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Welcome to the Anatomy of Pain - Trigger Point Master Program. This document
contains information to help you complete the course and reflective learning
exam and receive your NAT certification.
A digital copy of your home study course book, The Concise Book of Trigger
Points - 3rd Edition by Simeon Niel-Asher, should have arrived by email as two
pdf documents (Part 1 & Part 2) with this exam pack. If you ordered a hard copy
of the book, its on its way to you and should be delivered within 7-10 business
days.
The reflective learning exam is completed online, however we have included the
exam paper in this pack so that you have it to hand whilst you are studying.
Once you are ready, the exam can be easily accessed by clicking on the following
link or by copying and pasting it into your browser:
The objective of the reflective learning exam is to ensure that you have gained a
sufficient understanding of the learning material.
Once you have registered for this course, there is no time limit for the
completion of the exam.
To help you complete the course and gain your NAT Anatomy of Pain Trigger
Point Master certification, here are some answers to frequently asked questions
that we hope will help you!
1. Where do I start?
We recommend you begin the course by reading the book, The Concise Book of
Trigger Points - 3rd Edition and the attached reflective learning papers from
beginning to end. This will give you an overview of the material and an
understanding of what is required from the reflective learning exams.
Then read through each chapter at a slower pace, taking notes if that helps, so
that you gain a deeper understanding of the course. You may need to repeat
this more than once in order to fully grasp the material.
The reflective learning exam is divided into 7 parts and correspond to the
chapters in the Concise Book of Trigger Points - 3rd Edition book as follows:
You can choose to complete the reflective learning exam section by section as
you progress through the course. Your answers will be saved until you return to
the exam. Alternatively, you can complete the course learning first and then
work through the reflective learning exam afterwards. You should choose
whichever method suits your style of learning best.
4. Things I need to know before starting the online Reflective Learning exam:
(i) Your answers are saved as you submit each one, not at the end of the
exam. This means you will not lose any work.
(ii) Avoid using the browser back button as this will not work. Instead, use
the Previous button which will be under your Questions.
Do not click away from the exam until you have submitted your answers
and finished the exam.
(iv) If your exam page freezes, you can always click refresh on your web
browser and the exam will again load on the same question/s you were on.
To resume your exam, go back to the exams' Start Link and select the
Resume option to log in and finish your exam.
5. Certificates
Once you have satisfactorily completed the exam paper, you will be able to
download your certificate immediately. You may then use the initials NAT
after your name.
Team NAT
Theory:
1. At what week of foetal development are the proto bones, ligaments and
muscles in place?
(a) 5
(b) 7
(c) 9
(d) 12
3. Trigger Points make the host muscle shorter and fatter and reduce its mechanical
efficiency
(a) TRUE
(b) FALSE
(a) TRUE
(b) FALSE
(b) FALSE
(c) Tingling
(d) Loss of sensation
7. What is the name of the main chemical that activates the electrical voltage across
the synaptic cleft of the nerve synapse?
(a) Acetylcholine
(b) Noradrenaline
(c) Nicotine
(d) Sodium
(b) Hair
(c) Tooth
(d) Muscle
(a) TRUE
(b) FALSE
10. Which of the following possible mechanisms put forward by Dommerholt for
trigger point genesis is NOT correct?
(a) Low-level muscle contractions
(b) Uneven intramuscular pressure distribution
(c) Direct trauma
11. Which of the following chemicals was NOT present in a trigger point milieu as
analysed by Shah et al. (2003)?
(a) Prostaglandins
(b) Substance P
(c) Cytokines
(d) Bradykinin (BK)
(e) Sodium Chloride
(f) Hydrogen (H+)
13. Which of the following Autonomic Symptoms has NOT been found to be
associated with trigger point activity?
(a) Hypersalivationincreased saliva production
14. What is the name of the chemical released from nociceptors terminals in
Peripheral sensitization?
(a) Substance A
(b) Substance B
(c) Substance P
(d) Substance Z
15. What is the name of the chemical that has been shown to increase sensitivity of
receptors in the spinal cord during Central Sensitization?
(a) Dopamine
(b) Seratonin
(c) N-Methyl-D-Aspirate (NMDA)
(d) 5 Hydroxy-Triptamine (5HT)
(c) Pectoralis
(d) Serratus Anterior
17. Which one of these tight muscles is NOT part of the lower crossed pattern (Janda
1996)?
(a) Erector Spinae
(b) Psoas
18. Which of the following postural structures commonly manifests trigger points?
(a) Upper Trapezius
(b) Levator Scapulae
(c) Sternocleidomastoideus (SCM),
(b) Satellite
(c) Attachment
(d) Degenerative
(e) Diffuse
(f) Latent
21. Which of the following muscles is related to pain in the eye region?
(a) Sternocleidomastoid
(b) Digastricus
(c) Orbicularis oculi
(d) Infraspinatus
(a) Frowning
(b) Anxiety
(c) Computer use
(d) Wearing a tight hat or helmet
24. A complex and extremely important muscle, the orbicularis oculi is composed of
how many parts?
(a) One
(b) Two
(c) Three
(d) Four
25. What syndrome can be related to pain in the orbicularis oculi muscle?
(a) Marfans Syndrome
(b) Iridocorneal endothelial Syndrome
27. Trigger points in the masseter muscle cause referred pain patters in what areas?
(a) Eyebrows
(b) Jaw
(c) Molar teeth
(d) Neck
29. Bite plates may be used in order to help ease pain in which muscle?
(a) Occipitofrontalis
(b) Pterygoideus lateralis
(c) Digastricus
(d) Sternocleidomastoid
31. Trigger points in the scalenus anterior, medius and posterior muscles cause pain
patterns in what areas of the body?
(a) Arms
(b) Fingers
(c) Chest
(d) Shoulder
(a) Smoking
(b) Pillow height
(c) Anxiety
(d) Chronic lung problems
(c) Laughter
(d) Tiredness
35. What are the main symptoms of Temporomandibular Joint Disorder (TMJ)??
(a) Facial pain
(b) Popping sounds
(c) Headaches
(b) Masseter
(c) Sternocleidomastoid
(d) Pterygoideus medialis
37. What are the secondary muscles associated with Temporomandibular Joint
Disorder (TMJ)?
(a) Temporalis
(b) Masseter
(c) Mylohyoid
38. Symptoms of Temporomandibular Joint Disorder (TMJ) are rarely seen in which
age group?
(a) Under 20
(b) Under 30
(c) Under 40
(c) Under 50
(b) Three
(c) Four
(d) Five
(b) Depression
(c) Poor glasses
(d) Scoliosis
(d) Back
47. The splenius capitis and splenius cervicis are involved in the movement of which
part of the body?
(a) Shoulders
(b) Back
(c) Spine
(d) Neck
51. In what areas of the body are trigger points formed in the rectus abdominis
muscle?
(a) Chest
(b) Abdomen
(c) Pelvis
(d) Neck
52. What advice can be offered regarding pain in the quadratus lumborum muscle?
(a) Correct any leg length discrepancy
(b) Change mattress
(c) Refrain from any exercise
(d) 70%
55. How many people are affected by lower back pain at least once in their lifetime?
(a) 5 out of 10
(b) 7 out 10
(c) 9 out 10
(d) Everyone
56.. Chronic lower back pain is defined as pain that lasts more than:
(a) 6 weeks
(b) 4 months
(c) 6 months
(d) 1 year
59. What are some causes of trigger points in the trapezius muscle?
(a) Telephone to ear
(b) Scoliosis
(c) Tennis
(d) Playing musical instruments
(c) Abdomen
(d) Lower back
62. What are some indications of trigger points in the rhomboideus muscle?
(a) Localized pain
(b) Grinding/grating joints
63. Where are referred pain patterns noticed for trigger points in the serratus anterior
muscle?
(a) Ribs 6 to 8
(b) First 3 ribs
(c) Last 8 ribs
(d) Chest
(b) Stress
(c) Cars with heavy steering
(d) Too many push-ups and heavy bench pressing
65. Where are the referred pain patterns noticed for trigger points in the pectoralis
muscle?
(a) Abdomen
(b) Arm
(c) Shoulder
(d) Chest
66. What is important when considering lifestyle changes for patients suffering from
pain and trigger points in the pectoralis major muscle?
(b) Two
(c) Three
(d) Four
(c) Infraspinatus
(d) Subscapularis
(d) Supraspinatus
(a) Shoulder
(b) Wrist
(c) Forearm
(d) Fingers
78. The plamaris longus muscle is absent in what percentage of the population?
(a) 10
(b) 11
(c) 13
(d) 15
80. Which lifestyle changes must be considered for those suffering from trigger points
and pain in the brachioradialis muscle?
(a) Avoid prolonged standing and carrying objects (e.g. briefcase)
(b) Change sleeping position
84. In which areas are referred pain patters noticed for trigger points in the wrist
flexors?
85. What causes trigger points and pain in the wrist extensors?
(b) Wrist
(c) Lower arm
(d) Palm of hand
87. Where are pain patterns noticed for trigger points in the supinator muscle?
(a) Elbow
88. What are some symptoms of trigger points in the opponent pollicis/adductor
pollicis muscles?
(a) Thumb pain
(b) Loss of fine motor control
(c) Wrist pain
89. Which of the following muscles is NOT included in the small hand muscles?
91. When analysing a wrist condition, pain in which areas of the body must be
considered?
(a) Head
(b) Neck
(c) Shoulder
(d) Elbow
93. How many strong zones of pain are noticed in the buttocks for trigger points in the
gluteus maximus muscle?
(a) 1-2
(b) 2-3
(c) 3-4
(d) 4-5
94. What lifestyle change may help ease the pain of trigger points in the gluteus
medius muscle?
(a) Stretching
(b) Cycling
(c) Daily long walks
(d) Placing a pillow between knees at night
(d) Piriformis
96. The pain from trigger points in the gluteus minimus can extend down to the:
(a) Toes
(b) Foot
(c) Ankle
(d) Knee
97. What can cause trigger points and pain in the piriformis muscle?
(b) Cylinder
(c) Pear
(d) Trapezoid
(a) 2
(b) 3
(c) 4
(d) 5
102. What can cause trigger points and pain in the adductor muscles?
(a) Hip surgery
(b) Leg splint/cast
106. What type of symptoms may be felt in the thigh by those suffering from trigger
points in the sartorius muscle?
(a) Ache
(b) Sharp pain
(c) Tingling
(d) Immobility
(c) Heel
(d) Toe
114. Which muscles are antagonists of the extensor digitorum longus muscle?
(a) Flexor digitorum longus
(b) Flexor digitorum brevis
(c) Flexor hallucis longus
115. What are some causes of pain and trigger points in the fibularis longus, brevis,
and tertius muscles?
(b) Gastrocnemius
(c) Soleus
(d) Plantaris
117. What are some symptoms of trigger points in the gastrocnemius muscle?
118. The tendon in the plantaris muscle in the leg is equivalent to the tendon of which
muscle in the arm?
(a) Brachioradialis
(b) Opponens pollicis
121. The referred pain patters for trigger points in the popliteus muscle are noticed in
which parts of the body?
(a) Knee
(b) Ankle
(c) Toes
(d) Calf
122. Where is pain strongly felt for trigger points in the flexor digitorum longus
muscle?
(a) Thumb
(b) Calf
(c) Forefoot
(d) Ankle
126. Where are referred pain patterns noticed for trigger points in the quadratus
plantae muscle?
(a) Forefoot
(b) Heel
(c) Thumb
(d) Ankle
Congratulations! You have now completed the NAT Anatomy of Pain Trigger Point
Course Reflective Learning Exam.
If you need any help with submitting your exam online, please contact
support@nielasher.com.
Team NAT