Musculo III - Exam 2 Review

True or False: when performing IASTM, we should focus on loosening the deep tissue only.

False. We should release the superficial fascia first in order to address deeper tissues.

With DFM, if the lesion lies in the belly of the muscle, it must be ______(1)_____________ and in tendons with a sheath, the sheath must be _______(2)_____________. a) Put on slack (shortened) b) Put in middle range for best length-tension c) Put on stretch (lengthened)

1) belly of muscle --> a) Put on slack (shortened) 2) tendons with a sheath --> c) Put on stretch (lengthened)

True or False: in both the spine and peripheral joints, SNAGs/MWMs should be performed with 3 reps.

False With SNAGs (spine), they should be performed with 3 reps. With MWMs (peripheral joints), they should be performed with 10 reps.

True or False: Only moderate (25-35%) tension should be applied to the anchors/ends, no matter what the intended effect is

False. *No tension* should be applied to the anchor or end, because this would make the tape much more likely to fall off

True or False: dry needling is built on the same principles as acupuncture

False. Acupuncture is based on western principles including energy planes and meridians, vs. dry needling which is inserted into the tight muscle itself

True or False: kinesiology tape can be used only for inhibitory and facilitory effects on muscles and to decrease swelling.

False. Kinesiology tape can also be used for mechanical correction

True or False: DFM has strong evidence to support its efficacy

False. There is not a lot of evidence for DFM, but there is some evidence for its use in tennis elbow and supraspinatus with impingement

True or False: musculotendinous strength of a tendon decreases with rest once reaching 4 weeks

False: musculotendinous strength of a tendon decreases with rest once reaching *2 weeks* Rest is CATABOLIC to tendons; we don't want to completely shut someone down for this reason. This is why we need to use controlled loading and educate our patients about overloading the tendon

True or False: IASTM is done globally, treating in a 3-dimensional kinetic chain model (all planes)

True

True or False: the longer that you hold a isometric contraction, the greater the benefits in terms of tendon stiffness and healing

True 20s contractions resulted in greater tendon adaptation than 1s contractions at equal exercise volume.

True or False: When performing the MWM for tennis elbow, the patient is supine with their palm facing down into the table grasping a towel roll or holding a dumbbell. The belt is wrapped just below the elbow and the PT stabilizes the distal humerus and distal forearm. The PT applies a dorsal/posterior glide while the patient grips the towel roll or does wrist extension.

True I'm sick of writing MWM questions so this will suffice Repeated 10x with elbow extended and 10x each at 45 and 90 degrees of elbow flexion by abducting the shoulder

True or False: Unlike other types of taping, KT allows for the full ROM, is dynamic (can be worn during activities/sports), and can withstand fluids

True! KT also can limit muscular atrophy, provides proprioceptive input, and can increase muscle force

True or False: When treating the spine, mobilizations with movement (MWMs) are specifically called SNAGs

True. In the spine, we call them Sustained Natural Apophyseal Glides (SNAGs), versus in peripheral joints where we refer to them as Mobilizations with Movement (MVMs)

When working with a shoulder pain patient, you should strengthen the ______(1)___________ first, then the _______(2)___________, then the _______(3)_____________. a) Global shoulder musculature (humeral positioners) b) Bi-articular muscles that also cross the shoulder c) Scapular rotators d) Rotator cuff

1 --> c) Scapular rotators 2 --> d) Rotator cuff 3 --> a) Global shoulder musculature (humeral positioners)

Label the following as characteristics of a) active trigger points, b) latent trigger points, or c) both 1) Can provoke motor dysfunctions 2) Do not create symptoms familiar to the patient 3) Produce the patient's familiar pain 4) Can produce spontaneous symptoms 5) Do not produce spontaneous symptoms

1) Can provoke motor dysfunctions --> c) both 2) Do not create symptoms familiar to the patient --> b) latent 3) Produce the patient's familiar pain --> a) active 4) Can produce spontaneous symptoms --> a) active 5) Do not produce spontaneous symptoms --> b) latent

Match the alternative intervention with its description. 1) Cortisone injection 2) Prolotherapy 3) Platelet Rich Plasma (PRP) a) Injection of a sugar and water solution into an area to attempt to stimulate the body's inflammatory response for natural healing b) Removal of patient's own platelets and processing of them into a collagen matrix that is injected to stimulate healing and regenerative processes c) Injection of a steroid into an area with a goal of decreasing pain through decreasing inflammation

1) Cortisone injection --> c) Injection of a steroid into an area with a goal of decreasing pain through decreasing inflammation 2) Prolotherapy --> a) Injection of a sugar and water solution into an area to attempt to stimulate the body's inflammatory response for natural healing 3) Platelet Rich Plasma (PRP) --> b) Removal of patient's own platelets and processing of them into a collagen matrix that is injected to stimulate healing and regenerative processes

Match the KT term with the definition. a) Target tissue b) Anchor c) Ends d) Base e) Therapeutic direction 1) Last part of the tape that is laid down 2) Tissue that requires treatment 3) Tape beyond the first part of tape laid down, the stretched portion of the tape 4) The recoil of the tape toward the beginning of the application 5) Beginning of application

1) Last part of the tape that is laid down - c) Ends 2) Tissue that requires treatment - a) Target tissue 3) Tape beyond the first part of tape laid down, the stretched portion of the tape - d) Base 4) The recoil of the tape toward the beginning of the application (anchor) - e) Therapeutic direction 5) Beginning of application - b) Anchor

Match the category/percentage of stretch of the KT and the intended effect(s). 1) Muscle inhibition 2) Joint/ligament damage 3) Muscle facilitation 4) Mechanical correction a) Full - 75-100% b) Moderate - 25-35% c) Severe - 50-75% d) Paper off - 10-15% (KT), 0-10% (RT)

1) Muscle inhibition - d) Paper off - 10-15% 2) Joint/ligament damage - a) Full - 75-100% 3) Muscle facilitation - b) Moderate - 25-35% 4) Mechanical correction - c) Severe - 50-75%

Match the model and the rationale for why soft tissue mobilization can be used. 1) Neurophysiological 2) Biochemical 3) Biomechanical 4) Biopsychosocial a) Break up fluid status, removal of edema and retained metabolites. Normalization of fluid pressure potentials. b) Biofeedback for tone reduction, temperature control, imagery, and potential placebo effect. c) Inhibition of tone (shut down overactive muscles) and facilitation of muscles (wake up 'sleepy' muscles) d) Stretching of short muscles, myofascial release of limited connective tissue

1) Neurophysiological --> c) Inhibition of tone (shut down overactive muscles) and facilitation of muscles (wake up 'sleepy' muscles) 2) Biochemical --> a) Break up fluid status, removal of edema and retained metabolites. Normalization of fluid pressure potentials. 3) Biomechanical --> d) Stretching of short muscles, myofascial release of limited connective tissue 4) Biopsychosocial --> b) Biofeedback for tone reduction, temperature control, imagery, and potential placebo effect.

Label the following contraindications for IASTM as a) relative or b) absolute 1) Open wound or unhealed suture 2) Cancer 3) Varicose veins 4) Kidney dysfunction 5) Rheumatoid arthritis 6) Osteoporosis 7) Osteomyelitis 8) Myositis ossificans 9) Uncontrolled HTN 10) Pregnancy

1) Open wound or unhealed suture -> b) absolute 2) Cancer -> a) relative 3) Varicose veins -> a) relative 4) Kidney dysfunction -> b) absolute 5) Rheumatoid arthritis -> a) relative 6) Osteoporosis -> a) relative 7) Osteomyelitis -> b) absolute 8) Myositis ossificans -> b) absolute 9) Uncontrolled HTN -> b) absolute 10) Pregnancy -> a) relative (due to ligamentous laxity) Other *relative:* anti-coagulants, burn scars, acute inflammatory conditions Other *absolute:* unhealed fx, thrombophlebitis, patient intolerance, hematoma

True or False: KT showed significant improvements in pain and disability compared to manual therapy alone

False. There was no long-term difference in pain and disability with KT compared to sham taping in one study. In another study, they found that KT was superior to no tape/sham/placebo for pain reduction, but *not* better than other interventions (manual, therex) for pain reduction and disability

True or False: the mechanism by which dry needling works is well understood

False. We aren't quite sure *WHY* dry needling works, but since it is safe and has shown some good short-term outcomes in the research, it is commonly done (benefits outweigh the risks)

True or False: beneficial long-term outcomes have been seen with the use of cortisone injections into tendons

False. When cortisone is injected into tendons, they often become weaker and more susceptible to rupture

True or False: eccentric exercise has better outcomes than heavy slow exercise, including a decrease in tendon swelling and change in extracellular matrix (increased collagen turnover).

False: *heavy slow* exercise has better outcomes than *eccentric* exercise, including a decrease in tendon swelling and change in extracellular matrix (increased collagen turnover). The reason that heavy slow resistance (HSR) exercise is better than eccentric might be due to mechanotransduction - the physiological process of cells responding to a mechanical load

True or False: DFM and IASTM have many of the same indications, but DFM is applied parallel and is less specific than IASTM.

False: DFM and IASTM have many of the same indications, but *IASTM* is applied parallel and is less specific than *DFM.* IASTM also decreases operator fatigue and energy expenditure compared to DFM.

True or False: In healthy tissues, collagen fibers are bundled tightly and are mostly type II collagen.

False: In healthy tissues, collagen fibers are bundled tightly and are mostly *type I collagen*

True or False: the more pressure that is applied with IASTM, the more fibroblast proliferation that is seen. Because of this, more pressure is always better

False: While the thing about more pressure = more fibroblast proliferation is true, more pressure is NOT always better!

True or False: With DFM, the PT's fingers and patient's skin move separately from each other

False: With DFM, the PT's fingers and patient's skin move *simultaneously* to avoid injury to the skin

True or False: there is no difference seen in the efficacy of eccentric exercise in active vs. sedentary individuals

False: eccentric exercise has been seen to be less successful in sedentary individuals. Because of this, we might need to be more conservative with our eccentric protocols for someone who is sedentary vs. someone who is active and regularly exercising

Match the NPRS rating for tendinopathies and the "zone" that they are in. a) 0-2 b) 3-5 c) 6-10 1) High risk zone 2) Safe zone 3) Acceptable zone

a) 0-2 --> 2) Safe zone b) 3-5 --> 3) Acceptable zone c) 6-10 --> 1) High risk zone In the safe zone, we should think about increasing speed, load, and reps with our eccentric exercise. In the acceptable zone, we are applying stress to allow the tendon to heal.

Your patient Linda has been experiencing L-sided neck pain with turning her head over her shoulder towards the right. Upon assessment, you note a (+) C7 CPA for pain and hypomobility, and R rotation is 25% with pain compared to L rotation. You decide to perform a SNAG, what is the appropriate application? a) C6 segment, anterior force on L articular pillar, into R rotation, overpressure from R hand, 1-3 reps b) C6 segment, anterior force on R articular pillar, into R rotation, overpressure from L hand, 3-10 reps c) C7 segment, anterior force on L articular pillar, into L rotation, overpressure from R hand, 1-3 reps d) C8 segment, anterior force on R articular pillar, into L rotation, overpressure from L hand, 3-10 reps

a) C6 segment, anterior force on L articular pillar, into R rotation, overpressure from R hand, 1-3 reps Force should be applied on segment ABOVE (C6 instead of C7) on the side of pain (L side) into the limited motion (R rotation) Overpressure should come from the opposite hand where the force is applied/where the pain is(L hand) Should do 1-3 reps in the spine

What changes are seen in tendons with tendinopathy vs. healthy tissue? (Select ALL that apply) a) Collagen fibers are thinner and more loosely organized b) Higher amount of type II collagen c) Only areas of swelling, not of degeneration d) Increased water content and swelling within tissues

a) Collagen fibers are thinner and more loosely organized d) Increased water content and swelling within tissues CORRECTIONS: b) Higher amount of type *III* collagen c) Areas of *both* swelling/inflammation *AND* degeneration

Which of the following is NOT a sign of tendinopathy a) Impaired lymphatic drainage b) Collagen degeneration and necrosis c) Neovascularization (neurogenic inflammation) d) Irregular fiber structure e) Increased ground substance

a) Impaired lymphatic drainage -- I made this up

You have a patient with shoulder pain and limited elevation. You decide to perform the shoulder MWM. What benefits would you expect to see (Select ALL)? a) Improved elevation ROM b) Improved cervical ROM c) Improved pain pressure threshold d) Negative painful arc test

a) Improved elevation ROM c) Improved pain pressure threshold

You decide to implement MWMs with your patient Tiffany who has shoulder impingement. Which of the following describes this treatment? a) Patient seated, stabilize the scapula and medial humeral head and apply a posterolateral glide while she performs active shoulder abduction b) Patient sidelying, stabilize the scapula and medial humeral head and apply a posterolateral glide while she performs active shoulder abduction c) Patient seated, stabilize the scapula and clavicle and apply a posterolateral glide while she performs active shoulder abduction d) Patient supine, stabilize the scapula and clavicle and apply a posterolateral glide while she performs active shoulder adduction

a) Patient seated, stabilize the scapula and medial humeral head and apply a posterolateral glide while she performs active shoulder abduction Would want to perform 10 reps with 3-5 sets

Select ALL of the following that are potential side effects of dry needling. a) Pneumothorax b) Spinal cord injury c) Bruising and soreness d) Subarachnoid hemorrhage e) Infection f) Internal tissue damage g) Epidural hematoma

a) Pneumothorax c) Bruising and soreness e) Infection f) Internal tissue damage g) Epidural hematoma

Which of the following is TRUE regarding IASTM in the research? a) Shown to improve strength + stiffness of ligaments b) Does not have clinically meaningful improvements in pain and function in patients w/ plantar heel pain c) Shown to decrease perfusion and vascularity to the area d) Have many high quality studies supporting its use

a) Shown to improve strength + stiffness of ligaments Corrections: b) *Does* have clinically meaningful improvements in pain and function in patients w/ plantar heel pain c) Shown to *increase* perfusion and vascularity to the area d) *Do not* have many high quality studies supporting its use

You are working with a gluteal tendinopathy patient whose current pain is a 2/10. Which of the following would be the BEST therex for this patient today? a) Sidelying, performing hip abductions with 3 seconds up and 1 second down for 3x10 b) Supine, performing resisted hip ER against a theraband since their pain is too high to strengthen the glute med c) Positioning the patient in single leg stance (on the affected side) and having them hold themselves there (watching pelvis for symmetry) for 3x20s d) Sidelying with stool under foot/distal lower limb, slowly controlling motion of leg from stool down to table (10-30s down) for 3x8

a) Sidelying, performing hip abductions with 3 seconds up and 1 second down for 3x10 For patients in the low tissue irritability stage (0-3/10), we can incorporate concentric and plyometric activities along with the eccentric and heavy slow activities that we likely introduced in the moderate irritability stage. For the activity above, we are focusing more on the "up" (concentric) portion of the activity than the "down" (eccentric) portion. We could make this a heavy slow exercise by making both concentric and eccentric 3 second contractions. Incorporating plyometric exercise is especially important for athletes, so tendons are strengthened to withstand the demands of their sport (running, jumping, etc.)

Your patient Alejandro has come into the clinic with LBP, presenting with painful and guarded lumbar paraspinals. You are thinking that he may benefit from soft tissue mobilization. Which of the following would make you more thoughtfully consider the application of soft tissue for Alejandro? a) Taking Coumadin b) Decreased circulation c) Impaired proprioception d) Has high levels of pain, but can tolerate technique e) None of the above

a) Taking Coumadin Taking medications, such as blood thinners like Coumadin, are a relative contraindication for soft tissue mobilization so it would be good to think more closely about this decision. Other relative contraindications include skin infection/rash, open wounds/lacerations/healing incision sites, patient intolerance, and psychological concerns.

You are cutting KT for two different patients on the SAME EXACT treatment area (same size/length)! For the first patient, you are intending to use it for mechanical correction, but for the other patient you are using it for muscle inhibition. Which of the following is TRUE regarding the tape that you are cutting? a) The tape that you cut for muscle inhibition is longer than that for mechanical correction b) Both will be the same length c) The tape that you cut for mechanical correction is longer than that for muscle inhibition d) None of the above

a) The tape that you cut for muscle inhibition is longer than that for mechanical correction Since these are both covering the same treatment area (same size/length), the tape for mechanical correction will be shorter. This is because you will be applying more tension (50-75%) to this piece of tape than that for muscle inhibition (10-15%), which means that this piece of tape will therefore be stretched to cover a greater area when applied.

You're getting sick of Tiffany asking for MWMs from you EVERY session, so you decide to teach her the self MWM for glenohumeral abduction. How should you instruct Tiffany to do this? a) "Sit down and put a band around the front of your shoulder and through a door to hold it in place. Then, do that same motion that we do when we do the MWM together." b) "Stand up and put a band around the front of your shoulder and through a door to hold it in place. Then, do that same motion that we do when we do the MWM together." c) "Lie down and wrap a band around the back of your shoulder and underneath the foot of the table. Then do the opposite of the motion that we do when we do the MWM together." d) "Do whatever gives you good vibes"

b) "Stand up and put a band around the front of your shoulder and through a door to hold it in place. Then, do that same motion that we do when we do the MWM together."

Your patient Tito came into your clinic with Achilles tendinopathy. His mom and doctor told him that he's not allowed to play basketball for 2 weeks until the inflammation has subsided, but he insisted on coming to see you because "ball is life. And without it, there is no life." What should you tell Tito and his mom? a) "It's just a tendinopathy - playing on it won't make it worse. After the season ends, we can work more on fixing the issue." b) "We won't shut you down completely, but we do need to decrease the amount of stress on the tissue. By providing the right amount of stress, we can help the tendon heal and get you back to playing sooner." c) "You need to listen to the doctor because he is an all-knowing being who is superior to me" d) "Let's start with some eccentric exercises today, and if you feel better tomorrow then we can re-introduce basketball activities"

b) "We won't shut you down completely, but we do need to decrease the amount of stress on the tissue. By providing the right amount of stress, we can help the tendon heal and get you back to playing sooner." Tendon cells respond to mechanical stimuli (strain) and depriving them of this leads to degeneration and apoptosis. So, "shutting him down" entirely wouldn't be beneficial. We do need to make sure that he isn't being strained or stretched excessively though because that can also be detrimental.

Your patient asks you what happens physiologically when you perform a MWM. What do you tell them? a) "When we do the MWM, it corrects a positional fault that is causing your issues. This creates long-term improvements in alignment." b) "When we do MWM, we are causing changes in your fight or flight system causing alterations in HR, BP, and skin conductance/temp." c) "When we do MWM, we are creating a neurophysiological effect that decreases muscle guarding and a biophysiological effect by repositioning the joint itself" d) All of the above

b) "When we do MWM, we are causing changes in your fight or flight system causing alterations in HR, BP, and skin conductance/temp." Positional fault: while this can be corrected short-term, the positional fault will likely return to its pre-treatment status BUT there will be lasting decreases in pain and increases in function.

What is the recommendation for DFM? a) 5-10 min, 4x/wk for 5-10 sessions b) 20 min, 3x/wk for 6-12 sessions c) 15 min, 3x/wk for 5-10 sessions d) 10 min, 4x/wk for 6-12 sessions

b) 20 min, 3x/wk for 6-12 sessions This is the traditional guideline, but you don't really have to do the 20 min guideline

You are doing IASTM on your patient Johnny (at ~8 min mark), when you start to notice some redness appearing. According to D.Scotti, what should you do at this point? a) Immediately stop the technique as this is an abnormal response and this patient should not receive this tx again b) Back off at this point since you have probably achieved the needed adhesion breakdown and don't want to cause extreme redness/bruising c) Continue with the technique, but with lighter strokes d) Continue with the technique until you feel that you have targeted and broken down all adhesions in the area

b) Back off at this point since you have probably achieved the needed adhesion breakdown and don't want to cause extreme redness/bruising Producing a LOT of redness/bruising is probably too aggressive, so this would be a good place to stop

Your patient Nancy comes into the clinic with LBP. She recently had a fall while hiking with her boyfriend, and she has a large scrape on her lower back. She's seen some stuff online about KT and asks if you can use it on her low back (right where the scrape is). What do you do? a) Don't use it. There is poor evidence that KT is effective in patients with LBP, so she wouldn't benefit from it. b) Don't use it. She has a large scrape (open wound) in the area, so this is a contraindication. c) Use it. Since the patient has the expectation that this will work, the psychological benefits could decrease her pain. d) Use it. Try using KT on her thoracic spine (above the scrape) to see if the placebo effect will decrease her pain

b) Don't use it. She has a large scrape (open wound) in the area, so this is a contraindication.

Which of the following is TRUE regarding the difference between isometric and isotonic exercise? a) Isometric exercise results in less pain, but isotonic exercise results in less guarding b) Isometric exercise results in less pain and less guarding than isotonic c) Isotonic exercise results in less pain and less guarding than isometric d) Isometric exercise results in less guarding, but isotonic exercise results in less pain

b) Isometric exercise results in less pain and less guarding than isotonic Isometrics induce analgesia and reduce inhibition at the primary motor cortex --> less pain, less guarding compared to isotonics (concentric/eccentric)

You're doing DFM over the hamstring belly in a patient who just recently had a hamstring strain. When your patient asks why this is beneficial you tell them... a) It will decrease the interpretation of pain signals and pain that you have in the tissue b) It will decrease the scarring that develops perpendicular to the actin and myosin filaments or collagen c) It will facilitate fibroblast proliferation along the longitudinal axis of the healing breach d) It will facilitate the function of the lymphatic and circulatory system to decrease inflammation in the tissue

b) It will decrease the scarring that develops perpendicular to the actin and myosin filaments or collagen

Select ALL of the following that are indications for kinesiology taping. a) Severe joint instability b) Muscle imbalances c) Wound approximation d) Injuries to ligaments, tendons, and joints e) Postural insufficiency f) Pain relief over active malignancy sites g) Neurological conditions h) Circulatory and lymphatic conditions i) Fascial adhesions and scars j) All of the above

b) Muscle imbalances d) Injuries to ligaments, tendons, and joints e) Postural insufficiency g) Neurological conditions h) Circulatory and lymphatic conditions i) Fascial adhesions and scars

Which of the following is INCORRECT regarding PRP? a) Uses patient's own plasma b) Often covered by insurance c) Strong evidence that it does not improve heel pain (plantar fasciitis) d) Some evidence suggests it could be beneficial in other areas (not the heel)

b) Often covered by insurance This is *NOT* covered by insurance and is quite expensive. Want to make sure that the patient knows that it is 1) not covered and is quite expensive and 2) the "jury is still out" in terms of the evidence of its efficacy

Your patient Nacho has come to your clinic complaining of shoulder pain. When performing your ROM assessment, you note that he is most limited in IR and abduction. Which of the following mobilizations would be beneficial to perform (Select ALL)? a) C1-2 SNAGs into rotation b) Posterior glide c) Anterior glide d) Inferior (caudal) glide

b) Posterior glide --> this can improve IR, ER, and flexion ROM d) Inferior (caudal) glide --> this can improve abduction ROM

Select ALL of the following that are reasons why we would use eccentric exercise. a) Improve elasticity of the tendon through increased synthesis of elastin fibers b) Remodel the tendon by increasing type I collagen synthesis c) Increase tendon stiffness d) Increase blood flow to the injured area to promote healing e) Restore optimum musculotendinous length for active tension to normal f) Reduce risk of reinjury g) All of the above

b) Remodel the tendon by increasing type I collagen synthesis c) Increase tendon stiffness e) Restore optimum musculotendinous length for active tension to normal f) Reduce risk of reinjury

Your patient Tiny, a 386 lb OL, comes into your clinic after suffering a lateral ankle sprain. You are past the acute stage, and upon assessment, see that he is lacking DF ROM. Based on what you know about MWMs, would MWMs be beneficial for Tiny? a) No, they would not be beneficial. We should be working on balance, neuromuscular re-ed, and strengthening of the ankle muscles. b) Yes, they would be beneficial. They can improve both the posterior glide and ankle DF ROM which could have contributed to his lateral ankle sprain to begin with c) Yes, they would be beneficial because they would have a psychological effect that would make Tiny feel better. d) No, they would not be beneficial. Instead you should consider performing a posterior glide.

b) Yes, they would be beneficial. They can improve both the posterior glide and ankle DF ROM which could have contributed to his lateral ankle sprain to begin with In foot/ankle patients who are lacking DF ROM, you should consider using MWMs. This could include patients that are post-op, those with an ankle sprain, Achilles tendinopathy, plantar fasciitis, etc. This also could be beneficial for people with issues further up the chain, such as someone with PFP whose lack of DF ROM is contributing to their pain

Your aunt Barb recently had KT put on her shoulder from a PT session. She texts you about how annoying it is that it's wet after her shower and says that she's gotta blow dry it. What do you say? a) "Go ahead Barb, we don't want it wet on your skin because that invites infection." b) "Just let it air dry. Deal with it" c) "Don't blow dry it - pat it dry with a towel instead." d) "You can take the KT off now that your PT session is done, it's not supposed to get wet. They can apply new tape next time."

c) "Don't blow dry it - pat it dry with a towel instead." Don't ever want our patients to blow dry the tape because the adhesive is heat-activated. If they blow dry it, it will SUPER activate the adhesive, making it extremely difficult (and painful) to take the tape off

Your patient Tom asks you how KT helps with pain. What do you tell him? (HINT: You can choose more than one) a) "We really don't use it for pain, it's mostly just for swelling and postural corrections." b) "It probably doesn't really do anything, but if it makes you feel good then we'll do it!" c) "It compresses the skin to stimulate receptors, similar to when we do joint mobs." d) "It decompresses the skin to decrease inflammation, which lowers the pain sensation and improves circulation."

c) "It compresses the skin to stimulate receptors, similar to when we do joint mobs." d) "It decompresses the skin to decrease inflammation, which lowers the pain sensation and improves circulation." It does both decompression (decreasing inflammation --> unloading of mechanoreceptors; skin lift mechanism --> helps improve flow in lymphatic/circulatory systems) and compression (compression and stimulation of mechanoreceptors)

Your patient Laura, who you treated with dry needling in her upper trap last session, has come into your clinic complaining of bruising and soreness. What should you tell her about these side effects? a) "These are indicators that you are not a good candidate for dry needling." b) "Your muscles were likely not brought to exhaustion with dry needling, so we may need to be more aggressive next time." c) "These are common s/sx seen with dry needling. If you are okay with these s/x and found benefits with the tx, it is safe to incorporate if needed again in the future." d) "This likely means that you did not respond well to the treatment, so we should avoid this in the future."

c) "These are common s/sx seen with dry needling. If you are okay with these s/x and found benefits with the tx, it is safe to incorporate if needed again in the future." These are the most common side effects and patients should be educated about them prior to treatment.

Your patient is complaining of R-sided neck pain that is worst with extension and R rotation. They have a (+) C5 CPA for pain and hypomobility. You decide to perform a SNAG, what is the best FIRST treatment? a) C4 segment, anterior force on R articular pillar, into R rotation, overpressure from L hand, 1-3 reps b) C5 segment, anterior force on spinous process, into extension, overpressure from R hand, 1-3 reps c) C4 segment, anterior force on spinous process, into extension, 1-3 reps d) C5 segment, anterior force on R articular pillar, into R rotation, overpressure from L hand, 1-3 reps

c) C4 segment, anterior force on spinous process, into extension, 1-3 reps Treat extension before rotation; option A is not a BAD option, but we want to focus on extension before rotation Overpressure for flexion/extension comes from the weight of the head, rather than added overpressure from an extremity

Which of the following is TRUE regarding the impact of soft tissue mobilization on the endocrine system? a) Increases release of cortisol b) Maintains oxytocin and ACTH levels c) Changes levels of oxytocin, ACTH, nitric oxide, and beta endorphins d) Improves blood sugar levels through release of insulin

c) Changes levels of oxytocin, ACTH, nitric oxide, and beta endorphins In patients with high pain levels, we see high cortisol levels. Soft tissue can result in changes in the above hormones, allowing for the patient to feel better

Which of the following is INCORRECT regarding the mechanism/goal of IASTM? a) Breaks down unhealthy tissues to activate physiological response b) Promotes resorption of scar tissue c) Decreases fibroblastic recruitment and activation d) Stimulates tissue turnover and regeneration of soft tissues e) Promotes tissue remodeling

c) Decreases fibroblastic recruitment and activation It actually *increases* fibroblastic recruitment and activation

Which of the following is INCORRECT regarding SNAGs? (Select ALL) a) Should be pain free throughout b) Lumbar SNAGs are applied at approximately 90 degrees c) Force is applied, but changes as you move d) Thoracic SNAGs are applied at approximately 60 degrees e) Passive overpressure is applied at the end of the movement f) Done in the pain free ROM

c) Force is applied, but changes as you move f) Done in the pain free ROM Force should be sustained throughout the entire movement Always are carried out to end range SNAGs are applied relative to the treatment plane - lumbar spine is 90 degrees, thoracic spine is 60 degrees, and cervical spine is 45 degrees

After treating your patient Linda with SNAGs, what would you expect to see? a) Reduction in pain, but no improvements in ROM until further sessions b) Rebound pain within the first 4-24 hours c) Immediate improvement in pain and ROM d) Improvements in pain and ROM after 24 hours

c) Immediate improvement in pain and ROM

You're doing DFM over the glute med tendon in a patient with gluteal tendinopathy in the subacute stage. When your patient asks why this is beneficial you tell them... a) It will decrease the interpretation of pain signals and pain that you have in the tissue b) It will decrease the scarring that develops perpendicular to the actin and myosin filaments or collagen c) It will facilitate fibroblast proliferation along the longitudinal axis of the healing breach d) It will facilitate the function of the lymphatic and circulatory system to decrease inflammation in the tissue

c) It will facilitate fibroblast proliferation along the longitudinal axis of the healing breach

Select ALL of the following that would be an appropriate progression for IASTM of the gastroc. a) Position the ankle in PF b) Perform it in seated off the table c) Position the ankle in DF d) Perform while the patient is standing e) Perform while the patient does resisted PF

c) Position the ankle in DF d) Perform while the patient is standing e) Perform while the patient does resisted PF The progressions are with stretching, strengthening, and weight-bearing

You are working with a gluteal tendinopathy patient whose current pain is a 7/10. Which of the following would be the BEST therex for this patient today? a) Sidelying, performing hip abductions with 3 seconds up and 3 seconds down for 3x10 b) Supine, performing resisted hip ER against a theraband since their pain is too high to strengthen the glute med c) Positioning the patient in single leg stance (on the affected side) and having them hold themselves there (watching pelvis for symmetry) for 3x20s d) Sidelying with stool under foot/distal lower limb, slowly controlling motion of leg from stool down to table for 3x10

c) Positioning the patient in single leg stance (on the affected side) and having them hold themselves there (watching pelvis for symmetry) for 3x20s In a patient who has HIGH tissue irritability (7-10/10), the best strengthening at this point would be pain free isometrics for pain control. The option above would strengthen the glute med in the Trendelenberg position and by just having them hold it there (rather than actively bring it up - concentric) this would be an isometric and functional way to strengthen and control pain You also could include strengthening of the hip ERs (surrounding musculature), but b) isn't the best option because of the explanation. We don't want to completely shut down a muscle, even if they have high tissue irritability

Which of the following clusters of positive findings is MOST accurate for a patient with lateral elbow tendinopathy (tennis elbow)? a) Resisted wrist extension w/ elbow flexed, Mill's Test, passive wrist extension b) Resisted wrist flexion w/ elbow flexed, Mill's Test, passive wrist flexion w/ elbow extended c) Resisted wrist extension w/ elbow extended, Mill's Test, pain free grip strength d) Resisted wrist extension w/ elbow flexed, Mill's Test, pain free grip strength

c) Resisted wrist extension w/ elbow extended, Mill's Test, pain free grip strength Could also see a positive finding of pain with passive wrist flexion w/ elbow extended since this is stretching the affected structure(s)

Your patient Joe that you have been treating for supraspinatus tendinopathy with eccentric exercise comes into the clinic today telling you about his Halloween weekend and how LIT it was. When you ask him how he's been feeling, he tells you that he had pain for around a day and a half after your last session. What does this mean to you? a) No pain, no gain BABY! b) You likely utilized a manual therapy technique that was too aggressive in your last session, so you should stick to only therex from now on c) The intensity of the eccentric exercise was likely too much, so you should adjust the sets, reps, or type of exercise this time d) He definitely went too hard at the Halloween party and needs to get his crap together

c) The intensity of the eccentric exercise was likely too much, so you should adjust the sets, reps, or type of exercise this time With eccentric exercise, SORENESS is okay, but the reproduction of THE PAIN is not. If soreness and stiffness lasts >24 hours, then you should adjust your exercise prescription because this is not normal. If the soreness lasts <24 hours, this is normal and to be expected.

Your uncle Fred with tennis elbow has cornered you at Thanksgiving dinner. He's asking you about what he should do to treat it. What should you suggest to him? a) "You should try a cortisone injection! They have good short AND long-term outcomes!" b) "I'll give you some tips about modifications you can make, and that will actually give you the best short and long-term results! You don't even need PT!" c) "You should get a cortisone injection now, but once it stops working then you should start PT." d) "We should get you in to see a PT. They can do MWMs, stretching, and strengthening that will actually give you the best long-term results"

d) "We should get you in to see a PT. They can do MWMs, stretching, and strengthening that will actually give you the best long-term results" Cortisone injections provide beneficial short-term results, but NOT long-term. In the long-term, the wait and see method is actually better than the cortisone injection.

You are working with a patient s/p hamstring strain and have decided to perform IASTM on their hamstring. Which of the following is the BEST protocol (in order) to follow when applying this technique? a) Active warm-up on the bike, stretching into hip flexion, IASTM for 15-20 min, Nordic HS curls + bridges + RDLs b) Hot pack, stretching into hip flexion, IASTM for 15-20 min, Nordic HS curls + bridges + RDLs, ice PRN. c) Hot pack, IASTM for 8-10 min, Nordic HS curls + bridges + RDLs, stretching into hip flexion, ice d) Active warm-up on the bike, IASTM for 8-10 min, stretching into hip flexion, Nordic HS curls + bridges + RDLs, ice PRN. e) Hot pack, Nordic HS curls + bridges + RDLs, stretching into hip flexion, IASTM for 15-20 min, ice PRN

d) Active warm-up on the bike, IASTM for 8-10 min, stretching into hip flexion, Nordic HS curls + bridges + RDLs, ice PRN. The protocol order is: 1) warm up (preferably active over moist heat/US) -> 2) IASTM for 8-10 min -> 3) stretching (if appropriate) -> 4) strengthening/neuromuscular re-ed -> 5) cryotherapy IF NEEDED

Which of the following is INCORRECT regarding the self MWM for tennis elbow? a) Patient is standing against a wall b) Perform either wrist extension or grip c) Use other hand to glide the proximal forearm towards the wall d) Forearm is supinated

d) Forearm is supinated Shoulder is slightly flexed (10-15 degrees) and forearm is slightly PRONATED, not supinated

What are the 5 physiological systems affected by KT? a) Skin, fascia, adipose, muscle, joints b) Fascia, skin, elastin, muscle, joints c) Muscle, joints, fascia, circulatory/lymphatic systems, elastin d) Joints, muscle, circulatory/lymphatic systems, fascia, skin

d) Joints, muscle, circulatory/lymphatic systems, fascia, skin

Which of the following is NOT a "comparable sign" (objective sign) that should be identified during assessment and re-assessed following MWM/SNAG treatment a) Pain associated with specific functional activities b) Loss of joint movement c) Pain associated with movement d) Neurological symptoms

d) Neurological symptoms

Which of the following is NOT a contraindication for using KT? a) Active cellulitis or skin infection b) Active malignancy sites c) DVT d) Pregnancy

d) Pregnancy Pregnancy is a *precaution*, not a contraindication. The other contraindication is over open wounds

Which of the following is INCORRECT regarding prolotherapy? a) Goal is to stimulate body's inflammatory response b) More commonly seen in degenerative conditions c) Uses dextrose d) Research has shown no beneficial short-term outcomes

d) Research has shown no beneficial short-term outcomes Research has shown a potential rapid improvement in the short-term, but not much research into long-term effects. The research (even for short-term) is limited

You are working with a gluteal tendinopathy patient whose current pain is a 5/10. Which of the following would be the BEST therex for this patient today? a) Sidelying, performing hip abductions with 3 seconds up and 1 second down for 3x10 b) Supine, performing resisted hip ER against a theraband since their pain is too high to strengthen the glute med c) Positioning the patient in single leg stance (on the affected side) and having them hold themselves there (watching pelvis for symmetry) for 3x20s d) Sidelying with stool under foot/distal lower limb, slowly controlling motion of leg from stool down to table (10-30s down) for 3x8

d) Sidelying with stool under foot/distal lower limb, slowly controlling motion of leg from stool down to table (10-30s down) for 3x8 Once a patient is in the moderate tissue irritability stage (4-6/10), we can begin eccentrics and consider heavy slow exercise within patient tolerance. The exercise above would focus on eccentric strengthening - the stool would allow for passive positioning of the leg into abduction, taking out the concentric portion of the exercise. You could make this a heavy slow exercise by removing the stool and performing the concentric and eccentric for 3 seconds each and applying a load (if the patient is able to tolerate this). When prescribing eccentrics, we start with low load, long duration (10-30s) and less reps (5-10) then progress to high load, faster speed (<6 sec) and more reps (15+)

You are working with a patient who has patellar tendinopathy and you want to improve their quad strength. Based upon what you know about concentric and eccentric exercises, which is the BEST exercise selection for this patient? a) Seated knee extensions with ankle weight b) Prone hamstring curls with dumbbell c) Single leg BW squat d) Both A + B e) Both A + C

e) Both A + C This would include both concentric (seated knee extensions) and eccentric (single leg BW squat) strengthening for the quads. Based on the research, concentric exercise ALONE is not as effective for patients with tendinopathy.

Which of the following is INCORRECT regarding the body response to dry needling? a) Goal is to elicit a twitch response in the muscle b) The subcutaneous tissue is stimulated, allowing for remodeling of cytoskeleton and collagen c) Immediate positive change is seen in mechanoreceptors d) Observe changes in sympathetic tone, realignment of fibroblasts, and changes in viscosity e) Do not want to bring the muscle to fatigue with the twitch as this is too aggressive

e) Do not want to bring the muscle to fatigue with the twitch as this is too aggressive We actually *want to bring the muscle to fatigue/exhaustion.* If we don't, then we are likely to see side effects such as muscle spasms.

You have a whole squad of patients in your clinic that want KT done and since you're the expert, all your colleagues sent them to you. Which of the following patients would be the BEST candidate for KT? a) Lucy, a 33 y.o woman w/ anterior glide of the shoulder who is currently 5 mo pregnant b) Nina, a 44 y.o woman with lymphadema in her RLE and a hx of COPD c) Bruce, a 86 y.o man with lateral elbow tendinopathy who has very fragile skin d) Oscar, a 38 y.o 5k runner w/ gluteal tendinopathy and a hx of DM2 e) John, a 27 y.o basketball player 5 days s/p R lateral ankle sprain w/ significant edema/ecchymosis and hx of ankle instability f) Tracy, a 35 y.o woman 2 days s/p R hamstring tear w/ significant edema/ecchymosis who is currently taking Coumadin

e) John, a 27 y.o basketball player 5 days s/p R lateral ankle sprain w/ significant edema/ecchymosis and hx of ankle instability All the other patients listed have some sort of precaution for using KT a) Lucy, pregnant b) Nina, hx of COPD (respiratory conditions) c) Bruce, fragile/sensitive skin d) Oscar, DM f) Tracy, taking Coumadin Other precautions: CHF w/ edema, CAD

With which of the following conditions would DFM NOT be indicated? a) Tendinopathy b) Tenosynovitis c) Sprained ligament d) Strained muscle belly e) None of the above

e) None of the above All are indications for DFM

Select ALL of the following that are indications for IASTM. a) Tendinopathy b) Tenosynovitis c) Muscle strain d) Ligament sprain e) Scar tissue/adhesions f) All of the above

f) All of the above

When re-assessing your patient after performing a SNAG, you notice no changes in pain or ROM. Select ALL of the following that could contribute to this lack of improvement. a) Technique is not indicated b) Improper technique application c) Local discomfort (not "their pain") d) Poor handling skills e) Poor communication with patient f) All of the above

f) All of the above

Which of the following patients is the BEST candidate for dry needling? a) Sam, a 25 y.o male with Achilles tendinopathy and trigger points in the gastroc who does not want to be needled b) Lucy, a 18 y.o female with LBP and trigger points in the QL, who has psoriasis in the area to be needled c) Simone, a 35 y.o female with headaches and upper trap trigger points who has lymphedema d) Nick, a 55 y.o male s/p TKR with quad trigger points and varicose veins e) Sheila, a 32 y.o female with trigger points in the pec major and bilateral breast implants f) Will, a 85 y.o male with trigger points in the hamstrings who is taking Coumadin

f) Will, a 85 y.o male with trigger points in the hamstrings who is taking Coumadin While anticoagulant therapy is a *precaution,* the rest of these patients would be contraindicated a) Sam --> does not want to be needled b) Lucy --> psoriasis in the area to be needled (skin lesion - infection, rash) c) Simone --> lymphedema d) Nick --> varicose veins (or any vascular disease) e) Sheila --> implants

Which of the following is NOT a precaution for dry needling? a) Metal allergies b) Fear of needling c) Severe hyperalgesia/allodynia d) Cognitive impairments/unable to communicate e) Anticoagulant therapies/abnormal bleeding tendencies f) Compromised immune system g) Fragile/sensitive skin h) 1st trimester/high risk pregnancy

g) Fragile/sensitive skin This is a precaution for *KT taping,* not dry needling