Intro to BLT, Still's and FPR

Question 1

What are the direct OMT techniques?

Answer 1

MFR, INR, ST, MET

Question 2

What are the combination OMT techniques?

Answer 2

MFR, Stills

Question 3

What are the indirect OMT techniques?

Answer 3

MFR, INR, BLT, FPR

Question 4

What is BLT?

Answer 4

The method involves the minimization of periarticular tissue load and placement of the affected ligaments in a position of equal tension in all appropriate planes so that the body’s inherent forces can resolve the somatic dysfunction.

Question 5

What article is BLT based on?

Answer 5

“Osteopathic Technique of William G Sutherland” from 1949 Year Book of Academy of Applied Osteopathy

Question 6

In BLT, what are primarily involved in the maintenance of the somatic dysfunction and are used in the reduction of the SD?

Answer 6

ligaments

Question 7

What was Dr. Still’s Lesson to Dr. Sutherland?

Answer 7

A pt who steps on a nail would draw his leg away, causing a membranous strain between fibula and tibia.

Question 8

What are the indications for BLT?

Answer 8

• SD that involve ligamentous articular strains

- Areas of lymphatic congestion or local edema

Question 9

What are the contraindications for BLT?

Answer 9

• fractures
• open wounds
• soft tissue or bony infections
• abscesses
• DVT
• anticoagulation, disseminated or focal neoplasm
• recent post-operative conditions over the site of the proposed treatment
• aortic aneurysm

Question 10

What are the side effects of BLT similar to?

Answer 10

post-exercise soreness

Question 11

What is the type of motion at an articulation determined by?

Answer 11

shape of the joint surface, position of the ligaments, and forces of the muscles acting upon the joint

Question 12

ligament tension is (more/less) variable than muscles?

Answer 12

LESS because ligaments do not stretch or contract as muscles do

Question 13

In normal movements, does the total tension within a ligamentous articular mechanism change?

Answer 13

No, only the relationships between the joint’s ligaments and the position of the joint

Question 14

What are the biochemical changes secondary to immobilization?

Answer 14

• fibrofatty infiltrates in capsular folds and recesses (longer=more infiltrate)
• loss of water and glycosaminoglycans in ground substance
• collagen fiber lubrication associated with maintenance of interfiber distance (must be maintained for smooth movement)
• microadhesions form and new collagen is laid down haphazardly
• immobilization for >12 weeks results in loss of collagen since rate of degradation > rate of synthesis

Question 15

How much force is needed to move an immobilized joint? After several repetitions?

Answer 15

10 times normal force;

3 times normal force

Question 16

What are the steps in BLT?

Answer 16

1. position in the shifted neutral (indirect) - superior segment or distal structure over inferior segment for balanced ligamentous tension in all planes of motion
2. activating force of inherent respiration - respiratory assist: holding breath at position of greatest ease toward air hunger but don’t pass out
3. reevaluate for motion improvement

Question 17

What is FPR?

Answer 17

a treatment method in which a dysfunctional body region is addressed with a combination of neutral positioning, application of an activating force (compression, torsion, or distraction), and placement into position of ease.

Question 18

Who developed the FPR technique?

Answer 18

Stanley Schiowitz DO

Question 19

What are the advantages of FPR?

Answer 19

• easily applied, effective and time efficient
• good pt satisfaction
• thorough

Question 20

What are indications for FPR?

Answer 20

myofascial or articular SD

Question 21

What are absolute contraindications for FPR?

Answer 21

1. unstable fracture affected by treatment positioning
2. manifestation of neurological symptoms brought on by the treatment position
3. exacerbation of potentially life-threatening symptomatology by treatment position (EKG changes, drop in O2 sats) in a monitored pt

Question 22

What are relative contraindications of FPR?

Answer 22

1. treatment is not well tolerated or significant symptoms or signs occur during the process
2. comorbidities that place the pt at risk for fracture (severe osteoporosis, malignancy)
3. moderate to severe joint instability
4. spinal stenosis/nerve root impingement where positioning could exacerbate the condition

Question 23

When is FPR maximally effective?

Answer 23

When the SD has a primarily myofascial component

Question 24

What is the mechanism of FPR?

Answer 24

SD is initiated or maintained by increased activity in gamma motor neurons of the muscles –> spindles resulting in increased tension in the muscle even in “neutral”.
Positioning in neutral position results in: inverse spindle output eliminating the afferent excitatory input to the spindle cord through group 1a and II, and unloading of the joint
initial response is soft tissue then articular

Question 25

What are the steps of FPR?

Answer 25

1. setup: monitor SD and put in “neutral” position AKA flatten the curve
2. Use a activating force (compression, torsion, or distraction)
3. Place in indirect position for greatest ease and HOLD for 3-5 second
4. return and re-evaluate: return to the starting position and re-evaluate for the SD

Question 26

What is the Still Technique?

Answer 26

combined manipulative method using both indirect and direct components.
first place dysfunctional region in indirect position, an axial force (compression, traction, torsion) is added then used to carry the region toward or through the restrictive barrier

Question 27

Who created Still technique?

Answer 27

AT Still through reference work by Richard Van Buskirk DO PhD

Question 28

What are the indications of Stills?

Answer 28

SD in virtually all tissues of the body, efficacy only limited by knowledge of anatomy, safe to use for patients of all ages

Question 29

What are the contraindications for Stills?

Answer 29

recent wounds (surgical or otherwise) or fractures less than 6 weeks old

Question 30

What are the steps of the Still Technique?

Answer 30

1. initial indirect positioning
2. add <=5 lb compression/torsion
3. move through the restrictive barrier while maintaining the localizing force
4. final treatment position: anatomic barrier
5. return patient to neutral and reasses for TART