CCEP Soft Tissue Techniques 3 — Questions and Answers
Question 1: Strain-counterstrain (positional release) therapy for a tender point in the anterior talofibular ligament region requires positioning the ankle in:
- Plantarflexion and slight inversion to shorten the involved tissue (Correct answer)
- Maximum dorsiflexion and eversion to stretch the ligament
- Neutral subtalar position with knee flexed to 90 degrees
- Full eversion with external tibial rotation
Correct answer: Plantarflexion and slight inversion to shorten the involved tissue
Counterstrain positions the tissue in its shortened position (plantarflexion and inversion for the ATFL) to reduce mechanoreceptor firing and release the tender point.
Question 2: Which soft tissue approach is most evidence-supported for treating lateral epicondylalgia (tennis elbow) in a subacute presentation?
- Eccentric exercise combined with deep transverse friction massage to the ECRB (Correct answer)
- Cryotherapy alone applied for 20-minute sessions
- Superficial effleurage massage without tissue deformation
- Static stretching of the wrist extensors for 30 seconds only
Correct answer: Eccentric exercise combined with deep transverse friction massage to the ECRB
Eccentric loading combined with deep transverse friction to the ECRB targets the degenerative tendinopathy pathology and stimulates collagen remodeling.
Question 3: Proprioceptive Neuromuscular Facilitation (PNF) Contract-Relax technique for hip flexor tightness affecting gait works primarily through:
- Autogenic inhibition via Golgi tendon organ activation during isometric contraction (Correct answer)
- Reciprocal inhibition of the gluteus maximus during hip flexor contraction
- Mechanical elongation of sarcomeres without neurological input
- Gamma motor neuron suppression from spindle unloading
Correct answer: Autogenic inhibition via Golgi tendon organ activation during isometric contraction
The isometric contraction in Contract-Relax activates Golgi tendon organs, which reflexively inhibit the same muscle via Ib afferents, allowing greater subsequent lengthening.
Question 4: During IASTM treatment of the wrist flexor tendons, the clinician notices petechiae forming under the skin. The correct interpretation is:
- A normal tissue response indicating microtrauma-stimulated healing is occurring (Correct answer)
- A sign of severe pathology requiring immediate cessation and medical referral
- Evidence of a coagulation disorder requiring immediate cessation
- An allergic reaction to the instrument material requiring a different tool
Correct answer: A normal tissue response indicating microtrauma-stimulated healing is occurring
Petechiae during IASTM represent expected microtrauma to hypovascular tissue, triggering a local inflammatory healing cascade that is part of the intended therapeutic mechanism.
Question 5: The myofascial technique known as 'skin rolling' is most useful for assessing and treating which condition?
- Superficial fascial restrictions and cutaneous hypersensitivity zones (Correct answer)
- Deep ligamentous adhesions below the muscle layer
- Intra-articular adhesions of the hip joint
- Neurovascular bundle entrapments in fascial tunnels
Correct answer: Superficial fascial restrictions and cutaneous hypersensitivity zones
Skin rolling lifts and rolls the superficial fascia and dermis, revealing restrictions and treating cutaneous hypersensitivity zones that accompany somatic dysfunction.
Question 6: When applying manual lymphatic drainage (MLD) to a post-surgical ankle, which sequence is correct?
- Proximal clearance of inguinal nodes first, then progress distally toward the ankle (Correct answer)
- Begin at the ankle edema and drain distally toward the foot
- Start at the popliteal nodes and work simultaneously up and down
- Treat the ankle first to mobilize fluid before opening proximal channels
Correct answer: Proximal clearance of inguinal nodes first, then progress distally toward the ankle
MLD requires proximal clearance first — the inguinal and popliteal nodes must be opened before distal fluid is mobilized to avoid creating a 'traffic jam.'
Question 7: Soft tissue mobilization of the carpal tunnel region to address median nerve tension should include treatment of which proximal structure to maximize neurodynamic mobility?
- Pronator teres, brachialis, and pectoralis minor along the median nerve course (Correct answer)
- Extensor digitorum communis and posterior interosseous nerve
- Flexor carpi ulnaris and Guyon's canal contents
- Anterior scalenes targeting the ulnar nerve corridor
Correct answer: Pronator teres, brachialis, and pectoralis minor along the median nerve course
The median nerve traverses the pronator teres and passes beneath pectoralis minor; treating these proximal restrictions restores neurodynamic mobility throughout the entire nerve path.
CCEP Soft Tissue Techniques 3
Strain-counterstrain (positional release) therapy for a tender point in the anterior talofibular ligament region requires positioning the ankle in: