Practice Questions WI 13 examples Flashcards
Your patient demonstrates better trunk flexor versus trunk extensor endurance in the Modified
Biering Sorenson test. Which of the following is true?
a. The patient has a low risk for first time low back injury
b. The patient has a decreased risk of
reoccurrence of a resolved low back injury
c. Core stabilization exercises are not
indicated for this patient
d. Trunk extension exercises focusing on the
deep
lumbar erector spinae areindicated
Trunk extension exercises focusing on the deep
lumbar erector spinae are indicated
Corrective action for NWNL ration = spinal stabilization exercise training to improve balance in endurance times
FLAT, WEDGE 60-60-90, Side PLANK
Your patient demonstrates a positive Pushup Test. What are the expected associated findings?
a. Increased shoulder external rotation
b. Forward head with protracted shoulders
c. Inhibition of pectoralis minor
d. Inhibition of upper trapezius
b. Forward head with protracted shoulders
Push Up Screening Indicators: Forward head with protracted shoulders ,Increased internal rotation shoulders, Scapula winging, tipping
Normal result:
Scapular retraction without excessive/asymmetrical winging, elevation or rotation as trunk is lowered
Abnormal Result:
Excessive/asymmetrical scapular winging, elevation or rotation
Indicates weakened/inhibited lower scapular stabilizers: serratus anterior, lower/middle trapezius SALT-M
Your patient demonstrates a positive prone Active Straight Leg Raise Test (ASLR) with form
closure dysfunction. Which of the following myofascial stabilizing systems is likely involved?
a. Posterior oblique system
b. Anterior oblique system
c. Lateral oblique system
d. None of the above
Posterior oblique system
Closure Dysfunction (Form or FORCE)
Passive compression of SI joints with medially-directed force applied to lateral innominate as patient attempts ASLR. Improvement in any assessment criteria indicates positive test
FORCE Closure Augmentation
Activation of anterior oblique sling with patient reaching UE toward opposite knee against tester resistance as patient attempt ASLR
Corrective action for both FORM and FORCE
Prone or Supine ASLR
Temporary application of pelvic (trochanteric)belt
Core stabilization training with emphasis on posterior oblique stabilizing system or AOS if Supine
Which of the following is a goal of the assessment of spinal stability?
a. Identify aberrant motor patterns
b. Identify excessive muscle stiffness
c. Identify bony anomalies
d. Identify ligamentous laxity in motion segments
a. Identify aberrant motor patterns
Goal is to identify loss of stability, motor control and aberrent recruitment patterns
Results provide data for reeducation of faulty motor patterns and creating dynamic stability in the presence of mechanical compromise
Which of the following is true regarding abdominal bracing?
a. Provides less mechanical stability than abdominal \
hollowing
b. Involves drawing the abdominal wall inward toward the
spine
c. Involves low level of muscle contraction
d. None of the above
c. Involves low level of muscle contraction
Abdominal bracing is the act of “stiffening” or “tightening” the muscles of the midsection, as if someone was about to strike you in the trunk. Begin by contracting the muscles of the trunk in a hoop-like fashion without drawing the abdominal wall inward.
The level of contraction should be low, about 10 % of maximum. Continue to breathe while maintaining the abdominal brace.
The Lumbar Shear Stability Test involves
a. Identifying the ability of the lumbar muscles
to prevent shear instability
b. Identifying the ability of the lumbar muscles
to prevent compression instability
c. Identifying the ability of the lumbar muscles
to prevent rotary instability
d. Identifying the ability of the latissimus dorsi
to activate the posterior oblique stabilizing
subsystem in the lumbo-pelvic-hip complex.
Patient lies prone with body on table and feet on floor.
Clinician applies P-A pressure onto each SP noting elicited segmental pain.
Patient slightly raises legs off floor and examiner applies P-A pressure to painful segment(s)
Positive test = pain with resting position that diminishes in active position, indicates ability of lumbar extensors to stabilize against shear instability
Corrective action = spinal stabilization exercise training
Which of the following is a characteristic of postural muscles?
a. Responsible for maintaining posture
especially during gait
b. Type II muscles
c. Tend to become weak and inhibited
d. Generally fast-twitch muscles designed for
movement
a. Responsible for maintaining posture
especially during gait
Responsible for maintaining posture especially during gait
Type I Slow Twitch
Tend to become short and tight
Not necessarily weak
Which of the following is characteristic of the Lower Cross Syndrome?
a. Short and tight abdominal musculature
b. Weak gluteus maximus musculature
c. Short and tight upper trapezius musculature
d. Weak erector spinae musculature
b. Weak gluteus maximus musculature
LCS Weak
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Which of the following is true regarding rehabilitation exercises for the spine?
a. Endurance is more important than strength
to maintain spinal stability
b. Strength is more important than endurance
to maintain spinal stability
c. Neither strength nor endurance are
important because stability is provided by
the spinal ligaments
d. It is important to train both strength and
endurance but strength is emphasized first
a. Endurance is more important than strength
to maintain spinal stability
Endurance more important than strength to maintain spinal stability
Strength reserve necessary for unpredictable activities
Which of the following is true regarding the establishment of a positive progressive slope with regards to exercise design?
a. Initiate reconditioning with multiple exercises
to decrease boredom
b. Add new exercises 1 at a time after positive
progression has been established
c. Restore complex movement patterns early in
the program
d. None of the above
b. Add new exercises 1 at a time after positive
progression has been established
Ensuring the progressive positive slope
Initiate reconditioning process with limited number of exercise
Add new exercises one at a time after positive slope established
Add/remove exercises based on positive slope changes
Patient lifestyle changes
Must change patterns that result in tissue loading in excess of threshold
In developing rehabilitation programs for health rather than athletic performance which of the
following is NOT emphasized?
a. Muscle endurance
b. Motor control perfection
c. Maintenance of spinal stability during activity
d. High level muscle contraction at maximal velocity
d. High level muscle contraction at maximal velocity
Training for health versus performance
Emphasizes muscle endurance, motor control perfection, maintenance of spine stability during ADLs
Integration of prevention& rehab strategies:
Must reduce source that exacerbates tissue overload. Exercise enhances prevention and rehabilitation outcomes
Your patient states she has ipsilateral sacroiliac joint pain during the prone Straight Leg Raise Test. Voluntary activation of the contralateral latissimus dorsi reduces the pain. What is the indication?
a. Decreased form closure with posterior
sacroiliac ligament dysfunction
b. Decreased force closure with dysfunction
in the posterior oblique system
c. Increased form closure with inhibition of
the anterior oblique system
d. Increased force closure with dysfunction in
the long
dorsal portion of the sacrotuberous ligament
b. Decreased force closure with dysfunction
in the posterior oblique system
Your patient has an anterior innominate on the right. Which of the following additional test would you expect to be positive?
a. Shoulder Abduction test
b. Balance Error Scoring Test
c. Trunk Flexion Test
d. Fukuda Stepping Test
c. Trunk Flexion Test
TF Test Indicators Anterior pelvic tilt Gluteal “amnesia” Decreased abdominal tone Asymmetrical lateral grooves in abdom. wall Impaired respiration
Functonal Screening Indicators
Normal pattern of activation- Trunk lifted enough for scapulae to clear table
Abnormal patterns
Foot/feet lifted off table (iliopsoas)
Increased lumbar lordosis (Lumbar erector spinae/iliopsoas)
Your patient has a sacroiliac joint force closure dysfunction identified with the supine Active Straight Leg Raise Test (ASLR). What restoration strategy is indicated?
a. Temporary application of pelvic
(trochanteric) belt
b. Temporary application of pelvic
(trochanteric) belt and
high repetition abdominal crunches
c. Core stabilization training targeting the
anterior oblique stabilizing system
d. Core stabilization training targeting the
posterior
oblique stabilizing system
c. Core stabilization training targeting the
anterior oblique stabilizing system
See Question # 3 for explanations
The normal muscle activation sequence in the Side Lying Hip Abduction Test is
a. Hip abduction with flexion above 45 degrees
b. Pure hip abduction to 45 degrees
c. Hip external below 45 degrees
d. Hip hiking at the onset of the movement
b. Pure hip abduction to 45 degrees
Functional Screening Sequence:Hip Abduction
Normal pattern of activation
Pure hip abduction to 45 degrees
Abnormal patterns Hip flexion (TFL dominance/tensor mechanism) Hip external rotation (Piriformis) Hip hiking (Quadratus Lumborum)
How does the muscular system reflect the status of the sensorimotor system?
a. It can receive information from either he
musculoskeletal or central nervous
systems but not both
b. It is at a “functional crossroad” between
the sympathetic and parasympathetic
nervous systems
c. Change in tone within the muscular system
is often a reflection of dysfunctional status
of the sensorimotor system
d. The effect of joint pathology is always
reflected locally in the sensorimotor system
It is at a “functional crossroad” between the
sympathetic and parasympathetic nervous
systems
With regards to Janda’s Postural Syndromes, we can view a patient with pes planus and know
a. The patient will also have an ipsilateral
ilium upslip
b. The patient will also have ipsilateral genu
valgus
c. The patient will also have ipsilateral
shoulder elevation
d. All of the above
b. The patient will also have ipsilateral genu
valgus
Over pronated foot (pes planus) ipsi genu valgus ipsi coxa varus ipsi dropped iliac crest ipsi lumbar scoliosis contra thoracic scoliosis ipsi dropped shoulder
Noting a lateral shift of the pelvis may drive us to do what functional test?
a. Prone hip extension
b. Shoulder abduction
c. Sidelying hip abduction
d. Neck flexion
c. Sidelying hip abduction
Lateral shift or rotation of pelvis
Asymmetrical height of iliac crest
Adducted hips or varus position
Positive result on single-leg stance test
Trendelenburg sign or increased lateral pelvic shift during loading response during gait
This lateral shift of the pelvis and associated aberrant movement patterns found on the above named test may be associated with
a. Inhibition of the Gluteus Medius
b. Inhibition of Quadratus Lumborum
c. Facilitation of Transverse Abdominus
d. All of the above
a. Inhibition of the Gluteus Medius
(QL synergistic dominant, pulling pelvis
forward)
Your patient has an anterior pelvic tilt with a noted positive Ely’s Sign and Positive Thomas Test. What is an expected associated finding?
a. Positive shoulder abduction test
b. Positive side lying hip abduction test
c. Positive prone hip extension test
d. Positive stepping test
c. Positive prone hip extension test
Normal pattern of activation Glute max/hamstrings? Hamstrings/glutes? Contralateral lumbar erectors? Ipsilateral lumbar erectors? No universally agreed-upon pattern of activation
Abnormal patterns
Altered firing order: more trunk muscle activation than hip extensor activation
Anterior pelvic tilt/increased lumbar lordosis (iliopsoas, lumbar erector spinae hyperactivity)
Knee flexion (synergistic dominance of hamstrings)
Which of the following is an indicator for performing the Hip Abduction Screening Test? . a. Lateral shift or rotation of pelvis b. Asymmetrical height of iliac crest c. Adducted hips or varus position d. All of the above
Lateral shift or rotation of pelvis
Asymmetrical height of iliac crest
Adducted hips or varus position
Positive result on single-leg stance test
Trendelenburg sign or increased lateral pelvic shift during loading response during gait
What is the estimated percentage of muscle maximal volitional contraction (MVC) for spinal
stability?
a. 70-80%
b. 5-10%
c. 100%
d. More than 50% but less than 80%
b. 5-10%with co contraction of abdominal’s and
paraspinal muscles
The increased muscle activation necessary to provide stability in spinal segments damaged by ligamentous laxity or disc disease
a. Results in greater compressive force
b. Results in less compressive force
c. Results in greater shear force
d. Results in less shear force
a. Results in greater compressive force
Segments damaged by ligamentous laxity or disc disease require greater muscle activation (McGill 2003)
Results in greater compressive force
Which of the following is an abnormal pattern of muscle activation in the Neck Flexion Test?
a. Extension of occiput on atlas
b. Flexion of occiput on atlas
c. Preferential recruitment of longus capitis over SCM
d. Reciprocal inhibition of rectus capitis posterior minor
a. Extension of occiput on atlas
Patient supine, tuck chin, lift head 2 cm and hold
Test terminated when chin tuck no longer maintained
Mean Endurance Capacity
Males: 18.2 sec
Females: 14.5 sec
Which of the following contributes to the force closure stability of the sacroiliac (SI) joint?
a. Deep front myofascial sling
b. Superficial front myofascial sling
c. Lateral oblique myofascial sling
d. Anterior oblique myofascial sling
d. Anterior oblique myofascial sling
Glute Max is primarily responsible for forced closure of SI joint
POM: Lats and Glutes
AOM: Obliques, 1 jt adductors (Pectineus, Add longus, brevis and magnus)
