CCEP Soft Tissue Techniques 5 — Questions and Answers
Question 1: When treating adhesive capsulitis of the glenohumeral joint with soft tissue techniques, the clinician should prioritize which capsular region first due to its greatest contribution to loss of external rotation?
- Posterior capsule and posterior band of the inferior glenohumeral ligament (Correct answer)
- Anterior capsule and subscapularis tendon
- Superior capsule and coracohumeral ligament only
- Inferior capsule and axillary pouch exclusively
Correct answer: Posterior capsule and posterior band of the inferior glenohumeral ligament
The posterior capsule and posterior IGHL are the primary restrictors of external rotation in adhesive capsulitis and must be addressed to restore this motion.
Question 2: Spray and stretch technique for quadratus lumborum trigger points uses a vapocoolant spray directed in which pattern?
- In parallel sweeps from the lower ribs downward to the iliac crest while passively laterally flexing away (Correct answer)
- In circular motions centered over the trigger point for 60 seconds
- Directly over the TrP perpendicular to the skin before any movement
- From distal to proximal along the referral zone before treating the TrP
Correct answer: In parallel sweeps from the lower ribs downward to the iliac crest while passively laterally flexing away
The spray is applied in parallel unidirectional sweeps from the superior to inferior QL attachment (rib to iliac crest) while the clinician simultaneously introduces lateral flexion stretch.
Question 3: Soft tissue treatment for cuboid syndrome following an inversion ankle sprain is most effective when combined with which manipulation?
- Cuboid whip or cuboid notch manipulation to restore its position under the peroneus longus groove (Correct answer)
- High-velocity thrust to the talocrural joint in long axis distraction
- Subtalar joint mobilization into pronation using calcaneal gapping
- First MTP manipulation into dorsiflexion for propulsion restoration
Correct answer: Cuboid whip or cuboid notch manipulation to restore its position under the peroneus longus groove
The cuboid whip manipulation directly addresses the plantar subluxation of the cuboid that disrupts the peroneus longus groove, while soft tissue work releases the surrounding retinacular tension.
Question 4: The concept of 'tissue memory' or 'somatic memory' in myofascial release theory suggests that stored trauma patterns can be addressed through:
- Sustained gentle pressure that allows the tissue to unwind spontaneously through inherent motility (Correct answer)
- Aggressive deep tissue work to mechanically override the stored tension pattern
- Electrical stimulation to reset the neuromuscular engram
- Prolonged ice application to reduce the inflammatory component of tissue memory
Correct answer: Sustained gentle pressure that allows the tissue to unwind spontaneously through inherent motility
Indirect myofascial release uses gentle sustained pressure to allow spontaneous tissue unwinding, theoretically releasing stored mechano-emotional patterns without forcing correction.
Question 5: Cupping therapy applied to the posterior thigh for hamstring flexibility creates its therapeutic effect primarily through:
- Negative pressure that lifts and decompresses superficial and deep fascia layers (Correct answer)
- Positive pressure that compresses adhesions between muscle planes
- Localized hyperthermia that increases collagen extensibility
- Reflexive sympathetic nervous system dampening via cutaneous stimulation
Correct answer: Negative pressure that lifts and decompresses superficial and deep fascia layers
Cupping creates negative pressure (suction) that lifts tissue layers, decompresses fascial planes, and separates inter-tissue adhesions in a way that compression-based techniques cannot.
Question 6: A runner presents with proximal hamstring tendinopathy. Which soft tissue approach is contraindicated because it increases compressive load on the already compromised tissue?
- Deep massage directly over the ischial tuberosity attachment while the hip is in 90 degrees of flexion (Correct answer)
- Longitudinal stripping along the hamstring belly in prone
- Eccentric loading in the mid-range away from full hip flexion
- IASTM applied along the musculotendinous junction in standing
Correct answer: Deep massage directly over the ischial tuberosity attachment while the hip is in 90 degrees of flexion
With proximal hamstring tendinopathy, hip flexion beyond 70 degrees compresses the tendon against the ischium; applying deep massage in this position dramatically worsens compressive tendinopathy.
Question 7: The purpose of post-treatment therapeutic exercise immediately following soft tissue mobilization of the shoulder rotator cuff is to:
- Neurologically re-educate the tissue in its newly available range and integrate the gains (Correct answer)
- Fatigue the muscle to prevent protective guarding during the remainder of the visit
- Increase local lactic acid production to stimulate collagen synthesis
- Test whether the soft tissue treatment achieved adequate depth of penetration
Correct answer: Neurologically re-educate the tissue in its newly available range and integrate the gains
Motor re-education following soft tissue work 'teaches' the nervous system to utilize the newly available tissue mobility, preventing immediate regression to prior movement patterns.
CCEP Soft Tissue Techniques 5
When treating adhesive capsulitis of the glenohumeral joint with soft tissue techniques, the clinician should prioritize which capsular region first due to its greatest contribution to loss of external rotation?