Deck 16: The Spine: Exercise and Manipulation Interventions

Question 1

Your patient describes frequent headaches, especially when working at her computer, which get progressively worse during the day.The following limitations in motion are noted: capital flexion, lower cervical extension, cervical side bending, and lateral rotation of the shoulders.Use of a pressure cuff to test control of capital flexion shows the ability to maintain an increase in pressure of 8 mm Hg for 3 seconds.She is not able to lie prone and perform axial extension by lifting her forehead off the table.All of the following would be appropriate methods for initiating your interventions except:

A)Gentle manual traction to the suboccipital region followed by passive capital flexion to increase flexibility.
B)Training of deep cervical flexors to maintain capital flexion for 10-second holds, using a pressure cuff for feedback.
C)Prone-lying axial extension with the head over the end of the table, holding for 10 seconds at a time.
D)Supine lying with a foam roller placed longitudinally under the spine and head, allowing the shoulders to roll outward into external rotation.

Answer 1

C

Question 2

All of the following may be indications for using stretching or mobility exercises in acute spinal conditions except:

A)When there is an accompanying postural impairment that prevents an alignment that would relieve symptoms.
B)When there is decreased mobility in the extremities that restrict postural alignment.
C)When an inflamed tissue is the cause of restriction.
D)When fluid stasis prevents movement.

Answer 2

C

Question 3

The decision to utilize dynamic exercises in the later stages of a spinal rehabilitation program should be based on:

A)Strength of the muscles demonstrating antigravity function.
B)Patient demonstrating effective deep segmental and global stabilization techniques.
C)Patient demonstrating 20 minutes of cardiopulmonary endurance activities without exacerbating symptoms.
D)Patient's ability to maintain an isometric contraction of the trunk musculature for 3 minutes.

Answer 3

B

Question 4

Your patient is in the chronic phase of healing with decreased ROM of C4-5 resulting in activity restrictions related to flexion and rotation of her head.You perform a spinal manipulation technique consisting of small amplitude oscillations for 1-2 minutes that go through the restrictive joint barrier with a goal to improve her joint ROM.What grade of manipulation will you document?

A)Grade II
B)Grade III
C)Grade IV
D)Grade V

Question 5

Your patient is recovering from a low back injury that occurred when picking up her 15-lb infant 4 weeks ago.The symptoms are no longer acute.She has learned the basic drawing-in maneuver and neutral spine position and can maintain her neutral spine while rolling, transitioning from supine to sit and from sit to stand.Now you plan to progress her exercises in order to improve her ability to return to managing household responsibilities.How should you progress the exercises to improve the stabilizing function in the abdominals?

A)Wall slides, beginning with 10 repetitions; progress to 25, then begin squats
B)Maintain neutral spine while walking for 10 minutes two times a day; progress to 5 times a day
C)Curl-ups on a mat; progress to doing curl-ups on an unstable surface such as a gym ball
D)Supine; maintain neutral spine while alternating arms, then add alternating legs; increase repetitions until she can hold the position for 3 minutes; progress difficulty by increasing the lever arm or adding weights to arms and legs

Question 6

Safe and effective use of muscle energy techniques to improve joint mobility requires that the therapist closely follows the procedural guidelines, including:

A)Never use muscle energy in the craniocervical region because of the risk of vertebral artery occlusion.
B)Perform the technique a minimum of 8-10 repetitions to achieve the outcome.
C)Have the patient hold the contraction for 15 seconds against moderate to maximum resistance followed by movement into the new range.
D)Use a gentle hold-relax technique to create submaximum, isometric contractions followed by movement into the new range.

Question 7

Anterior-posterior pelvic tilt exercises are used:

A)To strengthen the abdominal muscles.
B)To strengthen the back extensor muscles.
C)To train the transversus abdominis.
D)To perform range of motion (ROM) of the lumbar spine.

Question 8

For a patient to be able to learn good body mechanics for lifting:

A)The abdominal muscles must be strong enough to maintain a posterior pelvic tilt.
B)The patient must be able to maintain a neutral spinal posture against the force being lifted.
C)The spine needs to be braced in extension by the trunk muscles.
D)Emphasis should be placed on strengthening the lower extremity musculature, not the spinal musculature.

Question 9

Your patient is recovering from a back injury that occurred 3 weeks ago.You decide it is time to place him on a progressive walking program and integrate it with the other fundamental stabilization interventions in order to:

A)Improve control of the spine while performing a basic functional activity and to improve cardiopulmonary endurance.
B)Strengthen the legs while improving cardiopulmonary function.
C)Improve cardiopulmonary function and his sense of well-being.
D)Develop muscular endurance along with general lower extremity strengthening.

Question 10

Fundamental techniques that every patient with spinal impairments should learn before progressing to basic and advanced training exercises include:

A)Strengthening exercises for the cervical and trunk stabilizers, including the abdominals, longus colli, quadratus lumborum, and cervical and lumbar multifidus muscles.
B)Safe use of weights and elastic resistance while maintaining the spine in a neutral posture.
C)Safe stretching techniques prior to any stabilization, strengthening, or power training.
D)Kinesthetic awareness of safe spinal positions and movement, activation of deep segmental muscles, and global muscle control of spinal posture when moving the extremities or moving from one position to another.

Question 11

Manipulation to increase thoracic spinal rotation requires clear communication in the medical record describing the treatment outcome for the segment.When using the V-spread contact, one finger is placed on the superior transverse process and the second finger is placed on the contralateral inferior transverse process.The rule of the lower finger describes the direction of rotation as:

A)Rotation of the segment occurs in the direction of the finger on the side of the inferior transverse process.
B)Rotation of the segment occurs in the direction of the finger on the side of the superior transverse process.
C)There is no rotation with the V-spread because the lower finger equally counteracts the force through the superior finger, creating an anterior glide.
D)A distraction occurs with the V-spread as the lower finger creates movement inferiorly through the lever arm of the transverse process as the force is applied.

Question 12

To effectively stretch the scalene muscles on the left, the patient:

A)Axially extends the neck, side bends to the right, and rotates to the left.
B)Places the left hand behind the head, rotates head to the left, and looks down.
C)Rotates head to the right, looks down, and places left hand behind the head.
D)Tucks in chin and nods the head through 15° of motion.

Question 13

Rhythmic stabilization exercises are important in a spinal rehabilitation program because they:

A)Develop postural muscle response to external disturbances.
B)Make the patient feel good.
C)Develop strength using isometric holds.
D)Develop awareness of the neutral spinal posture.

Question 14

Modified bridging, partial lunges, partial squatting, and upper extremity pushing and pulling exercise are used in spinal exercise programs for the purpose of:

A)Using weight-bearing exercises rather than exercising in supine- or prone-lying positions.
B)Adding variety to what could be a monotonous program.
C)Strengthening the trunk-stabilizing musculature.
D)Developing extremity strength in conjunction with trunk stabilization to prepare for functional activities.

Question 15

To effectively apply a manipulation technique to improve cervical flexion, you would:

A)Position the patient supine with knees flexed and her arms at her side and use a two-thumb contact on the spinous process while pressing in a caudal direction.
B)Stand on one side of the patient with your body facing caudally and contact the cervical pillar on that side with the second metacarpal phalangeal joint and apply a caudally directed force.
C)Position the patient prone and use a two-thumb contact on the transverse processes of the superior restricted segment of the three-joint complex and apply a caudally directed force.
D)Position the patient prone and apply force through the thumbs to slide the superior vertebra in a cephalad-anterior direction.

Question 16

Individuals with symptoms from an intervertebral disk lesion and individuals with osteoporosis should not do:

A)The drawing-in maneuver.
B)Anterior and posterior pelvic tilt motions.
C)Dynamic trunk flexion exercises.
D)Stabilization exercises in the supine position.

Question 17

Of the following choices, the most effective way to stretch tight lumbar extensor muscles is:

A)In supine, pull both thighs to the chest until the sacrum is lifted off the mat.
B)In long sitting, reach both hands toward the feet as far as possible.
C)While standing, bend over and touch the toes.
D)In prone, perform press-ups.

Question 18

The first step in training a patient with spinal stabilization techniques should be:

A)Performing posterior pelvic tilt followed by alternating arm and leg motions.
B)Developing muscular endurance prior to strength.
C)Teaching awareness of safe spinal motions and functional position.
D)Developing control of extremity motions while in the functional position.

Question 19

The quadratus lumborum is an important stabilizer of the spine in which planes of motion?

A)Frontal and sagittal
B)Sagittal and coronal
C)Transverse and frontal
D)Sagittal and transverse

Question 20

Positional traction is used to:

A)Allow the patient to relax the musculature and therefore get greater separation of the vertebrae.
B)Isolate a passive distraction stretch to a specific facet.
C)Substitute for mechanical traction when a traction unit is not available.
D)Apply traction when the therapist is not strong enough to apply a sufficient amount of manual traction.

Question 21

Spinal manipulation techniques are contraindicated:

A)In pregnant women.
B)In patients with osteoporosis.
C)In patients currently using corticosteroids.
D)In the high cervical spine because of risk of vertebral artery compromise.