Special Test for Lower Back/Special Test for hips

Question 1

While performs the Straight leg test, Pain at an angle of 40 degress is indicative of
A. Hamstring tightness
B. Calf tightness
C. IVD pressure on sciatic nerve
D. SI Joint Pain

Answer 1

C. IVD pressure on sciatic nerve
Rationale:
Pain at 35-70 Degrees: Intervertebral Disc (IVD) Pressure on Sciatic Nerve
Why pain occurs: At this range, the straight leg raise test begins to stretch the sciatic nerve and other structures surrounding the lumbar spine. If there’s an issue like a herniated intervertebral disc pressing on the sciatic nerve roots, especially if the herniation is lateral, this movement increases pressure on the nerve and causes radiating pain, often described as a sharp or shooting pain down the leg.
Interpretation: Pain between 35-70 degrees of leg elevation is typically considered a positive indication of nerve root irritation, often due to lumbar disc herniation. This range puts tension specifically on the sciatic nerve, so pain here points more toward nerve involvement than just muscle tightness.

Incorrect answers:
A) Pain at 10-30 Degrees: Tight Hamstrings
Why pain occurs: When the leg is raised at a low angle (10-30 degrees) with the knee straight, there is a mild stretch on the hamstring muscles. If these muscles are tight, they will resist the stretch, and the patient may feel discomfort or pain in the hamstrings or the back of the thigh.
Interpretation: Pain or tightness in this range often indicates muscle tightness rather than nerve or joint involvement. However, to confirm hamstring tightness as the cause, it’s important to ask the patient to localize the pain—if it’s in the hamstring area, it’s more likely due to muscle tightness.

B) Calf tightness:
Calf tightness is not commonly assessed with the SLR test alone. If present, it would more likely be elicited with dorsiflexion of the foot (e.g., Bragard’s test or Lasegue’s test), not strictly from raising the leg to 40 degrees.

D) Pain at 70 Degrees or More: Sacroiliac (SI) Joint Pain
Why pain occurs: As the leg is lifted higher (70+ degrees), the hamstrings are fully stretched, and the sciatic nerve tension is maximized. However, in some cases, this movement may cause slight movement or stress in the pelvis, which can aggravate the sacroiliac (SI) joint if there’s an underlying issue there.
Interpretation: Pain occurring only at high degrees of elevation (70+ degrees) is more likely to indicate a problem with the SI joint rather than the hamstrings or sciatic nerve. SI joint pain often feels like a deep ache or discomfort around the lower back or buttocks.
Summary of Indications by Pain Range
10-30 degrees: Pain here likely indicates tight hamstrings. Confirm by asking if the pain is localized to the back of the thigh.
35-70 degrees: Pain in this range is suggestive of sciatic nerve compression or intervertebral disc herniation (especially lateral herniations) if it radiates down the leg.
70+ degrees: Pain at this point may indicate SI joint pain, which can feel more diffuse or achy and often affects the lower back or buttocks area.

Question 2

How do you perform the Sciatic Nerve test for Lower Limb Tension Tests and what does it mean

Answer 2

1. Sciatic Nerve - LLTT
   
   1. Perform the Straight Leg Raising Test (Test is below)
      Positive = Radicular Symptoms

How to perform:
* Patient lying supine, hip is medially rotated and adducted
* Lift involved leg upward by supporting the foot around the calcaneus (keep knee straight)
* Positive = Pain at 10-30 degrees
* Indicates = Tight Hamstrings (Ask where pain is_
* Positive = Pain at 35-70 degrees
* Indicates = IVD pressure on sciatic nerve (usually a lateral herniation)
* Positive = Pain at 70 degrees or more (Ask where pain is)
Indicates = SI joint pain

More information
1. Pain at 10-30 Degrees: Tight Hamstrings
Why pain occurs: When the leg is raised at a low angle (10-30 degrees) with the knee straight, there is a mild stretch on the hamstring muscles. If these muscles are tight, they will resist the stretch, and the patient may feel discomfort or pain in the hamstrings or the back of the thigh.
Interpretation: Pain or tightness in this range often indicates muscle tightness rather than nerve or joint involvement. However, to confirm hamstring tightness as the cause, it’s important to ask the patient to localize the pain—if it’s in the hamstring area, it’s more likely due to muscle tightness.

2. Pain at 35-70 Degrees: Intervertebral Disc (IVD) Pressure on Sciatic Nerve
   Why pain occurs: At this range, the straight leg raise test begins to stretch the sciatic nerve and other structures surrounding the lumbar spine. If there’s an issue like a herniated intervertebral disc pressing on the sciatic nerve roots, especially if the herniation is lateral, this movement increases pressure on the nerve and causes radiating pain, often described as a sharp or shooting pain down the leg.
   Interpretation: Pain between 35-70 degrees of leg elevation is typically considered a positive indication of nerve root irritation, often due to lumbar disc herniation. This range puts tension specifically on the sciatic nerve, so pain here points more toward nerve involvement than just muscle tightness.
3. Pain at 70 Degrees or More: Sacroiliac (SI) Joint Pain
   Why pain occurs: As the leg is lifted higher (70+ degrees), the hamstrings are fully stretched, and the sciatic nerve tension is maximized. However, in some cases, this movement may cause slight movement or stress in the pelvis, which can aggravate the sacroiliac (SI) joint if there’s an underlying issue there.
   Interpretation: Pain occurring only at high degrees of elevation (70+ degrees) is more likely to indicate a problem with the SI joint rather than the hamstrings or sciatic nerve. SI joint pain often feels like a deep ache or discomfort around the lower back or buttocks.

Question 3

How do you perform the Wells Leg Raising test and what does it indicate?

Answer 3

• Patient in supine while doctor raises the uninvolved leg
  
  • Positive = back and sciatic pain on the opposite side
    Indicates = Further presumptive evidence of a space (usually a medial herniation)

Question 4

What does the Bragard’s Test indicate and how do you perform it?

Answer 4

• Patient lying supine or sitting
• Doctor lifts leg off table like in SLR Test to the level of pain (This pain typically indicates tension on the sciatic nerve or associated structures.)
• Examiner then lowers the leg just below the level of pain and adds dorsiflexion of the ankle stretching the sciatic nerve (This ensures that the leg is still close to the threshold for sciatic nerve tension but not actively triggering pain. Bending the foot upwards stretches the sciatic nerve further)
  
  • Positive = pain radiating below knee
    Indicates = disc herniation, neural impingement

More information:
Interpretation of Bragard’s Test:
Positive Test (Pain Radiating Below the Knee):
This typically suggests sciatic nerve irritation or compression, which may result from conditions like a disc herniation or neural impingement.
Disc Herniation: If the pain radiates below the knee, it often indicates that a lumbar disc herniation (most commonly at L4-L5 or L5-S1 levels) is pressing on the sciatic nerve roots.
Neural Impingement: Other conditions like spinal stenosis, spondylolisthesis, or piriformis syndrome can also compress the sciatic nerve, leading to similar symptoms.
Why Dorsiflexion Causes Pain in This Test:
Dorsiflexion of the ankle stretches the sciatic nerve by pulling on it from the distal end (the lower leg). If the nerve is irritated, compressed, or inflamed due to a disc herniation or other causes, this additional stretch causes pain that travels down the nerve pathway. This further confirms neural involvement as opposed to just muscular tightness.
Clinical Significance:
Bragard’s test helps differentiate between muscular pain (which might cause discomfort in the thigh but not below the knee) and neural pain due to conditions that involve the sciatic nerve or nerve roots.
A positive result strongly indicates that the patient’s pain is likely due to nerve impingement rather than isolated muscular issues, guiding the practitioner to consider treatments or imaging studies focused on nerve-related conditions.

Pain Felt Above the Knee:
Hamstring or Gluteal Muscle Tightness:

If the patient experiences pain in the thigh or buttock area, it could indicate tightness in the hamstring or gluteal muscles rather than an issue with the sciatic nerve.
In these cases, the discomfort is often muscular in nature, rather than neural. This can happen when the muscles are stretched during leg raising, and it usually doesn’t involve radiating pain below the knee.
Sciatic Nerve Irritation (Proximal Region):

Sometimes, if the sciatic nerve is irritated or compressed near its origin in the lower spine, pain may also be felt in the buttock or thigh area. However, if the pain does not radiate past the knee, it may indicate milder sciatic nerve irritation rather than a full impingement affecting the nerve roots at the lower lumbar spine.
Piriformis Syndrome:

In cases of piriformis syndrome, the sciatic nerve is compressed by the piriformis muscle in the buttock, causing pain in the gluteal region, sometimes radiating down the thigh but typically not past the knee.
Pain from piriformis syndrome tends to stay in the buttock or upper thigh, as opposed to pain from a herniated disc, which often radiates below the knee.
Lesser Sciatic Nerve Involvement:

Sometimes, an issue with the smaller nerves (like the posterior femoral cutaneous nerve) can cause pain in the upper leg without extending below the knee.
Key Takeaway:
Above-the-Knee Pain: Often indicates muscular issues (hamstring or gluteal muscles) or more localized sciatic irritation, such as piriformis syndrome.
Below-the-Knee Pain: Generally suggests more significant sciatic nerve involvement or lumbar nerve root compression, as in cases of disc herniation or neural impingement.

Question 5

What does the Valsalva test indicate and how do you perform it?

Answer 5

• Patient is seated, takes a deep breath and blows out with closed mouth (like straining at stool)
  
  • Positive = Pain in back or down the legs
    Indicates = A space occupying lesion causing an increase in intrathecal pressure

more information:
Intrathecal pressure refers to the pressure within the subarachnoid space of the spinal canal, where cerebrospinal fluid (CSF) circulates around the brain and spinal cord. This pressure is essentially the pressure of cerebrospinal fluid (CSF) in the spinal canal and is also often referred to as intracranial pressure (when measuring CSF pressure within the skull). It’s a crucial measurement because abnormal intrathecal pressure can indicate or lead to neurological issues.

Question 6

What does the Kemp’s test indicate and how do you perform it?

Answer 6

• Place patient in standing position
• Instruct the patient to slowly extend, sideband, and rotate the thorax and lumbar spine to the affected side. The idea is to have the patient run their fingertips of the hand on the affected side down the posterolateral aspect of the affected leg as far as they can go.
• This movement helps to compress the intervertebral foramen, the nerve root and the facet joints on that side
  
  • Positive: Radiating pain or other neurological signs in the affected leg (nerve involvement) or localized pain (Facet involvement)

The picture is a bit misleading. Patient is in proper position but the examiner is applying pressure to the right shoulder. This is technically called the Quadrant Test. Without applying pressure, it is the Kemp Test.*

Question 7

How do you perform the Bechterewis Test and what does it indicate?

Answer 7

• The patient sits with a flexed neck.
• The patient is asked to extend one knee at a time.
• If no symptoms result, the patient is asked to extend both legs simultaneously.
  
  • Positive = Symptoms in the back or leg
    Indicates = Sciatic Nerve Involvement

Question 8

What does the Supported Forward Bend Test Indicate and how do you perform it?

Answer 8

• The patient is in a standing position.
• The examiner stands behind the patient and asks the patient to bend or flex forward until the lumbosacral pain is felt.
• The patient then returns to the upright position.
• The examiner again asks the patient to bend forward. The examiner, this time, supports the patient’s sacrum with his or her thigh and guides the movement by grasping both the ilium (pelvis immobilized).
• Positive: Pain Disappears
  Indicated: Sacroiliac Syndrome

More information:
The Forward Bending Support Test (also known as the Goldthwait’s test) is used to differentiate pain originating from the sacroiliac (SI) joint versus pain from the lumbar spine or other structures. Here’s an explanation of why this test might relieve pain when the examiner supports the sacrum:

SI Joint Stabilization: When the examiner supports the patient’s sacrum and pelvis during the second bend, they essentially immobilize the SI joint. If the initial pain during unsupported forward bending is due to instability or dysfunction in the SI joint, stabilizing the pelvis helps reduce movement in this joint. This stabilization can relieve pain because it prevents excessive or abnormal movement in the SI joint, which would otherwise cause irritation or stress to inflamed or dysfunctional SI joint structures.

Isolating Lumbar vs. Sacroiliac Pain: Forward bending involves both lumbar spine flexion and slight movement in the SI joint. Without stabilization, both the lumbar spine and SI joint are free to move, and pain may be felt from either region. By stabilizing the sacrum and pelvis, the movement is primarily restricted to the lumbar spine, so if pain disappears, it suggests that the SI joint was the source of pain, not the lumbar spine.

Mechanics of Pain Relief: In cases of sacroiliac syndrome, pain often results from stress or irregular motion in the joint or surrounding ligaments. Supporting the pelvis reduces the load on the SI joint structures, which can immediately alleviate discomfort caused by movements that would otherwise aggravate the joint.

Question 9

What does the Gillet’s Test or Marching test indicate and how is it performed?

Answer 9

• While the patient stands, the squatting examiner palpates the PSIS’ with one thumb and the other thumb parallel with the first thumb on the sacrum.
• The patient is then asked to stand on one leg while pulling the opposite knee up toward the chest.
• This causes the innominate bone on the same side to rotate posteriorly and the sacrum to rotate to the same side.
• The tcst is repeated with the other leg palpating the other PSIS .
  
  • Positive = If the sacroiliac joint on the side on which the knee is flexed moves minimally or up,
    Indicates = the joint is said to be Hypo-mobile, Normally, the tested PSIS moves down or inferiorly

Question 10

What muscles does the trunk rotators stretch, stretch and how do you perform it?

Answer 10

• The patient is seated on the table, with knees bent and legs hanging over the side
• Keeping the spine lengthened, the patient twists to the right as far as possible, keeping the nose in alignment with the sternum
• Reach under the patient’s right arm to place your right hand on the anterior shoulder.
• Place your left hand on the left scapula, near the inferomedial border.
• The patient relaxes and breathes in. On exhale take the patient farther in rotation.
• Hold for 30-60 seconds

Muscles stretched:
External Obliques: As the patient twists, the contralateral external oblique (opposite side of the rotation direction) is lengthened. So, if rotating to the right, the left external oblique is stretched.

Internal Obliques: The ipsilateral internal oblique (same side of the rotation direction) is stretched. For a right twist, the right internal oblique is lengthened.

Rectus Abdominis: The rotation puts a slight stretch on the rectus abdominis, particularly if the spine is kept lengthened, as this muscle helps stabilize the torso during the twist.

Transversus Abdominis: This deep muscle isn’t directly stretched by rotation but is activated to stabilize the trunk during the movement. It may not lengthen significantly but helps hold the posture.

Multifidus: This muscle group supports controlled rotation. The multifidus fibers are lengthened as the spine rotates, especially in the lumbar region.

Erector Spinae: The erector spinae muscles on the side opposite the twist (contralateral side) are stretched as the spine rotates and extends slightly.

Latissimus Dorsi: The latissimus dorsi on the side of the twist can be stretched if the shoulder and arm positions contribute to lengthening the muscle. The stretch will be greater if the patient keeps their arm stabilized on the opposite side of the body.

Rotatores and Semispinalis: These small muscles, which assist with fine-tuning rotation, will also be stretched as the spine rotates, particularly in the thoracic and lumbar regions.

Question 11

How do you perform the Quadratus Lumborum Stretch?

Answer 11

• The patient is lying on the left side, with the back at the edge of the table and the right leg hyperextended and hanging over the edge of the table.
• The left leg is bent and as close to his chest as possible.
• The patient reaches his right arm up over the head.
• Stand behind the patient, cross your arms and place your left hand against the right iliac crest; your right hand is spread wide and placed on the lateral aspect of the rib cage
• Ask the patient to relax take and take a deep breath. On exhale bring the patients foot closer to the floor increasing the QL stretch
  Hold for 30-60 seconds

Question 12

how to perform the assisted Latissimus Dorsi stretch

Answer 12

• The patient is prone on the table, arms outstretched and externally rotated
• Using a stable front-to-back lunge stance, grasp the patients’s arms or wrists securely.
• The patients takes a deep breath and on exhale, take the arms farther forward toward the ceiling, and externally rotate the arms more.
  Hold for 30- 60 seconds

Question 13

Self stretch for lower trunk flexor

Answer 13

• Lie facedown on the floor.
• Place both hands palms down; fingers point forward by each hip.
• Slowly arch the back, contracting the buttocks.
  Continue arching the back and lift your head and chest off the floor

MUSCLES STRETCHED
* Most-stretched muscle: Rectus abdominis, external/internal oblique
* Lesser-stretched muscles: Quadratus lumborum, psoas major,
iliacus, rotatores, intertransversarii

Question 14

Self stretch for Seated Lower Trunk Extensor

Answer 14

• Sit upright in a chair with legs separated.
• Slowly round the upper back and begin to lean forward.
• Continue to bend at the waist and lower the head and abdomen between the legs and below the thighs

MUSCLES STRETCHED
Most-stretched muscle: Iliocostalis lumborum, multifidus
Lesser-stretched muscles: Interspinales, rotatores, spinalis thoracis

Question 15

Self stretch reclining lower trunk extensor

Answer 15

• Lie on the back with the legs extended.
• Flex the knees and hips, bringing the knees up over the chest.
• Cross the feet at the ankles and separate the knees so that they are at least shoulder-width apart.
• Grasp the thighs at the inside of the knees and pull the legs down to the chest

MUSCLES STRETCHED
Most-stretched muscle: Iliocostalis lumborum, multifidus
Lesser-stretched muscles: Interspinales, rotatores, splnalis thoracis

Question 16

How to perform a self seated Lumbar Lateral Flexor

Answer 16

• Sit upright in a chair.
• Interlock the hands behind the head, with the elbows in a straight line
• across the shoulders.
• While keeping both elbows back and in a straight line, laterally flex the waist, and move the right elbow toward the right hip

MUSCLES STRETCHED
Most-stretched muscle: Left external oblique, left internal oblique, left rotators
Lesser-stretched muscles: Left intertransversarii, left multifidus, left quadratus lumborum

Question 17

Whst is a tip to differentiate between Ely’s test, Hibbs test, and Nachlas Test

Answer 17

Question 18

What does the Nachlas (Knock ass) test indicate and how do you perform it?

Answer 18

How to perform
Patient prone, examiner flexes knee in attempt to touch patient’s heal to ipsilateral buttock

* (+) Local pain -> SI/lumbar/knee ligament sprain, quadriceps strain 
	* (+) Radiating pain -> femoral nerve pathology

Question 19

What does the Hibbs test indicate and how do you perform it?

Answer 19

How to perform:
Patient prone with knee flexed 90*, examiner then stabilizes the patient’s pelvis with one hand and proceded to slowly push the patients ankle laterally – causing internal rotation of the femur

• • (+) Sacroiliac pain -> SIJ pathology
    • (+) Hip pain -> Hip Lesion

(+) Radicular pain -> piriformis entrapment of sciatic nerve

Question 20

What does the Trendelenburg Test for and how is it performed?

Answer 20

Stand behind the patient and observe the iliac crest/top of hip of the Un- supported leg
* Have patient stand on one leg
* Normally the gluteus medius muscle on the supporting side should contract as soon as the leg leaves the ground
* It normally prevents the unsupported hip from dropping and causing instability
* Normal = The pelvis should elevate on the unsupported side
* Positive = Pelvis on the unsupported side remains in position or descends
* Indicates = Weak or nonfunctioning Gluteus Medius muscle on the supported side

Question 21

What does Yeoman sign test for and how is it performed?

• Patient lies prone
• Examiner flexes the patient’s knee to 90 degrees and extends the hip
• Positive = pain in the SI joint or Lumbar Region
• SI Joint Pain Indicates pathology in the anterior SI ligaments.
• Pain in lumbar region indicates lumbar involvement
• Anterior thigh paresthesia may indicate femoral nerve stretch since this is a Femoral Nerve Tension Test

Answer 21

Purpose:
Specifically designed to assess sacroiliac joint dysfunction and anterior sacroiliac ligament involvement.
Mechanism:
The patient lies prone.
The examiner stabilizes the pelvis at the sacrum and lifts the thigh of the tested leg into extension, simultaneously applying pressure to the SI joint.
This maneuver stretches the anterior SI ligaments, lumbar spine, and hip flexors.
Pain Reproduction:
Anterior pelvic pain: Indicates strain on the anterior SI ligaments or hip flexors.
Posterior pelvic pain: Suggests sacroiliac joint dysfunction, often involving ligamentous structures.
Strengths:
Targets the anterior sacroiliac ligaments more specifically than FABER or the SI Joint Stress Test.
Limitations:
May elicit pain from the hip flexors or lumbar spine, leading to potential false positives.

Question 22

How is Fabers Test performed and what does it indicate?

Answer 22

1. FABER Test (Flexion, Abduction, External Rotation)
   Purpose:
   Primarily used to assess hip joint pathology (e.g., labral tear) but also stresses the sacroiliac joint, making it a dual-purpose test.
   Mechanism:
   The tested leg is placed in a “figure-four” position (flexion, abduction, and external rotation), and downward pressure is applied on the knee while stabilizing the opposite pelvis.
   This creates rotational forces through the pelvis and sacroiliac joint.
   Pain Reproduction:
   Groin or anterior thigh pain: Indicates hip joint pathology.
   Posterior pelvis pain: Suggests sacroiliac joint dysfunction or ligament involvement.
   Strengths:
   Easy to perform and useful for assessing both hip and SI joint contributions to pain.
   Limitations:
   Non-specific; cannot definitively distinguish between hip pathology and SI joint issues without further testing.

Question 23

How do you perform the Sacroiliac joint Stress test

Answer 23

Purpose:
Evaluates posterior sacroiliac ligament integrity and the overall stability of the SI joint.
Mechanism:
The patient lies supine.
The examiner applies direct outward pressure to both anterior superior iliac spines (ASIS).
This maneuver creates a shearing force on the sacroiliac joint, specifically stressing the posterior SI ligaments.
Pain Reproduction:
Posterior pelvic pain: Indicates posterior sacroiliac ligament involvement or SI joint inflammation.
No pain: Suggests the ligaments and joint are intact.
Strengths:
Simple and direct; isolates the posterior SI joint structures more effectively than FABER or Yeoman’s.
Limitations:
Does not assess anterior SI joint structures or differentiate well from generalized pelvic instability.

Question 24

Which of the following special tests is MOST useful for diagnosing a hamstring strain?
A) Trendelenburg Test
B) Resisted and Passive ROM Testing
C) FABERE Test
D) Hibb’s Test

Answer 24

✅ B) Resisted and Passive ROM Testing – Correct. Hamstring strain is best evaluated by assessing resistance (active contraction) and passive stretching of the hamstrings. Pain with resisted knee flexion or passive stretching indicates strain.

❌ A) Trendelenburg Test – Incorrect. This test evaluates gluteus medius weakness and hip stability, not hamstring strain.

❌ C) FABERE Test – Incorrect. This test is used to assess hip joint pathology, sacroiliac dysfunction, or labral injuries, not hamstring strain.

❌ D) Hibb’s Test – Incorrect. This test evaluates sacroiliac joint pathology and radicular pain, not hamstring injuries.

Question 25

A patient presents with sharp anterior hip pain and reports a clicking sensation when moving their hip. Which condition is MOST likely? A) Acetabular Labral Tear B) Piriformis Syndrome C) Hamstring Strain D) Myositis Ossificans

Answer 25

✅ A) Acetabular Labral Tear – Correct. Labral tears are associated with anterior hip pain and mechanical symptoms such as clicking, locking, or catching. They are commonly diagnosed with the FABERE and Resisted SLR tests. ❌ B) Piriformis Syndrome – Incorrect. This condition presents as deep buttock pain and possible sciatic nerve compression, not clicking or anterior hip pain. ❌ C) Hamstring Strain – Incorrect. Hamstring strains cause posterior thigh pain rather than anterior hip pain or clicking. ❌ D) Myositis Ossificans – Incorrect. This condition involves the formation of bone within muscle tissue due to trauma and would present with localized swelling and stiffness rather than clicking sensations.

Question 26

Which test is MOST appropriate to assess for Iliotibial Band Syndrome? A) Noble’s Compression Test B) Piriformis Test C) Gaenslen’s Test D) Yeoman’s Test

Answer 26

✅ A) Noble’s Compression Test – Correct. This test is specific for IT Band Syndrome, applying pressure over the lateral femoral condyle to reproduce pain. ❌ B) Piriformis Test – Incorrect. This assesses for Piriformis Syndrome, which causes sciatic nerve irritation rather than IT Band pain. ❌ C) Gaenslen’s Test – Incorrect. This test evaluates sacroiliac joint dysfunction, not IT Band pathology. ❌ D) Yeoman’s Test – Incorrect. This test is used to assess sacroiliac joint pathology and hip flexor tightness, not IT Band dysfunction.

Question 27

A positive Trendelenburg Test suggests weakness in which muscle? A) Piriformis B) Gluteus Medius C) Iliopsoas D) Hamstrings

Answer 27

✅ B) Gluteus Medius – Correct. The Trendelenburg Test assesses the strength of the gluteus medius. A positive test (hip drop on the opposite side) indicates weakness. ❌ A) Piriformis – Incorrect. The piriformis is involved in hip rotation but does not stabilize the pelvis during gait. ❌ C) Iliopsoas – Incorrect. The iliopsoas is a hip flexor, not an abductor responsible for pelvic stability. ❌ D) Hamstrings – Incorrect. The hamstrings control knee flexion and hip extension, not pelvic stabilization.

Question 28

Which of the following is the MOST appropriate rehabilitation exercise for a patient recovering from a hamstring strain? A) Mini-Squats with Elastic Resistance B) Bridging C) Single-Leg Balance with External Challenges D) Step-Ups and Step-Downs

Answer 28

✅ B) Bridging – Correct. Bridging strengthens the hamstrings and glutes while minimizing strain on the injured muscle. It allows for controlled hip extension in a functional range. ❌ A) Mini-Squats with Elastic Resistance – Incorrect. While beneficial for general lower body strength, this primarily targets the quadriceps and knee stability rather than hamstring recovery. ❌ C) Single-Leg Balance with External Challenges – Incorrect. This improves proprioception and stability but does not specifically target hamstring strength. ❌ D) Step-Ups and Step-Downs – Incorrect. While useful for overall lower limb strength, this movement places more demand on the quadriceps and glutes rather than directly rehabilitating the hamstrings.

Question 29

What is the PRIMARY mechanism of injury for a hamstring strain? A) Chronic overuse from prolonged sitting B) Excessive eccentric contraction during sprinting or kicking C) Blunt trauma to the posterior thigh D) Gradual degenerative changes in muscle fibers

Answer 29

✅ B) Excessive eccentric contraction during sprinting or kicking – Correct. Hamstring strains often occur during high-speed running when the muscle transitions from eccentric to concentric contraction. ❌ A) Chronic overuse from prolonged sitting – Incorrect. While prolonged sitting may contribute to tight hamstrings, it is not a direct cause of acute strain. ❌ C) Blunt trauma to the posterior thigh – Incorrect. Direct trauma can cause contusions or myositis ossificans, but hamstring strains typically result from overstretching or eccentric loading. ❌ D) Gradual degenerative changes in muscle fibers – Incorrect. Hamstring strains occur acutely rather than due to gradual degeneration. **How Eccentric Hamstring Exercises Reduce Strain Risk** Eccentric exercises improve the hamstring’s ability to absorb force by increasing its tensile strength, neuromuscular control, and fascicle length, all of which are crucial for injury prevention. Here’s how: 1. Strengthening the Muscle-Tendon Unit to Absorb Force When the hamstring is subjected to a sudden stretch (e.g., during sprinting or rapid deceleration), it must resist excessive lengthening. Eccentric training (like Nordic hamstring curls) enhances the hamstring's ability to tolerate high loads without failing. This prevents microtears and strains by ensuring the muscle doesn’t become overstretched beyond its capacity. 2. Increasing Fascicle Length & Reducing Injury Susceptibility Hamstring muscle fascicles (bundles of muscle fibers) lengthen in response to eccentric training. Longer fascicles allow the muscle to stretch further before reaching a critical point where injury might occur. Studies show that short hamstring fascicles are strongly linked to higher strain risk, especially in athletes. 3. Improving Neuromuscular Control & Coordination Eccentric exercises force the hamstring to control movement under load, improving reflexive responses. This is crucial during activities like sprinting, jumping, or changing direction, where rapid force absorption is needed. Better neuromuscular control reduces compensatory movement patterns that contribute to strain injuries. 4. Enhancing Elastic Energy Storage & Shock Absorption The hamstrings act as a spring during dynamic movements, storing and releasing energy efficiently. Eccentric training improves this function, allowing the muscle to dissipate force rather than absorb it abruptly, lowering injury risk. 5. Real-Life Application in Sprinting & Sports Hamstring strains most often occur during the terminal swing phase of sprinting, when the hamstring is lengthening under high tension. Eccentric training prepares the muscle for this specific demand, decreasing the likelihood of strains in high-speed movements. Key Takeaway: By improving force absorption, muscle length, neuromuscular control, and energy dissipation, eccentric exercises make the hamstrings more resilient, reducing the risk of overstretching and strain injuries, particularly in sprinting, jumping, and deceleration-heavy activities.

Question 30

Which of the following exercises is BEST for improving hip external rotator strength? A) Clamshells B) Side-Lying Hip Abduction C) Figure-4 Anterior Hip Stretch D) Quadrant (Scouring) Test

Answer 30

✅ A) Clamshells – Correct. Clamshells specifically strengthen the hip external rotators, particularly the gluteus medius and minimus. ❌ B) Side-Lying Hip Abduction – Incorrect. This exercise strengthens the hip abductors but does not target external rotation. ❌ C) Figure-4 Anterior Hip Stretch – Incorrect. This is a flexibility exercise for the anterior hip rather than a strengthening exercise. ❌ D) Quadrant (Scouring) Test – Incorrect. This is a diagnostic test for hip joint pathology, not an exercise.

Question 31

Which of the following best describes the role of eccentric hamstring exercises in injury prevention? a) They reduce muscle flexibility, increasing injury risk b) They improve the muscle’s ability to absorb force, reducing strain risk c) They shorten the hamstring, preventing overstretching injuries d) They primarily strengthen the quadriceps to improve knee stability

Answer 31

✅ (b) They improve the muscle’s ability to absorb force, reducing strain risk Why? Eccentric exercises strengthen the hamstring by training it to absorb force effectively, which helps prevent excessive strain, especially in activities like sprinting and jumping. ❌ (a) They reduce muscle flexibility, increasing injury risk Why wrong? Eccentric exercises actually increase flexibility by promoting muscle lengthening under load, reducing the risk of strains. ❌ (c) They shorten the hamstring, preventing overstretching injuries Why wrong? Eccentric training lengthens muscle fibers, improving flexibility and reducing overstretching risk. ❌ (d) They primarily strengthen the quadriceps to improve knee stability Why wrong? Eccentric hamstring exercises specifically target the hamstrings, not the quadriceps. Quadriceps strengthening is more relevant for knee stability.

Question 32

Which movement is MOST important for assessing functional lower extremity strength in an elderly patient to prevent falls? a) Straight-leg raise b) Partial squat c) Step-up onto a box d) Bridging

Answer 32

✅ Correct Answer: (c) Step-up onto a box Why? Step-ups mimic real-life tasks like climbing stairs, requiring both strength and balance, which are critical for fall prevention. ❌ (a) Straight-leg raise Why wrong? This mainly tests hip flexor endurance, not functional lower body strength or fall risk. ❌ (b) Partial squat Why wrong? While helpful for lower body strength, it does not fully assess dynamic movement and balance like a step-up does. ❌ (d) Bridging Why wrong? Bridges strengthen the posterior chain but do not mimic functional weight-bearing activities like stair climbing or stepping.

Question 33

Which of the following conditions would benefit MOST from strengthening the hip abductors? a) Patellofemoral pain syndrome b) Achilles tendinopathy c) Plantar fasciitis d) Hamstring tendinopathy

Answer 33

✅ Correct Answer: (a) Patellofemoral pain syndrome (PFPS) Why? Weak hip abductors contribute to knee valgus (inward knee collapse), a key factor in PFPS. Strengthening them helps stabilize the knee and reduce pain. ❌ (b) Achilles tendinopathy Why wrong? Achilles tendinopathy is more related to calf function rather than hip abductor weakness. ❌ (c) Plantar fasciitis Why wrong? Plantar fasciitis is more influenced by foot mechanics and calf tightness than hip abductor weakness. ❌ (d) Hamstring tendinopathy Why wrong? While hip strength is important, hamstring tendinopathy is more directly influenced by hamstring and glute function rather than hip abductors.

Question 34

Which of the following is a common mistake during a supine hamstring stretch that reduces its effectiveness? a) Keeping the knee slightly bent b) Rounding the lower back c) Using a towel or strap for support d) Keeping the opposite leg flat on the ground

Answer 34

✅ Correct Answer: (b) Rounding the lower back Why? Rounding the back causes compensation in the spine rather than isolating the hamstring stretch, reducing effectiveness. ❌ (a) Keeping the knee slightly bent Why wrong? This can actually be beneficial for people with tight hamstrings, preventing excessive strain. ❌ (c) Using a towel or strap for support Why wrong? A strap can help achieve a better stretch by assisting with leg positioning. ❌ (d) Keeping the opposite leg flat on the ground Why wrong? Keeping the opposite leg flat promotes a more stable stretch and helps maintain proper pelvic alignment.

Question 35

Which of the following is an appropriate modification for a patient struggling with a standard clamshell exercise due to hip weakness? a) Perform it with a resistance band b) Perform it standing instead of lying down c) Reduce the range of motion and focus on activation d) Hold a dumbbell against the hip for added resistance

Answer 35

✅ Correct Answer: (c) Reduce the range of motion and focus on activation Why? A limited range of motion allows for proper muscle activation without compensation, making the exercise more effective for beginners. ❌ (a) Perform it with a resistance band Why wrong? Adding resistance is a progression, not a modification for someone struggling. ❌ (b) Perform it standing instead of lying down Why wrong? A standing variation (e.g., lateral band walks) is more advanced and requires greater balance and control. ❌ (d) Hold a dumbbell against the hip for added resistance Why wrong? This increases difficulty rather than making it more accessible.

Question 36

During bridging exercises, which compensatory movement indicates poor gluteal activation? a) Lifting the hips too high, leading to excessive lumbar extension b) Keeping the knees slightly apart c) Activating the core before lifting d) Engaging the hamstrings and glutes equally

Answer 36

✅ Correct Answer: (a) Lifting the hips too high, leading to excessive lumbar extension Why? Overextending the hips often means the lower back (rather than glutes) is doing the work, reducing glute activation. ❌ (b) Keeping the knees slightly apart Why wrong? A slight knee separation can actually help maintain proper hip alignment. ❌ (c) Activating the core before lifting Why wrong? Core activation is beneficial and does not indicate poor glute activation. ❌ (d) Engaging the hamstrings and glutes equally Why wrong? Ideally, the glutes should be the primary mover, but hamstring activation is still expected.

Question 37

Which of the following movement patterns is most likely to contribute to a hamstring strain during sprinting? a) Landing with a bent knee and dorsiflexed ankle b) Rapid deceleration when the hamstring is in an eccentric contraction c) Jumping from a squat position d) Gradually increasing running speed

Answer 37

✅ Correct Answer: (b) Rapid deceleration when the hamstring is in an eccentric contraction Why? The hamstring is highly vulnerable when it lengthens under load (eccentric contraction), especially during high-speed deceleration. ❌ (a) Landing with a bent knee and dorsiflexed ankle Why wrong? This position is generally safer and reduces impact forces. ❌ (c) Jumping from a squat position Why wrong? Jumping stresses the quadriceps more than the hamstrings. ❌ (d) Gradually increasing running speed Why wrong? A gradual increase in speed reduces injury risk rather than contributing to it.

Question 38

Which of the following is the most effective progression for hamstring rehab following a grade I strain? a) Passive stretching → Isometric holds → Eccentric loading b) Sprinting → Stretching → Strengthening c) Heavy resistance training → Isometric holds → Passive stretching d) No stretching → Only strength training

Answer 38

✅ Correct Answer: (a) Passive stretching → Isometric holds → Eccentric loading Why? This follows a logical progression: gentle stretching to restore mobility, isometric holds to reintroduce loading, and eccentric exercises to strengthen the muscle while controlling lengthening. ❌ (b) Sprinting → Stretching → Strengthening Why wrong? Sprinting too soon risks re-injury, and stretching before strengthening is not optimal. ❌ (c) Heavy resistance training → Isometric holds → Passive stretching Why wrong? Heavy loading too early can worsen the strain. ❌ (d) No stretching → Only strength training Why wrong? Stretching is important for regaining flexibility and preventing future strains.

Question 39

Which of the following exercises provides the MOST functional carryover to walking and stair climbing? a) Supine hamstring stretch b) Clamshell with resistance band c) Step-up with controlled eccentric lowering d) Bridging

Answer 39

✅ Correct Answer: (c) Step-up with controlled eccentric lowering Why? Step-ups closely mimic real-world movements like climbing stairs and stepping onto curbs, making them highly functional. ❌ (a) Supine hamstring stretch Why wrong? Stretching does not directly translate into strength or functional movement. ❌ (b) Clamshell with resistance band Why wrong? While beneficial for hip stabilization, clamshells do not directly mimic walking or stair climbing. ❌ (d) Bridging Why wrong? Bridges strengthen the posterior chain but do not involve stepping motions.

Question 40

Question 1: Which of the following statements about groin strain is TRUE? a) The adductor magnus is the most commonly injured muscle in groin strain. b) Groin strains are always isolated injuries with no other conditions involved. c) The mechanism of injury often involves forceful abduction of the thigh. d) Grade 3 groin strains are always more painful than Grade 2 strains.

Answer 40

**Answer: c) The mechanism of injury often involves forceful abduction of the thigh. ✅** Explanation: (a) Incorrect: The adductor longus is the most commonly injured muscle, not the adductor magnus (which ranks second in occurrence). (b) Incorrect: Studies show that 30-90% of patients with groin strain have coexisting injuries such as hernias, labral tears, or hip OA. (c) Correct: A groin strain typically results from overstretching of the adductors by a forceful abduction movement, often occurring during sudden direction changes in sports. (d) Incorrect: A full Grade 3 rupture may be less painful than a Grade 2 strain because the nerve endings may be severed.

Question 41

Which of the following special tests would NOT be useful for ruling in or out a groin strain? a) Resisted Hip Adduction Test b) Passive Hip Abduction Test c) Ely’s Test d) Palpation of the adductor muscles

Answer 41

**Answer: c) Ely’s Test ✅** Explanation: (a) Correct: Resisted hip adduction will reproduce pain in an injured adductor muscle. (b) Correct: Passive abduction will stretch the adductors, potentially reproducing pain in a strained muscle. (c) Incorrect: Ely’s Test assesses femoral nerve compression or quadriceps contracture, not adductor injuries. (d) Correct: Palpation is useful to locate tender points, muscle defects, or swelling in a suspected groin strain.

Question 42

A 28-year-old soccer player reports medial thigh pain after a quick directional change. What is the MOST likely diagnosis? a) Hip osteoarthritis b) Iliotibial band syndrome c) Groin strain d) Myositis ossificans

Answer 42

**Answer: c) Groin strain ✅** Explanation: (a) Incorrect: Hip OA typically presents with stiffness, not an acute onset of pain during movement. (b) Incorrect: IT band syndrome is a lateral knee/hip issue, not a medial thigh pain condition. (c) Correct: Groin strains commonly occur in athletes with sudden stopping, starting, or changing direction in sports. (d) Incorrect: Myositis ossificans can develop weeks after a muscle contusion, but it does not present acutely after an injury.

Question 43

Which special test is most appropriate for assessing hip degenerative joint disease (DJD)? a) Ely’s Test b) FABERE Test c) Trendelenburg Test d) Piriformis Test

Answer 43

Answer: b) FABERE Test ✅ Explanation: (a) Incorrect: Ely’s Test assesses femoral nerve compression and quadriceps tightness, not hip DJD. (b) Correct: FABERE (Patrick’s Test) reproduces pain in hip DJD due to joint degeneration. (c) Incorrect: Trendelenburg Test evaluates hip abductor weakness, which may be seen in DJD but is not a primary diagnostic tool for it. (d) Incorrect: Piriformis Test assesses piriformis syndrome, not hip joint pathology.

Question 44

Which special test is used to assess iliotibial band syndrome? a) Ober’s Test b) Trendelenburg Test c) Ely’s Test d) Gaenslen’s Tes

Answer 44

**Answer: a) Ober’s Test ✅** Explanation: (a) Correct: Ober’s Test evaluates IT band tightness, which is a key factor in IT band syndrome. (b) Incorrect: Trendelenburg Test assesses hip abductor weakness, not IT band tightness. (c) Incorrect: Ely’s Test is used to evaluate femoral nerve compression or quadriceps tightness, not ITBS. (d) Incorrect: Gaenslen’s Test assesses SI joint dysfunction, not IT band pathology.

Question 45

Myositis ossificans is best described as: a) An inflammatory disorder of the hip bursa b) A calcium deposit within a muscle following trauma c) A degenerative hip condition d) A condition primarily affecting the hip flexors

Answer 45

Answer: b) A calcium deposit within a muscle following trauma ✅ Explanation: (a) Incorrect: Bursitis is inflammation of the bursa, but myositis ossificans involves abnormal bone formation in muscle tissue. (b) Correct: Myositis ossificans occurs when a muscle develops calcifications due to trauma, such as a severe contusion. (c) Incorrect: It is not a degenerative condition like hip osteoarthritis. (d) Incorrect: It is not limited to hip flexors—it can occur in any muscle that has experienced trauma.

Question 46

Question 5: What is the most likely finding in a patient with snapping hip syndrome? a) Positive Noble’s Compression Test b) Pain with resisted hip adduction c) Audible or palpable snapping sensation d) Pain with resisted knee flexion

Answer 46

**Answer: c) Audible or palpable snapping sensation ✅** (c) Correct: Snapping hip syndrome is characterized by a snapping sensation during movement, often felt at the hip. Explanation: (a) Incorrect: Noble’s Compression Test is used for Iliotibial Band Syndrome (ITBS), not snapping hip. (b) Incorrect: Pain with resisted adduction is a finding in groin strain, not snapping hip. (d) Incorrect: Resisted knee flexion is typically painful in hamstring injuries, not snapping hip syndrome External snapping hip (IT band over the greater trochanter) vs. Internal snapping hip (iliopsoas over iliopectineal eminence) might have different associated tests (e.g., FABER, Gaenslen’s, and Thomas Test for internal snapping hip). Pain is not always present with snapping hip, but when it is, it’s usually linked to inflammation or overuse rather than a resisted movement test.

Question 47

Which of the following best differentiates internal snapping hip from external snapping hip? a) External snapping hip is associated with the iliopsoas tendon, while internal snapping hip involves the IT band. b) Internal snapping hip occurs when the iliopsoas tendon moves over the iliopectineal eminence, while external snapping hip occurs when the IT band moves over the greater trochanter. c) Internal snapping hip is always painful, whereas external snapping hip is painless. d) External snapping hip occurs in younger patients, while internal snapping hip occurs in older patients.

Answer 47

✅ Answer: b) Internal snapping hip occurs when the iliopsoas tendon moves over the iliopectineal eminence, while external snapping hip occurs when the IT band moves over the greater trochanter. Explanation: (a) Incorrect: The iliopsoas tendon is responsible for internal snapping hip, but the IT band is responsible for external snapping hip—the answer choice has them reversed. (b) Correct: Internal snapping hip is caused by the iliopsoas tendon moving over the iliopectineal eminence, whereas external snapping hip is due to the IT band snapping over the greater trochanter. (c) Incorrect: Snapping hip can be painless or painful, depending on inflammation or irritation. It is not always painful. (d) Incorrect: Snapping hip syndrome occurs in athletes of all ages, particularly those who engage in repetitive hip flexion (e.g., dancers, runners).

Question 48

Which of the following is the most appropriate special test to assess for functional leg length discrepancy? a) Ely’s Test b) Trendelenburg Test c) Noble’s Compression Test d) Supine to Sitting Test

Answer 48

**✅ Answer: d) Supine to Sitting Test** Explanation: (a) Incorrect: Ely’s Test assesses for rectus femoris tightness or femoral nerve root irritation, not leg length discrepancy. (b) Incorrect: Trendelenburg Test assesses for gluteus medius weakness or sacroiliac joint dysfunction, not leg length discrepancy. (c) Incorrect: Noble’s Compression Test is used to diagnose iliotibial band syndrome (ITBS), not leg length discrepancy. (d) Correct: Supine to Sitting Test is used to determine functional leg length discrepancy, which can result from pelvic obliquity, muscle imbalances, or asymmetrical movement patterns.

Question 49

Which condition is most commonly associated with a positive Trendelenburg Test? a) Hip DJD b) Groin strain c) Snapping hip syndrome d) Piriformis syndrome

Answer 49

✅ Answer: a) Hip DJD Explanation: (a) Correct: Hip DJD (degenerative joint disease/osteoarthritis) often leads to gluteus medius weakness, resulting in a positive Trendelenburg Test (pelvic drop on the unsupported side when standing on one leg). (b) Incorrect: Groin strain affects the adductor muscles, not the gluteus medius, so it does not cause a positive Trendelenburg Test. (c) Incorrect: Snapping hip syndrome involves tendon movement over bony structures and does not primarily involve gluteus medius weakness. (d) Incorrect: Piriformis syndrome involves sciatic nerve irritation and external rotator tightness but does not typically cause a Trendelenburg sign.

Question 50

Which of the following statements about myositis ossificans is correct? a) It is a genetic disorder that affects the bone marrow. b) It results from a failure of muscle tissue to heal properly, leading to abnormal bone formation. c) It is primarily diagnosed with manual muscle testing. d) It exclusively affects the hip adductor muscles

Answer 50

**(b) Correct: Myositis ossificans occurs when muscle tissue fails to heal properly, causing heterotopic bone formation (calcification within the muscle).** Explanation: (a) Incorrect: Myositis ossificans is not a genetic disorder but rather a condition caused by trauma, contusions, or repetitive strain, leading to abnormal bone formation in muscle tissue. (c) Incorrect: Diagnosis is primarily confirmed via imaging (X-ray or ultrasound), not manual muscle testing. (d) Incorrect: It can occur in various muscle groups, especially the quadriceps, but not exclusively in the hip adductors

Question 51

Which of the following is the best treatment choice for chronic osteoarthritis (OA) of the hip? A) Low-Level Laser Therapy (LLLT) B) Russian Stimulation C) Contrast Hydrotherapy D) All of the above

Answer 51

Correct Answer: D) All of the above A) Correct – LLLT stimulates cartilage repair and reduces inflammation, making it effective for OA management. B) Correct – Russian Stimulation strengthens weakened muscles around the hip, improving joint stability. C) Correct – Contrast Hydrotherapy enhances circulation and reduces joint stiffness, making it beneficial for OA. D) Correct – A combination of these therapies provides a comprehensive approach to managing chronic OA.

Question 52

Which statement about myositis ossificans is TRUE? A) It is best treated with aggressive deep tissue massage. B) It results from an abnormal healing response where bone forms in muscle tissue. C) Stretching should be performed with maximal force to break down the ossification. D) The condition is always irreversible.

Answer 52

Correct Answer: B) It results from an abnormal healing response where bone forms in muscle tissue. A) Incorrect – Deep tissue massage can worsen ossification and should be avoided. B) Correct – Myositis ossificans occurs when trauma leads to calcium deposition in muscle tissue instead of normal healing. C) Incorrect – Stretching should be gentle and controlled to avoid exacerbating the condition. D) Incorrect – While severe cases may require surgical intervention, many individuals recover with conservative management. Rest and Activity Modification: Limiting movement and avoiding activities that might exacerbate the condition, especially if it's acute. Ice and Heat Therapy: Applying ice to reduce inflammation and heat later on to relax the muscle and promote blood flow. Pain Management: Using over-the-counter pain relievers such as NSAIDs (ibuprofen) to reduce pain and inflammation. Physical Therapy: Gentle stretching and strengthening exercises can help prevent muscle stiffness and improve range of motion once the acute pain decreases. Observation: In some cases, the condition resolves on its own, and only observation is required to monitor progress. Avoiding Aggressive Manipulation: Vigorous massage or manipulation of the affected area can aggravate the condition, so these should be avoided during the healing phase.

Question 53

Which of the following physical modalities should NOT be used in the early stages of myositis ossificans? A) Effleurage B) Pulsed Ultrasound C) Shortwave Diathermy D) Interferential Current (IFC) Therapy

Answer 53

Correct Answer: C) Shortwave Diathermy A) Incorrect – Effleurage promotes circulation and lymphatic drainage without aggravating ossification. B) Incorrect – Pulsed Ultrasound at low intensity can reduce inflammation without promoting further ossification. C) Correct – Shortwave Diathermy generates deep heat, which can stimulate further calcification and worsen the condition. D) Incorrect – IFC Therapy is useful for pain management without increasing bone formation.

Question 54

Which physical modality is most appropriate for reducing pain and inflammation in Snapping Hip Syndrome? A) Interferential Current (IFC) Therapy B) Shortwave Diathermy (SWD) C) Myofascial Release D) Cross-Fiber Friction

Answer 54

**Correct Answer: A) Interferential Current (IFC) Therapy** A) Correct – IFC Therapy reduces pain, improves blood flow, and stimulates deep tissue healing, making it ideal for addressing inflammation in the iliotibial band (ITB), gluteus maximus tendon, and tensor fasciae latae (TFL). B) Incorrect – SWD delivers deep heat, which may be useful for chronic tightness but is less specific for acute inflammation. C) Incorrect – Myofascial release is beneficial for improving tissue mobility but does not have direct anti-inflammatory effects. D) Incorrect – Cross-Fiber Friction can help break down adhesions but may exacerbate inflammation in the acute stage.

Question 55

Which of the following is the best treatment choice for chronic osteoarthritis (OA) of the hip? A) Low-Level Laser Therapy (LLLT) B) Russian Stimulation C) Contrast Hydrotherapy D) All of the above

Answer 55

Correct Answer: D) All of the above A) Correct – LLLT stimulates cartilage repair and reduces inflammation, making it effective for OA management. B) Correct – Russian Stimulation strengthens weakened muscles around the hip, improving joint stability. C) Correct – Contrast Hydrotherapy enhances circulation and reduces joint stiffness, making it beneficial for OA. D) Correct – A combination of these therapies provides a comprehensive approach to managing chronic OA.

Question 56

Which statement about myositis ossificans is TRUE? A) It is best treated with aggressive deep tissue massage. B) It results from an abnormal healing response where bone forms in muscle tissue. C) Stretching should be performed with maximal force to break down the ossification. D) The condition is always irreversible.

Answer 56

**Correct Answer: B) It results from an abnormal healing response where bone forms in muscle tissue.** A) Incorrect – Deep tissue massage can worsen ossification and should be avoided. B) Correct – Myositis ossificans occurs when trauma leads to calcium deposition in muscle tissue instead of normal healing. C) Incorrect – Stretching should be gentle and controlled to avoid exacerbating the condition. D) Incorrect – While severe cases may require surgical intervention, many individuals recover with conservative management.

Question 57

Which of the following physical modalities should NOT be used in the early stages of myositis ossificans? A) Effleurage B) Pulsed Ultrasound C) Shortwave Diathermy D) Interferential Current (IFC) Therapy

Answer 57

Correct Answer: C) Shortwave Diathermy A) Incorrect – Effleurage promotes circulation and lymphatic drainage without aggravating ossification. B) Incorrect – Pulsed Ultrasound at low intensity can reduce inflammation without promoting further ossification. C) Correct – Shortwave Diathermy generates deep heat, which can stimulate further calcification and worsen the condition. D) Incorrect – IFC Therapy is useful for pain management without increasing bone formation. **Mechanism of Shortwave Diathermy in Myositis Ossificans Worsening Increased Metabolic Activity & Circulation** SWD increases blood flow and metabolic activity in the targeted tissues. In MO, the body is already undergoing abnormal heterotopic ossification (bone formation in soft tissues). Increased blood flow can provide more nutrients and osteogenic signals to the affected area, promoting further calcification. Heat-Stimulated Enzymatic Activity & Osteoblast Activation The deep heating effect of SWD can activate osteoblasts (bone-forming cells). This exacerbates the calcification process, worsening MO progression. Delayed Resorption of Calcified Tissue In normal healing, MO undergoes a remodeling phase where some of the abnormal bone is reabsorbed. SWD interferes with this process by stimulating rather than breaking down calcified deposits, prolonging the condition. Why SWD Is Contraindicated in MO Early application of heat (such as SWD) is particularly harmful because it encourages bone growth instead of resorption. Instead of diathermy, treatment typically includes ice, NSAIDs, and gentle ROM exercises to prevent further ossification.