STM RELIABLE EXAM EVALUATION QUESTIONS WITH
ANSWERS 2025/2026 GRADED A+
direct myofascial release - -intent: to improve mobility of soft tissues through application
of a slow, controlled mechanical stress directly into a restriction
-pressure gradually increased or repeated until mobility of tissue is felt to improve
-tissue may be manipulated while pt is either passively or actively moving (depends on
pt tolerance)
indirect myofascial release - -applied similarly to direct
-amt of force is lower in intensity but much longer in duration (gives tissues an
opportunity to release)
-often used when pt's are tender or extremely guarded (pt feedback essential!)
movement approach: PNF (basic principles) - 1) always keep treatment approach
positive, reinforcing what pt can do on both physical & psychological levels
2) help pts achieve their highest level of function
3) direct the entire human being in each treatment & not a specific problem or body
segment
-use diagonal mvmts based on synergistic patterns
-ex: rhythmic initiation, rhythmic stabilization, contract relax, hold relax
movement approach: Alexander technique - -based on theory that in each human there
exists an integration mechanism that produces more optimal coordination & functioning
-cornerstone of this technique: position of head & neck (pt learns to activate primary
locus of control here)
-palpatory & verbal feedback given as new positions & mvmt patterns are learned
-best learned slowly & w/ positive reinforcement
-often used w/ TMJD
movement approach: Feldenkrais method - -seeks to retrain body away from aberrant
mvmt patterns into more efficient ones
-designed to help body reprogram brain to integrate whole mind-body entity
2 basic approaches:
1) awareness through mvmt
2) functional integration (hands on)
-cornerstone of method: idea that all persons exhibit some abnormal mvmt either from
previous trauma or old habit patterns
histological makeup of connective tissue - -CT subclassified into CT proper, cartilage &
bone
-CT proper subclassified by orientation & density (dense regular, dense irregular, &
loose irregular)
,different cells of connective tissues - fibroblasts, fibrocytes, myofibroblasts,
macrophages & histiocytes, mast cells, plasma cells
fibroblasts - synthesize collagen, elastin, reticulin & ground substance
fibrocytes - matured fibroblasts, found in stable mature CT
myofibroblasts - contract via actin & myosin to pull tissues together
macrophages & histiocytes - -"big eaters" found in traumatic, inflammatory, or infectious
conditions
-clean & debride area of waste/foreign products
mast cells - secrete histamine (vasodilator) & heparin (anticoagulant)
plasma cells - -produce antibodies
-present only in infectious conditions
components of extracellular matrix - fibers (collagen, elastin & reticulin) & ground
substance
collagen fibers - -very tensile
-Type I: CT proper (loose & dense)
-Type II: hyaline cartilage
-Type III: fetal dermis, lining of arteries
-Type IV: basement membranes
elastin fibers - -more elastic
-found in lining of arteries (also ligamentum flavum & nuchae)
reticulin fibers - delicate meshwork for support of internal organs & glands
what is ground substance - viscous gel w/ high water concentration; provides medium in
which collagen & cells lie
purpose of ground substance - 1. diffuse nutrients/waste products
2. mechanical barrier against bacteria
3. maintains critical interfiber distance, preventing microadhesions
4. provides lubrication btwn collagen fibers
-more abundant in early life, decreases w/ age
components of ground substance - -glycosaminoglycans: lubricating effect,
maintenance of interfiber distance
-proteoglycans: primarily bind water
, process of collagen synthesis - -begins in fibroblast by absorption of amino acids into
cell
-amino acids are synthesized into polypeptide chains in the rough ER >> which
synthesizes protocollagen >> tropocollagen
-tropocollagen passes to interstitial spaces & form collagen fibrils. Initially, tropocollagen
molecules are hydrostatically attracted to each other & form bonds >> collagen matures
>> the weak hydrostatic bonds convert to strong covalent bonds
stress - -force applied to connective tissues
-types: tension, compression, shear
tension - pulling force along length of tissue (ex: whiplash injury)
compression - stress applied along length of tissue causing a decrease in length &
increase in perimeter (ex: compression force on IVDs when in an upright position)
shearing - one part of a tissue slides over another, forces meet in opposite directions
(ex: L5 sliding over S1 leading to higher incidence of disc herniation at this level)
strain - deformation/change in length that may occur as a result of stress (deformation
per unit length or percent change)
different components of stress-strain curve - -toe region: elastic component (temporary
length change)
-elastic region: temp length change
-point of yield: tissues stretch beyond elastic range, point of permanent deformation
-plastic region: stress continues, tissue is permanently deformed
-point of failure: rupture occurs
components of viscoelastic model of connective tissue - -viscous (permanent)
deformation
-elastic (temporary deformation)
-spring (elastic) & a hydraulic cylinder (plastic) linked in series
spring portion (viscoelastic model of connective tissue) - -temporary change when
subjected to stretch
-poststretch recoin in which all length gained during stretch is lost over a short period of
time
-the "slack" taken out of CT fibers
hydraulic cylinder portion (viscoelastic model of connective tissue) - -after stretch, part
of extensibility gained remains even after a period of time
-no postmanipulation recoil
-some changes result from breaking intermolecular bonds btwn collagen molecules,
fibers & cross-links
ANSWERS 2025/2026 GRADED A+
direct myofascial release - -intent: to improve mobility of soft tissues through application
of a slow, controlled mechanical stress directly into a restriction
-pressure gradually increased or repeated until mobility of tissue is felt to improve
-tissue may be manipulated while pt is either passively or actively moving (depends on
pt tolerance)
indirect myofascial release - -applied similarly to direct
-amt of force is lower in intensity but much longer in duration (gives tissues an
opportunity to release)
-often used when pt's are tender or extremely guarded (pt feedback essential!)
movement approach: PNF (basic principles) - 1) always keep treatment approach
positive, reinforcing what pt can do on both physical & psychological levels
2) help pts achieve their highest level of function
3) direct the entire human being in each treatment & not a specific problem or body
segment
-use diagonal mvmts based on synergistic patterns
-ex: rhythmic initiation, rhythmic stabilization, contract relax, hold relax
movement approach: Alexander technique - -based on theory that in each human there
exists an integration mechanism that produces more optimal coordination & functioning
-cornerstone of this technique: position of head & neck (pt learns to activate primary
locus of control here)
-palpatory & verbal feedback given as new positions & mvmt patterns are learned
-best learned slowly & w/ positive reinforcement
-often used w/ TMJD
movement approach: Feldenkrais method - -seeks to retrain body away from aberrant
mvmt patterns into more efficient ones
-designed to help body reprogram brain to integrate whole mind-body entity
2 basic approaches:
1) awareness through mvmt
2) functional integration (hands on)
-cornerstone of method: idea that all persons exhibit some abnormal mvmt either from
previous trauma or old habit patterns
histological makeup of connective tissue - -CT subclassified into CT proper, cartilage &
bone
-CT proper subclassified by orientation & density (dense regular, dense irregular, &
loose irregular)
,different cells of connective tissues - fibroblasts, fibrocytes, myofibroblasts,
macrophages & histiocytes, mast cells, plasma cells
fibroblasts - synthesize collagen, elastin, reticulin & ground substance
fibrocytes - matured fibroblasts, found in stable mature CT
myofibroblasts - contract via actin & myosin to pull tissues together
macrophages & histiocytes - -"big eaters" found in traumatic, inflammatory, or infectious
conditions
-clean & debride area of waste/foreign products
mast cells - secrete histamine (vasodilator) & heparin (anticoagulant)
plasma cells - -produce antibodies
-present only in infectious conditions
components of extracellular matrix - fibers (collagen, elastin & reticulin) & ground
substance
collagen fibers - -very tensile
-Type I: CT proper (loose & dense)
-Type II: hyaline cartilage
-Type III: fetal dermis, lining of arteries
-Type IV: basement membranes
elastin fibers - -more elastic
-found in lining of arteries (also ligamentum flavum & nuchae)
reticulin fibers - delicate meshwork for support of internal organs & glands
what is ground substance - viscous gel w/ high water concentration; provides medium in
which collagen & cells lie
purpose of ground substance - 1. diffuse nutrients/waste products
2. mechanical barrier against bacteria
3. maintains critical interfiber distance, preventing microadhesions
4. provides lubrication btwn collagen fibers
-more abundant in early life, decreases w/ age
components of ground substance - -glycosaminoglycans: lubricating effect,
maintenance of interfiber distance
-proteoglycans: primarily bind water
, process of collagen synthesis - -begins in fibroblast by absorption of amino acids into
cell
-amino acids are synthesized into polypeptide chains in the rough ER >> which
synthesizes protocollagen >> tropocollagen
-tropocollagen passes to interstitial spaces & form collagen fibrils. Initially, tropocollagen
molecules are hydrostatically attracted to each other & form bonds >> collagen matures
>> the weak hydrostatic bonds convert to strong covalent bonds
stress - -force applied to connective tissues
-types: tension, compression, shear
tension - pulling force along length of tissue (ex: whiplash injury)
compression - stress applied along length of tissue causing a decrease in length &
increase in perimeter (ex: compression force on IVDs when in an upright position)
shearing - one part of a tissue slides over another, forces meet in opposite directions
(ex: L5 sliding over S1 leading to higher incidence of disc herniation at this level)
strain - deformation/change in length that may occur as a result of stress (deformation
per unit length or percent change)
different components of stress-strain curve - -toe region: elastic component (temporary
length change)
-elastic region: temp length change
-point of yield: tissues stretch beyond elastic range, point of permanent deformation
-plastic region: stress continues, tissue is permanently deformed
-point of failure: rupture occurs
components of viscoelastic model of connective tissue - -viscous (permanent)
deformation
-elastic (temporary deformation)
-spring (elastic) & a hydraulic cylinder (plastic) linked in series
spring portion (viscoelastic model of connective tissue) - -temporary change when
subjected to stretch
-poststretch recoin in which all length gained during stretch is lost over a short period of
time
-the "slack" taken out of CT fibers
hydraulic cylinder portion (viscoelastic model of connective tissue) - -after stretch, part
of extensibility gained remains even after a period of time
-no postmanipulation recoil
-some changes result from breaking intermolecular bonds btwn collagen molecules,
fibers & cross-links
