CMT Manual Therapy Techniques & Approaches 3 — Questions and Answers
Question 1: In Kaltenborn's approach, what is the resting (loose-packed) position of the glenohumeral joint?
- Full abduction and external rotation
- 70° abduction and 10° horizontal adduction (Correct answer)
- 90° abduction with neutral rotation
- Arm at side with slight internal rotation
Correct answer: 70° abduction and 10° horizontal adduction
The resting position of the glenohumeral joint is approximately 70° abduction and 10° horizontal adduction, where joint congruency is minimal.
Question 2: Which of the following best describes a Grade V manipulation (thrust technique)?
- Large-amplitude passive movement through full range
- High-velocity low-amplitude thrust at the end of range (Correct answer)
- Sustained stretch at the limit of range
- Rhythmic oscillation within the pain-free range
Correct answer: High-velocity low-amplitude thrust at the end of range
Grade V manipulation is a high-velocity low-amplitude (HVLA) thrust delivered at or near the end of the available range to restore joint motion.
Question 3: The concept of 'joint play' as described by Mennell refers to:
- Active range of motion available at a joint
- Passive accessory movement not under voluntary control (Correct answer)
- The elastic zone before the physiological limit
- The range gained after joint manipulation
Correct answer: Passive accessory movement not under voluntary control
Mennell's joint play describes the passive accessory movements within a joint that cannot be produced by voluntary muscle action.
Question 4: During lumbar spine PA mobilization in prone, which structure is primarily being mobilized when pressure is applied over the spinous process?
- Intervertebral disc nucleus
- Zygapophyseal (facet) joints (Correct answer)
- Sacroiliac joint
- Costovertebral joint
Correct answer: Zygapophyseal (facet) joints
Posteroanterior pressure on lumbar spinous processes primarily creates movement at the zygapophyseal joints of that motion segment.
Question 5: Which manual therapy technique is specifically contraindicated in a patient with acute vertebrobasilar artery insufficiency?
- Lumbar traction
- Cervical HVLA manipulation (Correct answer)
- Sacroiliac muscle energy technique
- Thoracic grade III mobilization
Correct answer: Cervical HVLA manipulation
Cervical HVLA manipulation is absolutely contraindicated with vertebrobasilar insufficiency due to risk of vertebral artery dissection and stroke.
Question 6: In neural mobilization, a 'slider' technique differs from a 'tensioner' technique in that sliders:
- Apply more longitudinal tension to the nerve
- Move the nerve through surrounding tissue with less tension (Correct answer)
- Require active patient movement only
- Target only the brachial plexus
Correct answer: Move the nerve through surrounding tissue with less tension
Neural sliders move the nerve through its bed by adding tension at one end while releasing it at the other, reducing overall nerve tension.
Question 7: The lumbar lateral shift correction technique is indicated when the patient presents with:
- Bilateral symmetrical lumbar flexion restriction
- Antalgic lateral deviation of the trunk away from the painful side (Correct answer)
- Hypermobile lumbar spine with instability
- Posterior element pain without disc involvement
Correct answer: Antalgic lateral deviation of the trunk away from the painful side
Lateral shift correction targets contralateral trunk list (deviation away from the painful side), often associated with lumbar disc herniation.
CMT Manual Therapy Techniques & Approaches 3
In Kaltenborn's approach, what is the resting (loose-packed) position of the glenohumeral joint?