Injury Prevention and Rehabilitation for Active Older Adul. · Injury Prevention and Rehabilitation for Active Older Adults After completing this program, the participant will be

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Injury Prevention & Rehab forActive Older Adults

CORRESPONDENCE EDUCATION PROGRAM # 2013-84

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Learning Objectives:Injury Prevention and Rehabilitation for Active Older Adults

After completing this program, the participant will be able to:

1. Review and understand the normal structure and function of bone, cartilage, jointstructures, tendons, and muscle.

2. List and understand physiologic changes associated with aging that affectneuromuscular function.

3. Understand the changes that occur to bone, cartilage, joint structures, tendons, andmuscles with increasing age.

4. Understand the importance of maintaining musculoskeletal function in the lives ofactive older adults.

5. Describes the effects of strength training in older adults.

6. Understand the different requirements for strength and cardiovascular testing in olderadults.

7. Develop a strength training and cardiovascular exercise prescription for older adults.

8. List and understand strength training principles and common systems of training.

9. Understand the concept of a kinetic chain and its implications for normal movement,injury, evaluation, and treatment.

10. Have a basic understanding how understanding the kinetic chain is important withplantar fasciitis, Achilles tendinitis, anterior medial knee pain, chronic hamstring musclestrain, low back pain, rotator cuff tendinitis, lateral elbow tendinitis, and wrist tendinitis.

11. List age-related changes to soft tissues and understand how these changes affectposture.

12. Understand the importance of and guidelines for stretching/flexibility.


13. Know the difference between active and passive stretching, and know the procedurefor basic stretches including stretches for: cervical extensors, pectorals, latissimus,infraspinatus, rhomboids, traps, hamstrings, quadriceps, hip flexors, calves, hipadductors, Iliotibial band, and low back.

14. Understand the basics of massage and its effects.

15. Understand basic nutrition requirements for older adults, its effect on bone health, andthe prevention of dehydration.

16. Describes changes to the shoulder girdle and joint associated with increasing age,including the predisposing factors to rotator cuff pathology.

17. Describe common elbow injuries and basic treatment guidelines for older adults,including humeral epicondylitis and valgus extension overload injuries.

18. Understand hand and wrist problems that will impact quality of life in older adultsand their basic management.

19. Understand the etiology, diagnosis, basic treatment, and rehabilitation of backproblems in older adults.

20. Understand the etiology, diagnosis, basic treatment, and rehabilitation of hip, knee,ankle, and foot pathology in older adults.


CEC/CEU TEST FOR:Injury Prevention and Rehabilitation for Active Older Adults

Please choose the best answer. Put all answers on the answer sheet.

1. With advanced age, there is an age-related decline in:a. Proprioception.b. Lean muscle mass.c. Balance.d. All of the above.

2. Which of the following is a physiological change related to aging?a. Increased neurotransmitter levelsb. Increased cell functionc. Increased cardiac outputd. Biochemical and functional changes in neuromuscular function

3. Bone is a composite tissue made of:a. Type I collagen.b. Hydroxyapatite.c. Osteocalcin.d. All of the above

4. Type I collagen is a ___________helix structure, which provides tensile strength tobone.a. Singleb. Doublec. Tripled. Quadruple

5. The cells responsible for bone formation are called:a. Osteoclastsb. Osteoblastsc. Osteocytesd. None of the above


6. Besides acting as a structural support, which of the following is a function of bone?a. Production of red blood cellsb. Calcium storage and homeostasisc. Buffer to excessive changes in blood pH.d. All of the above

7. Osteopenia leading to osteoporosis will not be seen as a visible loss of bone on X-raysuntil ______ to ________ percent of bone mineral loss has occurred.a. 20 to 40b. 30 to 50c. 40 to 60d. 50 to 70

8. All of the following will increase the development of osteoporosis except:a. Cancer.b. Diabetes.c. Immobilization.d. Proper nutrition.

9. Osteonecrosis is also known as:a. Osteopenia.b. Necrotyzing fascitis.c. Avascular Necrosis.d. Gaucher’s disease.

10. Which of the following is the leading cause of physical disability in the UnitedStates?a. Heart disease.b. Cancer.c. Osteoarthritis.d. Stroke.

11. Cartilage is made primarily from what type of collagen?a. Type I.b. Type II.c. Type III.d. Type IV.

12. Cartilage derives its nutrition from the:a. Blood vessels surrounding the joint.b. Lymphatic vessels.c. Synovial fluid.d. Bone marrow.


13. The layer of cartilage which is best for resisting shearing forces on the joint is the:a. Superficial layer.b. Middle zone.c. Lower zone.d. Deep zone.

14. Which of the following is a result of cartilage injury?a. Chondrocyte damage.b. Proteoglycan structure disruption.c. Increased collagen concentration.d. All of the above.

15. Grade IV cartilage damage is characterized by:a. Softening of the cartilage.b. Fibrillation of the cartilage.c. Fissuring of the cartilage.d. Cartilage loss with exposure of the underlying bone.

16. The main role of a meniscus is to:a. Resist shearing force.b. Distribute joint forces and act as a shock absorber for the joint.c. Serve as an attachment for cartilage.d. Maintain joint stability and proteoglycan content.

17. Which of the following can result from injury to the meniscus?a. Decreased congruity in the articulation of the bones in the joint.b. Increased forces on the bones comprising the joint.c. Damage to articular cartilage resulting in premature onset of arthritis.d. All of the above.

18. The peripheral 10-25% of the meniscus with the best vasculature is called the:a. Red-grey zone.b. Red-white zone.c. Red-red zone.d. White-white zone.

19. Within the meniscus in the knee, where are most complex tears found?a. The outer 2/3’sb. The inner 1/3c. The outer ¼d. The medial ½


20. In a knee with a torn anterior cruciate ligament, the joint can still have stable functionbecause:a. the meniscus can function as a knee stabilizer.b. The posterior cruciate ligament can function as a sole stabilizer of the knee.c. The medial and lateral collateral ligaments can prevent anterior instability.d. None of the above.

21. The labrum surrounding the glenoid of the shoulder joint acts to:a. Increase range-of-motion of the shoulder joint.b. Increase the stability of the shoulder joint,c. Decrease the stability of the shoulder.d. Decrease joint integrity.

22. The loss of the labrum’s extra-cellular matrix properties with increasing age resultsin:a. Altered patterns of joint loading.b. Increased vascularity.c. Increased risk of meniscus damage.d. None of the above.

23. A change in ligaments seen with increasing age is:a. Decreased water content.b. Increased dry collagen content.c. Less metabolically active fibroblasts.d. All of the above.

24. The hard, outer portion of the intervertebral discs is known as the:a. Annulus pulposus.b. Annulus fibrosis.c. Nucleus pulposus.d. Nucleus fibrosis.

25. Which type of cartilage makes up the nucleus pulposus?a. Type I cartilage.b. Type II cartilage.c. Type III cartilage.d. Type IV cartilage.

26. In what way does the nucleus pulposus obtain its nutrient supply?a. Diffusion.b. Osmosis.c. Convection.d. None of the above.


27. The annulus fibrosis has a water content of:a. 40 to 50%.b. 50 to 60%.c. 60 to 70%.d. > 70%.

28. A change to the intervertebral disc associated with aging is:a. Decreased gelatinous nucleus.b. Decreased notochordal cells.c. A presence of a transitional zone.d. All of the above.

29. What is the percentage of necrotic cells in the intervertebral discs in the elderly?a. 60%b. 70%c. 80%d. None of the above.

30. The most abundant proteoglycan molecule in tendons, aggregating chondroitansulfate, is also known as:a. Fibronectin.b. Aggrecan.c. Relaxin.d. Biglycan.

31. Changes in a tendon associated with aging include all of the following except:a. Decreased tendon diameter.b. Decreased cell count.c. Decreased fibroblast activity.d. Decreased dry weight of both collagen and its cross-links.

32. All of the following are changes in muscle associated with aging except:a. Increased contractile proteins.b. Decreased oxidative capacity.c. Decreased strength.d. Decreased levels of thyroxin.

33. With increasing age, it becomes crucial to help maintain the structure and function ofthe musculoskeletal system through:a. Patient education.b. Physical therapy/Rehab.c. Exercise.d. All of the above.


34. Which of the following is an accurate statistic regarding aging?a. Increased blood pressure and total peripheral resistance.b. Decreased maximum heart rate, stroke volume, cardiac output, contractility, arterial-venous oxygen difference, and ejection fraction.c. 5% to 20% decrease in VO2 max per decade after age 25.d. All of the above.

35. Aging is associated with:a. An increase in pulmonary function.b. An increase in plasma volume.c. An increase in insulin resistance.d. An increase in bone mineral density of approximately 1% per year.

36. The percentage of adults in the U.S. who do not engage in regular physical activity is:a. 50%.b. 60%.c. 70%.d. 80%.

37. Which type of exercise has been shown to have a positive impact in aging adults, andin some cases, reverse most physiologic changes associated with aging?a. Aerobic trainingb. Anaerobic trainingc. Strength trainingd. All of the above.

38. Which of the following is an end-result of high intensity resistance training in olderadults?a. Decreased risk of injuries.b. Enhanced rehabilitation.c. Decreased risk of coronary heart disease.d. All of the above.

39. A beneficial effect of strength training in older adults is:a. An increase in osteopenia.b. A negative effect on pain or disability in individuals with osteoarthritis.c. Increased ligament and tendon strength and thickness.d. An increase in glucose intolerance and insulin resistance.

40. Which of the following is considered the gold standard for strength testing?a. 1-repetition maximum.b. Curl-up test.c. Sit and reach test.d. The bench press test.


41. The valsalva maneuver results in:a. Increased cardiac output.b. Increased blood pressure and decreased venous return.c. Increased VO2max.d. Increased stroke volume.

42. The best choice of exercise to test lower extremity strength in an older adult would bea:a. Barbell squat.b. Dumbbell squat.c. Machine leg press.d. Machine leg extension.

43. A test which will measure both lower extremity strength and power is:a. the 3-minute Step Test.b. Wall squats.c. Sit to standd. None of the above.

44. A test which measures both upper extremity muscular strength and endurance is the:a. Barbell bench press test.b. Machine bench press test.c. Body weight push-up test.d. Lat pulldown.

45. Training principles to take into account when creating an exercise prescription are:a. Progressive overload and intensity.b. Total volume and rest intervals.c. Duration, frequency, and mode.d. All of the above.

46. A strength training intensity of approximately _______ has been shown to be veryeffective in increasing both strength and hypertrophy in older adults.a. 60%b. 70%c. 80%d. 90%

47. Three sets of 12 repetitions of a leg press with 250 lbs is a training volume of:a. 3000.b. 6000.c. 9000.d. None of the above.


48. Intensity, duration, frequency or mode is typically changed after _____ to _____weeks of training.a. 4 to 12b. 8 to 20c. 16 to 24d. 24 to 36

49. What is the increased protein requirement for older adults to prevent muscle atrophy?a. 0.8 to 1.0b. 1.0 to 1.6c. 1.6 to 2.0d. 2.0 to 2.4

50. An advantage of resistance training with machines is:a. It is safe and easy.b. Optimal muscle isolation.c. A spotter is not necessary.d. All of the above.

51. A disadvantage of variable resistance machines is:a. They require little time to set up or change the weight.b. They lack specificity to most movements that occur in daily life.c. They require balancing the weight during lifting through a range of motion.d. None of the above.

52. An advantage of free weight exercises is:a. They are heavy and bulky.b. They do not require stabilization by secondary muscles.c. They provide range of motion and muscle activation patterns similar to those in dailyactivity.d. All of the above.

53. Periodically changing training intensities, volumes, and exercises to continuestimulating muscles and connective tissue is called:a. Circuit training.b. Periodization.c. Interval training.d. None of the above.

54. In the preparatory phase of a periodization plan, the higher volume-lower intensitytraining will:a. Result in significant muscle hypertrophy and strength gains.b. Increase muscular power.c. Require more muscle activity from synergists and stabilizer muscles.d. Allow the muscles and connective tissue to gradually adapt to new stress and decreasethe risk of injury.


55. The strength phase of a periodization cycle involves training at an intensity of:a. 60% to 70%.b. 70% to 80%.c. 85% to 90%.d. 90% to 95%.

56. Which of the following principles states that unfit people achieve and lose strengthgains at a faster rate than trained individuals?a. Specificity principleb. SAID principlec. Reversibility principled. Fitness principle

57. Which of the following applies to isometric training?a. It occurs when there is tension in the muscle without a change in muscle length.b. It is frequently used in rehabilitation settings joint movements are contraindicated.c. It is not an effective form of strength training for athletes or higher level individuals.d. All of the above.

58. A type of training that involves moving through a range of motion at a constant speedis:a. Isometric training.b. Isokinetic training.c. Eccentric training.d. Dynamic training.

59. Which of the following statements regarding single set versus multi-set systems istrue?a. Studies have shown that in people greater than 50 years of age, a single set ofrepetitions is preferred.b. Multi-set training produces the same strength gains as single set training.c. Multi-set training is better than single set training at maximizing strength and powergains.d. None of the above.

60. Which of the following statements accurately describes the DeLorme system oftraining?a. The initial set is heavy and each subsequent set progressively decreases the resistance.b. The initial set is light and each subsequent set has progressively greater resistance.c. Multiple sets are performed with a constant resistance.d. None of the above.


61. Which of the following regarding a superset system is not correct?a. It consists of multiple exercises that work the same muscle group, with little or no restin between.b. It is performing multiple exercises that work opposing muscle groups, with little or notrest in between.c. It is common in bodybuilding, and results in muscle hypertrophy.d. None of the above.

62. The circuit system of training:a. Consists of multiple exercises using low reps and high intensities.b. Requires increased rest intervals between exercises.c. Is most beneficial for those wanting to develop cardiovascular fitness and muscularendurance.d. Involves adding cardiovascular activities in between strength training exercises.

63. A beneficial cardiovascular effect of aerobic training in older adults is:a. Decreased mortality from all causes.b. Decreased blood pressure.c. An increase in HDL and a decrease in LDL.d. All of the above.

64. Major risk factors for cardiovascular disease include all of the following except:a. Family history of heart disease.b. Current cigarette smoking.c. HDL cholesterol greater than 130 mg/dL.d. Body mass index > 30 kg/m2.

65. Which of the following is an absolute indication for terminating exercise testing?a. BP > 250/115b. Chest pain, dizziness, or fainting.c. Subject’s desire to stop.d. All of the above.

66. A gold standard for assessing cardiorespiratory fitness which directly measuresVO2max is the:a. Bruce Treadmill Testb. Astrand-Ryhming 6-Minute Cycle Testc. Rockport 1-Mile Walk Submaximal Field Test.d. Single-Stage Treadmill Walking Test.

67. The ACSM minimum recommendation for activity in adults is:a. 20 to 60 minutes of aerobic activity 3 days per weekb. 30 minutes or more of moderate intensity physical activity on most days of the week.c. 30 minutes of light intensity activity three days per week.d. None of the above.


68. An advantage of high-intensity training over low-intensity training is:a. Increased total energy expenditure is inversely related to mortality.b. Improved adherencec. Decreased risk of musculoskeletal injury.d. All of the above.

69. Excess Postoxygen consumption (EPOC) refers to:a. The energy requirement of an activity.b. The cardiovascular response to exercise.c. The increased amount of oxygen consumed immediately after exercise to restorehomeostasis of the body.d. None of the above.

70. What are the three components of a kinetic chain that must be coordinated to createactivity?a. Muscle activation.b. Mobilization.c. Stabilization.d. All of the above.

71. What are the three elements of an effective kinetic chain?a. Intact or functionally intact anatomyb. Appropriate physiological muscle activationc. Appropriate biomechanical forces and motionsd. All of the above

72. All of the following are changes seen in older adults which will decrease the inherentcapability of muscles to protect themselves from injury except:a. Increased eccentric muscle activation for load absorption.b. Decreased anaerobic endurance.c. Decreased force and power development.d. Loss of flexibility.

73. All of the following are associated with Achilles tendonitis except:a. Tenderness and/or swelling on the Achilles tendon with/without a palpable knot.b. Quadriceps/Iliotibial band inflexibility.c. Decreased active ankle dorsiflexion.d. Decreased ankle inversion/eversion control.

74. Pain over the anterior or lateral acromion and pain and weakness with horizontaladduction, forward flexion, and external rotation is a description of:a. Achilles tendonitis.b. Rotator cuff tendonitis.c. Elbow tendonitis.d. Wrist tendonitis.


75. Which of the following is a type of soft tissue?a. Muscleb. Ligamentsc. Articular cartilaged. All of the above.

76. “Forward Head” posture, or holding the head in front of the body, is found in peoplewho work at computers all day and results in:a. Tightness in the cervical extensors.b. Tightness in the cervical flexors.c. Weakness in the cervical extensors.d. None of the above.

77. The three elements necessary to optimize soft tissue length change through stretchinginclude all of the following except:a. Increased body temperature.b. Light, steady force.c. Ballistic movements.d. Long holding time.

78. Holding a stretch longer in older adults may:a. Create more muscle damage.b. Overcome the collagen changes and muscle stiffness associated with aging.c. Decrease subsequent force production.d. None of the above.

79. All of the following are precautions for stretching except:a. When forcing a joint beyond its range of motion, use extreme caution.b. Avoid stretching adjacent to a recent bony fracture.c. Avoid stretching swollen tissue.d. Avoid overstretching weak postural muscles.

80. Slowly leaning the trunk forward with one knee on the floor and the other knee bentwith your foot flat on the floor will stretch the:a. Hamstrings.b. Iliotibial band.c. Hip flexors.d. Tensor fasciae latae.

81. All of the following pertain to massage except:a. Manipulation of the soft tissues of the body to enhance health and healing.b. Soft tissue mobilization.c. Manipulating muscle tissue to promote blood flow and decrease muscle stiffness.d. None of the above.


82. Petrissage massage strokes are defined as:a. Passing the palmar surface of the hand or forearm over a body segment.b. Grasping a muscle and squeezing along the length of a muscle.c. Administering a series of claps or blows to the body part being treated.d. Rubbing one surface repeatedly over another.

83. Basic health benefits of massage which may be especially important in older adultsinclude all of the following except:a. Increased oxygen consumption and metabolic rate.b. Increased frequency and intensity of alpha brain waves associated with deeprelaxation.c. Decreased heart rate and rate of respiration.d. None of the above.

84. All of the following are contraindications to massage except:a. Insufficient peripheral circulation.b. Acute infection or inflammation.c. Irritating skin conditions.d. None of the above.

85. According to the National Academy of Science guidelines, the recommendations forcarbohydrates are:a. 20% to 35%.b. 10% to 35%.c. 45% to 65%.d. 60% to 70%.

86. All of the following are true regarding carbohydrates except:a. Eating carbohydrates leads to obesity.b. Carbohydrates improve immune system functioning.c. Carbohydrates are the preferred source of energy for the brain and muscles.d. Carbohydrates can counteract exercise-induced inflammation and immunosuppression.

87. All of the following are types of antioxidants found in carbohydrates except:a. Carotenoids.b. Vitamin C.c. Vitamin E.d. Carnitine.

88. Which of the following statements regarding the Glycemic Index is true?a. It was originally developed for alcoholics with end state liver disease.b. It attributes numerical values to meals as indicators of how high blood sugar rises afteringestion.c. People who eat high Glycemic Index foods tend to be less hungry.d. Lower Glycemic Index foods provide sustained energy, which is helpful for athletes inendurance sports.


89. The recommended minimum amount of protein suggested for older individuals is:a. 0.6 g of protein per kilogram of body weight.b. 0.8 g of protein per kilogram of body weight.c. 1.0 to 1.25 g of protein per kilogram of body weight.d. 2.8 g of protein per kilogram of body weight.

90. Fat Storage is directly related to:a. The amount of time spent exercising.b. Increasing age.c. Hormonal changes associated with menopause.d. All of the above.

91. Which of the following is a major factor affecting bone loss and osteoporosis?a. Aging.b. Decreased intestinal calcium absorption.c. Medications.d. All of the above.

92. What is the role of Vitamin A (retinol)?a. Maintaining vision.b. Regulating cell growth and division.c. Maintaining immune system efficiency.d. All of the above.

93. Which vitamin is essential for new cell growth, protein metabolism, the immunesystem, and helps keep blood glucose levels in check?a. Vitamin Db. Vitamin Ac. Vitamin B12d. Vitamin B6

94. Which of the following will contribute to dehydration in the elderly?a. Sarcopeniab. Stress incontinencec. Decreased thirst responsed. All of the above.

95. Which of the following is not considered a subgroup at high risk for supplementhealth scams?a. High school studentsb. Athletesc. Aging Baby Boomers.d. The elderly.


96. Nonsteroidal anti-inflammatory drugs (NSAIDS) and COX-2 inhibitors are used to:a. Block pain receptors in the cerebral cortex.b. Diminish pain and inflammation from musculoskeletal injury.c. Decrease the risk of renal failure associated with narcotic pain relievers.d. All of the above.

97. By the year 2020, the prevalence of arthritis in the United States will extend to over:a. 40 million people.b. 50 million people.c. 60 million people.d. 80 million people.

98. Common toxicities associated with COXIBs include all of the following except:a. Gastrointestinal.b. Hepatic.c. Cardiovascular.d. Renal.

99. Changes which occur in the shoulder with increasing age include which of thefollowing:a. Decreased range of motion of the shoulder.b. Decreased joint laxity of the shoulder.c. Increased degeneration of the rotator cuff tendons.d. All of the above

100. Changes to the rotator cuff tendons associated with increasing age include:a. Presence of incomplete tendon tears.b. Thickening of tendon fibers.c. Absence of granulation tissue.d. Parallel alignment of tendon collagen fibers.

101. The most commonly affected rotator cuff muscle is the:a. Teres major.b. Supraspinatus.c. Teres minor.d. Subscapularis.

102. An important disease to inquire about when taking the history of someone withpathology of the shoulder joint is:a. Cancer.b. Osteoarthritis.c. Autoimmune disease.d. All of the above.


103. The Acromial shape associated with full-thickness rotator cuff tears is:a. Type I, flat.b. Type II, curved.c. Type III, hooked.d. All of the above.

104. In an older adult with acute onset of shoulder problems after trauma, the mostfrequent diagnosis is:a. Rotator cuff tear.b. Fracture of the shoulder girdle.c. Impingement of the AC joint.d. Anterior shoulder dislocation.

105. The first step when beginning symptomatic treatment of a shoulder injury is:a. Application of ice to the shoulder for 20 to 30 min every 2 hours.b. Application of a heating pad for 20 to 30 min as needed.c. Restriction of movement.d. Prescribe analgesics.

106 Non-operative measures for rotator cuff problems include all of the following except:a. Acetaminophen or NSAIDS for six to eight weeks.b. Application of ice packs to the shoulder.c. Immobilization.d. Cortisone injections.

107. What is the most common condition affecting the Acromioclavicular joint in anolder adult?a. Bicep tendonitis.b. Degenerative arthritis.c. Rotator cuff tear.d. None of the above.

108. Which of the following is an exercise which will irritate the AC joint?a. Lat pulldowns.b. Tricep pushdowns.c. Bicep curls.d. Bench press.

109. Biceps Tendonitis and tears frequently accompany which shoulder problem?a. Rotator cuff problemsb. AC joint problemsc. Degenerative arthritisd. All of the above


110. Which of the following is a cause of frozen shoulder?a. Post-injury immobilizationb. Rotator cuff dysfunctionc. Idiopathicd. All of the above

111. Which of the following is a way to diagnose a frozen shoulder?a. Complete resolution of symptoms after receiving a cortisone injection in thesubacromial space.b. Improvement in symptoms with stretching and range of motion activities.c. No response to a cortisone shot in the subacromial space.d. Surgical release of adhesions.

112. One of the most common overuse injuries in the elbow is:a. Bicep tendonitis.b. Humeral epicondylitis.c. Valgus extension overload.d. Brachialis tendonitis.

113. Humeral epicondylitis can be defined as all of the following except:a. An extra-articular tendinous injury.b Excessive vascular granulation.c. Excessive amounts of lymphocytes, macrophages, and neutrophils.d. Impaired healing response in the tendon.

114. Which tendon is involved most often in medial humeral epicondylitis?a. Flexor carpi radialis tendon.b. Extensor carpi radialis brevis tendon.c. Extensor carpi radialis longus.d. Extensor carpi ulnaris.

115. Activities which involve repeated overhead throwing or serving can cause osseousand osteochondral injury in older adults referred to as:a. Lateral humeral epicondylitis.b. Medial humeral epicondylitis.c. Valgus extension overload injuries.d.Varus extension overload injuries.

116. Valgus stress to the elbow during the acceleration phase of throwing and servingmotions, create lateral compressive forces at the:a. Lateral epicondyle.b. Radiocapitellar joint.c. medial epicondyle.d. None of the above.


117. Expected findings during the examination of an older athlete from a unilaterallydominant upper extremity sport include all of the following except:a. Elbow flexion contracture.b. Reduced glenohumeral joint internal rotation.c. Increased wrist flexion.d. None of the above.

118. A test for elbow dysfunction which involves tapping of the ulnar nerve over thecubital tunnel retinaculum would be:a. The valgus stress test.b. Tinel’s test.c. Provocation tests.d. The bounce home test.

119. A test which assesses the integrity of the lateral ulnar collateral ligament is the:a. Varus stress test.b. Valgus stress test.c. Valgus extension overpressure test.d. None of the above.

120. Non-operative measures for rehabilitation of humeral epicondylitis include all of thefollowing except:a. A decrease or cessation of activity.b. Immobilization in an arm sling.c. Use of cortisone injections.d. Iontophoresis with dexamethasone.

121. The initial application of resistive exercise for the treatment of humeral epicondylitisfocuses on which of the following muscles?a. The rotator cuff musclesb. The deltoidc. Serratus Anteriord. All of the above.

122. Appropriate exercises to do 2-7 days after elbow arthroscopy and removal of loosebodies include all of the following except:a. Wrist flexion curls.b. Wrist extension curls.c. Isokinetic testing to formally assess distal strength.d. Forearm supination

123. Which of the following is a commonly affected joint in osteoarthritis of the hand?a. Distal interphalangeal joints.b. Proximal interphalangeal joints.c. Thumb metacarpal-trapezial joints.d. All of the above.


124. Physical findings associated with osteoarthritis of the hand include all of thefollowing except:a. Joint enlargement.b. Decreased range of motion actively and passively.c. Pain with motion or stress.d. Pain-free palpation of the hand.

125. In the early stages of osteoarthritis, the only positive finding radiographically maybe:a. Loss of joint space.b. Thickening of the subchondral bone.c. Osteophyte formation.d. All of the above

126. Treatment options for Distal Interphalangeal Joint Arthritis include all of thefollowing except:a. Nonsteroidal anti-inflammatory drugs.b. Splinting.c. Intra-articular steroid injections.d. Ice packs.

127. A mucoid cyst around the interphalangeal joints is:a. An osteophyte that has grown sufficiently large to deform the skin surface.b. The result of out-pouching of the synovial lining.c. Only found distal to the joint.d. All of the above.

128. If maintaining motion in an arthritic joint is important, the surgical intervention ofchoice would be:a. Arthroplasty.b. Arthrodesis.c. Either arthroplasty or arthrodesis.d. None of the above.

129. Accurate statements regarding Arthroplasty include all of the following except:a. Hand motion can be maintained.b. It will provide lateral stability to resist forces associated with a pinching motion.c. Hand grip will be preserved.d. There will be a decrease in pain.

130. Achiness around the thenar eminence and pain at the base of the thumb, especiallywith gripping or pinching activities are symptoms of:a. Distal Interphalangeal Joint Arthritis.b. Proximal Interphalangeal Joint Arthritis.c. Thumb Carpometacarpal Joint Arthritis.d. Scapholunate Joint Arthritis.


131. Early changes associated with Carpometacarpal Joint Arthritis include:a. Synovitis and ligamentous laxity.b. Propensity for subluxation.c. Increased joint pressure.d. All of the above

132. A procedure used to decrease the pain of Carpometacarpal Joint Arthritis that resultsin shortening of the thumb and loss of strength and stability is:a. Trapeziectomy.b. Thumb CMC joint arthrodesis.c. Ligament reconstruction tendon interpositional graft.d. None of the above.

133. An accurate statement regarding Scapholunate Advanced Collapse (SLAC) wouldbe:a. It is the most common degenerative problem in the wrist.b. It occurs with schaphoid malrotation in association with radial malalignment,scapholunate insufficiency, or scaphoid nonunion.c. It can be initiated by minor trauma.d. All of the above.

134. A type of treatment for Acute Scapholunate Dissociation Injuries would be:a. Scaphocapitate or triscaphe arthrodesisb. Direct ligament repairc. Wrist denervationd. Four-corner fusion and proximal row carpectomy.

135. Carpal tunnel syndrome is a complex of symptoms related to compression of the:a. Radial nerve.b. Median nerve.c. Ulnar nerve.d. All of the above

136. All of the following are accurate statements regarding Carpal tunnel syndromeexcept:a. Usually the 4th and 5th digits (ring finger and pinkie) are primarily involved.b. Activities like gripping the steering wheel, talking on the phone, and holding a coffeecup are associated with tingling or pain.c. Many patients feel like they are losing grip strength.d. There may be discomfort in the wrist which may radiate up the forearm.

137. The prevalence of lifetime low back pain is thought to be as high as:a. 70%.b. 80%.c. 90%.d. 99%.


138. The function of the Sacroiliac joint is to:a. Allow for motion along three cardinal planes.b. Resist axial loads.c. Allow segmental movement and to act as a shock absorber between the vertebralbodies.d. Transmit and buffer forces between the vertebral column and the lower limbs.

139. Muscles which act locally on the spine include all of the following except the:a. Multifidus.b. External obliques.c. Internal obliques.d. Transverse abdominus.

140. The second phase in the progression of changes that occur in the aging spine ischaracterized by:a. Degeneration of articular cartilage and z-joint laxity, along with annular bulging,tearing, and herniation of nuclear material leading to segmental instability.b. Segmental dysfunction and joint restriction occurring as a result of an initial injury.c. Bony overgrowth and peri-articular fibrosis which restore stability but also lead tospinal stenosis.d. None of the above.

141. Disc-mediated pain is more typically aggravated by:a. Flexion.b. Ipsilateral extension/rotation.c. Extension.d. All of the above.

142. An extension defect of the nucleus pulposus that is contained by the outer annularfibers and an intact posterior longitudinal ligament is referred to as a:a. Disc herniation.b. Disc protrusion.c. Disc extrusion.d. Disc sequestration.

143. Low back pain and leg pain which is worse with extension and relieved by flexionor sitting indicates a diagnosis of:a. Vertebral compression fractureb. Lumbar Spinal Stenosisc. Facet Arthropathyd. Spondylothesis.


144. Which of the following is a necessary component of a therapeutic exercise programfor an older adult?a. Lumbar stabilization exercises.b. A flexibility program for increasing hip mobility.c. Strengthening of the core musculature.d. All of the above.

145. Which of the following disorders has neurogenic claudication as its most commonpresenting symptom?a. Peripheral Vascular disease.b. Degenerative Lumbar Spinal Stenosisc. Muscular Scoliosis.d. None of the above.

146. All of the following are accurate statements regarding Degenerative Lumbar SpinalStenosis except:a. Pain, paresthesias, and weakness in the lower limb or buttock may be unilateral orbilateral.b. Walking downhill will be easier than walking uphill.c. Walking and standing are exacerbating factors.d. There is usually an absence of pain with sitting.

147. The estimated prevalence of vertebral compression fractures in postmenopausalwomen is:a. 20%.b. 40%.c. 60%.d. 75%.

148. Secondary causes of Osteoporosis include all of the following except:a. Poor nutrition.b. Excess Vitamin C.c. Alcoholism.d. Hyperthyroidism.

149. Calcitonin has been shown to block nociception in vertebral fractures by:a. Increasing blood beta-endorphin levels.b. Inhibiting prostaglandin synthesis.c. Inhibition of spinal serotonergic pathways.d. All of the above.

150. Causes of extra-articular pathology in the hip include all of the following except:a. Bursitisb. Tendonitisc. Labral tears.d. Myositis ossificans


151. The test for hip pathology which will elicit pain with resisted flexion of the hip withthe knee extended is called the:a. Axial distraction testb. The Shuck testc. The Stinchfield testd. The Faber test.

152. A test that will assess for contractures of the hip joint is:a. The Thomas test.b. The Ober test.c. The Ely test.d. All of the above.

153. Which of the following is an accurate statement regarding labral tears?a. Anterosuperior tears are the most common in athletes.b. Labral tears can be classified as radial flap, radial fibrillated, longitudinal peripheral,and unstable tears.c. Labral tears are associated with adjacent capsular laxity at the labrocapsular junctionleading to hip instability.d. All of the above.

154. The type of arthritis in the hip that causes a concentric loss of joint space and isassociated with synovitis is:a. Degenerative osteoarthritisb. Inflammatory arthritis.c. Traumatic arthritis.d. All of the above.

155. Which of the following is not a risk factor for Avascular necrosis?a. History of steroid use.b. Alcohol abuse.c. Diabetesd. Previous hip dislocation and femoral neck fractures.

156. Pain associated with osteoarthritis of the knee is thought to be due to:a. Subchondral bone microfractures.b. Osteophyte-induced impingement or irritation of the synovial nerve endings.c. Synovial inflammation from debris particles.d. All of the above.

157. All of the following are radiographic findings of osteoarthritis in the knee except:a. Joint space narrowing.b. Subchondral sclerosis.c. Osteophytes.d. A 40% increase in articular height.


158. What is an appropriate goal for physical therapy of the knee?a. Reduction of impairment and improvement of function.b. Improving biomechanics.c. Increasing the daily level of physical activity.d. All of the above.

159. Which of the following is not a basic principle of physical therapy for the knee?a. Improvements in terminal extension can make significant functional improvementsb. Non-weight bearing activity is healthier for the joint.c. Improvements in periarticular muscle flexibility to increase muscle function.d. None of the above

160. Which of the following statements regarding Hyaluronic Acid is incorrect?a. It maintains viscoelasticity of the synovial fluidb. It reduces inflammationc. Therapy with hyaluronic acid has been shown to decrease pain in OAd. Therapy with hyaluronic acid has been shown to repair articular cartilage

161. Which of the following regarding ankle sprains is true?a. Recovery from an acute ankle sprain will be prolonged in older adults.b. Lateral ankle sprains are more common than medial ankle sprains.c. Ankle sprains compromise the static support to the lateral ankle.d. All of the above.

162. An injury that occurs with supination and external rotation of the foot/talus relativeto the tibia and fibula is called a:a. Ankle Sprain.b. Syndesmotic injury.c. Anterolateral ankle impingement.d. None of the above.

163. Which of the following accurately describes Peroneal Tendonitis?a. It presents with lateral lower leg, ankle, and foot discomfort or a combination of these.b. It can be caused by ligamentous ankle instability.c. Persistent peroneal tendonitis may lead to chronic peroneal tendon tears which mayrequire surgical intervention.d. All of the above.

164. Common ankle fractures that one should consider when ankle sprains fail to healinclude all of the following except:a. Lateral talar process.b. Medial talar process.c. Anterior calcaneal process.d. Base of the fifth metatarsal.


165. Achilles Tendon rupture is associated with a:a. Palpable defect in the Achilles tendon in the hypovascular zone.b. Weak plantar flexion.c. Positive Thompson’s testd. All of the above.

166. The treatment goals after an Achilles tendon rupture includes all of the followingexcept:a. Restore tendon integrity.b. Restore tendon function.c. Avoid complications.d. None of the above.

167. A person who presents with activity-related and post-activity-related posterior heelpain aggravated by increased running mileage or running hills most likely is sufferingfrom:a. Achilles Tendon Rupture.b. Non-insertional Achilles Tendinopathy.c. Insertional Achilles Tendinopathy.d. Peroneal Tendinitis.

168. Plantar heel pain can be caused by:a. Fat pad atrophy.b. Plantar fasciitis.c. Calcaneal stress fractures.d. All of the above.

169. A presentation of medial plantar heel pain with weight bearing, particularly with thefirst steps after rest and with prolonged standing or exercising is most likely due to:a. Heel Fat Pad Atrophy.b. Achilles Tendinopathy.c. Plantar Fasciitis.d. Entrapment of the first branch of the lateral plantar nerve.

170. In cases of posterior tibial tendon insufficiency, operative reconstruction of thedynamic medial stabilizers includes:a. Tendon debridement.b. Augmentation/substitution of the posterior tibial tendon with an adjacent tendon.c. Possible spring ligament repair/tightening.d. All of the above.


171. An injury which can result from either direct blunt trauma to the midfoot or an axialload on the heel with the toes dorsiflexed on the ground is:a. A midfoot sprain.b. A Lisfranc injury.c. A sprain of the tarsometatarsal joints between the cuneiforms/cuboid and themetatarsal bases.d. All of the above.

172. All of the following are accurate statements regarding Hallux Valgus except:a. The common name of this disorder is a bunion.b. It results from an increased intermetatarsal angle between the first and secondmetatarsals and an increased hallux valgus angle between the first metatarsal and theproximal first phalanx.c. The patient commonly presents with forefoot discomfort, particularly with push-offwhen the forefoot is maximally loaded.d. It is unique to older adults.

173. Hyperextension of the first metatarsophalangeal joint causes:a. Hallux rigidus.b. Sesamoiditis.c. Turf toed. None of the above.

174. Which of the following accurately describes synovitis?a. It can be a result of trauma or overuse.b. It presents with dorsal and plantar pain at the involved metatarsophalangeal joint withassociated swelling.c. In advanced stages, the plantar capsular tissue, collateral ligaments, or both, becomeattenuated, leading to joint instability and resultant toe deformity.d. All of the above.

175. Possible disorders of the toenails include all of the following except:a. Freberg’s Infraction.b. Traumatic onychodystrophy.c. Onychomycosis.d. Ingrown toenails.

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Injury Prevention and Rehabilitation for Active Older Adul. · Injury Prevention and Rehabilitation for Active Older Adults After completing this program, the participant will be