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Flashcards in Chapter 15. Rehabilitation Deck (31):
1

949. The Henneman size principle of therapeutic
exercise says motor units are recruited in order of
(A) increasing size, decreasing contraction
strength, and diminishing fatigue
(B) increasing size, increasing contraction
strength, and diminishing fatigue
(C) increasing size, increasing contraction
strength, and escalating fatigue
(D) decreasing size, increasing contraction
strength, and diminishing fatigue
(E) none of the above

949. (C) Smaller, less powerful, fatigue resistant motor
units, which contain slow-twitch muscle fibers,
have the lowest firing threshold and are recruited
first. Demands for larger forces are met by the
recruitment of increasingly larger, more powerful,
fatigable motor units. The largest motor units
that contain the fast-twitch B fibers have the
highest threshold and are recruited last.

2

950. What is an example of an open kinetic chain
exercise?
(A) Leg press
(B) Knee extensions
(C) Push up
(D) Treadmill
(E) Bench press

950. (B) Open kinetic chain exercises are typically
performed where the foot/leg or hand/arm is
free to move, and non-weight bearing, with the
movement occurring at the peripheral joint.
Examples of these exercises would be knee
extensions, straight leg raises, and biceps curl. In
closed kinetic chain (CKC) exercise, the distal
part of the limb-upper or lower, is fixed to the
ground or to the wall or plate. Examples include
leg press, push up, and running exercises. In
bench press, the foot is on the floor so this too is
a CKC exercise. CKC exercises are felt to be more
“functional”, since these exercises may mimic
what patients do throughout the day or in an
employment setting and thus are often favored.
However, a mix of both types of exercises typically
recommended.

3

951. Which type of therapy has been found to
reduce the risk of falls in the elderly?
(A) Tai chi
(B) Pilates
(C) Yoga
(D) Strength training
(E) None of the above

951. (A)
A. Tai chi is an internal Chinese martial art often
practiced with the aim of promoting health
and longevity. Training consists of slow
motion routines that groups of people
practice together every morning in parks
around the world, particularly in China.
Many medical studies support its effectiveness
as an alternative exercise and a form of
martial arts therapy. Tai chi improves balance
in persons of all ages.
B. Pilates is a physical fitness system developed
in the early 20th century by Joseph
Pilates. Pilates called his method “contrology,”
because he believed his method uses the
mind to control the muscles. The program
focuses on the core postural muscles which
helps keep the body balanced and which are
essential for providing support for the spine.
C. Yoga is a group of ancient spiritual practices
originating in India. Yoga involves flexibility
exercise combined with strength training,
but also traditional chants and relaxation
techniques that relax the mind and the body.
D. Strength training has been found to be
effective in elderly patients but does not
specifically reduce falls.

4

952. Direct participants in interdisciplinary comprehensive
pain management include all of the
following, EXCEPT
(A) vocational counselor
(B) physical therapist
(C) psychologist
(D) general internal medicine physician
(E) occupational therapist

952. (D) While a family physician is important to provide
medical information to the team, the team
leader is most often a physician with sub-specialty
qualifications in pain management. The team
consists of professionals from a variety of therapeutic
groups that work together with the patient
to help them improve their function and manage
their chronic pain. All of the above except the primary
care physician can readily be found among
the interdisciplinary team.

5

953. Which of the following is true regarding aerobic
training?
(A) Persons placed on bedrest will experience
a decrease in resting heart rate
(B) Oxygen consumption (VO2) increases in
proportion to the intensity of the exercise
(C) For training to be effective, the duration
of aerobic training must be at least
10 minutes at a stretch
(D) Intensity of training must be within 40%
to 85% of maximal VO2 (VO2 max) to be
considered aerobic training
(E) Patients placed at bedrest will experience
an increase of VO2 max after 3 weeks

953. (D) When placed at bedrest, many detrimental
changes occur to the cardiovascular system.
People placed on bedrest will experience an
increase in resting heart rate. Oxygen consumption
(VO2) decreases in proportion to the
intensity of the exercise. Patients will experience
a 25% decrease in VO2 max after 3 weeks of
bedrest. Additionally, during bedrest muscle
breakdown occurs, osteoporosis occurs, and
joint contractures can set in. Therefore, during acute pain episodes, it is imperative that patients
are encouraged not to lie in bed for 24 hours.

6

954. All of the following are examples of core
strengthening programs for spine rehabilitation,
EXCEPT
(A) lumbar stabilization
(B) pilates training
(C) yoga
(D) abdominal exercises
(E) all of the above

954. (C)
A. Lumbar stabilization is a type of exercise
that attempts to strengthen muscles in the
abdomen and posterior spine (multifidus)
by cocontracting the muscles in a position of
“neutral spine.” Neutral spine is a position
where the spine hurts the least so exercise
can take place.
B. Pilates is an exercise designed by Joseph
Pilates to use machines to assist with
strengthening of muscles of the abdomen
and spine—the core muscles.
C. Yoga is an exercise of the mind and body.
Positions are attempted that achieve maximum
body stretch and relaxation. Strengthening
is not a part of the program.
D. Abdominal muscles are part of the core.
The core defined as muscles between the
chest (nipple line) and the waist.

7

955. Atypical exercise precaution that should be followed
with a patient who has chronic osteoarthritis
would be
(A) no exercise in patients with osteoarthritis
of three or more joints
(B) no weight bearing on a limb with knee
pain of 2 years’ duration
(C) no ice when knee effusion occurs after
exercise
(D) only low-impact exercises in a patient
with severe osteoarthritis of both knees
awaiting joint replacement surgery
(E) no stretching of a lower limb in a
patient with osteoarthritis of the ankle
who has a tight calf muscle

955. (D) The exercise program in patients with
osteoarthritis must be adjusted to their tolerance
level. Many patients are functionally
impaired, obese, and are at high risk for developing
medical complications such as type-2
diabetes or cardiovascular disease because of
their inactivity. Thus, even if a patient is awaiting
joint replacement because of chronic pain
from osteoarthritis a period of physical activity
before their surgery is warranted. Often protected
weight-bearing, low-impact exercises, or
exclusively aquatic exercises can allow the
patient to tolerate sessions of physical therapy
they otherwise could not tolerate.

8

956. A patient presents to your office with T6 paraplegia.
He was living independently until severity
of neuropathic pain in his legs increased to
10/10. Now he can no longer go to work because
the pain is so severe that he cannot concentrate
at work. The fact that this patient cannot work is
considered as
(A) impairment
(B) disability
(C) handicap
(D) physical capacity
(E) none of the above

956. (C)
A. The American Medical Association Guides
to the Evaluation of Permanent Impairment
define impairment as “a loss, loss of use, or
derangement of any body part, organ system,
or organ function.” Thus in this case,
the impairment would be the T6 injury.
B. The American Medical Association Guides
to the Evaluation of Permanent Impairment
define disability as “an alteration of an individual’s
capacity to meet personal, social,
or occupational demands or statutory or
regulatory requirements because of an
impairment.” Thus, the inability to walk
would be a disability. Another example
might be a finger injury. A lawyer might
have no vocational disability but a pianist
might have 100% disability from the same
impairment.
C. Impairment is the functional consequence
of the disability. Thus the inability to
work, play a sport, or pay the rent would
all be disabled.
D. Physical capacity is just the capacity of the
body to operate.

9

957. A patient presents to the office with 2-week
history of leg pain consistent with S1 radiculopathy.
Magnetic resonance imaging (MRI)
reveals a paracentral L5-S1 disc herniation. The
pain is worsened with bending forward, driving,
and lifting objects. Aproper type of physical
therapy exercise would be
(A) McKenzie method of physical therapy
with extension exercises
(B) yoga
(C) Williams method of physical therapy
with flexion exercises
(D) stationary bike
(E) no therapy

957. (A)
A. Although individualized exercises also are
performed, McKenzie exercises are most
well known as a set of spinal extension exercises.
The goal is to off-load the disk compression
on the spinal nerve and reduce the
pain in the leg. Often the pain “centralizes”
to the lower back where is can be improved
by other therapy methods. Although often
practiced, little is written and even fewer
studies have been performed to prove the
effectiveness of the therapy. The study referenced
above found improvement in leg
pain in the short term (0-3 months) compared
to other treatments but after 3 month,
the benefit was no longer seen.
B. Yoga is a form of exercise where bending forward
often occurs. This might worsen the
symptoms. For chronic back pain, yoga has
been found to be effective in a recent study.
C. Williams exercises are a set of flexion based
exercises. Persons with acute paracentral
disc herniations might get worse leg pain
with flexion-type exercises. Flexion spine
exercises can be beneficial in cases of stenosis
or lateral disc herniations where flexion
can result in offloading of neural structures.
D. Stationary bike is a flexion exercise. This can
result in more pressure on the disc increasing
the leg pain.
Although some studies suggest that physical
therapy has no effect on painful disc herniations,
many other studies find that therapy
has a significant beneficial effect.

10

958. Which of the following is false regarding
muscle tightness in the lower extremity?
(A) Gluteus maximus inflexibility may
decrease lumbar lordosis causing
increased forces on the lumbar spine
(B) The Ely test evaluates rectus femoris
tightness
(C) Lumbar lordosis can be increased in
iliopsoas tightness
(D) Anterior pelvic tilt may cause stress on
the lumbar spine and can be caused by
rectus femoris or hamstring tightness
(E) The Thomas test assesses tightness of
the iliopsoas muscle

958. (D)
A. Gluteus medius and hamstring inflexibility
can lead to posterior pelvic tilt, decreasing
lumbar lordosis.
B. The Ely test evaluates the rectus femoris.
C. Rectus femoris and iliopsoas tightness can
cause anterior pelvic tilt, increasing lumbar
lordosis.
D. Increasing or decreasing lumbar lordosis
can put stress on the lumbar spine.
E. The Thomas test evaluates for iliopsoas
muscle tightness while the Ely test evaluates
the rectus femoris.

11

959. Which of the following statements regarding
central pain is not correct?
(A) Patients with central pain are usually
affected by a change in temperature
(B) More than 10% of patients with a stroke
report significant central pain within the
first year
(C) Central pain caused by a thalamic
infarction is often a burning pain that
may be described as agonizing and is on
the side contralateral to the lesion
(D) Almost 90% of all central pain is caused
by cerebral vascular accidents
(E) No singular pharmacologic, surgical or
other treatment has been proven to be
helpful in the long term

959. (B) Ninety percent of all cases of central pain
are caused by cerebral vascular accidents but
only 8% of all stroke patients will report central
pain within the first year. The pain may be constant
(85%) or intermittent (15%) and is primarily
burning, prickling, aching, and lancinating.
Thalamic strokes cause agonizing burning pain
contralateral to the side of the lesion. Central
pain is almost always affected by change in
temperature and no one treatment has been
found to be efficacious in the long term.

12

960. Achilles tendinosis is a chronic source of pain
in many active adults. Which of the following
interventions has been found to be helpful in
the treatment of pain for this disease process?
(A) Nonsteriodal anti-inflammatory drugs
(B) Corticosteroid injections of the tendon
(C) Heel pads
(D) Topical laser therapy
(E) Ultrasonography

960. (A) Despite the controversy over the presence
or lack of inflammation in Achilles tendonosis,
there is weak evidence to support the use of
oral nonsteroidal drugs for pain control. On
the other hand there is weak evidence of lack
of effect for heel pads, topical laser, heparin
injections, and peritendinous corticosteroid
injections. There is no well-designed study
confirming the efficacy of ultrasound in treatment
of this disease. Eccentric loading has
been shown to be helpful.

13

961. Chronic pain from fibromyalgia is characterized
by the following statements, EXCEPT
(A) fibromyalgia affects women more often
than men
(B) there is a suggestion that genetic factors
contribute to the etiology of fibromyalgia
(C) mood and anxiety disorders are significant
comorbidities in fibromyalgia
(D) patients with fibromyalgia may experience
a range of other symptoms including
irritable bowel or bladder
syndromes
(E) cognitive disturbances are never part of
fibromyalgia and suggest that there is
an organic cause for the problem

961. (E) Fibromyalgia affects about 2% of the general
population, affecting 3.4% of women and 0.5%
of men. The symptoms include sleep disturbances,
stiffness, anxiety, depression, cognitive
disturbances, irritable bowel and bladder syndromes,
headaches, paresthesias, and other less
common symptoms. Fibromyalgia aggregates
in families and congregates with major mood
disorders in families, suggesting genetic factors
may be involved in the etiology of fibromyalgia.

14

962. The use of physical therapy that includes
“directional preference” in the treatment of low back pain has not been shown to
(A) decrease the need for surgery
(B) decrease the use of medications
(C) be associated with greater improvements
in pain control
(D) be as good as intensive dynamic
strengthening
(E) be better than nondirectional exercises

962. (A) McKenzie based exercises are often called
directionally based exercises and have been
thought to be better than regular physical therapy
in the treatment of low back pain. Not all studies
have agreed. Several large studies have evaluated
this paradigm. In one case, intensive
dynamic strengthening was found to be as good
as the McKenzie method for treatment of subacute
and chronic low back pain. Another large
study showed directional preference exercises
can decrease medication consumption by threefolds
and give rapid significant pain control when
compared to nondirectional therapy and opposite
directional therapy. No study has evaluated the
use of directional therapy in avoiding surgery.

15

963. Evaluation and treatment of anterior knee pain
that is insidious in onset, bilateral, peripatellar,
and most often problematic in repetitive loadbearing
movements includes all the following,
EXCEPT
(A) hamstring strengthening
(B) activity modification
(C) closed chain kinetic exercises
(D) patellar taping
(E) evaluation for apophysitis at the tibial
tuberosity in adolescents

963. (A) Patellofemoral pain syndrome (PFPS) is usually
insidious in onset and often bilateral. It is
most often associated with load-bearing exercises
and repetition of the exercise. It is relatively
benign, but in adolescents, one must consider
the presence of a traction apophysitis of the tibial
tuberosity. Closed kinetic chain exercises, patellar
taping, and activity modification along with
nonsteroidal anti-inflammatory drugs are the
mainstays of treatment. Strengthening of the
vastus medialis obliquus and other quadriceps
muscles are important in the treatment and not
strengthening of the hamstrings.

16

964. Which of the following is true regarding phantom
limb sensations?
(A) Body parts that are sparsely innervated
are most commonly represented
(B) Phantom sensations are unpleasant with
burning and jabbing
(C) The incidence of phantom sensations
decreases with age.
(D) The amputated limb phantom may feel
shortened
(E) Phantom limb sensations require
peripheral input

964. (D) Phantom limb sensation is an almost universal
occurrence at some time during the first
month following surgery.
A. The strongest sensations come from body
parts with the highest brain cortical representation,
such as the fingers and toes. These
highly innervated parts are also the areas of
most persistent phantom limb sensation.
B. Phantom sensations are either normal in
character or as pleasant warmth and tingling.
These are not painful.
C. The incidence of phantom limb sensation
increases with the age of the amputee. In children
who have amputation before 2 years
of age, the incidence of phantom limb sensation
is 20%; the incidence of phantom
limb sensation is nearly 100% when amputation
occurs after 8 years of age.
D. The phantom limb may undergo the phenomenon
known as telescoping, in which
the patient loses sensations from the mid
portion of the limb, with subsequent shortening
of the phantom. Telescoping is most
common in the upper extremity. During
telescoping, the last body parts to disappear
are those with the highest representation
in the cortex, such as the thumb, index
finger, and big toe. Only painless phantoms
undergo telescoping, and lengthening of
the phantom may occur if the pain returns.
Thus, patients may feel that the amputated
phantom limb shortened.
E. Phantom limb sensations do not appear to
require peripheral nervous system input.
Phantom limb sensations may be an attempt
to preserve the self image and minimize distortion
of the self image or may be a permanent
inherited neural memory of postural
patterns.

17

965. Which of the following physical examination
maneuvers are not found to correlate with
sacroiliac joint pain as confirmed by pain ablation
with diagnostic injection with lidocaine
under fluoroscopy, with at least 90% specificity?
(1) Patrick test
(2) Gaenslen test
(3) Compression test
(4) Distraction tests

965. (E) Multiple published studies and meta-analysis
of studies has found that the highest level of sensitivity
and specificity for any physical examination
test is 60%. The specific tests are as follows:
1. Patrick test—The hip is externally rotated,
the foot is placed on the opposite knee, and
gentle pressure is applied to the foot and ipsilateral
anterior superior iliac spine (ASIS).
Pain can then occur in either of the affected
sacroiliac joint. Also called the flexion, abduction,
and external rotation (FABER).
2. The goal of the Gaenslen test is to apply torsion
to the joint. With one hip flexed onto the
abdomen, the other leg is allowed to dangle
off the edge of the table. Pressure should
then be directed downward on the leg in
order to achieve hip extension and stress the
sacroiliac joint.
3. Apply compression to the joint with the
patient lying on his or her side. Pressure is
applied downwards to the uppermost iliac
crest (iliac compression test).
4. Distraction can be performed to the anterior
sacroiliac ligaments by applying pressure to
the anterior superior iliac spine (iliac gapping
test).

18

966. In pain management, tissue structures are
warmed via which of the following mechanism(
s)?
(1) Conduction
(2) Convection
(3) Conversion
(4) Radiation

966. (A)
1. Conduction is the transfer of heat from on
surface to another directly. Examples include
heat packs or paraffin.
2. Convection in the most general terms refers
to the movement of currents within fluids
(ie, liquids, gases, and rheids). This would
suggest movement of air or water across
body surfaces. Examples include hydrotherapy
or fluidotherapy.
3. Conversion is the transfer of heat via a change
in energy which occurs with ultrasound,
infrared lamps, and microwave treatments.
4. Radiation is energy in the form of waves or
moving subatomic particles but is not used
in therapy for pain management.

19

967. The SAID principle (specific adaptation to
imposed demand) of therapeutic exercise for
pain management includes the following:
(1) Stronger muscles develop with strength
training
(2) Oxidative capacities of skeletal muscle
decrease with aerobic training
(3) Pliability of connective tissue increases
with flexibility exercises
(4) Circulation to the brain increases with
aerobic training

967. (B)
1. Many studies show muscle hypertrophy
does occur with specific strength training.
2. Oxidative capacities of skeletal muscle
increase with aerobic training.
3. Stretching exercises work to enhance flexibility
and reduce stress on painful areas.
4. Brain function is not part of the SAID
principle.

20

968. Strength training consists of which type(s) of
muscle contraction?
(1) Isometric
(2) Isotonic
(3) Isokinetic
(4) Isoconcentric

968. (A)
1. Isometric exercise refers to contraction that
does not result in movement at the joint.
Often these exercises are used in the acute
injury setting when movement of the joint
or spine causes extreme pain increase.
2. Isotonic exercise refers to an equivalent
amount of weight being lifted throughout
the range of motion (ROM) of the joint when
contracting the muscle. This is the “traditional”
exercise strength training that patients and
nonpatients participate in. Machines such as
nautilus or free weights may be used.
3. Isokinetic exercise or “equal speed” exercise
is when the speed of movement remains constant.
This goal is for maximum tension to be
applied throughout the entire ROM of the
joint/muscle contraction. Machines must be
used for this type of exercise.
4. Concentric exercise is a shortening
contraction—all three of the above exercises
are examples of concentric exercise.

21

969. Which of these statements is (are) true regarding
lumbosacral (LSO) supports?
(1) There was moderate evidence that LSO
supports were effective for primary low
back pain prevention
(2) There was moderate evidence that LSO
supports were ineffective for primary
low back pain prevention
(3) Lumbar supports are less effective in
reducing back pain than no treatment
(4) Lumbar supports are more effective in
reducing back pain than no treatment

969. (C) The Cochrane back review systematically
examined 13 trials. Five were randomized preventative
trials. Two were nonrandomized
trials. Six were randomized therapeutic trials.
There was moderate evidence that LSO supports
were ineffective for primary low back
pain prevention. Although there was limited
evidence that LSO supports were more effective
than no treatment, there was no evidence
that LSO supports were better than other treatments
for low back pain.

22

970. Acomprehensive, inpatient chronic pain treatment
program advertises that they are CARF
accredited treatment center. CARF is
(1) Commission on Activity with
Rehabilitation Focus
(2) a certification for centers to show that
they have better outcomes for pain
reduction
(3) a certification for centers to show that
they have better outcomes for return to
work
(4) the rehabilitation accreditation
commission

970. (D) CARF (Commission on Accreditation of
Rehabilitation Facilities) accredits a rehabilitation
center if those services meet the standards
outlined in the CARF standards manual. The
CARF accreditation process certifies that the
center meets the highest standards of quality
but does not discuss or look at patient outcomes.
A CARF accredited center meets certain
minimum criteria set out to ensure that
patients receive quality care expected in an
interdisciplinary rehabilitation center.

23

971. Which of these statements regarding exercise is
false?
(1) Several studies indicate an increase in
all-cause mortality with long-term
regular exercise participation
(2) Physical activity is considered a major
risk factor for the development of cardiovascular
disease
(3) Both acute and chronic exercise can
increase blood pressure in the long-term
(4) Most studies indicate that aerobic exercise
training increases plasma triglycerides
and may lower high-density
lipoprotein (HDL) cholesterol

971. (E)
1. Several studies indicate a decrease in allcause
mortality with long-term, regular
exercise participation.
2. Physical inactivity is considered a major
risk factor for the development of cardiovascular
diseases.
3. Both acute and chronic exercise can decrease
blood pressure in the long term.
4. Most studies indicate that aerobic exercise
training decreases plasma triglycerides and
may increase HDL cholesterol.

24

972. Physical effects of aquatic therapy include
(1) increase in cardiac output
(2) decrease in stroke volume
(3) offloading of immersed joints
(4) increased psychological stress due the
aquatic exercise

972. (B)
1. Water immersion results in lowering the pressure
in the venous and lymphatic side of the
circulatory system. This results in increased
central venous pressure and right atrial distension.
Thus with increase in central blood
volume, the atrial pressure rises, the pulmonary
arterial pressure rises, and the cardiac
volume increases. These changes all lead to
an increase in stroke volume and increase in
cardiac output with aquatic exercise.
2. Stroke volume increases with aquatic exercise.
3. As the body immerses in water, the water is
displaced, creating a progressive off-loading
of the immersed joints. A person who is
immersed up to the pelvis has effectively
offloaded 40% of their body weight. This
allows the patient with chronic pain who
may not have been able to exercise because of
severe joint pain to exercise for a much longer
period of time and in an upright position. It is
hoped that the gains seen in the water can
translate to the land.
4. The exercise program decreases stress on
the mind and the body alike.

25

973. The use of muscle relaxants in the rehabilitation
of acute and chronic pain is common. Which of
the following statements is (are) true regarding
these drugs?
(1) Baclofen is a γ-aminobutyric acid
analogue
(2) The active metabolite of cyclobenzaprine
is meprobamate, which is a schedule
intravenous controlled substance
(3) Tizanidine has been shown to be helpful
in treating low back pain in several
studies
(4) Skeletal muscle relaxants, like metaxalone
and cyclobenzaprine, exert their
effects directly on the muscle contractile
mechanism in skeletal muscle

973. (B)
1. Baclofen is a γ-aminobutyric acid agonist
analog, and it inhibits synaptic transmission
in the spinal cord.
2. The active metabolite of carisoprodol, not
cyclobenzaprine, is meprobamate, which is
a schedule IV controlled substance.
3. Several studies have shown the efficacy of
tizanidine in patients with musculoskeletal
back pain with drowsiness being the main
reason for discontinuation.
4. Skeletal muscle relaxants are poorly named
as they have little or no effect on the skeletal
muscle contractile mechanism.

26

974. In acute musculoskeletal injury, which of the
following is (are) direct effect(s) of using cold as
a modality for treatment?
(1) Relieve pain
(2) Increase tissue repair
(3) Reduce hemorrhage
(4) Decrease risk of chromic pain

974. (B) In acute musculoskeletal injuries cold is
often used as part of the PRICE (protection,
rest, ice, compression, and elevation) method.
The effects of cold applied directly to the site of
injury are to reduce hemorrhage and vasodilation,
decrease local inflammatory response and
edema, and to reduce pain. It may also decrease
spasm associated with the injury.

27

975. The following types of pain syndromes have
been found to consistently respond to treatment
with botulinum toxin A:
(1) Myofascial pain
(2) Chronic low back pain
(3) Headache
(4) Tennis elbow

975. (C) Studies on the use of botulinum toxin A
(BTX-A) have been performed for the treatment
of multiple problems in pain management. Most
of the trials have been open label. The trials for
myofascial pain and headaches have been
mixed. Some of the discrepancies may have
been regarding dosing and injection site. There is no clear consensus for or against the use of
BTX-A in either disease. Open label studies on
chronic low back pain have been small but do
seem to have a positive effect. Asmall report in
1999 showed efficacy of BTX-A in tennis elbow,
but little further research has addressed this.

28

976. Which of the following has been validated as
effective in the treatment of neck pain?
(1) Soft collar
(2) Massage
(3) Cervical traction, mechanical traction
(4) Therapeutic exercises

976. (D) In 2001, The Philadelphia Panel for Evidence
Based Clinical Practice Guidelines on Selected
Rehabilitation Interventions for Neck Pain
reported on treatments for neck pain using the
methods defined by the Cochrane collaboration.
They found no evidence to include or exclude
the use of thermotherapy, massage, electrical
stimulation, mechanical cervical traction, and
biofeedback in the treatment of neck pain. They
did find that the only treatment with clinically
important benefits was therapeutic exercises.
Other studies have not found any benefit to any
type of cervical orthosis for the treatment of
neck pain.

29

977. In the treatment of a patient diagnosed with
fibromyalgia syndrome, there is not a clear consensus
on most therapies. Which of the following
is (are) true regarding therapies for
fibromyalgia?
(1) Ultrasound and massage are effective
treatments for the deep muscle aches of
fibromyalgia
(2) Recreational therapy can be an important
aspect of return to socialization
(3) Occupational therapy is less likely to
help return a patient to function than
other forms of therapy
(4) Aerobic exercise is probably the most
important therapeutic treatment for
fibromyalgia

977. (C)
1. Active, not passive, treatments have been
found to be occasionally helpful in treatment
of fibromyalgia. Passive treatments such as
ultrasound, diathermy, and/or massage
have no long-lasting benefit.
2. Often, recreational therapy is important to
get the patient to move more freely and
begin enjoying things again.
3. Occupational therapy can help optimize
ergonomics gait, work, sleep, and play postures.
As such they are very helpful in
returning to functional activities.
4. Aerobic activity is the cornerstone of treatment
for fibromyalgia. At least 20 minutes
per day are recommended. The exact mechanism
of its effectiveness is as of now unclear.

30

978. Which of the following regarding heat and cold
therapies for pain is (are) true?
(1) Both heat and cold have direct effects on
the muscle spindle
(2) Heat and cold are safe modalities and
should be used extensively in the long
term to get the best relief in chronic pain
(3) Both heat and cold can be helpful in
treatment of muscle spasm
(4) Transcutaneous electrical nerve stimulation
(TENS) has been consistently
shown to be helpful in treating chronic
muscle pains

978. (B)
1. and 3. Pain from muscle spasms can be
treated by affecting the muscle spindle.
Spindle firing rates are affected by both heat
and cold. These changes are both direct and
indirect. Use of these modalities may help the
muscle return to its normal resting length, but
the precise mechanism of alleviating muscle
spasm is still under investigation.
2. Heat and cold should be used with caution
and to a limited extent in the rehabilitation
of a chronic pain state.
4. Studies of TENS, acupuncture, and cold laser
have left questions about their usefulness in
reducing discomfort associated with chronic
pain.

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979. Which of the following is (are) true regarding
the treatment and rehabilitation of lateral epicondylitis
(LE)?
(1) The use of extra corporeal shock wave
therapy in LE has been validated and
should be used early on in the disease
process for best results
(2) Counterforce bracing in LE is a common
treatment and has consistently been
found to be of use
(3) Cold therapy has been found to be a
helpful adjunct to treatment of LE
(4) Poor prognosis for recovery and return
of function has been found with
employment in manual jobs

979. (D)
1. Extra corporeal shock wave therapy has had
conflict reports of efficacy by a Cochrane
review.
2. Counterforce bracing is the application of a
non-elastic strap that supports the forearm
in patients with LE. While some studies
have shown efficacy in the treatment of LE,
others have not.
3. A meta-analysis of all therapy modalities
showed no evidence for long-term benefit
for any physical modality.
4. Poor prognosis has been associated with
high level of strain at work, high level of
baseline pain, keyboarding, highly repetitive
monotonous work, and manual jobs.