Phys Med Question Bank

Question 1

What is the primary role of the respiratory system in exercise performance?
a) To improve muscle hypertrophy
b) To deliver oxygen and eliminate carbon dioxide
c) To regulate body temperature during activity
d) To enhance blood glucose levels

Answer 1

Correct Answer: b) To deliver oxygen and eliminate carbon dioxide
A) To improve muscle hypertrophy: Incorrect. Muscle hypertrophy is related to strength training and protein synthesis, not directly to the respiratory system’s role.
B) To deliver oxygen and eliminate carbon dioxide: Correct. The respiratory system’s primary function during exercise is to meet the increased oxygen demands of muscles and eliminate CO₂ produced during metabolism.
C) To regulate body temperature during activity: Incorrect. While the respiratory system contributes to heat exchange, this is not its primary role in exercise performance.
D) To enhance blood glucose levels: Incorrect. Blood glucose regulation is controlled by the endocrine system, primarily through insulin and glucagon.

Question 2

Which of the following conditions commonly affects respiratory function in athletes?
a) Hypertension
b) Asthma
c) Diabetes
d) Hyperthyroidism

Answer 2

Correct Answer: b) Asthma
A) Hypertension: Incorrect. This condition impacts the cardiovascular system but does not directly impair respiratory function.
B) Asthma: Correct. Asthma, including exercise-induced asthma, is a common respiratory condition affecting athletes.
C) Diabetes: Incorrect. While diabetes can impact overall health, it is not a direct respiratory condition.
D) Hyperthyroidism: Incorrect. This condition affects metabolism and heart rate, not respiratory function.

Question 3

Which symptom is most commonly associated with vocal cord dysfunction (VCD)?
a) Productive cough
b) Sudden wheezing during exercise
c) Persistent chest pain
d) Swelling in the legs

Answer 3

Correct Answer: b) Sudden wheezing during exercise
A) Productive cough: Incorrect. A productive cough is more typical of infections or chronic bronchitis.
B) Sudden wheezing during exercise: Correct. VCD is characterized by wheezing caused by inappropriate closure of the vocal cords, often triggered by exercise.
C) Persistent chest pain: Incorrect. Chest pain is more commonly linked to musculoskeletal issues or cardiac conditions.
D) Swelling in the legs: Incorrect. Leg swelling is unrelated to VCD and is more indicative of circulatory or cardiac issues.

Question 4

What mechanism causes bronchoconstriction in exercise-induced asthma (EIA/EIB)?
a) Increased environmental pollutants
b) Mast cell degranulation
c) Dehydration of airways
d) Hypoxia during maximal exertion

Answer 4

Correct Answer: b) Mast cell degranulation
A) Increased environmental pollutants: Incorrect. Pollutants can trigger EIA but are not the primary mechanism.
B) Mast cell degranulation: Correct. Mast cell degranulation releases mediators like histamine, causing bronchoconstriction and airway hyperreactivity.
C) Dehydration of airways: Incorrect. Dehydration may exacerbate symptoms but is not the underlying mechanism.
D) Hypoxia during maximal exertion: Incorrect. Hypoxia is a consequence of reduced oxygen delivery, not a cause of EIA.

Question 5

When assessing dyspnoea in athletes, which factor is most critical to determine its cause?
a) History of smoking
b) Onset, duration, and triggers of symptoms
c) BMI and body composition
d) Dietary habits

Answer 5

Correct Answer: b) Onset, duration, and triggers of symptoms
A) History of smoking: Incorrect. While smoking history is relevant, it is not as critical as understanding the onset and triggers of symptoms in athletes.
B) Onset, duration, and triggers of symptoms: Correct. These details are essential to differentiate between respiratory, cardiac, and other causes of dyspnoea.
C) BMI and body composition: Incorrect. While obesity can contribute to dyspnoea, it is not the most critical factor in this assessment.
D) Dietary habits: Incorrect. Diet is unrelated to dyspnoea unless it contributes to anemia or reflux.

Question 6

What is the diagnostic gold standard for exercise-induced asthma (EIA)?
a) Chest X-ray
b) Spirometry with a methacholine challenge
c) Blood gas analysis
d) Echocardiogram

Answer 6

Correct Answer: b) Spirometry with a methacholine challenge
A) Chest X-ray: Incorrect. A chest X-ray may identify structural or infectious issues but does not diagnose EIA.
B) Spirometry with a methacholine challenge: Correct. This test evaluates airway hyperresponsiveness, confirming EIA.
C) Blood gas analysis: Incorrect. This test is more useful in acute respiratory failure, not EIA diagnosis.
D) Echocardiogram: Incorrect. This is used to assess cardiac function, not respiratory conditions.

Question 7

Which of the following conditions commonly affects respiratory function in athletes?
a) Hypertension
b) Asthma
c) Diabetes
d) Hyperthyroidism

Answer 7

Correct Answer: b) Asthma
A) Hypertension: Incorrect. This condition impacts the cardiovascular system but does not directly impair respiratory function.
B) Asthma: Correct. Asthma, including exercise-induced asthma, is a common respiratory condition affecting athletes.
C) Diabetes: Incorrect. While diabetes can impact overall health, it is not a direct respiratory condition.
D) Hyperthyroidism: Incorrect. This condition affects metabolism and heart rate, not respiratory function.

Question 8

Which non-pharmacological intervention is beneficial for managing exercise-induced bronchospasm?
a) Gradual warm-up routines
b) Avoiding exercise altogether
c) Ice baths post-exercise
d) High-intensity interval training

Answer 8

Correct Answer: a) Gradual warm-up routines
A) Gradual warm-up routines: Correct. Gradual warm-ups reduce the likelihood of EIB by preparing the airways for increased demand.
B) Avoiding exercise altogether: Incorrect. EIB can often be managed effectively, so avoiding exercise is unnecessary.
C) Ice baths post-exercise: Incorrect. Ice baths do not address respiratory symptoms.
D) High-intensity interval training: Incorrect. This type of training can exacerbate EIB if not carefully managed.

Question 9

What is the primary treatment for acute respiratory symptoms in athletes with asthma?
a) Inhaled corticosteroids
b) Short-acting beta-2 agonists (e.g., salbutamol)
c) Sodium cromoglycate
d) Leukotriene antagonists

Answer 9

Correct Answer: b) Short-acting beta-2 agonists (e.g., salbutamol)
A) Inhaled corticosteroids: Incorrect. These are used for long-term asthma management, not acute symptoms.
B) Short-acting beta-2 agonists (e.g., salbutamol): Correct. These provide rapid relief for acute bronchospasm.
C) Sodium cromoglycate: Incorrect. This is preventive, not used for acute symptom relief.
D) Leukotriene antagonists: Incorrect. These reduce inflammation but are not first-line for acute symptoms.

Question 10

Chest pain during exercise could indicate all of the following EXCEPT:
a) Musculoskeletal injuries
b) Gastroesophageal reflux disease (GERD)
c) Carotid artery dissection
d) Exercise-induced asthma

Answer 10

Correct Answer: c) Carotid artery dissection
This condition affects the carotid arteries and does not typically present with chest pain during exercise.

A) Musculoskeletal injuries: Incorrect. Chest pain can result from strains or muscle injuries.
B) Gastroesophageal reflux disease (GERD): Incorrect. GERD can cause chest discomfort, especially during exercise.

D) Exercise-induced asthma: Incorrect. Chest tightness is a common symptom of asthma.

Question 11

What is an appropriate exercise prescription adaptation for athletes with vocal cord dysfunction?
a) Use of leukotriene antagonists
b) Avoiding controlled breathing techniques
c) Incorporating speech therapy and reducing trigger exposure
d) Increasing exercise intensity to desensitize the airways

Answer 11

Correct Answer: c) Incorporating speech therapy and reducing trigger exposure
A) Use of leukotriene antagonists: Incorrect. These are for asthma, not vocal cord dysfunction.
B) Avoiding controlled breathing techniques: Incorrect. Controlled breathing can be beneficial for managing VCD.
C) Incorporating speech therapy and reducing trigger exposure: Correct. Speech therapy helps improve vocal cord control, and reducing exposure to triggers prevents symptoms.
D) Increasing exercise intensity to desensitize the airways: Incorrect. This approach could worsen VCD symptoms.

Question 12

How is the pendular exercises performed and what does it help?

Answer 12

Purpose:
* Increase shoulder circulation and decrease effusion
* Provide mild traction of the glenohumeral joint
* Provide gravity-assisted motion at ranges between 45 and 90 degrees
(depending on angle of trunk)
* Maintain shoulder range of motion (below 90 degrees)
* Decrease pain
* Maintain passive range of motion during immediate postoperative phase,
especially if active movement is contraindicated (see specific precautions)

Position
* Standing in a staggered stance, supporting the upper body on the unaffected arm placed in front of the body on a table or plinth below the level of the shoulder
* The trunk is hinged forward at the hips without any rotation.
* The affected arm hangs passively using gravity to provide movement with as little upper extremity muscle activity as possible.

How to Perform Pendular Exercise
* Shift the body weight forward and backward (not the arm, the arm moves as a passive motion), creating momentum for the arm to passively swing forward and backward, driving the movement from hip and knee flexion and extension and the weight shift, not the arm.
* Shift the body weight side to side, creating momentum for the arm to passively swing side to side.
* Move the body in a circular motion to create clockwise and counterclockwise circular motion of the arm.
* Relaxation is necessary for the pain-relieving effects of traction from the weight of the dangling arm. The body should be perpendicular to the ground to allow the arm to be vertical and use gravity to provide some distraction.

Progression
* Increase range.
* Increase repetitions.
* Progress to active-assisted or active movement against gravity.

Precautions
* Pendular exercises are intended to be relatively passive. If there is hypermobility or recently repaired structures where strain (tension) should be limited, pendular exercises may not be appropriate (contraindicated) during the early protection phases.
* For example, after a supraspinatus tendon repair, pendular exercises may place excessive tension on the healing structure if the shoulder is suspended and allowed to hang without muscle contraction from the rotator cuff, and adduction across the body places further strain on the structure.
* Pendular (and other exercises/movements) are contraindicated for some fractures of the upper extremity until early callus formation is present.
* As for all postsurgical patients, contraindications and precautions are determined by the surgeon. The tissue strength, extent of damage, and surgical methods will all influence the length of time needed for sufficient scar tissue formation and tissue repair, as well as the type of forces that are likely to place excess force on the tissue.
* Patients who have downward sloping shoulders, inferior subluxation, or instability
should not perform this exercise unless the arm is supported using a sling.
* Cautious use of the exercise with acute tendinopathy (high severity, irritability)

Question 13

How are Wall Angels performed and what is it useful for?

Answer 13

Purpose:
Purpose: Strengthens the scapular muscles and improves thoracic and shoulder flexibility.

• Posture Improvement: Helps correct rounded shoulders and forward head posture.
• Scapular Stability: Encourages better scapular movement and control.
• Shoulder Mobility: Increases range of motion in the shoulder joints, especially in abduction and external rotation.
• Thoracic Spine Activation: Engages muscles in the upper back and improves thoracic extension.
• Core Stability: Requires core engagement to maintain a neutral spine against the wall.

Starting Position:
* Stand with your back against a wall, feet about 6 inches away from the wall, and your knees
slightly bent.
* Press your lower back, mid-back, and head gently against the wall to ensure a neutral spine.
* Arm Position:
* Lift your arms to form a 90-degree angle at the elbows, creating a “W” shape with your arms.
* Your shoulders, elbows, and wrists should all be touching the wall, if possible.

Movement:
* Slowly slide your arms up along the wall toward an overhead “Y” position, maintaining contact with the wall.
* Aim to reach as high as comfortable, keeping wrists, elbows, and shoulders aligned with the wall.
* Once you’ve reached your maximum range, slowly slide your arms back down to the starting “W” position.

Repetitions:
* Perform 8-10 repetitions, moving slowly and with control, ensuring the back stays flat against the
wall.

Question 14

How is the Oscillations or Prolonged Self-Stretching and Flexibility

Answer 14

Purpose:
* Prolonged stretch, as tolerated, for improving rotation

Position: Supine
* The involved arm abducted 45 degrees (or higher, based on
available range), supported on a pillow or foam pads if needed
Action
* Using the weight of the arm with or without holding a light weight, allow gravity to move the shoulder into either external or internal rotation, reaching the end range
* Hold for as long as tolerated.

Advantages
* Can be used as a home program.
* Prolonged stretch is used to promote connective tissue adaptations and extensibility.
* Gravity is used to provide a low-load prolonged positional stretch using the weight of the arm with or without free weights.

Progression
* Increase time in position.
* Increase sets.
* Increase weight

Question 15

How do you perform the Four-Point Kneeling on Exercise Ball Weight Shifting

Answer 15

Purpose
* Supported weight shifting for early closed chain neuromuscular coordination
* Improve local stabilizer function.

Precautions
* This exercise is not indicated for patients with major rotator cuff tears, extensive
arthritis, or labral tears.

Position
* Four-point kneeling with abdomen supported on an exercise ball
* Hands placed slightly wider than shoulder width
* Slight external rotation.

Action
* Maintain cervicothoracic alignment and scapulothoracic connection.
* Weight shift slightly to one side, taking more weight onto one arm than the other

Advantages
* Exercise ball provides support for body weight.
* Ball height will determine how much support is provided relative to the patient’s arm and leg length.
* Muscle activation, endurance, and neuromuscular coordination is in a closed chain position for stabilization, particularly for generalized instability or impaired proprioception.

Progression
* Time in the shifted position can be increased, based on ability to hold position without loss of core position or scapulothoracic connection.
* Movement from one arm to the next can be increased to
challenge the weight acceptance and neuromuscular coordination.
* Use unstable base; hands on balance board to challenge and
initiate rotator cuff and scapulothoracic muscle activity.
* Lift knees off the ground to a plank position over the ball or roll the body forward until the lower legs are supported by the ball requiring a longer lever arm and a more unstable challenge for the upper extremities
* Remove support from the exercise ball by deflating the ball or
using a smaller ball.
* Progress to four-point kneeling without a ball.

Question 16

How is the shoulder band workout performed and what is it useful for?

Answer 16

Purpose of Targeted Shoulder Band Exercises
* Shoulder Stability: Strengthen muscles around the shoulder joint, helping to improve shoulder stability.
* Rotator Cuff Activation: Focus on strengthening the rotator cuff
muscles, which are crucial for shoulder health and stability.
* Postural Improvement: Promote scapular alignment and strengthen
muscles that prevent rounded shoulders.
* Injury Prevention and Rehabilitation: Regular use can prevent injuries and is often used in rehabilitation for rotator cuff or shoulder impingement issues.

External Rotation (Rotator Cuff Focus)
* Setup: Attach the band at elbow height.
* Stand sideways to the anchor point with the band in the hand farthest from the anchor, holding your elbow close to your side at 90 degrees.
* Movement: Keeping your elbow at your side, rotate your forearm outward against the resistance of the band, focusing on slow and controlled movement.
* Repetitions: 2-3 sets of 10-15 reps per arm.

Internal Rotation (Rotator Cuff Focus)
* Setup: Stand facing sideways to the anchor point with the band
in the hand closest to the anchor point.
* Keep your elbow bent at 90 degrees and close to your body.
* Movement: Rotate your forearm inward across your body against
the band’s resistance. Return to the starting position slowly.
* Repetitions: 2-3 sets of 10-15 reps per arm.

Band Pull-Apart (Posterior Deltoids and Scapular Stability)
* Setup: Hold the band with both hands in front of you at shoulder
height, keeping arms straight.
* Movement: Pull the band outward by moving your arms apart until your shoulder blades squeeze together. Focus on activating the muscles in the upper back and rear shoulders.
* Repetitions: 2-3 sets of 10-15 reps.

Front Raise (Anterior Deltoids)
* Setup: Stand on the band with feet hip-width apart, holding the handles at your sides.
* Movement: Lift both arms straight up in front of you to shoulder height, keeping a slight bend in the elbows. Lower back down with control.
* Repetitions: 2-3 sets of 10-12 reps.

Tips for Effective Shoulder Band Exercises
* Controlled Movements: Move slowly to focus on form and avoid
compensating with other muscles.
* Engage Core: Keep your core engaged to avoid arching your back or
swaying.
* Breathing: Exhale during the pulling or lifting phase, and inhale while returning
to the starting position.
* Consistent Tension: Maintain tension in the band throughout each movement
for optimal muscle engagement.

Question 17

A patient has a max range of 10 inches, which range should be used for oscillations to not cause pain on a subacute injurty?
A) 2-7 inches
B) 5-7 inches
C) 5-6 inches
D) 4-9 inches

Answer 17

Correct answer 5–7 inches:
Staying in the middle of the range avoids reaching the extremes where the joint may experience strain or pain.
It provides gentle mobilization, which is ideal for reducing stiffness or improving mobility without risk.

5–6 inches:
This is a very narrow range and may be useful for more acute conditions or initial mobilization when caution is needed.
It’s less likely to make a significant impact on mobility if the patient can tolerate a slightly larger range.

4–9 inches:
This range approaches the extremes, which could be risky, especially if the joint or tissues are inflamed or stiff.
It might only be appropriate in later stages of rehabilitation when the patient can handle greater movement without discomfort.
For oscillations, always prioritize patient comfort and feedback, starting with smaller ranges (like 5–7 inches) and progressing as tolerated.

2-7 inches
Using 2–7 inches for oscillations might be acceptable depending on the patient’s condition and therapeutic goals. However, here’s how it fits in:

Pros of 2–7 inches:
Gentler approach: Starting closer to the neutral position (2 inches) minimizes stress on the joint, making it appropriate for acute pain, inflammation, or early-stage rehab.
It provides a gradual introduction to mobilization while staying well within a safe range.
Cons of 2–7 inches:
The range begins closer to the neutral zone (2 inches), which might not provide enough movement stimulation for patients who can tolerate mid-range oscillations. This could make the exercise less effective in improving mobility.

Question 18

Is infrared the same as red light therapy or LLLT?

Answer 18

Short answer No, although they do overlap.

ChatGPT
Infrared light, red light therapy (RLT), and Low-Level Laser Therapy (LLLT) are related but distinct, often overlapping in their use of specific light wavelengths and therapeutic applications. Here’s the breakdown:

1. Infrared Light
   Definition: Infrared (IR) light is a type of electromagnetic radiation with wavelengths beyond visible red light, ranging from 700 nm to 1 mm.
   Subcategories:
   Near-Infrared (NIR): 700-1400 nm (used therapeutically).
   Mid-Infrared (MIR): 1400-3000 nm.
   Far-Infrared (FIR): 3000 nm - 1 mm.
   Applications: Primarily for heat therapy, improved circulation, and pain relief.
   Mechanism: IR light generates warmth and penetrates tissues to increase blood flow and relaxation.
2. Red Light Therapy (RLT)
   Definition: RLT uses visible red light wavelengths, typically 620-700 nm, which penetrate the skin to stimulate cellular function.
   Applications:
   Collagen production (skin health).
   Wound healing.
   Inflammation reduction.
   Mechanism: RLT works by photobiomodulation, stimulating mitochondria to produce more ATP (energy), improving cellular health and repair.
3. Low-Level Laser Therapy (LLLT)
   Definition: LLLT is a therapeutic use of coherent laser light or LEDs with specific wavelengths, typically 600-1000 nm, including both red light and near-infrared light (NIR).
   Applications:
   Cellular healing and regeneration.
   Pain and inflammation reduction.
   Enhanced tissue repair and function.
   Mechanism: LLLT focuses on photobiomodulation by targeting cellular chromophores (e.g., cytochrome c oxidase in mitochondria) to boost ATP production without generating heat.
   Comparison of Infrared, RLT, and LLLT
   Feature Infrared Light Red Light Therapy (RLT) LLLT
   Wavelengths 700 nm - 1 mm 620-700 nm 600-1000 nm
   Thermal Effect Yes, primarily No No
   Type of Light Incoherent, non-focused Incoherent or LEDs Coherent or LEDs
   Mechanism Thermal effects Photobiomodulation Photobiomodulation
   Applications Heat, circulation, pain Skin health, inflammation Deeper cellular healing, repair
   Depth of Penetration Deeper with NIR (heating) Shallow (skin layers) Deeper with NIR wavelengths
   Are They the Same?
   Infrared light overlaps with LLLT when using near-infrared (NIR) for therapeutic purposes, but infrared light alone is not always used for photobiomodulation—it often generates heat instead.
   Red light therapy is part of LLLT but focuses on visible red wavelengths, typically for skin-level treatments.
   LLLT incorporates both red light and NIR light, combining their benefits for deeper tissue effects without heat.
   Summary
   Infrared light is not the same as red light therapy or LLLT.
   Red light therapy is a subset of LLLT, while infrared can be part of LLLT if near-infrared wavelengths are used for non-thermal photobiomodulation.

Question 19

Which of the following is the most common site for a lumbar disc herniation?
A. L1-L2
B. L3-L4
C. L4-L5
D. T12-L1

Answer 19

Correct Answer: C. L4-L5
Rationale: L5-S1 is the most common site for lumbar disc herniation, followed by L4-L5. This is due to the high mechanical stress and mobility in this region. The other levels are less prone to herniation.

Elaboration:

The L5-S1 and L4-L5 levels are the most common sites of lumbar disc herniation due to their location at the base of the lumbar spine, where the mechanical stress and mobility are greatest.
These regions bear significant axial loads and serve as the pivot points during activities involving bending, lifting, or twisting, making them susceptible to degeneration and herniation.
Other levels (e.g., L2-L3, L3-L4) are less affected because they experience less cumulative stress and have relatively thicker annulus fibrosis for protection.

Question 20

Which orthopaedic test is used to differentiate a lumbar disc herniation from a sciatica caused by other conditions?
A. Braggard’s Test
B. Straight Leg Raise (SLR)
C. Valsalva Maneuver
D. Bechterew’s Test

Answer 20

Correct Answer: B. Straight Leg Raise (SLR)
Rationale: The SLR test stretches the sciatic nerve and increases intradiscal pressure, which can provoke pain in cases of lumbar disc herniation. Braggard’s test is used as a follow-up to confirm nerve root involvement. Bechterew’s and Valsalva test also evaluate radicular symptoms but are less specific.

Question 21

Which symptom is a red flag requiring immediate referral in a patient with lumbar disc herniation?
A. Unilateral leg pain
B. Calf cramping
C. Saddle anesthesia
D. Pain worsening with sitting

Answer 21

Correct Answer: C. Saddle anesthesia
Rationale: Saddle anesthesia is a key symptom of cauda equina syndrome, a medical emergency. The other symptoms, while common in disc herniation, do not typically indicate an emergency.

Question 22

What is the primary purpose of pelvic tilts in the management of lumbar disc herniation?
A. Strengthen the gluteal muscles
B. Mobilize the lumbar spine and reduce pain
C. Increase disc hydration
D. Improve thoracic mobility

Answer 22

Correct Answer: B. Mobilize the lumbar spine and reduce pain
Rationale: Pelvic tilts are controlled exercises that promote gentle lumbar spine movement and reduce stiffness without increasing stress on the disc. They do not directly hydrate the disc or target the thoracic region.

How to Enhance Disc Hydration
Regular Movement and Exercise:

Dynamic Movement: Engaging in low-impact activities like walking, swimming, or cycling helps pump nutrients and fluids into the disc through a process called imbibition, which is facilitated by spinal loading and unloading.
Stretching and Mobility Exercises: Yoga and gentle spinal stretches improve spinal flexibility and create alternating pressure changes that enhance hydration.
Postural Optimization:

Avoid prolonged static postures, such as sitting or standing for long periods.
Practice proper ergonomics to reduce excessive spinal load, particularly during seated work.
Hydration:

Maintain adequate systemic hydration by drinking enough water daily. Well-hydrated tissues can better facilitate diffusion into the disc.
Nutritional Support:

Proteoglycan Support: Consume a diet rich in collagen, glucosamine, and chondroitin sulfate to support the matrix structure of the nucleus pulposus.
Include anti-inflammatory foods (e.g., omega-3 fatty acids) to reduce stress on the disc.
Decompression Therapy:

Spinal decompression (e.g., through traction or inversion therapy) can temporarily reduce pressure on the discs, promoting fluid movement into the nucleus.
Strengthening Core Muscles:

A strong core helps stabilize the spine and reduce excess load on the discs, preserving their integrity and hydration.
Minimizing Disc Stressors:

Avoid repetitive heavy lifting or improper lifting techniques.
Limit activities that compress or strain the spine excessively, such as prolonged bending or twisting.
Rest and Recovery:

Adequate sleep allows the discs to rehydrate, as the spine is unloaded in a lying position, facilitating fluid uptake by the nucleus pulposus.

Question 23

During the dysfunction stage of lumbar degenerative joint disease (DJD), which of the following changes occurs?
A. Vertebral segments become hypermobile.
B. Annulus fibrosis undergoes minor tears.
C. Joint capsule tightens.
D. Disc material is completely lost.

Answer 23

Correct Answer: B. Annulus fibrosis undergoes minor tears.
Rationale: In the dysfunction stage, biomechanical changes lead to weakness, bulging, and minor tears in the annulus fibrosis. Hypermobility occurs in the instability stage, and disc material loss characterizes the stabilization stage

Elaboration:
The annulus fibrosis is a tough, fibrous ring surrounding the nucleus pulposus.
During the dysfunction stage of disc degeneration:
Minor tears develop in the annulus, usually circumferential or radial.
These tears weaken the disc structure, leading to bulging or mild herniation.
Symptoms: Pain may occur due to the irritation of nearby nerve endings in the annulus or surrounding structures.
Next Stages:
Instability Stage: Hypermobility occurs as disc integrity weakens.
Stabilization Stage: Disc material loss leads to reduced mobility and eventual fusion or bony changes (e.g., osteophytes).

Question 24

What is the most appropriate physical modality for alleviating nerve compression in lumbar disc herniation?
A. Interferential Current Therapy (IFC)
B. Ultrasound Therapy
C. Spinal Traction
D. Heat Therapy

Answer 24

Correct Answer: C. Spinal Traction
Rationale: Spinal traction decompresses the spine and reduces nerve compression. IFC and ultrasound are helpful for pain relief but do not directly address compression. Heat therapy is more general for muscle relaxation.

Question 25

Which of the following exercises is contraindicated in a patient with acute lumbar disc herniation?
A. Foam Roller Self-Mobilization
B. Lumbar Rotation with Legs Supported on a Ball
C. Bridging with Trunk Support on an Exercise Ball
D. Unsupported spinal extension exercises

Answer 25

Correct Answer: D. Unsupported spinal extension exercises
Rationale: Unsupported spinal extension can increase intradiscal pressure and aggravate symptoms. The other exercises, when performed properly, support lumbar mobility and pain relief without excessive stress.

Question 26

What is the primary mechanism behind pain in posterior lumbar disc herniation?
A. Compression of the anterior longitudinal ligament
B. Increased hydrostatic pressure during flexion activities
C. Inflammation of the paraspinal muscles
D. Compression of the posterior longitudinal ligament

Answer 26

Correct Answer: B. Increased hydrostatic pressure during flexion activities
Rationale: Flexion increases hydrostatic pressure in the disc, causing the nucleus pulposus to push posteriorly and compress the nerve root. Anterior ligament compression occurs in anterior herniation

Elaboration:
The nucleus pulposus behaves like a gel, responding to forces by redistributing hydrostatic pressure.
During flexion (bending forward):
Pressure within the disc increases, especially posteriorly.
This causes the nucleus pulposus to migrate posteriorly toward the spinal canal or nerve roots, increasing the likelihood of compression or herniation in a weakened disc.
Clinical Implications:
Activities involving repetitive or sustained flexion (e.g., bending, lifting) can exacerbate disc herniation or sciatic pain.
Strengthening core and back muscles helps stabilize the spine and reduce strain on intervertebral discs.
In contrast, anterior herniations are rare and usually compress the anterior longitudinal ligament instead of nerve roots.

Question 27

Which statement is true about pelvic tilts performed for lumbar disc herniation?
A. They require the use of gluteal muscles.
B. They promote lumbar flexion without stressing the disc.
C. They increase spinal extension range.
D. They involve active hip rotation.

Answer 27

Correct Answer: B. They promote lumbar flexion without stressing the disc.
Rationale: Pelvic tilts gently promote lumbar flexion to alleviate pain and stiffness, without engaging hip rotators or stressing the disc.

Question 28

Do herniations heal on their own?

Yes, herniations can heal on their own in many cases, though the process depends on several factors, including the size of the herniation, the individual’s age, overall health, and adherence to conservative management strategies.

Answer 28

How Herniations Heal
Resorption of Disc Material:

The body can recognize the herniated disc material as “foreign” and initiate an inflammatory response. Over time, macrophages (a type of immune cell) help break down and absorb the extruded disc material.
This process is known as spontaneous regression and is more likely in cases of larger herniations with free fragments (sequestered herniations).
Reduction in Inflammation:

As the inflammation surrounding the nerve root subsides, the pain and neurological symptoms often improve, even if the herniation persists.
Dehydration and Retraction:

The herniated portion of the nucleus pulposus may lose water over time, shrinking and retracting back toward the disc space, reducing pressure on nearby nerves.
Factors That Influence Healing
Type of Herniation:

Sequestered or Extruded Herniations: More likely to regress naturally due to the body’s ability to resorb the free disc fragment.
Contained (Protruding) Herniations: Healing may be slower as the disc material remains within the annulus fibrosis.
Size of the Herniation:

Larger herniations are often more likely to regress due to the body’s inflammatory response being more robust.
Age and Health:

Younger individuals tend to heal faster due to better disc hydration and overall tissue repair capacity.
Lifestyle and Management:

Rest, physiotherapy, maintaining an anti-inflammatory diet, and avoiding activities that exacerbate the condition can enhance healing.
Timeframe for Healing
Most people experience significant improvement in symptoms within 6 weeks to 3 months of conservative treatment.
Full resolution of the herniation (if it occurs) may take 6 months to 1 year.
Conservative Management Strategies
Physical Therapy:

Strengthening core muscles to stabilize the spine.
Stretching and mobility exercises to reduce nerve root compression.
Pain Management:

Use of NSAIDs, heat/cold therapy, or epidural steroid injections for symptom relief.
Activity Modifications:

Avoiding heavy lifting, prolonged sitting, or activities that worsen pain.
Decompression Techniques:

Spinal traction or inversion therapy to temporarily reduce disc pressure.
When to Consider Surgery
Herniations that do not improve after 6–12 weeks of conservative treatment or cause severe symptoms, such as progressive neurological deficits (e.g., weakness, numbness, bowel/bladder dysfunction), may require surgical intervention. Common surgical options include:

Microdiscectomy: Removal of the herniated portion of the disc.
Laminectomy: Removing part of the vertebra to relieve pressure.