Physical Therapy Comprehensive Review 2026–2027
Physical Therapy Comprehensive Review 2026–2027 |
Rehabilitation Concepts & Practice Questions
Prepared for: Physical Therapy & Rehabilitation Candidates
Section I: Biomechanics & Gait Analysis
Question 1
During the stance phase of gait, the vertical ground reaction force (GRF) typically exhibits two peaks. At which
point does the GRF vector pass closest to the center of the knee joint in the sagittal plane, and what is the
primary implication for knee stability?
A. At heel strike, maximizing the knee extensor moment to prevent buckling
B. At mid-stance, minimizing the external knee moment and relying on passive structures
C. At push-off, maximizing the knee flexor moment to accelerate the limb
D. At terminal stance, generating a large external varus moment
Correct Answer: B
Rationale: At mid-stance, the vertical ground reaction force vector passes nearly through the center of
the knee joint in the sagittal plane. This alignment minimizes the external flexion or extension moment,
thereby reducing the demand for active muscle force to stabilize the knee. The joint relies primarily on
passive structures (ligaments, capsule) and bony congruency during this phase. This is a fundamental
biomechanical principle for understanding normal gait efficiency and pathological deviations.
Why the Other Options Are Incorrect:
A: At heel strike, the GRF vector is positioned anterior to the knee joint, creating an external flexion
moment. This requires active quadriceps contraction to prevent knee buckling—it does not minimize the
moment.
C: At push-off (terminal stance/pre-swing), the GRF is posterior to the knee, creating an external
extension moment. The primary muscular demand is for plantar flexors, not knee flexors.
D: Terminal stance does not generate a large varus moment in normal gait. The varus moment is more
relevant in pathological conditions such as knee osteoarthritis, but it is not the defining biomechanical
feature of this phase.
──────────────────────────────────────────────────────────────────────
Question 2
A rehabilitation protocol for patellofemoral pain syndrome (PFPS) emphasizes hip abductor strengthening.
Which biomechanical mechanism best explains the therapeutic effect?
A. Increased hip abductor strength reduces lateral force on the patella by controlling femoral adduction
B. Hip abductor strengthening directly increases the quadriceps angle (Q-angle)
C. Strengthening the gluteus medius improves ankle dorsiflexion range of motion
D. Hip abduction exercises increase patellofemoral joint contact area by tilting the patella medially
Correct Answer: A
Rationale: Weakness of the hip abductors (particularly gluteus medius) allows excessive femoral
adduction and internal rotation during weight-bearing activities. This malalignment increases the lateral
force vector acting on the patella, contributing to patellofemoral joint stress and pain. Strengthening the
hip abductors helps control femoral position in the frontal plane, thereby reducing lateral patellar
tracking forces.
Physical Therapy & Rehabilitation | Practice Review
, Physical Therapy Comprehensive Review 2026–2027
Why the Other Options Are Incorrect:
B: Hip abductor strengthening does not increase the Q-angle. In fact, by controlling femoral adduction, it
may functionally reduce the dynamic Q-angle during activity. The Q-angle is an anatomical measure
determined by bony landmarks.
C: The gluteus medius is a hip abductor and does not have a primary role in ankle dorsiflexion. Ankle
dorsiflexion is controlled by the tibialis anterior and other anterior compartment muscles.
D: Hip abduction exercises do not directly tilt the patella medially. Patellar tilt is influenced by the
balance of medial and lateral retinacular structures and the vastus medialis obliquus (VMO).
──────────────────────────────────────────────────────────────────────
Question 3
A patient demonstrates a Trendelenburg gait during assessment. Which muscle is primarily weak?
A. Gluteus maximus
B. Gluteus medius
C. Tensor fasciae latae
D. Adductor magnus
Correct Answer: B
Rationale: The gluteus medius is the primary pelvic stabilizer during single-leg stance. When this muscle
is weak, the pelvis drops on the contralateral (unsupported) side during the stance phase of the affected
limb. This is the defining characteristic of a Trendelenburg gait pattern.
Why the Other Options Are Incorrect:
A: Gluteus maximus weakness primarily affects hip extension power, contributing to difficulties with
stair climbing, running, and rising from a seated position—not pelvic drop during stance.
C: The tensor fasciae latae assists with hip flexion, abduction, and internal rotation. While it contributes
to pelvic stability, isolated weakness does not produce the classic Trendelenburg sign.
D: The adductor magnus is a powerful hip adductor and extensor. Its weakness does not produce the
contralateral pelvic drop characteristic of Trendelenburg gait.
Section II: Neurological Rehabilitation
──────────────────────────────────────────────────────────────────────
Question 4
A patient with an upper motor neuron (UMN) lesion is most likely to demonstrate which combination of
findings?
A. Flaccid paralysis, hyperreflexia, fasciculations
B. Spasticity, hyperreflexia, positive Babinski sign
C. Muscle atrophy, hyperreflexia, absent Babinski sign
D. Fasciculations, hypotonia, clonus
Correct Answer: B
Rationale: Upper motor neuron lesions disrupt the corticospinal and other descending pathways,
resulting in a characteristic cluster of signs: spasticity (velocity-dependent increase in muscle tone),
hyperreflexia (exaggerated deep tendon reflexes), and pathological reflexes including a positive
Babinski sign (extensor plantar response). These findings reflect loss of descending inhibitory control
over spinal reflex circuits.
Why the Other Options Are Incorrect:
Physical Therapy & Rehabilitation | Practice Review
, Physical Therapy Comprehensive Review 2026–2027
A: Flaccid paralysis and fasciculations are characteristic of lower motor neuron (LMN) lesions, not UMN
lesions. Hyperreflexia is a UMN finding, making this combination internally inconsistent.
C: Muscle atrophy is more prominent in LMN lesions (though disuse atrophy can occur with UMN lesions
over time). The absence of a Babinski sign is inconsistent with UMN pathology.
D: Fasciculations and hypotonia are LMN signs. Clonus can occur with UMN lesions, but this
combination is dominated by LMN features.
──────────────────────────────────────────────────────────────────────
Question 5
A patient with a C6 spinal cord injury would most likely retain which function?
A. Independent ankle dorsiflexion
B. Functional elbow flexion
C. Voluntary finger extension
D. Independent hip extension
Correct Answer: B
Rationale: A C6-level spinal cord injury preserves the C6 myotome, which includes the biceps brachii
(elbow flexors) and wrist extensors. Individuals with C6 tetraplegia typically have functional elbow
flexion and can use tenodesis (wrist extension-driven finger flexion) for some grasping activities. This is
a critical distinction for rehabilitation planning and assistive technology prescription.
Why the Other Options Are Incorrect:
A: Ankle dorsiflexion is mediated by L4-L5 innervation, which is well below a C6 lesion level. This
function would be lost.
C: Voluntary finger extension requires C7-T1 innervation (primarily radial nerve function). This is typically
impaired or absent with a C6 lesion.
D: Hip extension is mediated by L5-S1 innervation. This function would not be preserved with a C6 injury.
──────────────────────────────────────────────────────────────────────
Question 6
In constraint-induced movement therapy (CIMT), the "transfer package" includes behavioral techniques such
as daily monitoring and problem-solving. Which theoretical framework best explains the necessity of the
transfer package for achieving long-term functional gains?
A. Operant conditioning, where reinforcement schedules maintain the newly learned movement patterns
B. Learned nonuse reversal, where the transfer package overcomes the conditioned suppression of
movement
C. Skill acquisition theory, emphasizing blocked practice to enhance retention
D. Neural plasticity, where repetitive task practice alone induces cortical reorganization
Correct Answer: B
Rationale: CIMT addresses "learned nonuse," a behavioral phenomenon where the affected limb is
suppressed following neurological injury due to repeated failed attempts at movement. The transfer
package—which includes behavioral contracts, daily monitoring, and problem-solving strategies—is
specifically designed to overcome this conditioned suppression and promote use of the affected limb in
the natural environment. While neuroplasticity and motor learning principles are involved, the transfer
package's specific theoretical basis is the reversal of learned nonuse.
Why the Other Options Are Incorrect:
Physical Therapy & Rehabilitation | Practice Review
, Physical Therapy Comprehensive Review 2026–2027
A: Operant conditioning is a component of the behavioral approach, but it does not fully explain why the
transfer package is necessary for generalizing gains to real-world settings.
C: Skill acquisition theory emphasizes varied practice conditions for retention, not blocked practice.
Blocked practice is actually associated with poorer retention and transfer.
D: Neural plasticity is the underlying mechanism of recovery, but repetitive task practice alone does not
address the behavioral suppression that the transfer package specifically targets.
Section III: Musculoskeletal Assessment & Intervention
──────────────────────────────────────────────────────────────────────
Question 7
A patient is 6 weeks status post anterior cruciate ligament (ACL) reconstruction. Which of the following is the
MOST important treatment consideration?
A. The graft reaches its weakest point at this phase
B. Use passive range of motion to improve knee flexibility
C. Inflammation and swelling should be actively managed
D. Decreased quadriceps strength limits ambulation in both time and distance
Correct Answer: A
Rationale: The 6-week postoperative period represents the most critical phase of ACL graft healing.
During this time, the graft undergoes remodeling and revascularization, and its mechanical strength is at
its nadir. This is when the graft is most vulnerable to failure from excessive loading or premature return
to high-demand activities. Rehabilitation must balance protection of the graft with controlled
progression of range of motion and strengthening.
Why the Other Options Are Incorrect:
B: While range of motion is important, passive range of motion is generally well-tolerated by 6 weeks,
and aggressive ROM work is not the most critical consideration during the graft's weakest phase.
C: Inflammation and swelling are typically diminishing by 6 weeks. While still monitored, this is less
critical than protecting the healing graft.
D: Quadriceps strength deficits are expected at this stage and are addressed through progressive
strengthening. This is not the most important safety consideration during the graft's vulnerable phase.
──────────────────────────────────────────────────────────────────────
Question 8
A 30-year-old patient recovering from an ankle fracture has physician instructions for partial weight bearing
(PWB) on the involved extremity. Which assistive device is MOST appropriate for facilitating ambulation?
A. Single-point cane
B. Four-wheeled walker
C. Lofstrand crutches
D. Knee scooter
Correct Answer: C
Rationale: Lofstrand crutches (forearm crutches) are the most appropriate device for partial weight
bearing. They allow the patient to bear weight through the upper extremities while maintaining a
controlled percentage of body weight through the involved lower extremity. The forearm cuff design
provides stability and avoids the axillary pressure complications associated with traditional axillary
crutches.
Why the Other Options Are Incorrect:
Physical Therapy & Rehabilitation | Practice Review
Physical Therapy Comprehensive Review 2026–2027 |
Rehabilitation Concepts & Practice Questions
Prepared for: Physical Therapy & Rehabilitation Candidates
Section I: Biomechanics & Gait Analysis
Question 1
During the stance phase of gait, the vertical ground reaction force (GRF) typically exhibits two peaks. At which
point does the GRF vector pass closest to the center of the knee joint in the sagittal plane, and what is the
primary implication for knee stability?
A. At heel strike, maximizing the knee extensor moment to prevent buckling
B. At mid-stance, minimizing the external knee moment and relying on passive structures
C. At push-off, maximizing the knee flexor moment to accelerate the limb
D. At terminal stance, generating a large external varus moment
Correct Answer: B
Rationale: At mid-stance, the vertical ground reaction force vector passes nearly through the center of
the knee joint in the sagittal plane. This alignment minimizes the external flexion or extension moment,
thereby reducing the demand for active muscle force to stabilize the knee. The joint relies primarily on
passive structures (ligaments, capsule) and bony congruency during this phase. This is a fundamental
biomechanical principle for understanding normal gait efficiency and pathological deviations.
Why the Other Options Are Incorrect:
A: At heel strike, the GRF vector is positioned anterior to the knee joint, creating an external flexion
moment. This requires active quadriceps contraction to prevent knee buckling—it does not minimize the
moment.
C: At push-off (terminal stance/pre-swing), the GRF is posterior to the knee, creating an external
extension moment. The primary muscular demand is for plantar flexors, not knee flexors.
D: Terminal stance does not generate a large varus moment in normal gait. The varus moment is more
relevant in pathological conditions such as knee osteoarthritis, but it is not the defining biomechanical
feature of this phase.
──────────────────────────────────────────────────────────────────────
Question 2
A rehabilitation protocol for patellofemoral pain syndrome (PFPS) emphasizes hip abductor strengthening.
Which biomechanical mechanism best explains the therapeutic effect?
A. Increased hip abductor strength reduces lateral force on the patella by controlling femoral adduction
B. Hip abductor strengthening directly increases the quadriceps angle (Q-angle)
C. Strengthening the gluteus medius improves ankle dorsiflexion range of motion
D. Hip abduction exercises increase patellofemoral joint contact area by tilting the patella medially
Correct Answer: A
Rationale: Weakness of the hip abductors (particularly gluteus medius) allows excessive femoral
adduction and internal rotation during weight-bearing activities. This malalignment increases the lateral
force vector acting on the patella, contributing to patellofemoral joint stress and pain. Strengthening the
hip abductors helps control femoral position in the frontal plane, thereby reducing lateral patellar
tracking forces.
Physical Therapy & Rehabilitation | Practice Review
, Physical Therapy Comprehensive Review 2026–2027
Why the Other Options Are Incorrect:
B: Hip abductor strengthening does not increase the Q-angle. In fact, by controlling femoral adduction, it
may functionally reduce the dynamic Q-angle during activity. The Q-angle is an anatomical measure
determined by bony landmarks.
C: The gluteus medius is a hip abductor and does not have a primary role in ankle dorsiflexion. Ankle
dorsiflexion is controlled by the tibialis anterior and other anterior compartment muscles.
D: Hip abduction exercises do not directly tilt the patella medially. Patellar tilt is influenced by the
balance of medial and lateral retinacular structures and the vastus medialis obliquus (VMO).
──────────────────────────────────────────────────────────────────────
Question 3
A patient demonstrates a Trendelenburg gait during assessment. Which muscle is primarily weak?
A. Gluteus maximus
B. Gluteus medius
C. Tensor fasciae latae
D. Adductor magnus
Correct Answer: B
Rationale: The gluteus medius is the primary pelvic stabilizer during single-leg stance. When this muscle
is weak, the pelvis drops on the contralateral (unsupported) side during the stance phase of the affected
limb. This is the defining characteristic of a Trendelenburg gait pattern.
Why the Other Options Are Incorrect:
A: Gluteus maximus weakness primarily affects hip extension power, contributing to difficulties with
stair climbing, running, and rising from a seated position—not pelvic drop during stance.
C: The tensor fasciae latae assists with hip flexion, abduction, and internal rotation. While it contributes
to pelvic stability, isolated weakness does not produce the classic Trendelenburg sign.
D: The adductor magnus is a powerful hip adductor and extensor. Its weakness does not produce the
contralateral pelvic drop characteristic of Trendelenburg gait.
Section II: Neurological Rehabilitation
──────────────────────────────────────────────────────────────────────
Question 4
A patient with an upper motor neuron (UMN) lesion is most likely to demonstrate which combination of
findings?
A. Flaccid paralysis, hyperreflexia, fasciculations
B. Spasticity, hyperreflexia, positive Babinski sign
C. Muscle atrophy, hyperreflexia, absent Babinski sign
D. Fasciculations, hypotonia, clonus
Correct Answer: B
Rationale: Upper motor neuron lesions disrupt the corticospinal and other descending pathways,
resulting in a characteristic cluster of signs: spasticity (velocity-dependent increase in muscle tone),
hyperreflexia (exaggerated deep tendon reflexes), and pathological reflexes including a positive
Babinski sign (extensor plantar response). These findings reflect loss of descending inhibitory control
over spinal reflex circuits.
Why the Other Options Are Incorrect:
Physical Therapy & Rehabilitation | Practice Review
, Physical Therapy Comprehensive Review 2026–2027
A: Flaccid paralysis and fasciculations are characteristic of lower motor neuron (LMN) lesions, not UMN
lesions. Hyperreflexia is a UMN finding, making this combination internally inconsistent.
C: Muscle atrophy is more prominent in LMN lesions (though disuse atrophy can occur with UMN lesions
over time). The absence of a Babinski sign is inconsistent with UMN pathology.
D: Fasciculations and hypotonia are LMN signs. Clonus can occur with UMN lesions, but this
combination is dominated by LMN features.
──────────────────────────────────────────────────────────────────────
Question 5
A patient with a C6 spinal cord injury would most likely retain which function?
A. Independent ankle dorsiflexion
B. Functional elbow flexion
C. Voluntary finger extension
D. Independent hip extension
Correct Answer: B
Rationale: A C6-level spinal cord injury preserves the C6 myotome, which includes the biceps brachii
(elbow flexors) and wrist extensors. Individuals with C6 tetraplegia typically have functional elbow
flexion and can use tenodesis (wrist extension-driven finger flexion) for some grasping activities. This is
a critical distinction for rehabilitation planning and assistive technology prescription.
Why the Other Options Are Incorrect:
A: Ankle dorsiflexion is mediated by L4-L5 innervation, which is well below a C6 lesion level. This
function would be lost.
C: Voluntary finger extension requires C7-T1 innervation (primarily radial nerve function). This is typically
impaired or absent with a C6 lesion.
D: Hip extension is mediated by L5-S1 innervation. This function would not be preserved with a C6 injury.
──────────────────────────────────────────────────────────────────────
Question 6
In constraint-induced movement therapy (CIMT), the "transfer package" includes behavioral techniques such
as daily monitoring and problem-solving. Which theoretical framework best explains the necessity of the
transfer package for achieving long-term functional gains?
A. Operant conditioning, where reinforcement schedules maintain the newly learned movement patterns
B. Learned nonuse reversal, where the transfer package overcomes the conditioned suppression of
movement
C. Skill acquisition theory, emphasizing blocked practice to enhance retention
D. Neural plasticity, where repetitive task practice alone induces cortical reorganization
Correct Answer: B
Rationale: CIMT addresses "learned nonuse," a behavioral phenomenon where the affected limb is
suppressed following neurological injury due to repeated failed attempts at movement. The transfer
package—which includes behavioral contracts, daily monitoring, and problem-solving strategies—is
specifically designed to overcome this conditioned suppression and promote use of the affected limb in
the natural environment. While neuroplasticity and motor learning principles are involved, the transfer
package's specific theoretical basis is the reversal of learned nonuse.
Why the Other Options Are Incorrect:
Physical Therapy & Rehabilitation | Practice Review
, Physical Therapy Comprehensive Review 2026–2027
A: Operant conditioning is a component of the behavioral approach, but it does not fully explain why the
transfer package is necessary for generalizing gains to real-world settings.
C: Skill acquisition theory emphasizes varied practice conditions for retention, not blocked practice.
Blocked practice is actually associated with poorer retention and transfer.
D: Neural plasticity is the underlying mechanism of recovery, but repetitive task practice alone does not
address the behavioral suppression that the transfer package specifically targets.
Section III: Musculoskeletal Assessment & Intervention
──────────────────────────────────────────────────────────────────────
Question 7
A patient is 6 weeks status post anterior cruciate ligament (ACL) reconstruction. Which of the following is the
MOST important treatment consideration?
A. The graft reaches its weakest point at this phase
B. Use passive range of motion to improve knee flexibility
C. Inflammation and swelling should be actively managed
D. Decreased quadriceps strength limits ambulation in both time and distance
Correct Answer: A
Rationale: The 6-week postoperative period represents the most critical phase of ACL graft healing.
During this time, the graft undergoes remodeling and revascularization, and its mechanical strength is at
its nadir. This is when the graft is most vulnerable to failure from excessive loading or premature return
to high-demand activities. Rehabilitation must balance protection of the graft with controlled
progression of range of motion and strengthening.
Why the Other Options Are Incorrect:
B: While range of motion is important, passive range of motion is generally well-tolerated by 6 weeks,
and aggressive ROM work is not the most critical consideration during the graft's weakest phase.
C: Inflammation and swelling are typically diminishing by 6 weeks. While still monitored, this is less
critical than protecting the healing graft.
D: Quadriceps strength deficits are expected at this stage and are addressed through progressive
strengthening. This is not the most important safety consideration during the graft's vulnerable phase.
──────────────────────────────────────────────────────────────────────
Question 8
A 30-year-old patient recovering from an ankle fracture has physician instructions for partial weight bearing
(PWB) on the involved extremity. Which assistive device is MOST appropriate for facilitating ambulation?
A. Single-point cane
B. Four-wheeled walker
C. Lofstrand crutches
D. Knee scooter
Correct Answer: C
Rationale: Lofstrand crutches (forearm crutches) are the most appropriate device for partial weight
bearing. They allow the patient to bear weight through the upper extremities while maintaining a
controlled percentage of body weight through the involved lower extremity. The forearm cuff design
provides stability and avoids the axillary pressure complications associated with traditional axillary
crutches.
Why the Other Options Are Incorrect:
Physical Therapy & Rehabilitation | Practice Review
