COMSAE Phase 1 Form 115 Exam–
ACTUAL QUESTIONS AND ANSWERS
LATEST UPDATE THIS YEAR.pdf
Q1. A 35-year-old with chronic low back pain has a right posterior
innominate rotation. Which muscle is likely shortened?
• A) Left quadratus lumborum
• B) Right hamstrings
• C) Right iliopsoas
• D) Left gluteus maximus
Correct ,,,,Answer,,,,: B
Rationale: A posterior innominate rotation is a shear of the ilium in which the
ilium moves posteriorly on the sacrum. In this dysfunction, the ipsilateral
hamstrings are shortened, whereas the iliopsoas is typically shortened in an
anterior innominate.
Q2. A patient presents with a structural exam revealing a restricted T5
segment. The segment prefers rotation to the right and side-bending to the
right. It improves when the patient slumps forward into spinal flexion. What
is the correct diagnosis?
• A) T5 Neutral SR RL
• B) T5 Extended RR SR
, • C) T5 Flexed RR SR
• D) T5 Flexed RL SL
Correct ,,,,Answer,,,,: C
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed
as Flexed. According to Fryette's Second Law (Type II mechanics), when a single
segment is in a non-neutral position (flexion or extension), rotation and side-
bending occur in the same direction. Hence, rotation right and side-bending right
yields a diagnosis of "Flexed RR SR".
Q3. According to Fryette's first principle (Type I mechanics), when the spine
is in a neutral position (neither flexed nor extended), which of the following
occurs?
• A) Sidebending and rotation occur to the same side
• B) Sidebending occurs without rotation
• C) Sidebending and rotation occur to opposite sides
• D) Rotation occurs without sidebending
Correct ,,,,Answer,,,,: C
Rationale: Fryette's first principle (Type I mechanics) describes that when
multiple vertebral segments are in neutral position, sidebending and rotation
occur in opposite directions.
Q4. In muscle energy technique (MET), the patient's contraction force should
be:
, • A) Maximal contraction against a fixed barrier
• B) Submaximal (approximately 20% of maximal) isometric contraction
• C) Eccentric contraction only
• D) Isotonic contraction through full range
Correct ,,,,Answer,,,,: B
Rationale: MET uses a gentle (submaximal, ~20% effort) isometric
contraction by the patient, followed by relaxation and repositioning to the new
barrier. This avoids muscle fatigue and injury.
Q5. A patient has a right forward sacral torsion. Which of the following is
correct regarding L5 rotation?
• A) L5 rotates right
• B) L5 rotates left
• C) L5 is neutral
• D) L5 rotates posterior
Correct ,,,,Answer,,,,: A
Rationale: In a forward sacral torsion, L5 rotates to the same side as the oblique
axis. For a right forward sacral torsion (right axis), L5 rotates to the right. The
naming convention for sacral torsions: first word = axis side; second word =
direction of base rotation.
Q6. During a cranial exam, you feel a "wax paper" crunching sensation. This
indicates:
, • A) Normal flexion phase
• B) Cranial strain pattern
• C) Temporomandibular joint dysfunction
• D) Occipitoatlantal joint restriction
Correct ,,,,Answer,,,,: B
Rationale: A "wax paper" or "wet leather" crunching sensation during cranial
palpation indicates a cranial strain pattern. This occurs when the cranial bones
are not moving synchronously with the inherent rhythmic motion (cranial rhythmic
impulse). Normal cranial motion should feel smooth and symmetric.
Q7. A patient with right lateral bending of the lumbar spine with rotation to
the left. According to Fryette, this is a:
• A) Type I dysfunction
• B) Type II dysfunction
• C) Type III dysfunction
• D) Neutral dysfunction
Correct ,,,,Answer,,,,: A
Rationale: In Fryette's Type I (neutral) mechanics, sidebending and rotation
occur to opposite sides. Right lateral bending with left rotation is the classic Type I
pattern. This typically occurs in group curves and involves multiple vertebral
segments.
ACTUAL QUESTIONS AND ANSWERS
LATEST UPDATE THIS YEAR.pdf
Q1. A 35-year-old with chronic low back pain has a right posterior
innominate rotation. Which muscle is likely shortened?
• A) Left quadratus lumborum
• B) Right hamstrings
• C) Right iliopsoas
• D) Left gluteus maximus
Correct ,,,,Answer,,,,: B
Rationale: A posterior innominate rotation is a shear of the ilium in which the
ilium moves posteriorly on the sacrum. In this dysfunction, the ipsilateral
hamstrings are shortened, whereas the iliopsoas is typically shortened in an
anterior innominate.
Q2. A patient presents with a structural exam revealing a restricted T5
segment. The segment prefers rotation to the right and side-bending to the
right. It improves when the patient slumps forward into spinal flexion. What
is the correct diagnosis?
• A) T5 Neutral SR RL
• B) T5 Extended RR SR
, • C) T5 Flexed RR SR
• D) T5 Flexed RL SL
Correct ,,,,Answer,,,,: C
Rationale: Because the dysfunction improves in flexion, the segment is diagnosed
as Flexed. According to Fryette's Second Law (Type II mechanics), when a single
segment is in a non-neutral position (flexion or extension), rotation and side-
bending occur in the same direction. Hence, rotation right and side-bending right
yields a diagnosis of "Flexed RR SR".
Q3. According to Fryette's first principle (Type I mechanics), when the spine
is in a neutral position (neither flexed nor extended), which of the following
occurs?
• A) Sidebending and rotation occur to the same side
• B) Sidebending occurs without rotation
• C) Sidebending and rotation occur to opposite sides
• D) Rotation occurs without sidebending
Correct ,,,,Answer,,,,: C
Rationale: Fryette's first principle (Type I mechanics) describes that when
multiple vertebral segments are in neutral position, sidebending and rotation
occur in opposite directions.
Q4. In muscle energy technique (MET), the patient's contraction force should
be:
, • A) Maximal contraction against a fixed barrier
• B) Submaximal (approximately 20% of maximal) isometric contraction
• C) Eccentric contraction only
• D) Isotonic contraction through full range
Correct ,,,,Answer,,,,: B
Rationale: MET uses a gentle (submaximal, ~20% effort) isometric
contraction by the patient, followed by relaxation and repositioning to the new
barrier. This avoids muscle fatigue and injury.
Q5. A patient has a right forward sacral torsion. Which of the following is
correct regarding L5 rotation?
• A) L5 rotates right
• B) L5 rotates left
• C) L5 is neutral
• D) L5 rotates posterior
Correct ,,,,Answer,,,,: A
Rationale: In a forward sacral torsion, L5 rotates to the same side as the oblique
axis. For a right forward sacral torsion (right axis), L5 rotates to the right. The
naming convention for sacral torsions: first word = axis side; second word =
direction of base rotation.
Q6. During a cranial exam, you feel a "wax paper" crunching sensation. This
indicates:
, • A) Normal flexion phase
• B) Cranial strain pattern
• C) Temporomandibular joint dysfunction
• D) Occipitoatlantal joint restriction
Correct ,,,,Answer,,,,: B
Rationale: A "wax paper" or "wet leather" crunching sensation during cranial
palpation indicates a cranial strain pattern. This occurs when the cranial bones
are not moving synchronously with the inherent rhythmic motion (cranial rhythmic
impulse). Normal cranial motion should feel smooth and symmetric.
Q7. A patient with right lateral bending of the lumbar spine with rotation to
the left. According to Fryette, this is a:
• A) Type I dysfunction
• B) Type II dysfunction
• C) Type III dysfunction
• D) Neutral dysfunction
Correct ,,,,Answer,,,,: A
Rationale: In Fryette's Type I (neutral) mechanics, sidebending and rotation
occur to opposite sides. Right lateral bending with left rotation is the classic Type I
pattern. This typically occurs in group curves and involves multiple vertebral
segments.
