In a normal joint, ligaments guide and modulate movement. Usually, the combined constant tension throughout the physiological range of motion of the surrounding ligaments is at a balance and used to center the surrounding bones and structures. If an injury occurs, a bone may disrupt the physiological positioning of the joint space, resulting in ligamentous strains. When performing BLT, a physician must first test the patient’s range of motion and palpate the area to find any asymmetries or restrictions. Of the opposing ligaments palpated, the more lax ligament typically is the strained ligament, with the taut ligament being more normal.
The balance point is often palpated when additional manipulation of the joint causes increased tension on the ligaments and membranous structures. First, the physician disengages the joint space by compressing or decompressing and moving it into a position of ease. This method is considered the indirect component of the treatment. Once they feel a change in palpation quality, they may then exaggerate the joint by flexing, extending, rotating, or side-bending it in all planes of motion until they slowly bring it back into the diagnosed dysfunction and establish a balance point. This method is the direct component of the treatment. This balance point can also be found by utilizing the patient's respiratory cycle and its inherent effects on the movement of the spine.
Once the balance point is achieved, the dysfunction is held in position with about 1-3 pounds of force until the physician palpates a release of the surrounding tissues. If the physician manipulates the joints in the balance point, it will usually take 20-30 seconds to palpate the release. If the balance point is achieved using the respiratory cycles, then the balance point will typically lead to a release after several respiratory cycles.
After the tissue release is palpated and the dysfunction is corrected, the joint and surrounding structures should shift back to a physiologic neutral positioning with equal tension across the joint space.
After this technique is completed, it is important to reassess the condition of the affected area to gauge the success of the treatment.
The indications for balanced ligamentous tension include restriction of range of motion or asymmetry of motion in any plane.
Although balanced ligamentous tension is generally a safe technique, the only absolute contraindications include recent fractures, ligamentous tears/ruptures, recent suturing, burns, infections, or other acute injuries in the local area, or positioning that may elicit other symptoms to appear.
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