COMLEX Level 2 – OMM EXAM 2026/2027
COMPLETE ACCURATE TEST EXAM
ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED SOLUTIONS) 2026 EDITION
|BEST DOCUMENT FOR EXAM
A patient is considered for HVLA manipulation. Which patient conditions are
contraindications for HVLA?
Correct Answer:
Osteoporosis, fractures, bone cancer, rheumatoid arthritis, Down syndrome
Expert Rationale:
HVLA is contraindicated in conditions where bone integrity, ligament stability, or
structural strength is compromised. Osteoporosis and fractures increase the risk
of iatrogenic injury due to decreased bone strength. Bone cancer weakens skeletal
structures and increases fracture risk. Rheumatoid arthritis causes ligamentous
laxity and joint instability, particularly in the cervical spine. Down syndrome is
associated with atlantoaxial instability due to ligamentous laxity, making HVLA
dangerous. These conditions all increase the risk of neurovascular or structural
injury during high-velocity thrust techniques.
Why other options are incorrect:
• Normal musculoskeletal conditions: do not contraindicate HVLA if no instability
is present
• Muscle strain or mild somatic dysfunction: often appropriate for HVLA treatment
DIF: Analysis
,REF: Osteopathic Manipulative Medicine / HVLA Safety
OBJ: Identify contraindications to HVLA techniques
TOP: OMM Safety / Contraindications
If the ease of motion in translation of a cervical vertebra is to the LEFT, in what
direction will the ease of sidebending be?
Correct Answer:
Left sidebending
Expert Rationale:
In cervical mechanics, the principle of coupling states that translation and
sidebending are directly related. If a vertebra translates left, the segment is freer
to sidebend left. This reflects the mechanical coupling of cervical vertebrae where
sidebending and translation occur in the same direction in neutral mechanics.
Why other options are incorrect:
• Right sidebending: would oppose the direction of translation and is mechanically
restricted in this scenario
DIF: Application
REF: Osteopathic Principles / Cervical Spine Mechanics
OBJ: Apply cervical coupling principles in somatic dysfunction
TOP: Biomechanics / Cervical Spine
In what directions (flexion, extension, sidebending, rotation) does the SCM
normally function?
Correct Answer:
Flexion, ipsilateral sidebending, contralateral rotation (F StRa)
,Expert Rationale:
The sternocleidomastoid (SCM) muscle produces flexion of the cervical spine
when both sides contract. Unilateral contraction results in ipsilateral sidebending
and contralateral rotation due to its oblique fiber orientation from mastoid
process to sternum and clavicle. This predictable pattern is clinically important in
diagnosing and treating somatic dysfunction involving cervical musculature.
Why other options are incorrect:
• Ipsilateral rotation: contradicts SCM fiber orientation
• Extension: SCM does not extend the cervical spine
DIF: Basic
REF: Musculoskeletal Anatomy / SCM Function
OBJ: Describe SCM muscle actions
TOP: Anatomy / Cervical Musculature
What is the counterstrain point for the clavicular head of the SCM?
Correct Answer:
AC7
Expert Rationale:
The clavicular head of the SCM has a specific anterior cervical counterstrain point
located at AC7. Counterstrain techniques place the muscle in a position of
maximal comfort to reduce neuromuscular hypertonicity and reset proprioceptive
dysfunction. AC7 corresponds anatomically to the tender point associated with
clavicular SCM dysfunction.
Why other options are incorrect:
• AC8: corresponds to sternal head of SCM
• Other cervical levels: do not correspond to SCM clavicular trigger point
DIF: Recall
, REF: OMM Counterstrain / Cervical Region
OBJ: Identify SCM counterstrain points
TOP: OMM Techniques / Counterstrain
What is the counterstrain point for the sternal head of the SCM?
Correct Answer:
AC8
Expert Rationale:
The sternal head of the SCM corresponds to the AC8 counterstrain point. This
region is treated by positioning the head to reduce tenderness at the sternal SCM
attachment, allowing for neuromuscular relaxation and resolution of somatic
dysfunction.
Why other options are incorrect:
• AC7: corresponds to clavicular head of SCM
• Non-cervical points: not associated with SCM dysfunction
DIF: Recall
REF: OMM Counterstrain / Cervical Anatomy
OBJ: Identify SCM sternal head tender point
TOP: OMM Techniques / Counterstrain
According to the Rules of 3, what are the positional relationships of thoracic
vertebrae T1–T12?
Correct Answer:
T1–T3: at level
T4–T6: ½ level down
T7–T9: 1 level down
T10: full level down
T11: ½ level down
T12: at level
COMPLETE ACCURATE TEST EXAM
ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED SOLUTIONS) 2026 EDITION
|BEST DOCUMENT FOR EXAM
A patient is considered for HVLA manipulation. Which patient conditions are
contraindications for HVLA?
Correct Answer:
Osteoporosis, fractures, bone cancer, rheumatoid arthritis, Down syndrome
Expert Rationale:
HVLA is contraindicated in conditions where bone integrity, ligament stability, or
structural strength is compromised. Osteoporosis and fractures increase the risk
of iatrogenic injury due to decreased bone strength. Bone cancer weakens skeletal
structures and increases fracture risk. Rheumatoid arthritis causes ligamentous
laxity and joint instability, particularly in the cervical spine. Down syndrome is
associated with atlantoaxial instability due to ligamentous laxity, making HVLA
dangerous. These conditions all increase the risk of neurovascular or structural
injury during high-velocity thrust techniques.
Why other options are incorrect:
• Normal musculoskeletal conditions: do not contraindicate HVLA if no instability
is present
• Muscle strain or mild somatic dysfunction: often appropriate for HVLA treatment
DIF: Analysis
,REF: Osteopathic Manipulative Medicine / HVLA Safety
OBJ: Identify contraindications to HVLA techniques
TOP: OMM Safety / Contraindications
If the ease of motion in translation of a cervical vertebra is to the LEFT, in what
direction will the ease of sidebending be?
Correct Answer:
Left sidebending
Expert Rationale:
In cervical mechanics, the principle of coupling states that translation and
sidebending are directly related. If a vertebra translates left, the segment is freer
to sidebend left. This reflects the mechanical coupling of cervical vertebrae where
sidebending and translation occur in the same direction in neutral mechanics.
Why other options are incorrect:
• Right sidebending: would oppose the direction of translation and is mechanically
restricted in this scenario
DIF: Application
REF: Osteopathic Principles / Cervical Spine Mechanics
OBJ: Apply cervical coupling principles in somatic dysfunction
TOP: Biomechanics / Cervical Spine
In what directions (flexion, extension, sidebending, rotation) does the SCM
normally function?
Correct Answer:
Flexion, ipsilateral sidebending, contralateral rotation (F StRa)
,Expert Rationale:
The sternocleidomastoid (SCM) muscle produces flexion of the cervical spine
when both sides contract. Unilateral contraction results in ipsilateral sidebending
and contralateral rotation due to its oblique fiber orientation from mastoid
process to sternum and clavicle. This predictable pattern is clinically important in
diagnosing and treating somatic dysfunction involving cervical musculature.
Why other options are incorrect:
• Ipsilateral rotation: contradicts SCM fiber orientation
• Extension: SCM does not extend the cervical spine
DIF: Basic
REF: Musculoskeletal Anatomy / SCM Function
OBJ: Describe SCM muscle actions
TOP: Anatomy / Cervical Musculature
What is the counterstrain point for the clavicular head of the SCM?
Correct Answer:
AC7
Expert Rationale:
The clavicular head of the SCM has a specific anterior cervical counterstrain point
located at AC7. Counterstrain techniques place the muscle in a position of
maximal comfort to reduce neuromuscular hypertonicity and reset proprioceptive
dysfunction. AC7 corresponds anatomically to the tender point associated with
clavicular SCM dysfunction.
Why other options are incorrect:
• AC8: corresponds to sternal head of SCM
• Other cervical levels: do not correspond to SCM clavicular trigger point
DIF: Recall
, REF: OMM Counterstrain / Cervical Region
OBJ: Identify SCM counterstrain points
TOP: OMM Techniques / Counterstrain
What is the counterstrain point for the sternal head of the SCM?
Correct Answer:
AC8
Expert Rationale:
The sternal head of the SCM corresponds to the AC8 counterstrain point. This
region is treated by positioning the head to reduce tenderness at the sternal SCM
attachment, allowing for neuromuscular relaxation and resolution of somatic
dysfunction.
Why other options are incorrect:
• AC7: corresponds to clavicular head of SCM
• Non-cervical points: not associated with SCM dysfunction
DIF: Recall
REF: OMM Counterstrain / Cervical Anatomy
OBJ: Identify SCM sternal head tender point
TOP: OMM Techniques / Counterstrain
According to the Rules of 3, what are the positional relationships of thoracic
vertebrae T1–T12?
Correct Answer:
T1–T3: at level
T4–T6: ½ level down
T7–T9: 1 level down
T10: full level down
T11: ½ level down
T12: at level
