NASM-CES Exam Questions

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101.

During the assessment portion of a new client's first session, a Corrective Exercise Specialist performs a movement assessment. Which of the following options is not a component of this specific assessment type? 

  • To assess joint range of motion

  • To evaluate a client's dynamic posture

  • To identify compensatory movement

  • To observe the structural alignment of the musculoskeletal system when the body is in motion

Correct answer: To assess joint range of motion

Joint range of motion is assessed during the mobility assessments, not the movement assessment portion of the session. 

During the movement assessment, the goal is to evaluate a person's dynamic posture (also known as the structural alignment when the body is in motion) as well as identify any compensatory movements.

102.

A client performing the Davies Test Assessment demonstrates excessive trunk movement throughout the testing process. Which of the following would you most likely recommend based on this presentation? 

  • Core stabilization training

  • Modified Thomas Test

  • Hip abductor strengthening 

  • Lumbar flexion and extension testing

Correct answer: Core stabilization training

If excessive trunk movement is observed during the Davies test, it is most likely that the client has underactive local core stabilizers and would benefit from core stabilization training. 

The Modified Thomas Test and lumbar flexion/extension testing is appropriate for an observed anterior pelvic tilt. Hip abductor strengthening is beneficial for observed impairments of the lower body. 

103.

A client with layered crossed syndrome according to Janda's Syndromes presents with a multitude of postural impairments. Which of the following exercises would least likely be performed by this type of client in their Corrective Exercise Program?

  • Calf raises

  • Standing hip flexor stretch

  • Planks

  • Standing hip abduction

Correct answer: Calf raises

In a layered crossed syndrome, a client may present with overactive calf muscles, which would less likely need to be strengthened in a corrective exercise program. 

Muscles that are overactive, such as the hip flexors, will need to be lengthened using stretching. Planks and hip abduction target the abdominals and gluteus medius muscles respectively. In a layered crossed syndrome, these muscle groups are likely underactive and require strengthening to address the postural imbalances.

104.

A client post-operatively presents with significant scarring along their anterior knee. He reports that he has been having difficulty achieving full range of motion in that area. Which of the following techniques would you least likely expect their physical therapist to perform in order to help achieve a full range of motion?

  • Heat and cold packs to reduce inflammation

  • Manual scar tissue mobilization

  • Dynamic stretching

  • Mobilization with movement

Correct answer: Heat and cold packs to reduce inflammation

Heat and cold packs are not well-studied methods to help improve the range of motion of scar tissue postoperatively. 

Scar tissue mobilization through manual mobilization, stretching activities, and mobilization through movement are evidence-based methods to improve the range of motion of scar tissue.

105.

Which of the following scenarios would be the best example of the biopsychosocial model of pain?

  • A patient with chronic lower back pain due to a herniated disc, who experiences increased pain when stressed at work and finds relief through physical therapy and relaxation techniques

  • A patient with an acute ankle sprain who only experiences pain relief after taking over-the-counter pain medication

  • A patient with a severe headache, which is solely attributed to a family history of migraines, improves with the use of prescription migraine medication

  • A patient with chronic knee pain following a traumatic injury finds relief solely through a specialized surgical procedure

Correct answer: A patient with chronic lower back pain due to a herniated disc, who experiences increased pain when stressed at work and finds relief through physical therapy and relaxation techniques

Each individual experiences pain differently based on a variety of factors including but not limited to previous experiences, behaviors, and expectations. In this scenario, the patient's pain is attributed to a specific biological factor (the herniated disc), but it is also influenced by psychological factors (stress at work) and social factors (work environment). This patient experiences increased pain when stressed, which highlights the psychological and social aspects of pain. Additionally, the fact that they find relief through physical therapy (biological) and relaxation techniques (psychological) demonstrates the comprehensive approach of the biopsychosocial model in addressing and managing pain. 

106.

A female athlete demonstrates increased flexibility as compared to her male counterpart. Based on scientific research, which of the following statements correctly describes why women may have greater flexibility than men?

  • Women may have differences in muscle mass, joint geometry, and the composition of collagen in their bodies.

  • Women tend to be shorter than men, which reduces the amount of range of motion needed for their joints.

  • Women's ligaments are made of a unique flexible tissue, giving them a greater range of motion compared to men.

  • Women naturally have more elastic joints due to the presence of an extra layer of cartilage, which enhances their flexibility compared to men.

Correct answer: Women may have differences in muscle mass, joint geometry, and the composition of collagen in their bodies. 

While women can be equally strong or even stronger in some cases, the distribution of muscle in certain areas may affect flexibility. Joint structure, including bone shape and alignment, can vary between individuals and sexes. Variations in collagen composition can affect the elasticity and pliability of these tissues, which, in turn, influence flexibility.

It is incorrect to suggest that women's reduced height compared to men directly reduces the range of motion needed for their joints. Flexibility and joint range of motion are influenced by a multitude of factors, and making generalizations based on height alone is not scientifically accurate. Both men and women have similar joint structures. The presence of an "extra layer of cartilage" or a "unique flexible tissue" in women is not supported by scientific evidence.

107.

A client finishes performing the first three steps of the Corrective Exercise Continuum and is ready to move onto the final phase. Which of the following is the best example of integrated dynamic movement? 

  • Ball squat with an overhead press

  • Functional circuit training with upper body exercises

  • Isolated strengthening of the targeted muscle groups

  • Lower body plyometric training

Correct answer: Ball squat with an overhead press

Integrated dynamic movement involves the use of dynamic total body exercises where the lower/upper body as well as the lumbo-pelvic-hip complex each have coordinated responsibilities. This enhances the functional capacity of the human movement system by increasing multiplanar neuromuscular control. A ball squat with an overhead press is a compound movement that incorporates both the upper/lower body and the lumbo-pelvic-hip complex.

Functional circuit training that focuses on the upper body only is not an example of integrated dynamic movement, as it is limited to only one section of the body. Similarly, only focusing on lower body plyometrics is not considered integrated dynamic movements due to limitations on only one body section. Isolated strengthening is a key component of the third, not fourth phase of the Corrective Exercise Continuum. 

108.

A client complains of sharp lower back pain while walking. Which of the following statements regarding the erector spinae and the Deep Longitudinal Subsystem (DLS) is true?

  • The erector spinae is a component of the DLS, and the force transmission properties of these muscles can contribute to lower back pain during walking. 

  • A suboptimal DLS is responsible for lower back pain during walking, while the erector spinae primarily assists in hip flexion during the gait cycle.

  • A suboptimal DLS is responsible for lower back pain during walking, while the erector spinae functions separately as a global muscle group.

  • The erector spinae is a component of the DLS, and the force reception properties of these muscles can contribute to lower back pain during walking. 

Correct answer: The erector spinae is a component of the DLS, and the force transmission properties of these muscles can contribute to lower back pain during walking. 

The DLS consists of muscles such as the erector spinae, biceps femoris, tibialis anterior, and fibularis longus. Its function is the transference of force, especially during normal gait (walking). The erector spinae helps support the trunk in an upright position throughout the gait cycle. Dysfunction can lead to muscle imbalances and pain. 

The erector spinae is located along the posterior aspect of the trunk and inserts directly into the spine and ribs, making it unable to assist with hip flexion. Force reception is incorrect as it does not describe the transference of force between structures. The erector spinae is a part of the global muscular system; however, it does not function separately from the DLS. It functions with the DLS to assist with force transference during gait. 

109.

A client is instructed in an exercise to target the anterior tibialis muscle for isolated strengthening. Which of the following exercises best describes the technique to target this muscle group? 

  • Seated with a band and the ankle in dorsiflexion

  • Standing calf raises against a wall

  • Seated legs curls with the hips externally rotated

  • Seated with a band and the ankle in eversion

Correct answer: Seated with a band and the ankle in dorsiflexion

By sitting down, the exercise isolates the movement primarily to the ankle and lower leg, reducing the involvement of other muscle groups. Dorsiflexion is the movement that involves bringing the top of the foot closer to the shin, activating the anterior tibialis muscle. 

Ankle eversion involves moving the ankle laterally and activating the peroneal muscle group, not the anterior tibialis. Seated leg curls will target the hamstring muscle group. External rotation may activate the biceps femoris more optimally. Standing calf raises target the gastrocnemius, which is on the posterior side of the lower leg, not the anterior side where the anterior tibialis is located.

110.

A client has difficulty progressing in his dumbbell shoulder press. The Corrective Exercise Specialist performs a static postural analysis in order to further improve the client's training program. 

Which of the following would be most likely to be observed in the shoulder and thoracic spine region? 

  • Shoulders in front of the ears from a lateral viewpoint

  • Shoulders in line with the ears from a lateral viewpoint

  • External rotation of the elbow at rest

  • Shoulders slightly retracted

Correct answer: Shoulders in front of the ears from a lateral viewpoint

Ideal posture involves shoulders inline with the ears from a lateral viewpoint. Shoulders being in front of the ears would indicate a forward-rounded shoulder posture. Forward-rounded shoulders are a common postural deviation, often related to excessive tightness in the chest and anterior shoulder muscles. Limited thoracic spine extension can be associated with these rounded shoulders, which can restrict proper shoulder function and limit the ability to perform movements like the dumbbell shoulder press.

External rotation of the elbow at rest is not the correct body region to assess when observing the shoulder and thoracic spine region. Slightly retracted shoulders can potentially affect shoulder function. It is less common and less likely to be observed in the context of difficulty with an overhead dumbbell shoulder press.

111.

A new client completes their intake form. The Corrective Exercise Specialist learned that this new client had an old knee injury resulting in impaired joint motion, but reports no current pain. 

How should the fitness professional proceed in this scenario with isolated strengthening?

  • Inform the client that they will be unable to exercise that knee in this program due to the old injury impairing the joint motion

  • Proceed with caution in programming this client's program

  • Request that the client receive clearance from their physician to exercise their previously injured knee

  • Create a comprehensive exercise program to address movement impairments of the knee

Correct answer: Inform the client that they will be unable to exercise that knee in this program due to the old injury impairing the joint motion

Impaired joint motion is a contraindication to isolated strengthening due to the potential to cause tissue damage due to impaired biomechanics surrounding the joint. 

While the client does not report pain, it is outside of the professional scope of the Corrective Exercise Specialist to address impaired joint function. Precautions will require additional clearance from their physician to proceed with an exercise program. However, impaired joint function is a contraindication, not a precaution, to isolated strengthening.

112.

A client reports that they play tennis regularly on the weekends during their intake session. Which of the following would best describe why this is an important piece of information to gather during the assessment portion of the session?

  • To evaluate the client's potential risk of injury and set focused goals

  • To assess the client's preferences and potential nutritional needs for optimizing their sports performance

  • To determine the client's preferred activities on their days off

  • To understand the client's social life and recreational activities

Correct answer: To evaluate the client's potential risk of injury and set focused goals

Insight into an individual's physical activities outside of the work environment can assist the Corrective Exercise Specialist in designing the most optimal program to fit the client's needs. In this scenario, a tennis player may be more susceptible to repetitive injuries of the upper extremity. In addition to a Corrective Exercise Program to minimize the risk of injury, it also allows for consideration of biomechanical components of the tennis swing (shoulder strength, technique, grip, etc.) as it relates to the client's goals. 

The fact that they play tennis regularly doesn't necessarily provide enough detail to assess dietary preferences or nutritional needs. The client's tennis-playing habits and preferences are relevant to take note of, but are not the goals of this portion of the assessment process. While understanding a client's social life and recreational activities can be relevant to their overall well-being, in this context, the information about playing tennis is specifically gathered for health and assessment purposes.

113.

A client demonstrating a right-sided weight shift throughout the overhead squat assessment and dynamic movement assessments is instructed to perform activation techniques to improve the coordination of tissues and restore postural balance. 

Which of the following would you most likely expect the client to perform in this scenario? 

  • Left adductor strengthening

  • Right adductor strengthening

  • Left gluteus medius strengthening

  • Left piriformis strengthening 

Correct answer: Left adductor strengthening

Key activation exercises via isolated strengthening exercises on the opposite side should include the adductors.

On the same side, strengthening should include the gluteus medius. The piriformis should be targeted for inhibition, not strengthening.

114.

A client argues that flexibility and stretching are essentially the same thing. Which of the following responses would be the most appropriate in this situation as this client's Corrective Exercise Specialist?

  • Flexibility refers to the ability of a joint to move through a range, while stretching is the process to elongate the tissue.

  • You are correct; flexibility and stretching are completely synonymous and interchangeable terms in the world of corrective exercise.

  • Flexibility and stretching are often confused, but they have distinct differences. Flexibility pertains to joint mobility, while stretching is the act of stretching the joint. 

  • Flexibility can be influenced by strength training, while stretching is independent of training. 

Correct answer: Flexibility refers to the ability of a joint to move through a range, while stretching is the process to elongate the tissue. 

Flexibility is the state or ability of a joint to move through a ROM, while stretching is an active or passive process to elongate muscles and connective tissues in order to increase the present state of flexibility. 

Stretching does not affect the joint directly, rather the muscles and connective tissues surrounding the joint itself. Flexibility and stretching can be influenced by strength training due to the resting tension; however this can depend on the situation and has not been extensively studied.

115.

A client reports that he is being actively treated for Achilles tendinopathy. Which of the following statements best describes tendinopathy? 

  • Pain, swelling, and impaired performance in and around the tendon in response to overuse

  • A sudden, traumatic injury to the tendon resulting in inflammation

  • Temporary thickening of the tendon caused by excessive stretching

  • A genetic condition leading to abnormal development and structure of the tendon

Correct answer: Pain, swelling, and impaired performance in and around the tendon in response to overuse

Tendinopathy is a broad term encompassing pain, swelling, and impaired performance occurring in and around the tendons in response to overuse. 

An acute injury is not an example of tendinopathy, as it refers to a single event that initiates the pain, not overuse. Tendinopathy is not described by thickening or a genetic condition.

116.

Which of the following scenarios is the best example of autogenic inhibition? 

  • A yoga practitioner deepens their stretch by actively engaging the muscle being stretched, resulting in increased muscle relaxation and range of motion.

  • After a heavy set of squats, a weight lifter immediately experiences a decrease in muscle tension and flexibility in their quadriceps.

  • A runner performs static stretching exercises before a race, focusing on holding each stretch for an extended duration to improve flexibility.

  • A weight lifter performs a set of bicep curls and then immediately follows it with a set of tricep extensions, resulting in improved muscle coordination.

Correct answer: A yoga practitioner deepens their stretch by actively engaging the muscle being stretched, resulting in increased muscle relaxation and range of motion.

Autogenic inhibition is a process where the muscle being stretched is contracted for a few seconds before relaxation. This relaxation allows for a deeper stretch and increased range of motion. The yoga practitioner actively engages the muscle, experiences muscle relaxation, and achieves greater flexibility, which aligns with the concept of autogenic inhibition.

After a heavy set of squats, the weight lifter experiences a decrease in muscle tension, which is not typical of autogenic inhibition. It's more likely to be due to muscle fatigue or post-exercise muscle tightness.

The runner's scenario involves static stretching, which is a common practice in fitness to improve flexibility. However, it doesn't directly relate to autogenic inhibition, as it does not involve the active contraction of the muscle being stretched.

Focusing on coordination between antagonistic muscle groups (biceps and triceps), like the weightlifter following biceps curls with triceps extensions, isn't the same concept as autogenic inhibition.

117.

Which of the following scenarios best describes a force-couple relationship of the shoulder?

  • The trapezius and serratus anterior muscles work together to upwardly and downwardly rotate the scapula.

  • The deltoid and triceps brachii muscles work together to abduct and adduct the shoulder joint.

  • The infraspinatus and teres minor muscles work together to flex and extend the shoulder joint.

  • The pectoralis major and subscapularis muscles work together to rotate the shoulder joint.

Correct answer: The trapezius and serratus anterior muscles work together to upwardly and downwardly rotate the scapula.

The trapezius and serratus anterior muscles are responsible for the upward and downward rotation of the scapula, which is essential for proper shoulder movement and function. Together, the trapezius and serratus anterior work in coordination to create a force-couple relationship that allows for controlled movement of the scapula, which translates to smooth shoulder function. 

While the deltoid is responsible for shoulder abduction and the triceps brachii play a role in arm extension at the elbow, they do not typically work together to move the shoulder joint. 

The infraspinatus and teres minor muscles are primarily involved in the external rotation of the shoulder joint only. They do not, together, form an antagonistic pair that produces movement around the shoulder joint. 

Both the pectoralis major and subscapularis both play a role in shoulder internal rotation. Similar to the above incorrect answers, they do not form an antagonistic pair that produces movement around the shoulder joint since they both perform the same function.  

118.

Which of the following statements correctly describes how closed-chain overpronation affects the entire lower body kinetic chain?

  • Overpronation > internal tibial rotation > femoral adduction > knee valgus

  • Overpronation > external tibial rotation > femoral adduction > knee valgus

  • Overpronation > internal tibial rotation > femoral abduction > knee valgus

  • Overpronation > external tibial rotation > femoral abduction > knee valgus

Correct answer: Overpronation > internal tibial rotation > femoral adduction > knee valgus

Overpronation leads to internal tibial rotation, femoral adduction, and knee valgus alignment.

119.

A client performs isolated quad-strengthening exercises to improve their athletic performance. As it relates to the third step of the Corrective Exercise Continuum, how does isolated strengthening improve intramuscular coordination?

  • Enhanced motor unit activation, synchronization, and firing rate

  • Static motor unit activation, synchronization, and increasing cross-bridge strength

  • Neurological modulation, coordination, and resilience

  • Reducing reflex inhibition, force production, and firing rate

Correct answer: Enhanced motor unit activation, synchronization, and firing rate 

By enhancing motor unit activation, synchronization, and firing rate through isolated quad-strengthening exercises, the client can improve intramuscular coordination within their quadriceps muscles. Research has shown that each of these parameters is known to increase the strength of a muscle contraction. 

Static motor unit activation is not a term to describe motor unit behavior. Cross-bridge strength, neurological modulation, reflex inhibition, force production, and reliance are not physiological factors that describe intramuscular coordination in isolated strengthening.

120.

During a static postural assessment, a Corrective Exercise Specialist takes observational notes on the joint positioning and posture of a new client. Which of the following is not a standard kinetic chain checkpoint during this analysis? 

  • Glutes and lumbar spine

  • Head and cervical spine

  • Shoulders and thoracic spine

  • Foot and ankle

Correct answer: Glutes and lumbar spine

The static postural kinetic chain checkpoints are as follows

  • Head and cervical spine
  • Shoulders and thoracic spine
  • Lumbo-pelvic-hip complex
  • Knee
  • Foot and ankle