In strain and counterstrain, this indirect approach involves positioning the patient’s body in order to provide a position of ease, where tenderness and tension are virtually eliminated, and then holding the position for about ninety seconds. It focuses on at least one of more than 200 tenderpoints, which tend to be small and discrete areas of marked tenderness often found within muscle tendons or within the belly of the muscle itself. Some may also exist in the myofascial tissues rather than the muscle. Remember that tenderpoints do not necessarily relate to the point of actual trauma but can be distant from the affected traumatized area. Often, multiple tenderpoints exist, with the goal of strain and counterstrain being to treat the most painful tenderpoints first. Those tenderpoints associated with traumatic injury should involve a position of treatment that mimics the position of trauma while maintaining maximal comfort. When balanced ligamentous tension or BLT is used, there will be tension of the ligaments and of the membranous structures that are balanced through positioning of the joints. Because this is an indirect approach, this type of balance allows for the natural and inherent release of the affected tissues. The patient action of breathing itself is commonly used to facilitate the release of ligamentous tension. In facilitated positional release, which is also indirect, the physician provides a facilitating force to release tissue tension over a shorter period of time. Often, this facilitating force involves either the application of tension or compression of the affected tissues. It is a technique that can be used for any tissue texture changes found or for joint restriction that has been caused by myofascial tension on the joint. The affected joint is first placed into a neutral position prior to adding the facilitating force.
DETAILS OF OMT In this section, we will talk further about the different OMT that can be applied, including the indications and contraindications of each procedure as well as the typical sequence you will be expected to know and follow as you apply the various techniques. HVLA is a commonly applied OMT, in which you will apply a sudden and quick force to a restricted joint over a low amplitude so the actual movement of the joint is very small.
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