Official Study Guide Active Care Exam 1

Why is active care complementary to chiropractic care?

Because it extends the benefits of adjustments, improves long‑term outcomes, and teaches patients to self‑manage through movement.

What is active care?

Patient‑performed movement-based interventions such as exercise, motor control training, and mobility work.

Benefits of active care

Improves strength, mobility, stability, reduces recurrence, increases self‑efficacy, and enhances long‑term outcomes.

Difference between active and passive care

Active = patient does the work; Passive = provider does the work.

Three roles movement plays in patient care

Assessment, Treatment, Maintenance.

Effects of cardio training on health

Reduces all‑cause mortality, improves cardiovascular health, reduces diabetes, stroke, hypertension.

Recommended aerobic exercise per week

150–300 min moderate OR 75–150 min vigorous.

Effects of resistance training on health

Reduces all‑cause mortality, improves metabolic health, bone density, strength, and reduces chronic disease risk.

Recommended resistance training per week

At least 2 days/week targeting major muscle groups.

Correlation between strength and all‑cause mortality

Higher strength = lower mortality risk.

Why movement assessment improves diagnostics

Reveals root causes of dysfunction and identifies compensations not seen in static exams.

Source vs cause of pain

Source = where it hurts; Cause = why it hurts.

1 predictor of injury

Previous injury.

Relationship between pain, altered motor control, and injury

Pain alters motor control → compensations → increased injury risk.

What is motor control?

The nervous system’s ability to coordinate efficient movement.

What is altered motor control?

Poor timing, sequencing, or coordination of movement.

What is a mobility dysfunction (MD)?

A joint/tissue cannot move enough; passive ROM is limited.

General rule for MD

If passive ROM is restricted → mobility problem.

What is a stability/motor control dysfunction (SMCD)?

Movement is uncontrolled despite normal passive ROM.

General rule for SMCD

Passive ROM normal, active control poor.

How do we know patients are “better”?

Pain ↓, function ↑, movement normalized, patient can self‑manage.

Patterns or parts first?

Assess patterns first, then parts if needed.

When to look at the parts?

When a pattern reveals a specific regional limitation.

When should functional movement assessments be performed?

Initial exam, progress checks, symptom changes, discharge.

Why perform a functional movement assessment?

To identify root causes, guide treatment, and track progress.

How does the locomotor system develop?

Ground‑up: supine → prone → rolling → quadruped → kneeling → standing → walking.

Mobilizers vs stabilizers in compensation

Mobilizers become tight/overactive; stabilizers become weak/inhibited.

Why functional muscle imbalances occur

Body prioritizes efficiency and reinforces compensations.

Upper crossed syndrome: weak muscles

Deep neck flexors, lower traps, serratus anterior.

Upper crossed syndrome: tight muscles

Upper traps, levator scapulae, pecs.

Lower crossed syndrome: weak muscles

Glutes, abdominals.

Lower crossed syndrome: tight muscles

Hip flexors, lumbar extensors.

What is the kinetic chain?

The body as an interconnected system.

Primary tissue mediating kinetic chain

Fascia.

What is regional interdependence?

Dysfunction in one region affects another region.

Joints moving in 1 plane: stable or mobile?

Stable.

Joints moving in 3 planes: stable or mobile?

Mobile.

Mobile joints (prone to mobility restrictions)

Ankle, hip, thoracic spine, shoulder.

Stable joints (prone to stability issues)

Foot, knee, lumbar spine, scapula, cervical spine.

Hierarchy of movement: treat what first?

Mobility → motor control → functional patterning.

Should active care be generalized or individualized?

Individualized.

Primary focus of treatment

Correct the root cause of dysfunctional movement.

Restore length‑tension relationship

Stretching, soft tissue therapy, myofascial release.

Restore force‑couple relationship

Motor control training, activation exercises, neuromuscular re‑education.

Restore arthrokinematics

Adjustments and joint mobilization.

Goals of evidence‑inspired active care

Reduce pain, improve function, restore movement, prevent recurrence.

How to know if treatment was effective

Pain ↓, ROM ↑, strength ↑, movement quality ↑.

Three R’s: Reset

Restore mobility/arthrokinematics (adjustments, soft tissue, stretching).

Three R’s: Reinforce

Strengthen stabilizers (activation, isometrics).

Three R’s: Retrain

Integrate functional patterns (gait, squatting, lifting).

Four positions of 4x4 matrix

Supine, Quadruped, Kneeling, Standing.

Least challenging position

Supine.

Most challenging position

Standing.

Hallmark patterns per position

Supine = breathing/core; Quadruped = crawling; Kneeling = hip control; Standing = gait/balance.

Four levels of demand

Assisted, Active, Resisted, Dynamic.

Least difficult demand

Assisted.

Most difficult demand

Dynamic.

What is feedback?

Information that helps refine movement.

Two ways to change exercise difficulty

Change position or change demand.

Classification of exercise (e.g., 2x3)

Position number × demand number.

Next logical progression

Increase position OR demand by one level.

Primary goals in Step 1 of active care

Restore mobility and reduce pain.

Ideal treatments in Step 1

Adjustments, stretching, soft tissue.

Primary goals in Step 2

Improve stability and motor control.

Ideal treatments in Step 2

Activation, isometrics, patterning.

Difference between rehab and training

Rehab restores function; training enhances performance.

Four movement principles

Mobility first, stability second, patterning third, load last.

Mobility vs flexibility

Mobility = controlled ROM; Flexibility = passive tissue length.

What is useless flexibility?

Flexibility without stability or control.

Reduced ROM: active tension

Muscle contraction limitations.

Reduced ROM: passive tension

Tissue stiffness or shortening.

Joint hypermobility

Excess motion causing instability and injury risk.

Flexibility & injury (U‑shaped curve)

Too little OR too much flexibility increases injury risk.

Tight vs flexible muscles

Tight = protective stiffness; Flexible = may lack stability.

Effects of age on flexibility

Flexibility decreases with age due to collagen changes.

Cause of feeling of tightness

Neurological tone, not tissue length.

Why we experience tightness

Protective response from the nervous system.

Neuromuscular dysfunction → tightness

Poor motor control increases tone; treat with motor control, stretching, soft tissue.

Shortened tissues require

Long-duration stretching, eccentric loading, remodeling.

Fascia communicates/remodels in response to

Load, tension, movement.

Major afferent feedback structures

Muscle spindles, GTOs, joint mechanoreceptors.

Why adjust before exercise?

Improves joint mechanics and movement quality.

Indications for stretching

Tightness, limited ROM.

Contraindications for stretching

Acute injury, fracture, instability.

What stretching actually does

Improves stretch tolerance (short-term).

Duration of stretching effects

Minutes to hours.

Most important factor to modify

Frequency.

Cause of acute ROM increase

Neurological desensitization.

When most ROM increase occurs

First 20–30 seconds.

Optimal stretch duration

30sec

Optimal stretch frequency

3–7 days/week.

How long to be consistent

6–8 weeks.

Optimal stretch repetitions

2–4 reps.

Primary factor for tendon flexibility

Time under tension.

Time needed to stretch tendon

2–3 minutes.

Stretch-induced strength loss

Temporary strength decrease after long static stretching.

How to mitigate strength loss

Use dynamic warm‑ups or shorter holds.

Activities most affected

Power sports (sprinting, jumping).

Stretching effects on endurance

Minimal effect on economy or perceived exertion.

Static stretching vs strength training for ROM

Strength training can increase ROM as much or more.