CCSP - Certified Chiropractic Sports Physician Adjunctive Sports Therapies Questions and Answers — Questions and Answers
Question 1: A CCSP is treating an athlete with chronic Achilles tendinosis using Instrument Assisted Soft Tissue Mobilization (IASTM). What is the primary intended physiological effect of this therapy for this specific condition?
- To break down mature, well-organized collagen fibers from a previous injury.
- To stimulate a controlled local inflammatory response and fibroblastic proliferation. (Correct answer)
- To increase lymphatic drainage and rapidly reduce acute edema.
- To directly decrease nerve conduction velocity for immediate pain relief.
Correct answer: To stimulate a controlled local inflammatory response and fibroblastic proliferation.
In chronic tendinopathies, the healing process has stalled in a degenerative state (tendinosis). The goal of IASTM is to create controlled microtrauma, which re-initiates the normal inflammatory-healing cascade. This stimulates fibroblastic activity, leading to the synthesis of new, more organized collagen and remodeling of the tissue.
Question 2: An athlete is in the early post-operative phase following an ACL reconstruction and is exhibiting significant quadriceps inhibition and atrophy. Which form of electrical stimulation is MOST appropriate for addressing muscle re-education and preventing further disuse atrophy?
- Interferential Current (IFC)
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Neuromuscular Electrical Stimulation (NMES) (Correct answer)
- High-Voltage Pulsed Current (HVPC) for edema control
Correct answer: Neuromuscular Electrical Stimulation (NMES)
Neuromuscular Electrical Stimulation (NMES) is specifically designed to depolarize motor nerves to elicit a muscle contraction. Its primary use in rehabilitation is for muscle re-education, strengthening, and preventing disuse atrophy, which are the key goals for quadriceps recovery post-ACL surgery. TENS and IFC are primarily used for pain modulation, and while HVPC can be used for edema, it is not the primary choice for muscle re-education.
Question 3: Which of the following is considered a primary contraindication for the application of therapeutic cupping?
- Over an area of dense muscle tissue like the quadriceps.
- On a patient with myofascial trigger points in the upper trapezius.
- Directly over the antecubital fossa. (Correct answer)
- On the lumbar paraspinals of a patient with mechanical low back pain.
Correct answer: Directly over the antecubital fossa.
The antecubital fossa is a significant area of precaution and often a contraindication for cupping because it contains superficial and vital structures, including the brachial artery, median nerve, and major veins. Applying strong negative pressure in this area risks damage to these structures. The other options are common and appropriate sites for cupping.
Question 4: A collegiate swimmer is being treated with Low-Level Laser Therapy (LLLT), also known as photobiomodulation, for supraspinatus tendinopathy. The primary proposed mechanism of action at the cellular level is:
- Deep tissue heating through the conversion of light to thermal energy.
- Inhibition of nociceptors through the gate control theory of pain.
- Acoustic micro-streaming that alters cell membrane permeability.
- Absorption of photons by mitochondria, leading to increased ATP production. (Correct answer)
Correct answer: Absorption of photons by mitochondria, leading to increased ATP production.
The leading theory behind photobiomodulation (LLLT) is that specific wavelengths of light are absorbed by chromophores within the mitochondria (specifically cytochrome c oxidase). This absorption is believed to enhance the electron transport chain, leading to increased ATP synthesis, reduced oxidative stress, and modulation of inflammatory mediators, which collectively promotes tissue healing.
Question 5: A soccer player presents with patellofemoral pain syndrome, and the clinical exam suggests an overactive Tensor Fasciae Latae (TFL) and underactive Vastus Medialis Oblique (VMO). When applying kinesiology tape based on the theory of 'inhibition,' how should the tape be applied to the TFL?
- From the origin of the TFL to its insertion with a 50-75% stretch.
- Circumferentially around the thigh at the level of the TFL with maximal stretch.
- From the insertion of the TFL (at the IT band) towards its origin with a light (15-25%) stretch. (Correct answer)
- With a 'star' pattern directly over the point of maximum tenderness with no stretch.
Correct answer: From the insertion of the TFL (at the IT band) towards its origin with a light (15-25%) stretch.
According to common kinesiology taping theory, to inhibit or reduce the activity of an overactive muscle, the tape should be applied from the insertion of the muscle towards its origin. This direction of pull is thought to reduce neuromuscular facilitation. A light, paper-off stretch (15-25%) is used for this technique. Applying from origin to insertion is typically done to facilitate a muscle.
Question 6: Which of the following best describes the combined physiological rationale for using an intermittent pneumatic compression (IPC) device with cryotherapy in the acute management of a Grade II lateral ankle sprain?
- To create a cycle of vasodilation and vasoconstriction, known as the 'hunting response,' to increase blood flow.
- To limit edema formation via external pressure while reducing cellular metabolic demand to limit secondary hypoxic injury. (Correct answer)
- To stimulate fibroblastic proliferation and accelerate the formation of scar tissue in the affected ligaments.
- To cause deep tissue analgesia through nerve hyperstimulation while breaking up early hematoma formation.
Correct answer: To limit edema formation via external pressure while reducing cellular metabolic demand to limit secondary hypoxic injury.
The combination of cryotherapy and IPC is highly effective in the acute phase of injury. The cold therapy (cryotherapy) causes vasoconstriction and decreases the local metabolic rate of cells, which helps limit swelling and reduces the need for oxygen, thereby minimizing secondary hypoxic injury to surrounding tissues. The intermittent compression increases external hydrostatic pressure, which further limits edema formation and assists in lymphatic drainage.
CCSP - Certified Chiropractic Sports Physician Adjunctive Sports Therapies Questions and Answers
A CCSP is treating an athlete with chronic Achilles tendinosis using Instrument Assisted Soft Tissue Mobilization (IASTM).
What is the primary intended physiological effect of this therapy for this specific condition?