Review: Intro BLT/FPR/Stills Flashcards
Who developed BLT
Dr. Sutherland
Dr. Sutherland stated that osteopathic lesions are strains of the tissues of the body. When they involve joints, it is the ligaments that are primarily affected, so he named the dysfunctions what?
Ligamentous articular strain [note that LIGAMENTS are what we treat, not muscles]
Indications for BLT
SDs of an articular basis SDs of a myofascial basis Areas of lymphatic congestion or local edema
Relative contraindications for BLT
Fracture, dislocation, or gross instability in area to be treated Malignancy, infection, or severe osteoporosis in area to be treated
Biochemical changes secondary to joint immobilization
Microadhesions Overall loss of collagen Loss of water
Physiologic changes secondary to joint immobilization
Greatly increased force needed to move immobile joint After several repetitions, becomes easier
General goal of BLT
Balance articular surfaces or tissues in the directions of physiologic motion common to that articulation
Central principle of BLT (When is tx complete?)
Take that which you palpate as hard and make it soft When you feel flow come through dysfunctional area, your tx of that area is complete
PE reveals a left PTP at T7 that becomes more symmetrical with the other side in extension and prominent with flexion. What is the position of treatment for BLT? A. Flexed, RL, SL B. Flexed, RR, SR C. Extended, RL, SL D. Extended, RR, SR E. Neutral, RL, SR F. Neutral, RR, SL
C. Extended RL SL
Who developed FPR
Stanley schiowitz, DO
Define FPR
System of indirect myofascial release treatment. The component region of the body is placed into neutral position, diminishing tissue and joint tension in all planes and an activating force is added
Indications for FPR
SD in virtually all tissues, especially muscle spasticity Efficacy is only limited by practitioner’s knowledge of functional anatomy Safe to use on all ages
Contraindications for FPR
Recent wounds or fractures less than 6 wks old If the patient cannot voluntarily relax or tolerate position Severe osteoporosis or joint instability Radicular pain with tx Fracture or disc herniation in area being treated
PE reveals left PTP at T1-3 that do not change with flexion or extension. Which of the following levels would utilize the associated described position using an FPR technique? A. T1 N RL SR B. T1 N RR SL C. T2 N RL SR D. T2 N RR SL E. T3 N RL SR F. T3 N RR SL
C. T2 N RL SR
Still technique definition
Characterized as a specific, non-repetitive articulatory method that is indirect, then direct [attributed to AT Still but term was coined by Richard Van Buskirk, DO, PhD]
T/F: advantages of FPR are the same as advantages for still’s
True Easily applied, effective, time efficient, good pt satisfaction, thorough
T/F: indications/contraindications are the same for FPR and Stills
True
PE reveals L4 with left PTP that becomes more symmetric with flexion and prominent with extension. What would be the ending position of treatment for L4 using the Still technique? A. F RL SL B. F RR SR C. E RL SL D. E RR SR E. N RL SR F. N RR SL
D. E RR SR
Primary goal of FPR
Reduce abnormal muscle hypertonicity (superficial and deep) and restore lost motion to restricted articulation
For FPR, spinal facilitation is defined as: The maintenance of a pool of neurons (premotor, motor, or preganglionic sympathetics) in a state of partial or subthreshold ________; in this state, less afferent stimulation is required to trigger the discharge of impulses. Facilitation may be due to sustained increase in ________ input, abberant patterns of this input, or changes within the affected neurons themselves or their chemical environment.
Excitation; Afferent
Absolute contraindication for FPR
Lack of consent or cooperation
What is the FPR treatment technique for Lumbar, Flexed (type 2), prone?
Flex leg that is ipsilateral the PTP off the table Apply compression through the femur Internally rotate and adduct the LE Hold 3-5 seconds Return to neutral and reassess
What is the FPR tx technique for lumbar extended, prone?
Add <1 lb compression through TP contralateral to PTP you are monitoring Abduct the leg ipsilateral the PTP until motion is felt at the monitoring hand Induce internal rotation of the hip, then extend the leg Hold 3-5 s Return to neutral and reasses
Supine Lumbar Still’s technique for extension dysfunction: what forces are applied to the patient?
Flex until movement is felt at the segment and then add abduction Once motion is felt, back off flexion by extending until motion is felt at segment Apply ABDUCTION and INTERNAL rotation through segment [then compressive force is added, hip is brought through adduction and external rotation, then back to neutral supine]
Supine Lumbar Still’s technique for flexion dysfunction: what forces are applied to the patient?
Flex hip and knee until motion is felt at segment Apply INTERNAL ROTATION and ABDUCTION [compressive force is then applied, move hip through adduction and external rotation and back into full hip/knee extension]
Basic steps of FPR
- Segmental Dx 2. Neutralize sagittal plane (lordosis/kyphosis) 3. Facilitating force (compression/torsion) 4. Indirect, 3-plane positioning (shifted neutral) 5. Hold for 3-5 seconds 6. Reevaluate
FPR for hypertonic suboccipital mm
Pt supine with head and neck off table. Doc at head of table supporting pts head, monitoring hypertonic tissues with 3rd finger Slightly flex head and neck forward to flatten cervical curve Apply gently axial compression on occiput toward feet While maintaining compression, extend head and neck and SB to same side of hypertonic mm Hold for 3-5 seconds, return to neutral, release compression Reassess
FPR for cervical segmental dysfunction
Pt supine. Doc at head of table supporting pt head with one hand, monitoring articular pillars of affected segment with index finger and thumb Slightly flex pt head and neck forward to flatten cervical curvature Apply gentle axial compression on occiput towards feet While maintaining compression, move segment into its ease of motion Hold for 3-5 seconds, return to neutral, release compression, reassess
Still’s for OA SD
Pt supine with doc at head of table; place pad of index or middle finger on side of side-bending component in basioocciput, using palm to support pts head. Place other hand on top of pts head SB the head into its ease. Due to coupling motion at OA joint, slight rotation at opposite direction will occur. Introduce F/E depending on dx Compress through top of head. While maintaining compression, take head into neutral and articulate through RB. Release compression, return to neutral, and reassess
Still’s for AA SD
Pt supine or seated, doc at head of table. Place index or middle finger on TP of atlas (C1) on side of rotation Rotate head into ease of motion; compress through top of head. While maintaining compression, take head into neutral and articulate through RB. Compression is released and head returned to normal. Reassess
Still’s for typical cervical SD
Pt supine, doc at head of table. Place index or middle finger on articular pillar at level of SD, on side of rotation. SB and rotate the cervical segment into its ease. Introduce F/E depending on dx. Compress through top of head. While maintaining compression, take head into neutral and articulate through RB. Compression is released and head returned to normal. Reassess
BLT for OA SD
Pt supine, doc at head of table. Use one hand in “pincer” grasp of laminae on either side of midline for C1 to stabilize and monitor the OA through the atlas Place other hand on pts head to induce position of greatest BLT Test respiratory phases and have pt hold breath as long as possible in phase that provides best BLT. Repeat until best motion obtained (1-3x). Reassess
BLT for typical cervical Dx
Pt supine, doc at head of table with forearms and elbows resting on table. Place palms under pts head, palpate articular processes with index fingers bilaterally. Establish point of BLT in cervical spine by inducing the position of greatest BLT through head and neck. Test respiratory phases and have pt hold breath as long as possible in phase that provides best BLT. Repeat until best motion obtained (1-3x). Reassess
FPR Sacral evaluation
- Neutralize sagittal curve: placec pillow under lower abdomen 2. Thenar eminences on ILAs 3. Doc directs cephalad force with both hands (either both at once or one at a time) Positive test =diminished cephalad motion
Prone FPR Sacral SD
Prone FPR piriformis
Prone FPR: Gluteus Maximus
Prone FPR: Hamstring
Supine FPR: Quadriceps
Seated FPR: Costochondral SD
Seated FPR: Posterior Rib SD
Seated FPR: Inh/Ex Rib SD
Stills for superior innominate shear SD
Stills for Posterior Innominate Rotation SD
Stills seated technique for posterior rib
Stills: Supine Exhalation/Anterior TP rib
Stills: Supine inhalation/posterior TP rib
