PCE Musculoskeletal Physiotherapy and Manual Therapy 2 — Questions and Answers
Question 1: In the Maitland grading system, which grade describes a high-velocity, low-amplitude thrust beyond the normal range of motion?
- Grade II
- Grade III
- Grade IV
- Grade V (Correct answer)
Correct answer: Grade V
Grade V is Maitland's manipulation grade, performed beyond the anatomical limit of range using a high-velocity, low-amplitude thrust technique.
Question 2: A patient presents with a positive FABER test (pain in the posterior pelvis). Which structures are most likely implicated?
- ACL and posterior cruciate ligament
- Sacroiliac joint or hip joint (Correct answer)
- Lumbar facet joints at L4-L5
- Piriformis and sciatic nerve
Correct answer: Sacroiliac joint or hip joint
The FABER test (Flexion, Abduction, External Rotation) stresses both the sacroiliac joint and the hip joint; posterior pelvis pain during this test implicates the sacroiliac joint.
Question 3: According to the convex-concave rule, to increase glenohumeral internal rotation, the therapist should glide the convex humeral head in which direction?
- Anteriorly, because glide follows the direction of movement
- Superiorly, to decompress the joint
- Posteriorly, opposite to the direction of movement (Correct answer)
- Inferiorly, to distract the joint
Correct answer: Posteriorly, opposite to the direction of movement
When a convex surface (humeral head) moves on a fixed concave surface (glenoid), the joint glide is in the opposite direction to the intended bone movement — a posterior glide increases internal rotation.
Question 4: A patient with low back pain centralizes with lumbar extension. According to the McKenzie Method, which treatment is MOST indicated?
- Lateral flexion stretching
- Lumbar extension exercises (Correct answer)
- Lumbar flexion exercises
- Traction in neutral spine
Correct answer: Lumbar extension exercises
The McKenzie directional preference principle dictates that when symptoms centralize with extension, extension exercises are the primary treatment approach.
Question 5: Which of the following findings on the Ottawa Ankle Rules warrants an ankle radiograph?
- Tenderness over the anterior talofibular ligament
- Inability to bear weight immediately after injury and during assessment (Correct answer)
- Swelling localized to the lateral malleolus
- Tenderness over the Achilles tendon
Correct answer: Inability to bear weight immediately after injury and during assessment
The Ottawa Ankle Rules indicate radiography when the patient cannot take four steps (bear weight) both immediately after injury and during the clinical evaluation.
Question 6: The Hawkins-Kennedy test for shoulder impingement is performed by placing the shoulder at 90° of flexion and then:
- Applying external rotation to compress the infraspinatus
- Applying internal rotation to compress the supraspinatus under the coracoacromial arch (Correct answer)
- Applying horizontal adduction to stress the acromioclavicular joint
- Applying a downward force to assess labral pathology
Correct answer: Applying internal rotation to compress the supraspinatus under the coracoacromial arch
The Hawkins-Kennedy test compresses the supraspinatus tendon under the coracoacromial arch by internally rotating the shoulder held at 90° of flexion.
Question 7: Which outcome measure is most widely validated for assessing pain and function in patients with hip and knee osteoarthritis?
- Oswestry Disability Index (ODI)
- Neck Disability Index (NDI)
- DASH questionnaire
- WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) (Correct answer)
Correct answer: WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
The WOMAC is specifically designed and validated for hip and knee osteoarthritis, measuring pain, stiffness, and physical function across 24 items.
PCE Musculoskeletal Physiotherapy and Manual Therapy 2
In the Maitland grading system, which grade describes a high-velocity, low-amplitude thrust beyond the normal range of motion?