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

Accepted Answer

Improved flexibility and increased ROM by restoring extensibility of the muscle-tendon unit with specific stretching techniques is strongly supported by evidence and research. The benefits of stretching in reducing soft tissue injury risk or reducing muscle soreness are less conclusive, and pre-event stretching may actually impair physical performance.

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.

Accepted Answer

Hypomobility is usually associated with joint stability rather than instability. It is a decreased range of motion, and may be caused by muscle imbalance, weakness, tissue trauma or may occur without tissue trauma. It may also be associated with loss of passive or dynamic flexibility.

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

Accepted Answer

This type of stretching is known as static-progressive stretching, where the muscle group is stretched statically and then moved into the newly gained range for an additional stretch, progressively increasing the range of motion.

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.

Accepted Answer

The connective tissue, such as the fascia and tendons, provide the main resistance to passive stretch of a muscle. The muscle spindle is a sensory receptor that detects changes in muscle length, but it does not protect the sarcomeres from stretch. Sarcomere give is a phenomenon that occurs over a longer period of slow, sustained stretch, not a quick stretch. The Golgi tendon organ is involved in inhibiting muscle contraction in response to tension, not facilitating it.

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.

Accepted Answer

Knee flexion contracture refers to the inability to fully extend the knee, which means that full, passive knee extension is not possible. This can be due to a variety of reasons, such as soft tissue or joint capsule tightness.

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.

Accepted Answer

This method ensures that the stretch is applied gradually and safely across all joints involved, minimizing the risk of injury while effectively stretching the flexor digitorum profundus.

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.

Accepted Answer

This statement is not true. Self-stretching can also be effective when the proximal segment is stabilized and the distal segment moves.

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.

Accepted Answer

Decreased skin temperature in the extremities is not an indicator of relaxation. Instead, relaxation techniques such as deep breathing, progressive muscle relaxation, and meditation typically lead to increased blood flow to the extremities, which might increase skin temperature rather than decrease it. Lowered heart and respiratory rates, a flat facial expression, and decreased muscle tension are all indicators of relaxation.

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.

Accepted Answer

Slowly applying a low-load force and maintaining the end-range position for an extended period of time is the safest and most comfortable way to achieve soft tissue lengthening. This approach allows the tissues to gradually adapt and elongate without causing excessive stress or injury. Rapid-velocity stretch forces (options A and D) may be too aggressive and can lead to tissue damage or pain. Applying a high-load force (option C) also carries a higher risk of injury and discomfort.

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.

Accepted Answer

Flexing the shoulder while stabilizing the pelvis helps to effectively stretch the latissimus dorsi, which is a shoulder extensor and internal rotator.

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.

Accepted Answer

Using the stretch-induced gains in ROM during functional activities on a regular basis is the most effective way to maintain the flexibility gained through stretching. Continuing to stretch regularly will also help maintain flexibility, but performing daily resistance training of the stretched muscle or the muscle group opposite the stretched muscle is not necessary for maintaining gains in ROM. Applying heat on a daily basis may temporarily increase flexibility but will not contribute to maintaining gains in ROM in the long term.

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.

Accepted Answer

The long head of the biceps brachii is maximally stretched by extending the elbow, pronating the forearm, and extending the shoulder, as this position lengthens the muscle across both the shoulder and elbow joints.

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.

Accepted Answer

This technique is known as "hold-relax" or "contract-relax," which is a form of proprioceptive neuromuscular facilitation (PNF) stretching. It involves an isometric contraction of the muscle being stretched (in this case, the pectoralis major), followed by a relaxation phase where the muscle is stretched further.

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

Accepted Answer

The procedure described is a mechanical stretch as it uses a weight to provide a sustained force to increase range of motion. Ballistic stretches involve rapid, bouncing movements, while dynamic stretches involve controlled movements through a range of motion. Cyclic stretches alternate between stretching and relaxing the muscle.

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

Accepted Answer

Pseudomyostatic contracture is the term that best describes impaired extensibility of a muscle-tendon unit resulting from spasticity or rigidity due to a lesion of the central nervous system. This condition is characterized by a constant state of contraction that mimics muscle shortening, despite the absence of actual changes in the muscle's physical length.

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.

Accepted Answer

Scar tissue reducing soft tissue extensibility is a condition where stretching adaptively shortened tissues can be beneficial, as it helps in improving flexibility and range of motion. The other options (A, C, D) are contraindications to stretching because they involve conditions where stretching could cause harm or exacerbate the issue.

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.

Accepted Answer

Ballistic stretching involves quick, bouncing movements which can increase the risk of tissue trauma and muscle soreness due to the forceful nature of the stretches. It is generally not recommended for most populations because of the high risk of injury.

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.

Accepted Answer

A quick stretch of a muscle-tendon unit stimulates the primary (Ia) afferents, which in turn stimulate the extrafusal fibers of the muscle. This leads to a phasic elevation of tension in the muscle. The activation of the muscle spindle via the Ib fibers and facilitation of GTO can also contribute to the tensile response, but the primary mechanism is the activation of the Ia afferents. Inhibiting the secondary (II) afferents would not lead to muscle activation, as these afferents do not directly 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.

Accepted Answer

The answer of Which is the safest (for protection of...

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

Accepted Answer

Cast immobilization after a fracture is considered an extrinsic factor because it is an external factor limiting the range of motion (ROM), unlike the other options which are intrinsic to the body's own tissues or conditions.

Quiz 4: Stretching for Improved Mobility

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

Which of the following is an incorrect statement about hypomobility?

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

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

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

Each of the following is a true statement about self-stretching procedures except:

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:

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?

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

To maintain gains in ROM achieved as the result of a stretching program, it is recommended to:

To achieve maximum elongation of the long head of the biceps brachii during passive stretching:

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?

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

Ballistic stretching:

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:

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?

Which of the following is categorized as an extrinsic factor contributing to limited ROM?