Therapeutic Exercise Chapter 4

To help reduce post-stretch soreness after stretching into shoulder flexion, cold should be applied with the limb in which of the following positions? A) End-range shoulder flexion B) End-range shoulder extension C) Medium-range shoulder flexion D) Cold is not recommended after a stretch

A) End-range shoulder flexion

To achieve maximum elongation of the long head of the biceps brachii during passive stretching: A) Extend the elbow with the forearm in pronation and then extend the shoulder B) Flex the shoulder overhead after extending the elbow with the forearm in supination C) Extend the elbow with the forearm in supination and then extend the shoulder D) Flex the shoulder overhead after extending the elbow with the forearm in pronation

A) Extend the elbow with the forearm in pronation and then extend the shoulder

The goal of this exercise is to increase the flexibility (extensibility) of the pectoralis major muscle. You teach the patient to stand facing a corner with the shoulders abducted to 90°, elbows flexed to 90°, and hands and forearms placed on the walls. You tell the patient to relax into the stretch (by leaning into the corner) for 30 seconds; push his forearms into the walls for a count of six; then relax and lean forward toward the corner again and hold for 30 seconds. The self-stretching technique the patient is using is: A) Hold-relax (contract-relax) B) Contract-relax-contract (hold-relax-agonist contraction) C) Agonist contraction D) Static progressive stretching

A) Hold-relax (contract-relax)

Of the following choices, which is the most appropriate application of the hold-relax (contract-relax) method of muscle inhibition and elongation of the gastrocnemius muscle? Extend the patient's knee, stabilize the lower leg, and: A) Place the patient's ankle in as much dorsiflexion as is comfortable; have the patient isometrically contract the plantarflexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle B) Place the patient's ankle in a fully plantarflexed position. Have the patient concentrically contract the dorsiflexors against your manual resistance through as much ROM as possible C) Place the patient's ankle in as much dorsiflexion as possible; have the patient isometrically contract the doriflexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle D) Place the patient's ankle in a comfortably dorsiflexed position; have the patient concentrically contract the plantarflexors against your resistance through the available ROM. Then have the patient dorsiflex the ankle as far as possible

A) Place the patient's ankle in as much dorsiflexion as is comfortable; have the patient isometrically contract the plantarflexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle

The ability of soft tissue to assume a new and greater length after a stretch force is removed is called: A) Plasticity B) Viscoelasticity C) Elasticity D) Tissue memory

A) Plasticity

While instructing a patient to fully elongate the latissimus dorsi muscle, you would have her place the limb in which position? A) Shoulder flexion, abduction, and external rotation B) Shoulder extension, abduction, and internal rotation C) Shoulder extension, adduction, and internal rotation D) Shoulder flexion, adduction, and external rotation

A) Shoulder flexion, abduction, and external rotation

To use the phenomenon of creep in a stretching routine most effectively: A) The tissues should be warmed and the force (load) maintained as long as tolerated B) The force should be repeated in a cyclic manner C) A high-intensity, rapidly applied force should be applied D) The force should be great enough to cause necking

A) The tissues should be warmed and the force (load) maintained as long as tolerated

To maintain gains in ROM achieved as the result of a stretching program, it is recommended to: A) Use the stretch-induced gains in ROM during functional activities on a regular basis B) Perform daily resistance training of the muscle group opposite the stretched muscle C) Apply heat on a daily basis to the lengthened muscle groups D) Perform daily resistance training of the stretched muscle

A) Use the stretch-induced gains in ROM during functional activities on a regular basis

Your patient develops a contracture as the result of hypertonicity after a traumatic brain injury. This type of hip contracture is called a/an: A) Arthrogenic contracture B) Pseudomyostatic contracture C) Fibrotic contracture D) Mysostatic contracture

B) Pseudomyostatic contracture

Which of the following descriptions of stretching procedures performed for several repetitions during a single treatment session and repeated over a series of stretching sessions represents the most effective process to achieve plastic lengthening of soft tissues? A) In an end-range position apply several high-intensity, rapid velocity stretch forces B) Apply an end-range, low-load force slowly; maintain the end-range position for an extended time period and release the stretch force slowly C) Apply an end-range, high-load force slowly, maintain the end-range stretch for an extended time period D) In an end-range position apply several low-intensity, rapid velocity stretch forces

B) Apply an end-range, low-load force slowly; maintain the end-range position for an extended time period and release the stretch force slowly

Which of the following exercises provides the most stretch to increase flexion of the lumbar spine? A) Single knee to chest B) Double knees to chest C) Posterior pelvic tilt with the patient lying supine and legs straight D) Posterior pelvic tilt with the patient lying supine with hips/knees at 45o/90o

B) Double knees to chest

Ballistic stretching: A) Should be used only under the direction of a physical therapist for patients with long-standing contractures B) Increases muscle tension during the stretching maneuver and increases the chance of tissue trauma C) Is effective only if done concurrently with joint mobilization techniques D) Can be very effective because the rapid force has greater chance of reaching the plastic range, leading to tissue remodeling

B) Increases muscle tension during the stretching maneuver and increases the chance of tissue trauma

To increase terminal knee extension you position the patient prone so the lower leg is not supported on the treatment table. The patient relaxes while the lower leg and foot "hang" off the end of the table. The therapist adds a cuff weight around the ankle. What type of stretching procedure is being applied? A) Ballistic B) Mechanical C) Dynamic D) Cyclic

B) Mechanical

Each of the following is a true statement about self-stretching procedures except: A) A portion of body weight is often the source of the stretch force when the distal segment is fixed B) Self-stretching is effective only when the distal segment is stabilized and the proximal segment moves C) Proper stabilization of one segment sometimes can be achieved intrinsically (i.e., by an isometric muscle contraction) D) A stationary object or surface can be used to stabilize one body segment as the other segment is moved

B) Self-stretching is effective only when the distal segment is stabilized and the proximal segment moves

Which of the following in NOT a precaution for stretching interventions? A) Patient with suspected osteoporosis B) Soreness after previous session that lasted 4 hours C) Edematous tissue D) Vigorous stretching after prolonged immobilization

B) Soreness after previous session that lasted 4 hours

The safest form of stretch that yields the most long-term changes is the: A) Ballistic stretch B) Static stretch C) Cyclic stretch D) Passive stretch

B) Static stretch

Each of the following is a contraindication to stretching adaptively shortened tissues except: A) Sharp, acute pain during ROM B) When a shortened, multijoint muscle group crosses a hypermobile intermediate joint C) A bony block D) When tight (shortened) soft tissues provide functional stability of a body segment affected by paralysis

B) When a shortened, multijoint muscle group crosses a hypermobile intermediate joint

To achieve permanent lengthening of connective tissue: A) The collagen fibers must be stretched B) The region of necking, or macro-failure, must be reached C) Bonds between collagen fibers must be remodeled in the lengthened position D) Sarcomere give must occur

C) Bonds between collagen fibers must be remodeled in the lengthened position

The type of stretch technique that has a low velocity and short duration is called a: A) Ballistic stretch B) Static stretch C) Cyclic stretch D) Passive stretch

C) Cyclic stretch

You are teaching a client total body relaxation techniques as part of a pain management program. Each of the following is an indicator of relaxation except: A) Flat facial expression B) Lowered heart and respiratory rate C) Decreased skin temperature in the extremities D) Decreased muscle tension evidenced by relaxed jaw and hands

C) Decreased skin temperature in the extremities

Based on the neurophysiological properties of the contractile components of muscle, a high-intensity, quick stretch of a muscle-tendon unit is believed to create phasic elevation of tension in the stretched muscle by: A) Facilitating the muscle spindle via the IB fibers B) Facilitating the Golgi tendon organ (GTO) C) Facilitating the primary (Ia) afferents, which in turn stimulate the extrafusal fibers of the muscle D) Inhibiting the secondary (II) afferents, which in turn stimulate the extrafusal fibers of the msucle

C) Facilitating the primary (Ia) afferents, which in turn stimulate the extrafusal fibers of the muscle

In a patient's medical record you see "knee flexion contracture." What does it mean? A) The patient is unable to actively extend their knee through the full ROM despite full passive knee extension B) The quadriceps muscle group is tight and limits full, passive knee flexion C) Full, passive knee extension is not possible D) The patient cannot actively contract the hamstrings to flex the knee

C) Full, passive knee extension is not possible

Your patient has significant limitation in right shoulder external rotation. As you perform stretch interventions to improve ROM, you also need to develop strength in which of the following agonists? A) Subscapularis B) Anterior deltoid C) Infraspinatus D) Pectoralis minor

C) Infraspinatus

Which of the following is an incorrect statement about hypomobility? A) It may be associated with loss of passive or dynamic flexibility B) It may be caused by muscle imbalance or weakness C) It is usually associated with joint instability D) It may occur with or without tissue trauma

C) It is usually associated with joint instability

You are asked to do selective stretching with a patient with a spinal cord injury. You allow tightness of which of the following muscle groups to optimize function? A) Hamstrings B) Quadriceps C) Low back extensors D) Shoulder flexors

C) Low back extensors

The most effective means of stretching the latissimus dorsi is to: A) Place the patient in a prone position; stabilize the scapula and hyperextend the shoulder B) Place the patient in a supine position; stabilize the lateral border of the scapula as you flex the shoulder C) Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder D) Place the patient in a supine position; hyperextend the shoulder and move the arm over the side of the table as you stabilize the anterior aspect of the shoulder

C) Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder

Which of the following terms best describes impaired extensibility of a muscle-tendon unit as the result of spasticity or rigidity from a lesion of the central nervous system (CNS)? A) Myostatic contracture B) Fibrotic contracture C) Pseudomyostatic contracture D) Hypotonic contracture

C) Pseudomyostatic contracture

Which is the safest (for protection of the long arch of the foot) and most effective way to apply a long-duration self-stretch of the gastrocnemius-soleus muscle group? A) Stand facing a wall; lean into the wall while keeping both heels on the floor. Sustain that position for as long as possible B) Assume a long-sitting position on the floor; loop a towel or strap under one foot (strap should be at the heads of the metatarsals) and pull on the towel or strap C) Stand on a solid wedge (5°, 10°, or 15° angle) for an extended period of time D) Stand on a step with your heels hanging over the edge and let your heels drop slightly below step level and maintain that position as long as tolerated

C) Stand on a solid wedge (5°, 10°, or 15° angle) for an extended period of time

The glycosaminoglycans and water in the ground substance of connective tissue are important for connective tissue health because: A) They bind the collagen fibers together, giving them their crystalline qualities B) They stimulate the elastic qualities in elastin C) They reduce friction and maintain the distance between fibers D) They are the main structure that provides tensile qualities to tendons and ligaments

C) They reduce friction and maintain the distance between fibers

Which of the following statements about stretching is true? A) To effectively stretch the tensor fascia latae, you first flex the hip to 30° and then adduct the hip B) To maximally lengthen the wrist extensors, you fully flex the wrist and flex the elbow C) To stretch the posterior tibials, you dorsiflex and evert the foot and ankle D) To stretch the long head of the triceps brachii, you fully flex the elbow and then extend the shoulder past neutral

C) To stretch the posterior tibials, you dorsiflex and evert the foot and ankle

Connective tissue fatigue occurs: A) When the heart rate is maintained at 80% of the age-adjusted maximum during active exercise B) When there is a buildup of metabolites in connective tissue as the result of active stretching procedures C) When a muscle is not allowed adequate time to recover from exercise to exhaustion D) When a submaximal stress load is applied repeatedly and causes tissue failure

D) When a submaximal stress load is applied repeatedly and causes tissue failure

Which of the following is categorized as an extrinsic factor contributing to limited ROM? A) Bony block B) Inflammation of soft tissue C) Paralysis D) Cast immobilization after a fracture

D) Cast immobilization after a fracture

When applying a stretch, you first feel some resistance; as you maintain the stretch, you feel as though you can move into a greater range using the same amount of force. This describes what mechanical property of connective tissue? A) Stress relaxation B) Tissue failure C) Elastic limit D) Creep

D) Creep

With the patient in a supine position, you are passively stretching the hamstrings of the (R) lower extremity. To provide effective stabilization and minimize unwanted movement you should: A) Flex the (L) hip and knee and keep the (L) foot planted on the table to prevent a posterior tilt of the pelvis as you stretch the (R) hamstrings B) Flex the (L) hip and knee and keep the (L) foot planted on the table to prevent an anterior pelvic tilt as you stretch the (R) hamstrings C) Extend the (L) hip and knee and keep the (L) leg on the table to prevent an anterior tilt of the pelvis as you stretch the (R) hamstrings D) Extend the (L) hip and knee and keep the (L) leg flat on the table to prevent a posterior pelvic tilt as you stretch the (R) hamstrings

D) Extend the (L) hip and knee and keep the (L) leg flat on the table to prevent a posterior pelvic tilt as you stretch the (R) hamstrings

A person who has been on extended bed rest has a hip contracture that places the hip in a position of lateral rotation. You note in your documentation that your patient has a: A) Hip flexion contracture B) Hip adduction contracture C) Hip internal rotation contracture D) Hip external rotation contracture

D) Hip external rotation contracture

During a stretching maneuver, you apply a 30-second stretch of a shortened muscle group just up to the point of tissue resistance. After this maneuver, rather than relaxing with the patient and returning the body segment to a neutral position, you move the body segment into the newly gained range to apply another stretch of the same muscle group and hold the stretch for an additional 30 seconds. What term best describes this type of stretching? A) Static B) Cyclic C) Ballistic D) Static-progressive

D) Static-progressive

When a patient is involved in a stretching program, it is recommended that you: A) Strengthen the muscle to be stretched in order to convert nondistensible, noncontractile tissue to easily distensible contractile tissue B) Avoid strengthening the muscle that has been stretched because it is easier to achieve elongation when the muscle is weak C) Avoid active exercises for warm-up prior to stretching because it may increase excitability of the muscle tissue and prevent relaxation during stretching D) Strengthen the muscles that have been stretched because stretching may temporarily weaken a muscle

D) Strengthen the muscles that have been stretched because stretching may temporarily weaken a muscle

Stress within the elastic range of tissue deformation causes all of the following except: A) Straining of bonds (crosslinks) between collagen fibers B) Sarcomere give C) Squeezing water out of the ground substance D) Tearing the crystalline tropocollagen

D) Tearing the crystalline tropocollagen

Which of the following is a true statement about a muscle's response to immobilization or stretch? A) When a muscle is immobilized for a period of time, atrophy occurs more rapidly and extensively in fast twitch fibers than slow twitch fibers B) "Sarcomere give" is best described as a plastic change in muscle that occurs as the result of stretching C) A quick stretch of a muscle is believed to facilitate contraction of muscle fibers by means of the Golgi tendon organ D) The primary source of a muscle's resistance to passive stretch is the connective tissue in and around muscle

D) The primary source of a muscle's resistance to passive stretch is the connective tissue in and around muscle

What is the safest and most effective way of stretching the multijoint flexor digitorum profundis? A) Stabilize the wrist, MCP, and PIP joints in full extension; then passively extend the DIP joint B) With the wrist in neutral, stabilize the MCP and DIP joints in full extension; then passively extend the PIP joint C) First flex the wrist; then fully extend the DIP joint to the point of tissue resistance; then extend the PIP joint and then the MCP joint D) With the wrist stabilized in a neutral position, first extend the DIP joint, then the PIP joint, and then the MCP joint of each finger

D) With the wrist stabilized in a neutral position, first extend the DIP joint, then the PIP joint, and then the MCP joint of each finger