Deck 4: Stretching for Improved Mobility

Question 1

Multiple potential benefits and outcomes are speculated to result from stretching programs.Which of the following is strongly supported by evidence and research?

A)Reduction in the risk of soft tissue injury by participating in a stretching warm-up routine
B)Improved flexibility and increased ROM by restoring extensibility of the muscle-tendon unit with specific stretching techniques
C)Reduction in muscle soreness after rigorous exercise by participating in a warm-up and cool-down stretching routine
D)Enhanced physical performance (strength and endurance) in athletics when participating in pre-event (acute) stretching

Answer 1

B

Question 2

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.

Answer 2

C

Question 3

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

Answer 3

D

Question 4

Which of the following is a true statement about a muscle's response to stretch?

A)The muscle spindle is the motor receptor that protects the sarcomeres when a stretch is applied.
B)"Sarcomere give" is best described as a plastic change in muscle that occurs as the result of stretch force that is applied quickly.
C)A quick stretch of a muscle is believed to facilitate contraction of muscle fibers by means of the Golgi tendon organ (GTO).
D)The primary source of a muscle's resistance to passive stretch is the connective tissue in and around muscle.

Question 5

In a patient's medical record you see "knee flexion contracture." What does it mean?

A)The patient is unable to actively extend the knee through the full range of motion (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.

Question 6

What is the safest and most effective way of stretching the multijoint flexor digitorum profundus?

A)Stabilize the wrist, metacarpophalangeal, and proximal interphalangeal (PIP) joints in full extension; then passively extend the distal interphalangeal (DIP) joint.
B)With the wrist in neutral, stabilize the metacarpophalangeal 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 metacarpophalangeal joint.
D)With the wrist stabilized in a neutral position, first extend the DIP joint, then the PIP joint, and then the metacarpophalangeal joint of each finger.

Question 7

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 or active muscle contraction).
D)A stationary object or surface can be used to stabilize one body segment as the other segment is moved.

Question 8

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 rates.
C)Decreased skin temperature in the extremities.
D)Decreased muscle tension evidenced by relaxed jaw and hands.

Question 9

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 safest and most comfortable process to achieve soft tissue lengthening?

A)In an end-range position, apply several high-intensity, rapid-velocity stretch forces.
B)Slowly apply a low-load force; 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, and release the stretch quickly.
D)In an end-range position, apply several low-intensity, rapid-velocity stretch forces.

Question 10

The most effective means of stretching the latissimus dorsi in order to increase flexion of the shoulder 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.

Question 11

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 as soon as able 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.

Question 12

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.

Question 13

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.

Question 14

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

Question 15

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?

A)Myostatic contracture
B)Fibrotic contracture
C)Pseudomyostatic contracture
D)Hypotonic contracture

Question 16

Each of the following is a contraindication to stretching adaptively shortened tissues except:

A)Sharp, acute pain during ROM.
B)When ROM is limited because scar tissue has reduced soft tissue extensibility.
C)A bony block.
D)When tight (shortened) soft tissues provide functional stability of a body segment affected by paralysis.

Question 17

Ballistic stretching:

A)Should be used with elderly patients or patients with long-standing contractures.
B)Utilizes quick bouncing movements during the stretching maneuver, resulting in an increased chance for tissue trauma and muscle soreness.
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.

Question 18

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 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 muscle.

Question 19

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.

Question 20

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

Question 21

Stress within the elastic range of tissue deformation may cause all of the following except:

A)Straining of bonds (cross-links) between collagen fibers.
B)Microfailure between collagen bonds.
C)Squeezing water out of the ground substance.
D)Grade II ligament injuries.

Question 22

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 plantar flexors 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 plantar flexed 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 dorsiflexors 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 plantar flexors against your resistance through the available ROM.Then have the patient dorsiflex the ankle as far as possible.

Question 23

Which of the following is a true statement about a muscle's response to immobilization?

A)When a muscle is immobilized for a period of time, atrophy occurs more rapidly and extensively in fast-twitch fibers than in slow-twitch fibers.
B)As the immobilized muscle atrophies, an increase in fibrous and fatty tissue in the muscle occurs.
C)Atrophy of an immobilized muscle will begin after the first 30 days of inactivity, resulting in contractile weakness.
D)A muscle immobilized in a shortened position will have an increased ability to produce maximum tension at its resting length because of sarcomere absorption.

Question 24

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 exhaustion after exercise.
D)When a submaximal stress load is applied repeatedly and causes tissue failure as in a stress fracture or overuse syndrome.

Question 25

To most effectively use the phenomenon of creep in a stretching routine:

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 used.
D)The force should be great enough to cause necking.

Question 26

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

Question 27

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 tibialis, 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.

Question 28

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 transport nutrients and metabolites.
D)They provide bulk to add strength to ligaments and tendons.

Question 29

To achieve permanent lengthening of connective tissue:

A)The collagen fibers must line up in a parallel fashion.
B)The region of necking, or macrofailure, must be reached.
C)Bonds between collagen fibers must be remodeled in the lengthened position.
D)The ground substance between the fibers must be reduced.

Question 30

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)Warm up the tissues to be stretched by engaging in light-intensity active exercise or using therapeutic heat prior to stretching.