palpation. The physician uses involuntary motion to determine the degree of restriction and the specifics of dysfunction.
Assessing the motion mechanics at a joint requires gentle tactile discrimination. Large motions are not necessary, nor are they useful when working with the ligamentous components. Patients may be examined sitting, supine or prone.

Question 12

Principles of treatment

Answer 12

1. establishing balanced ligamentous tension in the articular mechanism so that the body’s inherent forces can resolve the strain.

the physician will need to assess the tension within the ligaments in all directions of motion. It is the most neutral position possible under the influence of all the factors responsible for the existing strain pattern.

The physician will hold this position while the activating forces within the body such as breathing resolve the strain. When the strain corrects, the physician will feel a shift or change in the tension in the joint such that the neutral that he created is no longer the point of minimal tension. In other words, the physician will often feel an increase in tension as the joint spontaneously moves towards its physiological neutral

Question 13

The point of balanced ligamentous tension is t

Answer 13

the point in the range of motion of an articulation where the ligaments and membranes are poised between the normal tension present throughout the free range of motion and the increased tension preceding the strain…which occurs as a joint is carried beyond it’s normal physiology

Question 14

HUMERUS BLT

• assessment

Answer 14

Freedom of rotation of the humerus in the glenoid cavity is tested with the arm at an angle of 45º to 90º laterally from the body, and the elbow flexed. Comparison of the motion on the two sides is made by carrying the hand laterally and upward to test external rotation of the humerus, and medially and downward for internal rotation. Restricted motion in one direction indicates lesion in the opposite position

Question 15

HUMERUS BLT Treatment:

Answer 15

Correction is made with the patient seated, the physician standing on the side of lesion, facing him. The operator’s hands reach around the humerus with the fingers as superior a contact on the humerus into the axilla as possible. Caution about placement as the brachial plexus is vulnerable to compression. Change your hand placement if tingling in the arm occurs. Leverage is placed with the humerus toward the chest and the fingers on the medial humerus pulling laterally. The patient reaches the hand of the involved side across his chest to the distal third of the opposite clavicle and holds that shoulder. The patient is instructed to move his uninvolved shoulder posteriorly, carrying with it the hand of the lesioned side. This draws the lower end of the humerus across the chest in order that the leverage over the fulcrum provided by the physician’s hand disengages the head of the humerus. Balanced ligamentous tension is then established by gently internally or externally rotating the humerus. A slight superior motion may also help engage the entire joint capsule. This position is held until there is a change in tissue tension. Respiratory cooperation may be employed to correct the lesion.

Question 16

Scapulothoracic joint BLT dx

Answer 16

The physician assesses position of scapula on thorax, i.e., scapulo-thoracic joint. A hypertonic serratus anterior will produce elevation and lateral displacement of scapula.

Question 17

Scapulothoracic joint BLT Treatment

Answer 17

he physician stands on the side of the shoulder to be treated, placing the pad of his thumb on the ribs at the mid-axillary line as superior as possible. The physician then slides his/her thumb posteriorly along the patient’s ribs until it is under the scapula with the pad of the physician’s thumb on the thoracic cage and the thumbnail against the scapula.

The physician asks the patient to lean towards him/her so that the thumb slides further under the scapula until he/she reaches the resistance of the serratus anterior. His/her thumb will act as a fulcrum for movement of the scapula. The physician places his/her other hand on top of the scapula, grasping the spine of the scapula with her fingers. An inferior traction is placed on the scapula to achieve balance between the serratus anterior, rhomboids and teres muscles. The physician holds this position until a relaxation of the serratus anterior is achieved

Question 18

The Basic Model of the Still Technique

Answer 18

1. Determine where the joint or tissue is positioned and/or where it moves most easily.
2. Move the restricted joint or tissue and its’ surrounding tissues into that position of ease.
3. Exaggerate the position of ease sufficiently to relax the affected tissue and those surrounding it.

*** 4. Introduce a vector of force (compression or traction) of about five pounds or less through the affected tissue. The point of initiation of the force vector should be on a part of the body that can be used as a lever that can introduce movement in the restricted tissue. The vector of force may be along the long axis of the body for the spine or its orientation may follow a different vector. In every case the vector of force must be through the affected tissue.

5. Using the force vector as if it were a lever, the tissue is taken through its range of motion towards and through the initial restriction. This movement will typically be a composite that utilizes all of the tissue’s normal planes of motion.
6. As the coupled force vector and tissue motion takes the tissue past its area of previous restriction there is a palpable release, sometimes accompanied by a click such as is commonly heard in HVLA treatments.
7. The force vector is then released and the tissue is passively returned to neutral and retested.

Question 19

Sensing hand or sensing finger:

Answer 19

the hand placed on the affected spinal segment, joint, muscle, or ligament.

1. It acts as a feedback sensor providing information about the adequacy of the initial positioning. That is the tissue will palpably relax when the appropriate position is achieved.
2. The sensing finger can provide information during the articulation that the track of motion is appropriate.
3. The sensing finger will be able to feel the release as the tissue passes through the barrier.

Question 20

Operating hand:

Answer 20

the hand and arm that sets the initial position of the patient’s tissue, provides the force vector through the tissue, and articulates the tissue along its motion path through the barrier.

Question 21

Force Vector:

Answer 21

conceived of as the lever, which is being used to articulate the tissue. By definition it always involves a force (compression or traction) no more than five pounds that is applied through the tissue.