Overview of Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
Balanced Ligamentous Tension (BLT), also known as ligamentous articular strain in some places, is based on the idea that the body’s ligaments can tell us when they’re in balance. Ligaments are like strong, elastic bands that connect bones to each other, and in a joint, they give feedback on tension. The Sutherland model suggests that if there’s uneven tension between ligaments, this can create imbalances in joints, creating a new set of “normal” conditions that can lead to problems.
We can readjust the balance of tension in these ligaments to bring them back to their natural range of flexibility and help the joint to function properly again.
How to apply BLT can vary depending where you are. Some techniques make a distinction between direct and indirect methods. One such technique follows these three main steps:
1. Release any tension in the joint that’s causing the problem.
2. Exaggerate the joint’s movement to mimic how it was originally injured.
3. Restore balance to the joint by feeling for a “wobble point”. This suggests that the ligaments are back in balance.
When we apply these principles to the pelvis, the main joints we look at are the lumbosacral joint (where the lower spine and pelvis connect) and the sacroiliac joints (where the base of the spine and the hip bones meet).
Anatomy and Physiology of Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
The pelvis, which includes a part called the sacrum and two innominate bones, forms the base of your body’s structure and is necessary for proper walking and maintaining posture. The sacrum is made up of five vertebra, or backbones, labelled S1 to S5. These vertebrae fuse or join together as we grow, usually completing this process between 18 to 30 years old. On either side of the sacrum, are joints known as sacroiliac joints that connect to the ilium (part of innominate), and they are crucial for proper sacral movement. There’s also the lumbosacral joint that connects to the final lumbar vertebra, labelled as L5. The lower part of the sacrum is called the coccyx, which is the last segment of your backbone. It’s connected to the rest of the sacrum via a fibrocartilaginous joint known as the sacrococcygeal symphysis.
The movement of the sacrum is possible through the use of several ligaments, which are like strong, elastic bands that connect bones together. For instance, the sacroiliac ligament connects the sacrum to the ilium and restricts excessive forward and downward sacral motion. Another ligament, the sacrotuberous ligament, works with the posterior sacroiliac ligament to resist a certain kind of movement of the sacrum during normal walking.
The sacrum contains important passages for nerves and blood vessels. They pass through openings called the greater and lesser sciatic foramen and include nerves such as the sciatic nerve (which controls sensation and movement in the leg), superior and inferior gluteal nerve, pudendal nerve, posterior femoral cutaneous nerve, nerve to quadratus femoris, and nerve to internal obturator muscle, as well as several major blood vessels.
Other important ligaments that contribute to the overall stability of the pelvis include the iliolumbar and ilioinguinal ligaments. The sacrum and ilium are also directly connected by the sacroiliac and interosseous sacroiliac ligaments. There are additional accessory pelvic ligaments that play their part as well. These include the iliolumbar ligament, inguinal ligaments, sacrotuberous ligaments, and sacrospinous ligaments.
The sacrum plays a key role in the proper movement of the pelvis. It has several points of rotation that allow for specific movements. These points are present in certain patterns across the sacrum and help in various actions like standing, walking, and even breathing.
The innominate is not a single structure but a combination of three bones formed during early development; the ilium, ischium, and pubis. These bones join to create the complete innominate, which includes the acetabulum (or hip socket) that holds the top of the thigh bone. This combination of bones is connected to the sacrum through a series of ligaments at places like the pubic symphysis and the sacroiliac joint, adding stability to the pelvis when we walk. On the innominate, two important spots called the anterior and posterior superior iliac spines are often used to diagnose pelvic issues because they can be felt easily from the outside and are consistently reliable landmarks.
Even though it plays a major role in maintaining stability during standing, walking, or running, the innominate is not fixed. It can move a little at its connections with the sacrum, allowing for small rotations of the pelvis as we do our everyday activities.
Why do People Need Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
You may need a particular kind of treatment if you have discomfort or issues in your pelvic area, specifically related to the functioning of your muscles and connective tissues, and other possible causes for your symptoms have been excluded.
When a Person Should Avoid Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
Pelvic BLT, a treatment often used to help with conditions affecting the lower back and hips, is considered to be very safe. This is because it uses passive methods – which means the patient doesn’t have to do anything – and can be either direct or indirect. This makes it a good choice for patients who can’t handle more active and direct treatments, like high-velocity, low-amplitude (HVLA, a type of manipulation therapy), muscle energy techniques, or articulatory techniques (these are all different ways to treat muscle and joint problems).
However, there are a few reasons why a patient might not be able to have this treatment. If a patient doesn’t want the treatment or can’t agree to it, it can’t be given. It’s also not recommended for people with broken bones in the area that needs treatment, or certain bone diseases or infections that weaken the bones.
Equipment used for Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
You don’t need any unique tools to conduct a pelvic BLT examination. The doctors might find it helpful to use a table that can change height and a stool. This can make them more comfortable and ensure they’re working in a position that doesn’t strain their body.
Preparing for Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
Good communication is key when a doctor is examining and treating a patient. The doctor needs to explain what they will be doing and why they are doing it, as well as the risks and benefits of the treatment. They should also discuss other options. The patient must give their approval before the treatment can start. In fact, when the doctor carries out what is called an osteopathic structural exam (an examination that focuses on your muscles and bones), they will specifically look out for any problems in the body, as well as regions with severe limitations.
How is Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions performed
These are a variety of techniques your doctor or therapist might use if you’re having issues with your sacroiliac (SI) joint, which connects your spine to your pelvis, or your lumbar sacral (LS) joint, which is where your lower spine and pelvis meet.
Short Lever SI Balanced Ligamentous Tension (BLT) Technique:
You’ll lie on your back on the treatment table. Your doctor will press on the area around your hip bone on the side that feels tight to find out exactly where the problem is. Using their hands, they will gently move your hip bone to help ease tension in the area. They’ll keep doing this until the area feels softer or warmer, or it’s easier to move. They’ll then repeat the pressure test to see if there’s been any improvement.
Long Lever SI Balanced Ligamentous Tension (BLT) Technique:
Again, you’ll lie on your back on the treatment table. Your doctor will use one hand to monitor the problematic SI joint, and your leg on that side as a long lever to balance tension in the joint. As with the short lever technique, they’ll keep doing this until they feel a change in the area before checking for improvement.
Sacroiliac (SI) Decompression
You’ll lie on your back while your doctor applies pressure to your tailbone and hip bone on the problematic side until they feel a release in the joint. You might be asked to breathe deeply to help with this process. They’ll check for any increase in warmth, softening of the tissues, or improved motion in your tailbone area.
Lumbo-sacral (LS) Decompression – Prone and Supine
Whether you’re lying on your stomach or your back, your doctor will apply gentle pressure to your lower spine and tailbone area, monitoring the changes in the tissues. They’ll adjust their pressure and motions until they notice a difference.
All of these techniques will be repeated until no further change is felt, and they’ll help diagnose and treat issues in the sacroiliac or lumbar sacral areas.
Possible Complications of Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions
Although the BLT method is thought to be among the safest, patients may still feel a bit of discomfort in the days after treatment. To help reduce any potential soreness, it’s suggested that patients drink lots of water after receiving the treatment.
What Else Should I Know About Osteopathic Manipulative Treatment: BLT/LAS Procedure – Pelvic Dysfunctions?
Osteopathic medicine is a field of medicine that focuses on treating the whole patient, not just specific illnesses or symptoms. This philosophy is applied in osteopathic manipulative treatment (OMT), which is a way to heal using the hands to diagnose, treat, and prevent illnesses or injuries.
OMT should be used when a patient’s body structure is out of balance, causing them pain or other uncomfortable symptoms. The specific treatment technique, such as balance ligamentous tension (BLT), is usually chosen based on the doctor’s expertise and how the patient’s body responds. This can be particularly beneficial in treating pelvic problems, including individuals who are pregnant or hospitalized.
During pregnancy, a woman’s body goes through many changes that can sometimes lead to discomfort, such as back or pelvic pain, stiffness or swelling in the lower legs. Many pain medications are not recommended during pregnancy, which makes OMT a useful and safe non-drug treatment option. In one study, OMT was found to be safe and did not increase the risk for pregnant patients.
In the hospital setting, OMT can also prove very beneficial for patients. This is because it does not require the patient to actively participate and can be done while they lie on their back. One trial showed that elderly hospitalized patients with pneumonia had shorter hospital stays and lower death rates when OMT was used alongside traditional treatments.
OMT was also helpful in speeding up the recovery of post-surgery patients, helping them to pass gas sooner and reducing their hospital stay. Using OMT to treat the pelvic region is particularly useful in post-surgery patients as it can help to restore bowel function, improve mobility, and reduce congestion by enhancing lymphatic and venous return.
Overall, the goal of using OMT is to help reduce the patient’s overall stress and discomfort level, enabling their body to focus energy on healing more effectively.