NCBTMB Exam Massage Application and Techniques 6

Question 1

A client presents with chronic adhesive capsulitis of the shoulder. During treatment, the therapist identifies a specific pattern of capsular tightening most restrictive in external rotation, followed by abduction, then internal rotation. Which term best describes this pattern and what does it indicate about tissue targeting?

Accepted Answer

Cyriax capsular pattern; the therapist should prioritize deep transverse friction to the anterior capsule before any stretching techniques

Answer

Cyriax described the capsular pattern for the glenohumeral joint as greatest restriction in external rotation, followed by abduction, then internal rotation. In adhesive capsulitis, the anterior capsule is heavily involved and responds best to deep transverse friction (DTF) to break down adhesions before stretching, making this the most clinically appropriate and complete answer.

Question 2

While performing neuromuscular therapy on a client's right piriformis, the therapist applies sustained ischemic compression to a trigger point for 8–12 seconds and releases. The client then reports a referral pattern down the posterior thigh that mimics sciatica. What is the MOST clinically significant distinction the therapist must consider before continuing?

Accepted Answer

Whether the referred pain is myofascial in origin or indicates true sciatic nerve entrapment by the piriformis, as compression techniques are contraindicated if neurological signs such as paresthesia or weakness are present

Answer

The piriformis can compress the sciatic nerve, producing piriformis syndrome with neurological symptoms. A myofascial referral pattern alone does not indicate nerve compromise, but if paresthesia, numbness, or weakness accompanies the referral, this signals possible neural entrapment rather than pure trigger point activity. Continuing ischemic compression in the presence of active neurological signs risks exacerbating nerve irritation and is contraindicated until the condition is further evaluated.

Question 3

A therapist is using proprioceptive neuromuscular facilitation (PNF) stretching on a client's hip flexors. After the client performs a 6-second isometric contraction against the therapist's resistance, the therapist moves the limb into a new range. Which neurophysiological mechanism is the therapist PRIMARILY exploiting during the subsequent passive phase, and what is the recommended window to take advantage of it?

Accepted Answer

Autogenic inhibition via Golgi tendon organ (GTO) activation, with the new stretch applied within approximately 2–3 seconds after contraction ends to capture the refractory period

Answer

In contract-relax PNF, the sustained isometric contraction activates Golgi tendon organs, which fire Ib afferents to inhibit the alpha motor neurons of the same muscle (autogenic inhibition), producing a brief window of reduced muscle tone. The therapist must move into the new range quickly — within roughly 2–3 seconds — because this neurally mediated inhibition is transient and the muscle's protective tone will return if the therapist delays.

Question 4

During a session using myofascial release (MFR) on the thoracolumbar fascia, a seasoned therapist applies a sustained, low-load, slow-speed drag across the tissue and waits for a release. A student observing asks why the therapist does not simply use deeper, faster pressure to save time. Which answer BEST captures the biophysical rationale for the MFR approach?

Accepted Answer

Fascia exhibits viscoelastic and thixotropic properties; sustained low-load stress allows the ground substance to shift from a gel to a sol state and permits collagen fiber realignment, whereas rapid high-load force triggers a protective elastic rebound without lasting deformation

Answer

Fascia is both viscoelastic (deforms under sustained load and recovers slowly) and thixotropic (transitions from a more gel-like to a more fluid state with sustained mechanical input). Rapid, high-force techniques exploit the elastic component and generate an immediate rebound without producing lasting tissue change. Slow, sustained loading allows creep deformation of the collagen matrix and a phase change in the ground substance, creating the conditions for lasting release and fiber realignment.

Question 5

A therapist is treating a client recovering from a Grade II medial collateral ligament (MCL) sprain of the knee, now 6 weeks post-injury and cleared for soft tissue work. The therapist plans to apply Cyriax deep transverse friction (DTF) to the ligament. Which of the following represents the MOST critical technical consideration that distinguishes proper DTF from standard cross-fiber friction at this stage?

Accepted Answer

DTF must be applied transversely across the ligament fibers with sufficient depth to reach the ligament itself, performed on a broadened and taut structure held in a position that places the MCL under slight tension — not slack — to ensure proper fiber engagement and stimulate organized collagen remodeling

Answer

Cyriax's DTF protocol for ligaments requires the tissue to be under slight tension (not slack) so the fibers are taut and accessible, and friction must be delivered perpendicular to fiber direction with enough depth to contact the ligament itself. This creates controlled microtrauma that stimulates fibroblast activity and promotes parallel, organized collagen deposition rather than disorganized scar tissue. Applying DTF to a slackened ligament or using longitudinal strokes defeats the mechanism of action.

NCBTMB Exam Practice Test

NCBTMB Exam Practice Test

NCBTMB Exam Massage Application and Techniques 6