Functional Management – Load Tolerance Testing & Graded Exposure

A set of Q&A flashcards covering load-tolerance testing for Achilles, patellar, and rotator-cuff tendinopathies, plus graded exposure for fear-avoidant spinal flexion.

What is the first exercise in the load-tolerance hierarchy for suspected Achilles tendinopathy?

A double-leg calf raise.

List the four progressive calf-raise tests used to assess Achilles tendinopathy tolerance (from least to most provocative).

1) Double-leg calf raise 2) Double-leg elevated calf raise 3) Single-leg elevated calf raise 4) Single-leg knee-bent calf raise.

After calf-raise drills for Achilles tendinopathy, which higher-demand movement category is introduced before sport-specific drills?

Hopping and jumping progressions (e.g., squat-jump stick, stiff-knee jumps, single-leg hops).

Why is the ordered progression of Achilles load tests important?

It minimises provocation, allows delayed pain responses to be monitored over 24–48 h, and helps match tissue capacity before advancing load.

What postoperative or flare-up friendly exercises are recommended if Achilles pain occurs at basic tolerance levels?

Seated or standing calf-raise isometrics and slow double-leg calf raises.

Name two moderate-load strength exercises for Achilles tendinopathy once basic tolerance is achieved.

Single-leg slow eccentric heel drops and heavy–slow resistance training.

Which drill category is emphasised when returning an Achilles patient to high-level function or sport?

Plyometric drills with controlled, incremental impact exposure.

In patellar tendinopathy testing, what is the very first jump test performed?

A double-leg jump and land.

Provide the complete five-step jump/hop sequence for patellar tendinopathy tolerance testing.

1) Double-leg jump & land 2) Double-leg stiff-knee jumps 3) Single-leg jump & land 4) Deep, slow single-leg jump 5) Triple forward single-leg hop (≤50 cm side-to-side difference).

What two key principles guide the 24–48 h monitoring period after patellar load testing?

Avoid sudden load spikes and accept only mild discomfort; sharp, lingering pain signals the need to regress (traffic-light system).

Give two isometric options for a patellar tendon patient unable to tolerate early jump loading.

Spanish squat holds and wall-sit holds.

Which eccentric exercise is commonly prescribed once patellar tendinopathy patients tolerate moderate load?

Slow eccentric decline squats at the appropriate decline angle.

What drill types dominate the final ‘return-to-play’ phase for patellar tendinopathy?

Jumping, sprinting, and other high-impact sport-specific drills.

During rotator-cuff symptom modification, what is the first action the clinician requests from the patient?

Ask the patient to demonstrate the painful shoulder movement.

How can thoracic extension modification reduce rotator-cuff pain during testing?

By improving thoracic posture, it may increase subacromial space or provide neuromodulation, easing impingement-type symptoms.

Which scapular adjustment is commonly trialled to decrease shoulder pain during the symptom-modification protocol?

Scapular retraction or depression adjustments.

What manual cue may be applied to test humeral head positioning during painful shoulder elevation?

A gentle posterior glide of the humeral head.

Give an example of an isometric strength test for a rotator-cuff-related shoulder.

Isometric external rotation hold with the arm in slight abduction.

Describe an eccentric loading progression for the rotator cuff once pain allows.

Slow-lowering lateral raises or external-rotation eccentrics, later adding more weight or slower tempo.

What is the first graded-exposure activity for a construction worker fearful of spinal flexion?

Low-level desensitisation such as supine knee-to-chest or cat–cow movements accompanied by education ("hurt ≠ harm").

Which stage of spinal-flexion exposure introduces controlled lifting of light objects from waist height?

Stage 4 – Loaded and functional flexion in a safe manner.

Why is graded exposure critical for fear-avoidant spinal flexion rehabilitation?

It builds confidence, demonstrates safety, prevents protective guarding, and progressively restores function without overstressing tissues.