Flashcards in Zinc/BLT Deck (89):
Define BLT/BMT according to Sutherland
Movement of a joint/articulation that does not cause asymmetry tensions in the ligaments
Is the tension distributed through the ligaments in any given joint balanced?
What is a consequence of Tensegrity
When one part changes, the entire part changes (body, region, joint...even cell)
What should exist in a normal joint relationship? Used by who?
Balanced ligamentous tension (BLT)
Wales in her terminology for the technique as well as the goal of the treatment
What happens when a force is applied to a joint? Used by who?
Ligamentous articular strain (LAS)
Beck in his terminology for the technique as well as the problem
Order of names for the technique
1. Balanced Membranous Tension (BMT)
2. Balanced Ligamentous Tension (BLT)
3. Ligamentous Articular Strain (LAS)
What year did Sutherland implement techniques?
What 2 peoples helped promote LAS and BLT?
1. Rollin Becker, DO
2. Anne Wales, DO
Is BLT indirect or direct?
Explain Soft Tissue OMT
Direct method that is typically applied at and through either an elastic or restrictive barrier
Rhythmic and Repetitious
What 2 direct methods do we use at the RESTRICTIVE barrier?
What 2 indirect methods do we use at the WOBBLE POINT?
Do the functional release OMT types require continuous adjustment of position/pressure in response to progressive change?
BLT (viscoelastic model)
Some elongation is lost and some is retained after application of tension force
How do we diagnose MFR?
Locate ease/bind "barriers"
Where do we take myofascial (target) tissues to in MFR?
To a specific start point
What do we wait for at the feather edge of the restrictive barrier in MFR?
Heat to cause collagen 'state' change from gel to sol and viscoelastic ("creep") resposne
How long might it take for the heat to cause collagen state?
20-30 seconds...while you adapt to TTC
What do we follow in MFR?
'Creep' until a release takes place
May we use release enhancing mechanisms (REMs) or other motions and/or joint positioning?
Do we need to "finish"...creep stops and there is return to normal?
Do we re-check TTC?
Give the definitions explainingg MFR and BLT/LAS
1. MFR - continuous adjustment of position/pressure in response to palpating progressive change of myofascial tissues
2. Continuous adjustment of position/pressure in response to palpating progressive change of ligamentous/joint capsular tissues
What is the major difference between MFR and BLT/LAS?
Which tissue you are listening to when you diagnose and treat!!!!
Does fine movement cause much change?
Yes (any motion at a mobile point can cause tissues to tighten)
Balance in not what?
Cramming beyond the tissue's elastic limits, and yet it is not touching light as a butterfly
Is a vital resilience still present in the tissue?
When is shifting point created?
When reached and applied to area that is not perfectly balanced
Should we sense that the tissue "animate"?
What is the key to successful treatment?
The delicate balance point to any part of the body or any tissue
Indirect BLT Balance Point
Point of balance of an articular surface from which all the motions physiologic to that articulation may take place
BMT Balance Point. Where is it used?
Applicable in interosseous or dural membranes
Used in OCMM and in interosseous membranes (radius, fibula)
Are balance feel and release similar in most function OMT?
1st-3rd observations of spinal joints by Fryette at al in BLT site mechanic returning physiological motion
1. T-L neutral
2. T-L non-neutral
3. 3 planes..all joints
3 points in BLT at spinal facets/joints
1. Importance of picturing facet/joint facings
2. Importance of translation/glide movements
3. Seek "balanced" tension around joint
BLT at regional transition zones
Not Fryette; balance entire region
What is the key for BLT site mechanics?
Usually minor motion SD
4. Metabolic-Hormonal (Bioenergic)
5. Respiratory Circulatory
What model is used in BLT/BMT/LAS and Zink?
What is the Common Compensatory Pattern in the Respiratory-Circulatory Model?
Left/Right/Left/Right (from top to bottom)
Opposite from bottom to top
Where did Zink graduate from? Where did he move to teach?
PCOM; Des Moies (Fluid Freak)
3 facts about Zink
1. Espoused RC model
2. Linked primary to secondary respiration with "Craniosternosacral Mechanism"
3. Developed ALS - wrote approach
3 facts about the underlying conditions for a patient being considered for the RC Model
1. Congestive component (edema, swelling)
2. Compromisses respiratory and/or circulation function
3. Would benefit from enhance immune function
3 dysfunction compromises for a patient being considered for the RC model
1. Lymphaticovenous pathways
2. "Terminal lymphatic drainage sites"
3. Diaphragm functions
4 places in RC Model for terminal lymphatic congestion
1. Supraclavicular (HEENT)
2. Posterior Axillary Fold (UE)
3. Sub-Xiphoid Process (abdominal)
4. Inguinal (LE)
Step 0 Findings
1. History of sign of infection (fever)
2. History indicating underlying congestive pathophysiology
Step 1 findings
1. Uncompensated zink fascial pattern (or CP in bedridden)
2. Terminal lymphatic drain site congestion
3. Scale muscle spasm (esp with rib 1 SD)
Step 2 findings
1. Not breathing down to pubic symphysis
2. Paradoxical respiration
3. Tight pelvic floor
Step 3 findings
1. Generalized signs of congestion
2. Secondary respiratory-related SD
3. Poor primary respiration mechanism
Step 4 findings
1. Organs congested (hepatomegaly)
1. Specific somatic site swollen
What are 3 things the RC model is about?
3. Pressure change
4 steps in optimal lymphatic treatment
1. Remove obstruction to flow
2. Maximize thoraco-abdomino-pelvic respiratory/circulatory pump interally
3. Externally augment the pumps
4. Stimulate local lymph drainage
2 things with "Remove Obstruction to Flow"
1. Correct key myofascial SD
2. Open myofascial pathways for drainage back to central system
2 things with "Maximize thoraco-abdomino-pelvic respiratory/circulatory pump interally"
1. Remove other key SD, especially at chest cage
2. Redome diaphragms/maximize respiration
1 things with "Externally Augment the Pumps"
Stimulate lymphaticovenous return by changing pressures (raise ribs, add pumps) and stimulating eNOS (endothelial nitric oxide synthase)
1 thing with "Stimulate Local Lymph Drainage"
Move fluids toward heart (effleurage-visceral OMT)
What are 3 steps in step 1 for diagnosing and treating fascial patters and associated SD
1 .Diagnose zink fascial pattern
2. Assess thoracoabdominal diaphragm functions
3. Assess for terminal lympahtic drainage dysfunction
What is the fascial SD effect for lymphatics, veins, arterioles
Lymphatics > veins > arterioles
What 2 places are transition zones at?
1. Anatomical regions: where structure changes
2. Where regional block (less motion structure) and regional rod (more motion) join
4 things about what transition zones are
1. Where structure changes --> function first changes
2. Highest area of compensation (postural, myofascial, etc)
3. Myofascial dysfunction reflects underlying boney SD
4. Areas where diaphragms attach (opportunity for 2-fers)
4 regions for transition zones
1. Cr-Cerv: OA-AA-C2 (we check and name for OA rotation)
2. Cerv-Th: T1-T4; ribs 1-2; manubrium
3. Th-L: lower ribs down to Th-L junction
4. Pelvic-Lumbar: L-P junction (named for pelvic rotation)
Are compensated patterns alternating?
Where are fascial patten SD at?
Sites where structure-function change
If pattern is not ideal, what is next best state?
What are the 4 patterns
2. Common compensated pattern (CCP)
3. Uncommon compensated patten (UCP)
4. Uncommon pattern
Fascial pattern palpated superficially reflects what? Assessed where?
Underlying direction deeper structures moved; assessed at first barrier
Regiona diagnosis allows what?
Unified regional OMT treatment if we wish
What do we listen to for direct/indirect myofascial?
What do we listen to for BLT (indirect) or LAS (combined)?
Do we compare muscle energy (direct) of one region to another?
Often regions prefer what?
SB-rotation to the same side (note Fryette Trpe spinal nomenclature is NOT used to describe REGIONAL motion)
Regions may be treated how?
With OMT of individual parts
Compensatory regional patterns usually linked to type 1 thoracic and lumbar spinal curves (postural compensation)
Soft tissue structures cross what?
Regions that may have significant impant
Note that OMT may be what?
Warranted even for compensated SD
Example is bed-ridden or for reompensation strategies)
What is goal in respiratory-circulatory system?
Enhance physiological homeostais
HVLA of 4 transition zones advantage
4 regions BLT/FPR advantage
Fewest possible side effects; comfortable in acute situations; best hospital choice
Regional MFR advantage
Several diaphragm "two-fers" (especially superior throacic inlet and inferior thoracic outlet: and prepares tissues for tensegrity needed for optimal local drainage
Are transtition zones vertebral units? Example?
Superior thoracic inlet is T1-T4 PLUS manubrium PLUS ribs 1-2 PLUS myofascial structures (including scalenes)
What is step 2?
5 discussion points
1. Active vs passive (elastic)
2. Synchronous motion (active vs passive)
3. Pressure gradients and Bernoully's principle
4. Organ location
5. OMT and pumps
4 diaphragm techniques
1. Cranial diaphragm
2. Sibson fascia (soft tissue)
3. Pelvic diaphragm
4. Thoracoabdominal diraphagm redoming
What is the Formation Phase?
Getting fluid, edema proteins and waste products into the lymphatics requires MOTION
2 things with Formation Phase
1. Primary inspiration
2. Secondary inspiration
2 one=way valves
1. Muscle pumps
Pressure changes between compartments or on-off pressure sensitive structures (spleen/liver) moves what?
4 steps of RC Model
1. Open pathways (we advocate zink)
2. Optimize respiration (primary and secondary; redome diraphragms)
3. Augment fluids (lymph pumps and add primary respiration)
4. Movilize fluids from concern sites (mesenteric lifts/local effleurage)