Lecture #2: OMM Lab #31 Prep lecture - Balanced Ligamentous Tension - Cervical, Thoracic, Lumbosacral

What are the goals of Balanced Ligamentous Tension (BLT)?

BLT aims to minimize peri-articular tissue load and place affected ligaments in a position of equal tension in all appropriate planes so the body's inherent forces can resolve the somatic dysfunction.

What are the three basic steps of BLT?

Disengage the joint to encourage free play, exaggerate the documented dysfunctional pattern to find the balance point, then maintain that balanced position until tissue release occurs.

What is meant by the disengage step of BLT?

Compress or decompress the tissues around a joint or segment to encourage free play before balancing the dysfunction.

What occurs during the exaggerate step of BLT?

Move the joint in the direction of the documented dysfunctional pattern, corresponding to the original position of injury, until the balance point is found.

What occurs during the balance step of BLT?

Maintain the position where ligamentous tension is equal in all directions until a release occurs.

Can BLT be performed directly or indirectly?

BLT can be performed either directly or indirectly, although it is performed indirectly most of the time.

What forces can be used during BLT?

BLT uses direct or indirect forces depending on the treatment approach and dysfunction.

What patient participation may be used during BLT?

Although BLT is categorized as a passive technique, respiratory cooperation may be incorporated during treatment.

What should always be done after BLT?

Reassess continuously during treatment and after completion to evaluate resolution of the somatic dysfunction.

Which BLT techniques are taught in this laboratory?

Cervical spine (C2-C7), thoracic spine (T1-T12), lumbosacral spine (L5-S1), and fibula including the interosseous membrane.

Which cervical spinal levels are treated with BLT in this lab?

Cervical vertebrae C2 through C7.

Which thoracic spinal levels are treated with BLT?

Thoracic vertebrae T1 through T12.

Which lumbosacral level is emphasized for BLT?

The L5-S1 lumbosacral articulation.

Which lower extremity structure is treated using BLT?

The fibula, including treatment of the interosseous membrane.

What example cervical dysfunction is demonstrated in the lecture?

C3 ERS right.

What is the first objective of the session?

Discuss the principles and goals of Balanced Ligamentous Tension.

What is another major session objective regarding treatment forces?

Differentiate between direct and indirect forces.

What session objective addresses patient selection?

Discuss indications and contraindications for BLT.

Which body regions should students correctly demonstrate BLT on?

Cervical spine, thoracic spine, lumbosacral spine, and fibula including the interosseous membrane.

Which diagnostic skills are reviewed in this lab?

Cervical diagnosis, metatarsal diagnosis, fibular head diagnosis, and rib diagnosis.

Which treatment techniques are reviewed besides BLT?

Rib muscle energy technique, cervical muscle energy technique, cervical soft tissue technique, and previously learned soft tissue techniques.

Which previous laboratory material should be reviewed?

FOM Lab 6 and FOM Lab 9.

What thoracic dysfunction type is demonstrated for T1-T2?

Non-neutral Type II dysfunctions.

What thoracic dysfunction example is provided for T1-T2?

T1 FRS right.

During T1-T2 BLT, which motions are balanced?

Flexion-extension, sidebending, and rotation while fine-tuning the balance point.

What thoracic dysfunction type is demonstrated for T4-T12?

Neutral Type I dysfunctions.

What example neutral thoracic dysfunction is demonstrated?

T8 NSlRr.

Where is the physician's contact placed for the T8 neutral dysfunction?

On the left transverse process of T8 while the fingers cross the midline.

How is left sidebending induced at T8 during BLT?

By pulling the rib cage and lowering the patient's shoulder.

How is right rotation induced during the T8 technique?

By lifting the finger on the left T8 transverse process while flexing that finger to induce left sidebending.

What second neutral thoracic example is presented?

T6 NSrRl.

Where are the physician's contacts for the T6 neutral dysfunction?

Left thumb contacts the T6 left transverse process and right thumb contacts the T7 right transverse process.

How is the flexion-extension balance point found for T6?

The patient flexes until T6 begins to move, then slightly extends to locate the balance point.

How is sidebending and rotation balanced during the T6 technique?

The patient lowers the right shoulder and rotates the torso to the left until balance is achieved.

What lumbosacral dysfunction example is demonstrated?

L5 FRS right.

Where are the physician's hands placed for the L5-S1 BLT technique?

Across L5 and along the sacrum.

How is flexion-extension balanced during the L5-S1 technique?

By lifting or lowering the physician's hand until the balance point is reached.

How are rotation and sidebending balanced for L5?

Rotate and sidebend L5 to the right to achieve ligamentous balance.

How is the lumbar-sacral balance point further refined?

Move each hand cranially and caudally in the direction of ease until balance is achieved.

What lower extremity structures are specifically included in the fibular BLT technique?

The fibula and the interosseous membrane.

What principle should be followed throughout every BLT treatment?

Practice awareness, follow BLT principles, continually assess tissue tension, and reassess throughout treatment.

What is the therapeutic endpoint of BLT?

A palpable tissue release that occurs while maintaining equal ligamentous tension in all directions.

Why is finding the balance point important in BLT?

The balance point minimizes ligamentous strain and allows the body's inherent forces to correct the somatic dysfunction.

What is meant by free play in BLT?

Free play is the motion obtained after disengaging joint tissues, allowing the balance point to be located more easily.

What direction is the dysfunction exaggerated toward during BLT?

The joint is moved in the direction of the documented dysfunctional pattern, corresponding to the original position of injury.