Thoracic & Lumbar: BLT, FPR, Stills

Question 1

Definition of BLT

Answer 1

method that involves the minimization of peri-articular tissue load and the placement of the affected ligaments in a position of equal tension in all appropriate planes so the body’s inherent forces can resolve the SD

Question 2

3 Principles of BLT

Answer 2

• Disengagement of the dysfunctional area
• Exaggeration of the dysfunctional pattern
• Balanced tension of ligaments

Question 3

Steps of BLT

Answer 3

Ex. L1 E SL RL
(1) patient lies prone
(2) place first fingers and thumbs on the transverse processes of the affected vertebra and the one below (ex. L1, L2)
(3) address the sagittal plane (ex. if extended then press on finger and thumb of inferior hand)
(4) side-bend by approximating the transverse processes on the same side (ex. L)
(5) rotate by adding pressure to the appropriate opposite finger and thumb (ex. rotate by pressing superior thumb and inferior 1st finger)
(6) test respiratory phases and instruct patient to accentuate cycle with greatest ease; make minor adjustments in patients position to maintain tissue balance
(7) Repeat step 6 until best motion obtained
(8) reassess TART

Question 4

FPR Definition

Answer 4

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

Question 5

Mechanism of FPR

Answer 5

• interaction between 1 alpha afferent and gamma efferent activity
• intrafusal fibers allowed to return to normal length
• 1 alpha afferent signals DECREASE
• DECREASES tension in extrafusal fibers
  -secondary effects: improved lymphatic drainage, venous drainage, and improved fluid dynamics

Question 6

FRP: Flatten the Curve

Answer 6

• Lordotic regions should be slightly flexed (patient slouch)
• Kyphotic regions should be slightly extended (patient sit up straight)

Question 7

Steps of FPR

Answer 7

Ex. T7 E RR SL
(1) Neutralize sagittal curve: monitor segment and instruct pt to extend spine to straighten the curve
(2) Activating force: add compression of <1lb localized to the segment
(3) Indirect positioning: triplanar indirect positioning
(4) hold for 3-5 sec
(5) return to neutral
(6) reassess TART

Question 8

Still’s Method Definition

Answer 8

combined manipulative method utilizing both indirect and direct components; dysfunctional region first placed in an indirect position and axial force (compression, traction, torsion) is added and then used to carry the region directly past neutral toward or through its restrictive barrier

Question 9

Steps of Still Technique

Answer 9

Ex. T1 E RR SR (end position: T1 F RL SL)
(1) Initial Positioning: place articular dysfunction to the shifted neutral position (ex. extend to localize to T1 then add rotation right and side-bending right); monitor at TP for tissue texture normalization
(2) Activating Force: add compression of <5lbs
(3) Motion: move patient through the direct barrier after compression or traction force
(4) Remove compression and return to neutral
(5) Recheck TART findings

Question 10

BLT
(1) Set-Up Position:
(2) Activating Force:
(3) End Position:

Answer 10

(1) Set-Up Position: Indirect
(2) Activating Force: Respiratory Assist
(3) End Position: Neutral

Question 11

FPR
(1) Set-Up Position:
(2) Activating Force:
(3) End Position:

Answer 11

(1) Set-Up Position: Flatten the curve & Indirect
(2) Activating Force: Compression or Traction
(3) End Position: Neutral

Question 12

Stills
(1) Set-Up Position:
(2) Activating Force:
(3) End Position:

Answer 12

(1) Set-Up Position: Indirect
(2) Activating Force: Compression or Traction
(3) End Position: Direct