Manual therapy and mobilisation

50 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Manual therapy and mobilisation, part of Therapeutic Exercise. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   In Mulligan's concept, what response is expected when a mobilisation with movement is correctly applied?

   1. ATemporary relief that only appears after 24 hours
   2. BA strong, painful stretch at the end of range
   3. CReproduction of the patient's usual pain
   4. DImmediate, pain-free and lasting improvement

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   Answer: D · Immediate, pain-free and lasting improvement

   Mulligan techniques must be pain-free and give immediate improvement in range or pain, which persists on repetition. If pain is provoked, the direction, grade or position is altered.

   • A: Relief should be immediate, not delayed.
   • B: A strong painful stretch is not the aim.
   • C: Provoking pain means the technique is wrong.

   Remember this

   Mulligan techniques should be pain-free with immediate, lasting improvement.

2. Question 2 · Easy

   During shoulder abduction, the convex humeral head glides on the concave glenoid in which direction?

   1. AAnteriorly
   2. BSuperiorly
   3. CInferiorly
   4. DPosteriorly

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   Answer: C · Inferiorly

   When a convex surface moves on a concave surface, the glide is opposite to the movement of the shaft. As the humeral shaft moves up in abduction, the head glides down.

   • A: Anterior glide accompanies external rotation.
   • B: Superior glide would crowd the head against the acromion.
   • D: Posterior glide accompanies internal rotation.

   Remember this

   Convex on concave: glide opposite to bone movement.

3. Question 3 · Hard

   A 55-year-old woman has a frozen shoulder in the thawing stage with low irritability, stiffness at the end of range and a capsular pattern. Which treatment is best?

   1. ARest in a sling for six full weeks
   2. BGrade III and IV oscillations at the limit of range
   3. CGrade V thrust under anaesthesia with no assessment
   4. DGrade I traction used as the only treatment

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   Answer: B · Grade III and IV oscillations at the limit of range

   Low irritability and stiffness dominance allow stronger mobilisation at the limit of range to stretch the contracted capsule. Gentle grades alone are not enough, and immobilisation prolongs the stiffness.

   • A: Immobilisation worsens stiffness.
   • C: A thrust without assessment is unsafe.
   • D: Grade I traction suits pain-dominant joints.

   Remember this

   Non-irritable stiff joints need Grade III to IV stretching mobilisation.

4. Question 4 · Hard

   A patient has lost 35 degrees of knee flexion and 5 degrees of extension after an effusion with a firm end-feel. This presentation indicates:

   1. AA non-capsular pattern from a meniscal block
   2. BA ligament sprain only
   3. CNo joint abnormality
   4. DA capsular pattern

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   Answer: D · A capsular pattern

   Greater loss of flexion than extension, with a firm end-feel, matches the knee capsular pattern in effusion or arthritis. A meniscal block would restrict extension with a springy end-feel.

   • A: A meniscal block limits extension more and feels springy.
   • B: A sprain gives pain with stress, not this proportional limitation.
   • C: The loss shows a clear abnormality.

   Remember this

   Flexion lost more than extension with a firm end-feel is the knee capsular pattern.

5. Question 5 · Medium

   A patient with hip osteoarthritis has a capsular pattern of restriction. Which movement is typically the most limited?

   1. AInternal rotation
   2. BExternal rotation
   3. CExtension
   4. DAdduction

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   Answer: A · Internal rotation

   In the hip capsular pattern, internal rotation, flexion and abduction are the most limited, with slight loss of extension and little loss of external rotation. In osteoarthritis internal rotation is usually the earliest and most restricted movement.

   • B: External rotation is relatively preserved.
   • C: Extension is only slightly limited.
   • D: Adduction is not part of the pattern.

   Remember this

   Hip capsular pattern: internal rotation, flexion and abduction are most limited.

6. Question 6 · Easy

   In Kaltenborn's grading, which grade takes up the slack in the tissues around the joint?

   1. AGrade V
   2. BGrade I
   3. CGrade II
   4. DGrade III

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   In open chain knee extension, the concave tibial plateau moves on the convex femoral condyles. In which direction does the tibia glide?

   1. ALaterally
   2. BPosteriorly, opposite to the shaft movement
   3. CMedially
   4. DAnteriorly, the same as the shaft movement

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   A patient in Muscat has an irritable, painful shoulder where pain comes on before any resistance is felt. Which mobilisation approach is most suitable?

   1. AGrade I or II oscillations in the pain-free range
   2. BGrade V thrust manipulation at the end of range
   3. CSustained Grade III stretching carried into pain
   4. DGrade IV oscillations at the limit of the range

   Answer and explanation in LearnFree account

9. Question 9 · Easy

   Deep transverse friction massage is applied:

   1. AAcross the fibres of the injured structure
   2. BOnly over bony prominences near the joint
   3. CAlong the length of the muscle belly
   4. DOver the whole limb in one long sweep

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    A patient taking warfarin, with an INR in the target range, asks for cervical manipulation for neck pain. What is the best approach?

    1. AManipulate only after heat has relaxed the neck muscles
    2. BAvoid thrust techniques and use gentle mobilisation or exercise
    3. CManipulate, as an INR in range removes any bleeding risk
    4. DUse repeated low-force thrusts over several days instead

    Answer and explanation in LearnFree account

11. Question 11 · Hard

    A 45-year-old woman has a sudden severe occipital headache and neck pain after a minor fall, with some visual disturbance. She asks for neck manipulation. What is the best step?

    1. ATeach home neck exercises
    2. BApply a cervical collar and discharge
    3. CPerform gentle Grade I mobilisation and review in a week
    4. DAvoid manipulation and arrange urgent medical assessment

    Answer and explanation in LearnFree account

12. Question 12 · Easy

    A hard end-feel at the end of passive elbow extension is caused by:

    1. AMuscle guarding
    2. BCapsular stretch
    3. CTissue approximation
    4. DBone contacting bone

    Answer and explanation in LearnFree account

13. Question 13 · Easy

    Which finding is a contraindication to spinal manipulation?

    1. ASuspected fracture of the vertebra
    2. BMild muscle guarding
    3. CMechanical low back pain
    4. DFacet joint stiffness

    Answer and explanation in LearnFree account

14. Question 14 · Medium

    In muscle energy technique, the patient's contraction for post-isometric relaxation is usually:

    1. AMaximal effort held steadily for 30 seconds
    2. BAbout 20% of maximal effort held for 3 to 7 seconds
    3. CA rapid ballistic contraction at full speed
    4. DNo contraction at all, only a passive stretch

    Answer and explanation in LearnFree account

15. Question 15 · Medium

    During right side-flexion of the lumbar spine, the right inferior articular facet glides:

    1. AAnteriorly
    2. BInferiorly
    3. CMedially
    4. DSuperiorly

    Answer and explanation in LearnFree account

16. Question 16 · Hard

    A 72-year-old woman with a T-score of minus 3.2 has thoracic stiffness. Which approach is most appropriate?

    1. AProlonged forced flexion stretching of the thoracic spine
    2. BHigh-velocity rotational manipulation of the thoracic spine
    3. CVigorous end-range Grade IV mobilisation of the spine
    4. DGentle low-grade mobilisation, avoiding thrusts

    Answer and explanation in LearnFree account

17. Question 17 · Medium

    Gentle Grade I and II oscillations reduce pain mainly by:

    1. AStretching the shortened joint capsule
    2. BStimulating joint mechanoreceptors that inhibit pain
    3. CBreaking down adhesions and scar tissue
    4. DRealigning the joint surfaces

    Answer and explanation in LearnFree account

18. Question 18 · Medium

    Which Mulligan technique is used for lateral epicondylalgia?

    1. APassive stretching of the wrist flexors at rest
    2. BA sustained lateral glide of the forearm during pain-free grip
    3. CFirm compression applied over the epicondyle
    4. DA high-velocity thrust applied to the radial head

    Answer and explanation in LearnFree account

19. Question 19 · Hard

    A painful, swollen knee with effusion needs gentle pain-relieving oscillations. In which position are they best applied?

    1. AThe loose-packed position at about 25 degrees of flexion
    2. B90 degrees of flexion of the knee
    3. CFull extension of the knee
    4. DFull flexion combined with rotation of the tibia

    Answer and explanation in LearnFree account

20. Question 20 · Medium

    How is a cervical SNAG applied?

    1. AThe patient lies prone and is moved only passively
    2. BA facet-plane glide is held while the patient moves actively
    3. CA thrust is applied at end range while the patient relaxes
    4. DThe neck is held in sustained traction for 20 minutes

    Answer and explanation in LearnFree account

21. Question 21 · Medium

    To improve mouth opening, which mobilisation of the temporomandibular joint is typical?

    1. ACaudal (inferior) distraction of the mandible
    2. BCranial compression applied to the ramus
    3. CLateral compression applied to the condyle
    4. DPosterior thrust applied to the mandible

    Answer and explanation in LearnFree account

22. Question 22 · Hard

    A patient has a stiff hip with internal rotation limited by a firm end-feel and little pain. Which accessory glide best targets this restriction?

    1. AAnterior glide of the femoral head
    2. BPosterior glide of the femoral head
    3. CInferior glide of the femoral head
    4. DLateral glide of the pelvis

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    What is the knee capsular pattern?

    1. AFlexion is more limited than extension
    2. BExtension is more limited than flexion
    3. COnly extension is limited
    4. DRotation is lost before flexion

    Answer and explanation in LearnFree account

24. Question 24 · Easy

    In Maitland's grading, a Grade III mobilisation is:

    1. AA large-amplitude oscillation to the limit of the range
    2. BA small-amplitude oscillation early in the free range
    3. CA small-amplitude oscillation at the limit of the range
    4. DA high-velocity thrust at the very end of the range

    Answer and explanation in LearnFree account

25. Question 25 · Medium

    A therapist wishes to improve glenohumeral internal rotation. Which glide of the humeral head is the usual choice?

    1. AAnterior glide of the humeral head
    2. BSuperior glide of the humeral head
    3. CInferior glide of the humeral head
    4. DPosterior glide of the humeral head

    Answer and explanation in LearnFree account