Postural stability of the spine is provided by:
Interaction of muscle control modulated by the central nervous system and passive restraints.
Elasticity of passive restraints.
Interaction of passive restraints and muscle control.
Muscle activity maintaining balance in the neutral zone.
Characteristics of the global muscles in the spine include all of the following except:
Provide dynamic stability to each segment in the spine.
Prime movers of the spine.
Multisegmental guy wires.
Control spinal orientation in response to external loads.
The spinal muscles that are activated first with rapid arm movements are the:
Transversus abdominis and multifidus.
Erector spinae and rectus abdominis.
Internal and external obliques.
Multifidus and internal obliques.
A sustained faulty posture that stresses the ligamentous or joint structures usually results in:
Diffuse pain that is relieved when the mechanical stress is stopped.
Diffuse pain that is relieved with pain medication, modalities, and massage
Sharp pain that cannot be relieved until the tissue heals.
Sharp pain that changes in intensity as the posture changes.
Which of the following is true of a flat low-back posture?
It should be the goal of all back rehabilitation programs.
It is typically associated with tight hip flexor muscles.
It is the best posture for a healthy spine.
It reduces the shock-absorbing function of the spinal curves.
To teach a patient how to manage painful symptoms related to poor posture, which of the following is most important?
High-repetition, low-resistance exercise program
Strengthening program
Stretching program
Awareness of the relationship between the faulty posture and pain
The difference between a lordotic posture and a slouched posture is:
Only the lordotic posture has lumbar lordosis.
Flexion in both the upper lumbar and lower thoracic spine occurs with the slouched posture.
Extension of the pelvis on the femurs occurs with the lordotic posture.
There is no difference; both affect the pelvis and lumbar spine the same way.
Your patient complains of cervical pain and headaches. You notice that she has a forward head and round back posture. The complaints could be derived from all of the following except:
Impingement on the neurovascular bundle from sternocleidomastoid muscle tightness.
Increased tension in the muscles of mastication with associated temporomandibular joint syndrome.
Irritation of the facet joints in the upper cervical spine.
Impingement of the suboccipital nerves.
Your patient describes posterior cervical pain and headaches that get progressively worse throughout each workday. She is a computer programmer, plays tennis on the weekends, and is an aerobic walker in the evenings. Your evaluation reveals a person who is physically fit with well-balanced flexibility and strength. Your treatment emphasis will be:
Teaching tension-reducing postures and modification of chair, desk, and computer heights.
Stretching the short suboccipital, levator, and scalene muscles.
Teaching proper warm-up exercises and progressing her aerobic program to running.
Changing her sleeping posture and pillow height.
Your patient describes increased pain in the back in the morning before getting out of bed. The patient should be:
Advised to place a board under a soft mattress.
Advised to sleep in a recliner or with a pillow under her knees to accentuate hip flexion.
Advised never to sleep prone.
Evaluated for sleeping posture and advised in mechanically safe adaptations.
Your patient describes having cervical and upper thoracic pain progressing throughout the day at work where she works by reaching forward and overhead on an assembly line. On evaluation you determine she is experiencing “stretch weakness” from prolonged postural positioning. The treatment program you design should primarily include all of the following except:
Environmental adaptations for ergonomic relief and protection.
Muscular endurance and strengthening.
Posture training for safe body mechanics.
Stretching for the involved postural muscles.
Your patient has a forward head posture. On testing (supine-lying), she cannot isolate capital flexion to lift her head when you ask her to flex her neck. Passively you can move the head about 5° into capital flexion and then feel tissue resistance. Based on these supine tests, what muscles are tight and what muscles are weak?
Tight suboccipital muscles and weak longus capitis and longus colli muscles
Tight erector spinae and weak sternocleidomastoid muscles
Tight splenius capitis and splenius cervicis muscles and weak multifidus muscles
Tight erector spinae and weak suprahyoid and infrahyoid muscles
Motion at a functional unit of the spine is defined by what is occurring with the:
Spinous process of the inferior vertebrae.
Spinous process of the superior vertebrae.
Anterior portion of the body of the inferior vertebrae.
Anterior portion of the body of the superior vertebrae.
The anterior pillar of the spine:
Is the weight-bearing portion of the spinal column.
Consists of the vertebral bodies and the vertebral arches.
Includes the sternum and the 12 pairs of ribs.
Provides the gliding mechanism for movement.
All of the following are generally true of the nucleus pulposus except:
It takes on and/or releases water in response to compressive loads.
It is covered superiorly and inferiorly by a cartilaginous end-plate.
It is the axis of motion for the functional units of the spine.
It is centrally aligned within the annulus fibrosis at all levels of the spine to provide uniform shock absorption.
Which of the following best describes scoliosis?
A lateral curvature of the spine wherein rotation of the vertebral bodies is toward the convexity of the curve
A transverse plane deviation of the vertebrae usually involving the thoracic and lumbar regions
An irreversible lateral curvature with fixed rotation of the vertebrae caused by lordotic posture
A collapse of intervertebral space resulting from weakness of the deep segmental muscle of the spine
The physical therapist has identified several postural muscles as having tight weakness. You know that these muscles need to be:
Stretched in a lengthened position.
Strengthened in a midrange position.
Strengthened in a shortened position.
Strengthened in a lengthened position.
The condition in which a patient has impaired posture along with adaptive shortening of soft tissues is which of the following?
Overuse syndrome
Postural pain syndrome
Postural fault
Postural dysfunction
Lumbar lordotic posture is generally accompanied by mobility impairments in any of the following muscles except the:
Iliopsoas.
External obliques.
Rectus femoris.
Tensor fascia lata.
A patient with forward head and increased thoracic kyphosis usually needs strengthening to any of the following muscles except the:
Sternocleidomastoid.
Scapular retractors.
Suprahyoid and infrahyoid muscles.
Upper thoracic erector spinae.
Scoliosis characterized by an irreversible lateral curvature with fixed rotation of the vertebrae is called:
Asymmetrical scoliosis.
Structural scoliosis.
Functional scoliosis.
Postural scoliosis.
You are asked to provide tactile reinforcement to teach postural alignment. Which of the following muscle groups would not be targeted to contract and hold for correct posture?
Cervical retractors
Scapular elevators
Scapular retractors
Abdominals
Good motions to relieve postural stress in the cervical and upper thoracic regions could include any of the following except:
Scapular elevation and depression.
Thoracic flexion.
Cervical side bends.
Cervical flexion, then extension.
Your patient with cervical headaches needs muscle endurance exercises to muscles that provide scapular stabilization. You know to provide exercises to all of the following muscles except the:
Serratus anterior.
Levator scapula.
Rhomboids.
Lower trapezius.
You need to teach a self-stretch for the scalenes. Which of the following is the correct technique?
Corner stretch
Capital nods
Side-bend the neck to the opposite side and rotate the head toward the side of restriction
Scapular depression with rotation and flexion to the opposite side
When side-lying, the best lower extremity position to stretch the tensor fascia lata includes all of the following except:
Hip flexion.
Hip extension.
Hip lateral rotation.
Hip adduction.
All of these structures articulate with the spine except the:
Clavicle.
Ribs.
Cranium.
Pelvis.
Flexion of the spine:
Occurs in the sagittal plane.
Occurs in the frontal plane.
Results in approximation of the spinous processes.
Occurs with a longitudinal force.
In the balanced upright posture, the gravity line is:
Anterior to the hip joint.
Posterior to the knee joint.
Anterior to the ankle joint.
Through the center of all the vertebral bodies of the trunk.
Treating the soft tissue of the back:
In principle is no different from treating soft tissues in the extremities.
Is more difficult than treating the extremities because of the way it is innervated.
Is usually not necessary because most back pain results from dysfunction of the facets or disks.
Involves using heat rather than cold, massage rather than exercise, and principles that in general are different from those used when treating the extremities.
Disk lesions are more common in the 30 year to 45 year age span because:
The annulus begins degenerating, loses tensile strength, and begins to tear with excessive forces.
The nucleus pulposus changes in chemical composition during this time and is capable of imbibing greater than normal amounts of water, causing greater than normal pressure against pain-sensitive structures.
The facets are wearing out and the entire joint complex is placed under greater stress.
This is not the most common age span for disk lesions.
One day following onset of pain and muscle guarding in the low back region, your patient stands with lumbar flexion and a sciatic scoliosis. Repeated flexion tests increase pain into the buttock. Repeated extension done after side gliding increases the pain in the midback and decreases the pain in the buttock. You begin treatment by:
Positioning the patient supine and having him bring both knees to his chest.
Having the patient lie prone and attempting passive extension with press-ups or prone propping maneuvers after side gliding the thorax.
Placing the patient in intermittent traction at less than half his body weight for 20 minutes.
Placing the patient on complete bed rest for at least 4 days, applying modalities and massage during that time.
Which of the following sacroiliac impairments will probably not respond to muscle energy techniques?
Posterior rotated innominate
Pubic symphysis hypomobility
Up-slipped innominate
Anterior rotated innominate
All resistive flexion and extension activities and exercises are contraindicated when there is an acute disk lesion because:
They cause increased pain.
They increase the intradiscal pressure.
They cause swelling of the nucleus against pain-sensitive structures.
Resisted extension is all right—but not flexion because it increases the bulge.
Following recovery of a posterolateral disk protrusion, your patient will be returning to a job that requires prolonged forward bending and stooping. Your instructions to the patient must include:
Interruption of the flexed postures at frequent intervals by standing upright and bending backward.
Advice to quit that job and find one that is sedentary.
No advice—forward bending helps maintain mobility in the spine.
Preparing for the forward bending by posterior tilting of the pelvis before bending and stooping.
Patients with osteoporosis are at high risk for compression fractures of the vertebral bodies. The primary segments of the spine at risk are the thoracolumbar regions. When planning intervention programs for this high-risk population all of the following are appropriate except:
Instruct in safe lifting techniques that minimize trunk flexion.
Strengthen the abdominals without adding weight-bearing stress on the vertebrae by initiating sit-up exercises.
Teach stabilization exercises to develop spinal stability.
Teach postural awareness and scapular stabilization techniques to decrease the progression of thoracic kyphosis.
Your patient has complaints of increasing low back pain during the day. Her job requires repetitive lifting and reaching overhead (25 lb maximum). On examination, you note that on forward bending she has difficulty moving smoothly midrange and that on side bending to the left there is an acute angle in the midlumbar region. Additional tests lead you to hypothesize that she has clinical instability in the midlumbar region. This could be caused by all of the following except:
Poor neuromuscular control of the deep segmental stabilizing musculature.
Degeneration of the intervertebral disk.
Advanced spondylitis.
Ligamentous laxity.
Your patient has acute joint trauma to the cervical spinal facets. Every time she attempts neck motions, there is increased pain and muscle guarding. A possible way to maintain integrity in the contractile units of the muscles is to:
Perform reverse muscle action using gentle scapular motions.
Apply cold.
Perform passive range of motion to the cervical spine.
Apply heat.
Your patient has nerve root symptoms and has been diagnosed as having degenerative joint disease of the spine. The approach for treating the cause of the symptoms should be:
Heat and massage.
Interventions that temporarily increase the size of the intervertebral foramina.
Intermittent setting exercises with the extensor muscles in the shortened position.
Relaxation exercises, including head rolls and conscious tension-release techniques.
Extreme caution should be used when manipulating the spine of patients with rheumatoid arthritis. There is high potential for subluxation of the vertebrae and damage to the spinal cord secondary to:
Joint effusion.
Synovial hypertrophy.
Ligamentous necrosis.
Pain.
All of the following statements are true about functional position (bias) of the spine except:
If there is an extension bias, it means there is a disk lesion.
The functional position may change as tissues heal and the individual gains mobility and strength.
A person with a nonweight-bearing bias is sensitive to the effects of gravity and feels greatest relief when lying down.
The functional position is not a static position but a range wherein nontraumatic or safe activity can occur.
Your patient has signs of an acute lumbar intervertebral disk protrusion. On testing, he experiences decreased symptoms when applying manual traction. To use mechanical traction effectively as part of the treatment plan during the early stages:
Use sustained traction for less than 10 minutes with a dosage of at least 50% of the body weight.
Use sustained traction for 20 minutes with a dosage of at least 50% of the body weight.
Use intermittent traction for 20 minutes with a dosage of at least 50% of the body weight.
Use intermittent traction for less than 15 minutes with a dosage of less than 50% of the body weight.
All of the following are techniques to increase temporomandibular joint (TMJ) motion except:
Place tongue blades between the front teeth and progressively adding more as tolerated.
Place your thumb and index finger against the patient’s incisors or molars and press the mandible caudally.
Instruct the patient to chew gum for at least 10 minutes, three times a day to build endurance.
Teach self-manipulation of the joints by placing dental rolls between the patient’s molars and asking him to bite down while attempting to close the front teeth.
Your patient complains of facial pain, especially when under tension and when eating. All of the following are appropriate except:
Jaw relaxation by clicking the tongue and resting the tongue on the hard palate behind the front teeth.
Stretching and strengthening the muscles of mastication so they can withstand the stress.
Teaching the patient extra-oral massage in the region of the masseter and/or temporalis muscle.
Relaxation techniques and controlled breathing.
Which of the following is contraindicated for a patient who has undergone L4/L5 laminectomy?
Joint manipulation at the thoracolumbar junction
Flexion exercises of the trunk
Extension exercises of the trunk
Strengthening of the transverse abdominals
Scheuermann’s disease:
Is a rheumatic disorder.
Results from weakened vertebral end-plates.
Begins with radicular signs that diminish over time.
Requires functionally increasing the lumbar lordosis to prevent development of kyphosis.
The vertebral arteries:
Enter the transverse foramen of C6 bilaterally in their course to C1.
Are protected in positions of extreme cervical extension.
Cause tension headaches when they are occluded.
Are compromised with severe TMJ dysfunction.
All of these are reasons to assess the thoracic spine during evaluation of patients who present with cervical spine dysfunction except:
The thoracic spine is prone to hypomobility.
There are common muscle attachments between the cervical and thoracic areas.
The thoracic spine becomes unstable with pain and soft tissue dysfunction in the cervical spine.
Joint manipulation performed along with high-velocity thrust of the thoracic spine often improves outcomes in patients with cervical complaints.
Your patient presents with a chief complaint of headaches with unknown etiology, beginning last week. During the course of the initial assessment you determine that the source of the headache most probably is not musculoskeletal (a cervical headache). Which of the following indicates that a referral to the patient’s physician is appropriate?
Pain or altered sensation in the face or TMJ region
Report of sharp pain or spikes in intensity
Unilateral headaches or bilateral headaches with one side predominant
Pain in the neck or suboccipital region that spreads in the head
The disc injury in which the nucleus has moved beyond the posterior longitudinal ligament is called which of the following?
Sequestration
Protrusion
Extrusion
Herniation
Typical pain described by a person with a disc lesion is an increase in pain with any of the following activities except:
Walking
Coughing
Standing
Sitting
The general time frame for the acute stage of recovery with a spinal pathology is:
1 week
2 weeks
4 weeks
6 weeks
A patient with a spinal stenosis is most likely to be categorized as having a:
Extension bias
Rotation bias
Non-weight-bearing bias
Flexion bias
Your patient has an injury to the posterior longitudinal ligament. She will likely present with symptoms that indicate which of the following?
Cues to get a patient to activate the deep cervical stabilizing muscles is which of the following?
Head flexion and slight flattening of the cervical lordosis
Head extension and slight flattening of the cervical lordosis
Head flexion and slight increase of the cervical lordosis
Head extension and slight increase of the cervical lordosis
Any of the following interventions are generally indicated in the subacute stage except:
Patient education
Modalities
Cardiopulmonary conditioning
Muscle performance
Your patient is in the acute stage of recovery from a spinal pathology and presents with a non-weight-bearing bias. Any of the following activities are likely to be tolerated except:
Mechanical traction
Stationary cycling
Partial suspension ambulation on a treadmill
Stabilization exercises with a buoyancy belt in the deep end of the pool
The posture that places the least amount of pressure on the lumbar disc is:
Reclined sitting at 120 degrees
Sitting upright at 90 degrees
Supine
A progression of exercises for your patient from deep segmental muscle activation could be any of the following except:
Activating the deep segmental muscles prior to performing curl-up exercises
Maintaining deep segmental control with extremity motions
Lower extremity weight-bearing exercises
Maintaining deep segmental control with functional activities
For muscle injuries of the spine, gentle isometric exercises should begin with the muscle in which of the following positions?
Mid-range
Lengthened
Shortened
Does not matter with gentle isometric exercises
Patient education for a client with a temporomandibular disorder includes finding and maintaining the resting position of the jaw. This is which of the following positions?
Teeth slightly apart, tongue behind front teeth resting on hard palate
Teeth slightly apart, tongue behind front teeth resting on the soft palate
Teeth together, tongue behind front teeth off hard palate
Teeth together, tongue behind front teeth resting on hard palate
Common impairments related to a right disk protrusion in the lumbar spine typically include any of the following except:
Flexed posture and deviation to the left side.
Peripheralization of symptoms with repeated back extensions.
Pain and muscle guarding.
Positive SLR sign between 30 and 60 degrees
Common impairments related to facet joint pathology typically include any of the following except:
Increase in neurological symptoms with spinal flexion.
Impaired posture.
Pain with repetitive lifting and carrying of heavy objects.
During the acute stage of recovery from a soft tissue injury in the spinal region, encourage your patients to limit bed rest to:
1 day sleeping only side-lying.
2 days with intermittent periods of walking.
5 days with bathroom breaks.
7 days with knees flexed to 45°.
Dowager’s hump:
Is the vertebral lipping seen on radiograph when there is a stress fracture.
Is a reference name for an increased thoracic kyphosis.
Is the bony necrosis of the vertebrae seen with Scheuermann’s disease.
Is a point of muscle tension in either the masseter or temporalis muscle of patients experiencing TMJ dysfunction.
Which of the following techniques would you choose to treat pubic symphysis impairment?
Shotgun manipulation technique
Lumbar traction static for 20 minutes with greater than 50% of body weight
Muscle energy using the rectus femoris
High-velocity thrust
The position of symptom relief in the acute stage of recovery is also referred to as the:
Stabilizing position.
Kinesthetic position.
Position of bias.
Stress-relief position.
A prone press-up stretches any of the following structures except the:
Lumbar extensors.
Hip flexors.
Inguinal ligament.
Lumbar flexors.
