The verb

The verb is perhaps the most important part of the sentence. A verb asserts something about the
subject of the sentence and expresses actions, events, or states of being. Therefore, the verb is the
critical element of the predicate of a sentence.

Verbs show several grammatical features which, when combined, result in larger categories that help
the speaker implement different meanings through different forms. These larger categories are: tense,
aspect, mood and voice. The first two usually signal the action in a time framework; the third one is
mostly concerned with the speaker’s stance to the message; and the last one relates the message the
prominence attached to the different actants. Once this has been said, there are not clear border lines
to distinguish one from the other, as all of them are very much dependant on the linguistic competence
of the user and, of course, on his intentions.

Talking About the Present

The simple present

The simple present is used to express an action that takes place repeatedly in the present time,
although not necessarily at the time of speaking.

Pain affects a significant number of PT patients.

This sentence implies that the usually course of pain is that of affecting PT patients, not at all times, not
all the time, but on regular periods (habitually).

Form of the simple present

In the affirmative the simple present has the same form as the infinitive but adds an s for the third
person singular.

Affirmative Negative Interrogative Negative

interrogative

I work I do not work do I work? do I not work?

you work you do not work do you work? do you not work?

he/she/it he/she/it does. does he/she/it does he/she/it works

works not work work? not work?

we work we do not work do we work? do we not work?

you work you do not work do you work? do you not work?

they work they do not work do they work? do they not work?

Irregular verbs form this tense in exactly the same way.

Always bear in mind that “-s” or “-es” are added to the third person singular.

Spelling notes

Verbs ending in ss, sh, ch, x and o add -es, instead of -s alone, to form the third person singular:
 I kiss, he kisses I box, he boxes

I rush, he rushes I do, he does

I watch, he watches I go, he goes

When -y follows a consonant we change the y into -i and add es:

I carry, he carries I copy, he copies I try, he tries

but verbs ending in -y following a vowel obey the usual rule:

obey, he obeys I say, he says

A note on the pronunciation of third person singular endings in the simple present tense:

/s/ after unvoiced consonants (/f/, /k/ /p/, /t/, /θ/) except /s, ʃ, ʧ/: Last letters; h / gh/ k / p / t / th/
/z/ after voiced consonants (/b/, /d/, /g/, /l/, /m/, /n/, /ŋ/, /r/, /D/, /ò/, /v/) except /z,ʒ, ʤ/, vowels and
diphthongs: Last letters; b, d, g, l, m, n, ing, r, o, the, v.
/Iz/(or/əz/) after /s/, /z/, /ʃ/, /ʒ/, /ʧ/ and /ʤ/

• Negative

PT does not relieve all sorts of pain.

PT treatments do not work properly if they are not conducted properly.

These sentences imply that actions are not just taking place at the time but they stress that they do not
happen regularly.

Always bear in mind that “do” is added for the first and second persons –both singular and plural-, and
for the third person plural, whereas “does” is added to the third person singular.

Contractions: the verb do is normally contracted in the negative and negative interrogative: I don't
work, he doesn't work, don't, I work? doesn't he work?
• lnterrogative

Do you feel better after the treatment?

Does it hurt much?

These questions request whether those actions happen regularly, not at the time of speaking.

Again, always bear in mind that “do” is added for the first and second persons –both singular and plural-
, and for the third person plural), whereas “does” is added to the third person singular.

Using the simple present.

As it has already been explained, the present tense shows a verbal feature, its aspect, which allows
several uses. Briefly, we’ll review which they are:

• To talk about something that happens all the time, repeatedly, or something that is always true
(scientific truths, anatomical truths, medical evidence, proverbs…). The simple aspect expresses that it is
not important whether the action is happening at the time of speaking, but rather that the action is
habitual, even though it is not happening at the time of the speaking:
 Fortunately, I see a lot of patients.

PTs take care of patients.

Back pain heals easily with appropriate PT treatments.

• With adverbs of time and frequency, e.g. always, often, sometimes, rarely, never, ever, every year,
monthly, twice a week, to say how often we do things:

I come to hospital at 9.00 every day.

She performs hydrotherapy once a week.

How often do you visit your PT? I visit her once a month.

• To talk about a situation that remains the same for a (long) period of time:

I specialize in sports injuries. I have been doing this for ten years now.

Remember that verbs of thinking or mental activity, feeling, possession and perception, and reporting
verbs are used only in the simple aspect. When we use them in the continuous aspect, they may change
their meanings:

He feels a dull pain every morning when he wakes up

but

The PT was feeling her spine to see where the problem was (palpating)

• It can be used for a planned future action or series of actions.

The procedure goes as follows: I first take out your sheet and then I turn you around.

• It must be used instead of the present continuous with verbs which cannot be used in the continuous
form, e.g. love, see, believe etc., so that we can say I love you but not I am loving you.

• It is used in conditional sentences, type 1:

If it hurts when I move your arm, it will be an indication of something injured in your shoulder.

Unless we reduce the fracture, it will be hurting you for a long time.

• It is used in time clauses

(a) when there is an idea of routine:

As soon as we take off her cast, she starts using her wrist.

(b) when the main verb is in a future form:

When we finish your treatment, you’ll be able to take up tennis again, although with
care.

The present continuous

The present continuous tense is formed with the present tense of the auxiliary verb be + the present
participle:
 Affirmative Negative Interrogative

I am working I am not working am I working?

you are working you are not working are you working?

he/she/it is working he/she/it is not working is he/she/it working?

we are working we are not working are we working?

you are working you are not working are you working?

they are working they are not working are they working?

Negative interrogative: am I not working? are you not working? is he not working? etc.

Note the irregular contraction aren't I? for am I not?

Interrogative contractions: am, is, are may be contracted:

Why's he working? Where're you working?

The spelling of the present participle

A When a verb ends in a single -e, this -e is dropped before ing:

argue, arguing hate, haling love, loving

except after age, dye and singe:

ageing dyeing singeing

and verbs ending in ee:

agree, agreeing see, seeing

B When a verb of one syllable has one vowel and ends in a single consonant, this consonant is
doubled before -ing:

hit, hitting run, running stop, stopping

Verbs of two or more syllables whose last syllable contains only one vowel and ends in a single
consonant double this consonant if the stress falls on the last syllable:

admit, admitting begin, beginning prefer, preferring

but

budget, budgeting enter, entering

(stress not on the last syllable).

A final l after a single vowel is, however, always doubled:

signal, signaling travel, travelling

except in American English.

C -ing can be added to a verb ending in y without affecting the spelling of the verb:

carry, carrying enjoy, enjoying hurry, hurrying

Study this example:

lt is 9.30. Mr. Johnson, the PT, is already treating one of his patients.

“is already treating one of his patients” means that he is treating him/her now, at the time of speaking;
in this case, the continuous aspect is reinforced by the adverb “already”.

Using the present continuous.

Therefore, we use the present tense in the continuous (or progressive) aspect for the following
purposes:

• To talk about something that is happening at the time of speaking:

- Ms. White is going to hospital.

- Mr. Hargreaves is assessing a patient. He’ll see you in a minute.

• To talk about something that is happening around the time of speaking, not necessarily at the precise
time of speaking:

- "I am reading a book about a new procedure on patients with acute back pain that I find really
interesting".

As it can be inferred, the article is not necessarily being read at the time of speaking, but rather, I am on
the process of reading it.

• To talk about something that is happening for a period of time, but may certainly change (abruptly) or
return to a more habitual situation; hence, we use it to talk about situations that, in a sense, are
contrary to normal:

- His shoulder is getting better with electrotherapy, but we’ll see.

- We are having a lot of appointments lately.

- Her condition is worsening more rapidly than we expected.

- She is seeing patients in Madrid, but she keeps her clinic in Barcelona.

• To talk about a definite arrangement in the near future (the most usual way of expressing one's
immediate plans):

I'm meeting my PT tonight. He is taking care of my back pain very efficiently.

Are you doing anything special tomorrow morning? No, I’m doing the exercises I was prescribed.

In these sentences, the time of the action must always be mentioned, as otherwise there might be
confusion between present and future meanings.
• To talk about a frequently repeated action, usually when the frequency seems unreasonable to the
speaker; in these sentences, the use of the adverb always is compulsory:

Mark is always complaining about his many back problems, but he does nothing about it.

However, and depending on the context, these frequently repeated actions may also express approval
or neutrality, rather than annoyance:

One of my colleagues is always studying new procedures to deal with her patients.

Caution: Verbs not normally used in the continuous tenses

Since the continuous aspect is chiefly used to express deliberate actions, some verbs will not normally
be used in the continuous aspect. These verbs can be grouped as follows:

A Verbs of the senses; as it has been stated, non-deliberate actions do not normally take
the continuous aspect. Thus, verbs like feel, hear, see, smell… which imply a non-deliberate
action, are not used in the continuous aspect. Similarly, the verbs notice and observe (=
notice), as well as feel, look, taste used when they are used as link verbs.

However, there are other sensorial verbs such as gaze, listen, look (at), observe (= watch),
stare and watch which imply a deliberate use of the senses; as a result, the continuous aspect
is to be used:

I am watching at the MRI, but I don’t see anything that could be a problem

They are listening to the ultrasound recording, but I don’t think they will find the etiology of the
problem there.

B Close in meaning are those verbs expressing non-deliberate feelings and emotions,
like, for instance admire (= respect), adore, appreciate (= value), care for (= like), desire,
detest, dislike, fear, hate, like, loathe, love, mind (= care), respect, value, want, wish. Their
“right” or immediate meaning does not involve any intention; if someone is admired, loved,
feared… is, so ta say, a result of an involuntary action; from a verbal perspective, this implies
that the continuous aspect cannot be used.

However, the continuous aspect can be used when the previously mentioned “right” or
immediate meaning is reinterpreted and an added deliberate value is incorporated into it.
Hence, the verb admire may be used in the continuous aspect if it is meant to express 'look at
with admiration'; in the same fashion, the verb appreciate may be used in the continuous
aspect when the meaning is transformed into 'increase in value'; the verb care can take the
continuous aspect when the meaning is that of 'look after'. Other verbs which may take
different –intentional- meanings with the continuous aspect are: long for, when it implies the
idea of 'look after/concern oneself with'; value whenever its meaning is that of 'estimate the
financial worth of; and enjoy like, and love when they express the idea of 'enjoyment with
intensity or unexpected enjoyment':

I’m loving this new course; I never thought it would be so helpful.

How are you liking your new position at the Department? I hate it. I certainly do.

C Those verbs expressing a mental activity are unintentional by nature, so the use of the
continuous aspect is almost discarded. Therefore, verbs such as agree, appreciate and see
(when their meaning is that of understanding), assume, believe, expect, feel (when their
 meaning is that of think), feel sure/certain, forget, know, mean, perceive, realize, recall,
recognize, recollect, remember, suppose, think (when its meaning is that of having an
opinion), trust (when its meaning is that of believe or have confidence in), and understand.

D Again, verbs involving the idea of possession, such as belong, owe, own, and possess
are considered as non-deliberate in their meaning, so, the continuous aspect is not used:

Sheila owns a beautifully equipped gym

E The auxiliaries, except be and have in certain uses.

F. The verbs concern, consist, contain, hold, keep, matter, seem, signify, and sound, when the
meaning of this last one is that of appearance, are not used in the continuous aspect, as
they portray qualities which, by virtue of their essence, are non-deliberate.

In a similar manner, the verb appear, when its meaning is that of seem, is not used in However,
the verb appear, when its meaning is that of 'come before the public', implies intentionality,
and is, therefore, possible to use it in the continuous aspect.

G. Feel, when followed by an adjective indicating the subject's emotions or a physical or

mental condition, e.g. angry/pleased, happy/sad, hot/cold, tense/relaxed,
nervous/confident, is normally used in the simple tenses but can also be used in the
continuous:

How do you feel/are you feeling? I feel/am feeling better.

Feel meaning 'touch' can be used in the continuous:

Her PT was feeling her hip to see if there was anything wrong that affected her gait.

Similarly, feel for meaning 'try to find something by touching':

The doctor was feeling for the switch in the darkness of the room.

H. The continuous aspect of the verb look is not used when it functions as a link verb, or with
look on –if its meaning is that of consider-, look up to and look down on.

He always looked up to his Professors, as they were his inspiration to become a physiotherapist.

But look (at), look for/in/into/out and look on –when its meaning is that of watch- are deliberate actions
and can be used in the continuous aspect:

John is looking for the bandage and cannot find it.

Mary was tired of her part-time job and was looking out for a better position.

I. The continuous aspect is not used with smell meaning 'perceive a scent/an odour', or with
smell used as a link verb, but can be used with smell meaning 'sniff at':

Why are you smelling the wound? Does it smell pungent?

J. Similarly, taste as a link verb is not used in the continuous, but taste meaning 'to test the
flavour' of can be used in the continuous:

This tea tastes bitter.

She was tasting the cake to see if it was sweet enough.

K. The verb see can be used in the continuous aspect when it means 'meet by appointment',
'interview'; it may also be used in the continuous aspect when it means 'visit' (usually as a
tourist):

The doctor is seeing her patients this morning.

I am seeing my PT this afternoon.

As the seminar is already finished, Mike and I are seeing the city.

It can also be used in the continuous aspect in the following phrasal verb combinations:

see about when its meaning is that of make arrangements; see to when its meaning is that of arrange;
see somebody out when its meaning is that of escort to the door; see somebody home when its
meaning is that of escort somebody home; see somebody to + place when its meaning is that of escort;
see someone off when its meaning is that of say goodbye to someone departing.

He was seeing about a work permit for him in Canada.

Susan has just arrived. She is seeing to the levers of the stretcher.

Is anybody seeing you home? It is important that you keep your cast off the floor for a while.

Margaret is leaving tomorrow. John is seeing her off at the airport.

L. Think, assume and expect may be used in the continuous aspect. Think can be used in the
continuous when no opinion is given or asked for; assume can be used in the continuous
aspect when its meaning is that of 'accept as a starting point'; and expect can be used in
the continuous aspect when it means 'await':

I am thinking of searching for a job abroad. Spanish PTs are well considered everywhere.

I'm assuming that you have time to do a lot of research.

Louise is expecting any information regarding the position she applied for.

The present perfect

The present perfect is used to talk about actions or states that began in the past but influence the time
of speaking, either psychologically or physically. In other words, the present perfect expresses a verbal
attitude towards the proximity or distance of any action that is, in any way, affecting the present time.

The present perfect demands the auxiliary to have, either in its have form or in the third person singular
has form. The combination of the auxiliary have and the past participle of the lexical verb generates that
idea of past in the present. That is:

Have/has + past participle of the verb

I have not felt this pain in my life. I definitely need to see my doctor.

In the example, what is clear is that the past painful experiences are brought to the time of speaking and
contrasted with the pain that the speaker is experiencing now.

Have you finished your exercises? If you have, you can start your stretching.
They have signed up a petition about the situation of PTs in our Health System.

Using the present perfect

Bearing these verbal characteristics in mind, the present perfect tense in its non-continuous (simple)
aspect is used for the following purposes:

• To talk about the present result of an action.

I have finished my physiotherapy treatment, so I am going home.

• To talk about a recent happening. When you talk about recent happenings, it is very common to use
several time adverbs to reinforce the verbal characteristics of immediateness; these adverbs are the
following:

Just: when we want to stress that something has taken place what we consider a very short time ago:

- Prof. Johnson has just started her lecture, so we’d better be quiet.

- She has just been hired in the new hospital, so she must be really happy.

Already: when we want to stress that something has happened sooner than expected:

- Anne has already finished her treatment and she feels very well now.

Similarly, when we want to express that are expecting something to happen but has not happened at
the time of speaking. In these situations, we use yet instead of already, but only in questions and in
negative sentences:

Hasn’t Anne finished her treatment yet?

For unfinished periods of time that continue up to the present, we use expressions such as today, this
morning, this evening, this week...

She has not come to hospital this morning. I guess she is not feeling ok.

• To talk about situations which, by contrast, are to be remembered as a first or only experience, we use
ever and never.

Have you ever felt this pain before?

I have never studied Human Anatomy in English, so it will take me much longer.

In these two examples, the use of the present perfect compares the present situation to our past
experiences as a whole.

• In the same fashion, we use the present perfect to talk about something you have not done during a
period of time that spans up to the present; in these instances, we usually make the “time when” we
last did the same thing:

- My PT has told me she has not seen a patient in my condition since she was doing her internship.

• A different situation in terms of meaning, but parallel in terms of use occurs in those situations that
have occurred or existed for a long time. They are usually stressed by the adverb always if we want to
highlight the idea of continuity at the time of speaking:
- We have always treated our patients with the outmost respect.

- This hospital has been open for many years now.

• We use the present perfect to say how much and how many things we have done or to express how
many times we have done something:

- I have had five appointments this morning.

- They haven’t worked much this summer.

- She has undergone three surgeries so far.

• And we use the present perfect with certain time expressions, some of them expressed by means of
the superlative:

- I must say this is the most interesting case that l have ever seen.

Time expressed here by the insertion of ever.

- Is this the first time that you have had a cast on?

Present Perfect Continuous

The present perfect in the continuous aspect is used to express that an action that began in the past has
not been discontinued up to the present, and is even going on at the time of speaking, or it has lasted
until almost the very time of speaking.

In terms of aspect, it is a very interesting combination, since, on the time basis of the present, it blends
the idea of contrasting a past action, which would, almost inevitably, lead us to a closed –perfected,
finite- action, with the idea of progression –thus, an unfinished, non-finite action.

Have/has been + gerund + past participle.

• To talk about an action that began in the past and has recently stopped or just stopped:

- Have you been seeing many patients today? You certainly look tired.

• To ask or say how long something has been happening. In this case the action or situation began in the
past and is still happening or has just stopped.

- John and I have been dealing with this patient since she was first admitted into hospital.

The following particles and questions are common when we want to stress the idea of continuity from
the past into the present or a very recent end to an action that has been going on for a long time:

• How long...?

- How long has she been suffering these symptoms?

• For (to stress time as a period):

- She has been suffering this pain for over a month now.

- I have been specializing in specific manipulations for elite athletes for five years.
Caveat: do not use "for" in expressions with "all":

- She has been treating my mother all my life (not "for all my life").

• Since (to say the beginning of a period):

- I have been teaching anatomy since 1980.

- I have been working very hard since I got this position.

In the present perfect continuous the important thing is the action itself and it does not matter whether
the action is finished or not. The action can be finished (just finished) or not (still happening).

In the present perfect the important thing is the result of the action and not the action itself. The action
is completely finished.
Talking About the Past

The simple past

The simple past is mostly used to express that an action took place before the time of speaking and it is
already finished. The consequences of that finished action do not affect the present from a subjective
point of view and the time it lasted is not relevant for the speaker.

John suffered a severe ankle sprain and had to be treated by a PT.

Form

The simple past has the following forms:

Affirmative Negative Interrogative Negative

interrogative

I worked I did not work did I work? did I not work?

you worked you did not work did you work? do you not work?

he/she/it worked he/she/it did not did he/she/it work? did he/she/it not
work work?

we worked we did not work did we work? did we not work?

you worked you did not work did you work? did you not work?

they worked they did not work did they work? did they not work?

• Affirmative:

- The past of the regular verbs is formed by adding -ed to the infinitive.

- The past of the irregular verbs has its own form.

She tried all sorts of treatments until she fully recovered.

I studied PT when I found out about its relevance in modern societies.

The simple past tense in both sentences imply that the actions took place in the past, they are
considered as finished events by the speaker –do not seem to have a subjective influence in the
present- and the time it took for both actions to happen is discarded as the tense is non progressive
(continuous).

• Negative:

- Did/didn't + the base form of the verb.

They did not understand the importance of the interview in the diagnostic phase.

She did not follow my advice and she did not go to see her PT. Now, she is in pain.

As in the affirmative sentences, the meaning expressed by the simple past tense is that of events that
took place in the past and the duration of which is not relevant for the speaker. It must be noted,
however, that the auxiliary form of the form to do “did” does not show any differences between third
person singular and any other person.

• Questions:

- Did I/you/... + the base form of the verb.

Did she finish her Masters in electrotherapy?

Didn’t they make an appointment earlier?

Spelling notes
The final consonat is doubled after a short, stressed vowel, but if the final syllable is not stressed, the
final consonant is not doubled. However, and exceptionally, in British English -l is doubled at the end of
the word, regardless of where the stress lies.
We stop We stopped

IN Br.Eng.
We travel We travelled

If the verb ends in –e, the simple past tense only adds a -d.
We like We liked

In those verbs ending in –y, two spelling issues had to be taken into account. When –y occurs after a
consonant, it changes to -i and –ed is added.
We try We tried

But in those cases when –y is preceded by a vowel, only -ed is added.

We play We played

A note on the pronunciation of the simple past in regular forms.

After unvoiced sounds such as -p, -f, -s, -k, (-sh), and (usually spelled as –ch) the final –ed is
pronounced like -t as in “cat”. The –e remains silent.

After voiced sounds such as b, g, v, z, (usually spelled as –ge), (usually spelled as –ge), m, n, ŋ, l, ,
(usually spelled as –th or -the) and -r the final –ed is pronounced like –d as in “dad”. As in the previous
case, the –e also remains silent.

The final –ed is also pronounced like d in “dad” after all vowel sounds.

For verbs ending in -d and -t the final –ed is pronounced id as in “did” or “bid”. In this particular case,
the –e in –ed is not silent, and adds an extra syllable to the simple past form of the verb.

Using the simple past

• As it has already been pointed put, to talk about actions or situations in the past:

- When I studied my PT degree in Valladolid, I shared a flat with other students.

- She moved to London to work as a PT, because she found it a challenge.

• To talk about the time when an action took place:

- When did you hurt your shoulder?

- I hurt it last weekend.

• To relate events from the past the speaker does not consider subjectively attached to the time of
speaking:

- They established the Spanish PT Association in 1981.

- Electrical stimuli were already used for therapeutical purposes in the XIX century.

• It is also used to relate a succession of actions in the past:

- Anne saw a score of patients in the morning and also took care of the afternoon shift. When she got
home, she went straight to bed.

The past continuous

In parallel to the present continuous, the past continuous tense is formed with the past tense of the
auxiliary verb to be + present participle of the verb.

- Jeannie was studying the afternoon everything happened.

Using the past continuous

The intrinsic verbal features of the continuous (or progressive) aspect reinforce the notion of “action in
course”. Thus, the action expressed by this tense relate the idea of a past action to that of
“progression”, stressing the value of the “time it took” for the verbal action to be completed. Contrarily
to what is the case with the present tense in its continuous aspect, in the past the idea of intentionality
is less clear. The prevalence of duration over intention is, therefore, out of question.

- Mike was suffering severe back pains when we last met him.

In this sentence, the idea of suffering is not only set in the past by means of the past tense, but it
underlines the idea of a lasting pain through the use of the continuous aspect.

We also use the past continuous to set a specific action within a longer timeframe. In other words, the
action expressed by the past continuous is understood to have already been started, but whether it was
finished or not remains unclear:

- This time last year, I was finishing my degree.

• In a similar fashion as it was with case for the simple past, the past continuous may also be used to tell
a story that happened in the past; the difference between these two tenses lies in the fact that the past
continuous, because of its progressive aspect, highlights the time the action took, rather than just the
action.

- She was examining my scan results in her office.

Always bear in mind that the combination of the simple past and the past continuous in time sentences
is very frequent. As the former is used for those verbal actions where the importance lies in the action
itself, regardless of the duration, and the latter stresses the time it took the action to occur, they tend to
be present in time clauses with “when” and “while”.

- When Peggy Sue arrived at the hospital, her PT was still treating some other patients.

- While I was manipulating one of my patients, an emergency came in and I had to take care of him.
In these two sentences, the verb in the simple past tense expresses an action that is set in time within
the timespan of another one. This latter action is expressed by means of the past continuous. It is
important to notice that whereas “while” will always take the past continuous tense, “when” may take
both the simple past and the past continuous.

Past Perfect

The past perfect is a verb tense expressing through its features an aspect that is finite and non-
progressive. In other words, the past perfect is used to talk about actions that began in the past and
finished in the past as well and where no significant relevance is assigned to the duration of the verbal
action. It is generally used with a past reference, this being either overt or covert. Although it is usually
associated with the present perfect, the subjective links attached to the present perfect are not so easily
found in the past perfect tense.

I had already sprained my ankle when I decided to give up the race.

In this sentence, the action expressed by the past perfect keeps a relation of priority in time towards the
second action. However, and as it has been stated, no subjective bonds may be integrated in such
relation; otherwise, both actions would be considered as taking place simultaneously.

Form of the past perfect tense

The past perfect demands the auxiliary form of the verb to have in its past form, to provide the tense
with the idea of a past action, along with the past participle of the lexical verb. That is:

Had + past participle of the verb.

When I stopped my PT treatment, my back had improved tremendously.

Using the past perfect tense.

Until John was admitted in hospital, Louise had not seen such a serious back injury.

In this sentence, the past reference that sets the past perfect tense is overtly established by means of
the time clause containing the simple past tense. Tehrefore, it is easy to understand that one of the
actions (the past perfect clause) takes place before the other.

Past Perfect Continuous

The past perfect continuous shows an action that began in the past and went on continuously up to a
time in the past; again, the notion of process is intensified by the continuous aspect. As it was the case
with the present perfect continuous, the combination of a past finite aspect –reinforced by the presence
of the auxiliary had- and the progressive aspect that the continuous adds brings about a finite but
progressive verbal notion.

-Gary had been exploring patients without even noticing he suffered a disability in his right thumb.

In this example, there is no doubt Gary came to realize, at a certain point in time, that he suffered a
disability that prevented him from doing what he used to do on a regular basis as a PT. Continuity and
finite action are, hence, intertwined.

Form of the past perfect continuous.

As it has already been anticipated, the past perfect continuous demands the auxiliary form of the verb
to have in its past form, to provide the tense with the idea of a past action, along with the past
participle of the verb to be, and the present participle of the lexical verb. That is:

Had been + gerund of the verb.

- Arthur had been using ultrasound techniques with patients until very recently.

Using the past perfect continuous

• It has already been stated that the main use of the past perfect continuous is to say how long
something had been happening before something else, overtly or covertly expressed, happened:

- Margaret and John had been malpracticing as non-chartered PTs until they were finally sued by one of
their patients.

• To ask or say how long something had been happening. In this case the action began in the past and
finished in the past, but its progression is important for us.

- Greg and Sue had been treating this patient since she was first admitted into hospital.

Again, and as it was the case for the present perfect continuous, there are several particles that are
common when we want to stress the idea of continuity, an action that had been going on for a long
time:

• How long...?

- How long had your father been living with such pain?

• For (to stress time as a period):

- She had been working in the same department for over twenty years when she retired.

- I had been assessing athletes for seven years before I signed for a professional team.

• Since (to say the beginning of a period):

- I had been teaching English for PTs since 1980. Then I moved on to corpus linguistics.
Talking about the future

The simple present tense

The versatility of the simple present is out of any question; it has already been explained that it not only
addresses present actions, beliefs, thoughts… but also accounts for past events –historical present. Yet,
its functionality is not limited to the past and the present; in some cases, the simple present also adopts
a future meaning.

Present tense form will not be discussed in this section, as it has already been analysed.

Using the simple present tense

It is commonly used to talk about timetables, schedules...:

- When does your flight for NY leave? It leaves tomorrow at 7.30.

- The new hospital opens next month.

In the previous examples, an idea of impersonality is attached through the use of the simple present
tense; such impersonality also deprives the use of the simple present of any notion of intention or
compromise. Therefore, although it may be used in the first person, both singular and plural, this idea of
detachment should always be kept in mind.

The present continuous tense

Compare the following two sentences:

- I assess several patients this coming Saturday.

- I am assessing several patients this coming Saturday.

These two sentences may seem identical in meaning, but there is a slight difference between them; the
intrinsic verbal features of intention attached to the continuous form provide the second one with a
compromise on the speaker. The first one, on the other hand, seems to express a plan without a
deliberate action on the part of the speaker, as it is part of a schedule concerning his assessment but
without his direct intervention in the plan.

The form of the present continuous will not be analyzed here, as it shares the same characteristics
described previously.

Using the present continuous tense.

• As it has been put forward in previous paragraphs, the present tense in its continuous aspect is used
to talk about what you have arranged to do in the near future. As the continuous aspect adds the idea of
a deliberate action, it is most suitable for personal arrangements.

- I am seeing quite a number of patients this afternoon.

- We are delivering a speech at a conference on orthopaedics next spring.

• Another potential use of the present tense in its continuous aspect is found with verbs of movement
or position. However, a slight difference is to be highlighted; whereas in the previous use of the
presente continuous the idea of arrangement is clear, in this second instance, there might not be an
actual plan or arrangement already defined.
- What are you doing tonight? I’m exhausted; I think I’m staying at home tonight.

- We are going for a drink when we finish our shift; are you coming with us?

In the previous examples, the idea of future action that is not related to an actual arrangement is seen
in “I’m staying” and “are you coming?”

• Caveat. The present tense cannot be used in its continuous aspect for this purpose with those verbs
which do not usually take the continuous aspect. (See Talking about the present.) To express actual
intention with those verbs, the future simple (will/shall) form is the most natural choice.

- We’ll think of a better way to address your condition.

- I’m sorry, Mrs. Hargreaves, but I’ll only know when I finish my examination.

Be going to

The “be going to” form is not itself neither a tense nor an aspect, but does take verbal features of tense
and aspect that make it comparable with the present continuous tense, the closest verbal option in
terms of meaning.

- I’m going to be a PT when I finish my degree.

- I’m going to borrow some money to set up my own clinic.

Form of Be going to

It has already been said that even when it is not a verb tense, nor does it have a definite verb aspect, it
does share characteristicis of both. In fact, it makes use of the verbal features of the present continuous
in terms of intentionality or purpose –planning- but they are somewhat diluted as an auxiliary form,
adding the semantic content of the lexical verb in its infinitive form.

- Be going to + lexical verb

- Tim is going to deliver his lecture in front of an audience of well-trained PTs.

Since the verbal features of “be going to” are downtoned as it becomes a sort of an auxiliary, it does
expresses the deliberateness of the present progressive but not the same degree of compromise with
the arrangements.

Using the Be going to form.

• It is used to say what we have already decided to do or what we intend to do in the future, generally
with a time expression:

- She is going to meet her new colleagues at four o’clock this afternoon.

• Similarly, the Be going to form is also used with time clauses when the subject’s intention is
emphasized, rather than the idea of future action:

- What are you going to do when you become a PT?

• It does occur when predictions are implied:

- Your back is really tight. I am afraid my manipulation is going to hurt you at a certain point.
• The Be going to form is used with some verbs that do not take the present continuous form, such as
like, be, think…

- I don’t know what I’ll do when I finish my degree; I am going to think about it very seriously.

- Your injury is going to be fine soon if you take up exercise and lose some weight.

• Caveat: Very rarely is the Be going to form used with the verbs go and come. The present continuous
is the preferred choice in these cases:

- She is going to go to a Conference on Special treatments for patients living with a disability.

- She is going to a Conference on Special treatments for patients living with a disability.

The simple future

The simple future is not a tense itself, but rather a modal construction which has been agreed upon to
be called the simple future; yet, and as Will and Shall are modal verbs, the Will/Shall+bare infinitive
form does not show a neutral future aspect, but, rather, a sense of future combined with several other
modal meanings.

-Your patient will be here any minute now.

Form of the future simple

Affirmative Negative Interrogative

I will study I will not (won’t) study

I shall study I shall not (shan’t) study Shall I study?

You will study You will not (won’t) study Will you study?

He/She/It will study He will not (won’t) study Will he/she/it study?

We will study We will not (won’t) study Will we study?

We shall study We shall not (shan’t) study Shall we study?

You will study You will not (won’t) study Will you study?

They will study They will not (won’t) study Will they study?

Using the simple future.

As it has been described in the table above, the modal Will may be used with all three persons, although
a distinction may be established reagarding the alternative form Shall. Whereas Will, being a modal, is
closer to the neutral notion of future, Shall covers a wider range of modal meanings, from commitment
to offer or request. See the examples below:

- Will you help me with my exercises?

- If everything else fails, we will try this new approach.

- Shall I help you with your exercises?

- I shall not give up until I have fully recovered.

The first two sentences establish what may be considered the “basic” or “neutral” notion of future, but
always, because of the modal nature of Will, with undertones of commitment or informal request. The
idea of arrangement for the future is not as strong with Will as it is with the present continuous or even
with the Be going to form.

However, in the last two sentences, Shall expresses not only a future action or the arrangements for
such future action, but also a stronger commitment that overcomes the mere notion of future or plans
for the future. Shall is, therefore, a modal verb that expresses determination for the future in the first
place, rather than future plans arranged with determination; it expresses offers and suggestions for the
future in the first place, rather than just a future that includes an offer or a suggestion.

It is not an easy distinction, but it is a clearcut distinction that needs be understood.

Having tackled this first distinction, the uses of the simple future may now be easier to explain:

• The simple future is used when there is no arrangement preconceived and something is planned right
at the time of speaking; as there is no previous arrangement, the idea of probability is much more vague
than if the Be going to form or the present continuous were used:

- So, you injured your shoulder again when you were moving in; have you called your PT?

- No, I was just waiting for my pain to disappear, but I will call her right away.

• As it has already been discussed, the simple future is a common option when offering, refusing and
promising to do something, or when asking someone to do something:

- Don’t worry Mr. Blackwell, I will help you with your coat.

- Mike is very reluctant to share with his colleagues the techniques he uses. He won’t give any details
about them.

- I really promise I will have my stretching exercises done before I start jogging.

- Will you hand me the notes I wrote on Ms. Jonson’s case, please?

• It is also common when making predictions about an action that, as habitual, is assumed to be taking
place again.

- PT will be better considered and understood in a few years.

• It is also used to express the speaker’s opinions about the future; therefore, it is not uncommon with
verbs and expressions such as: probably, perhaps, surely, expect, bet, hope, think, suppose, guess. This
use is clearly linked with the modal meaning of both Will and Shall:

- I hope the patient will recover satisfactorily.

- She will probably feel much better when the treatment is over.

• The simple future is used in sentences which include clauses of time, condition and purpose:

- I am calling for an appointment early in the morning so my PT will see me as soon as possible.

- If she keeps on wearing high heels, she’ll eventually injure her back again.
- When I apply heat on your low back, it will heal your pain.

Future Continuous

The future continuous, because of its hybrid nature (its continuous aspect and the modality that is
present by means of the Will/Shall), is neither a tense nor a modal verb, but a verbal structure that
accommodates the motion of intention and continuity in the future.

Form of the future continuous

As stated in the previous paragraph, the future continuous takes a modal component, Will/Shall, and a
verbal component, provided by the verb to be used as an auxiliary, and the lexical verb in its present
participle form.

Will + be + gerund of the verb.

- I will be studying anatomy for the final exam this evening, so I cannot join you for dinner.

- This time next year she will already be working as a PT.

Using the future continuous

• The future continuous is used to talk about plans or arrangements that will keep on during a certain
period of time; bear in mind that, as it has been explained previously, the modality of Will/Shall along
with the continuous aspect add the idea of intention, not just that of arrangement or plan:

- I am sorry I cannot take any more patients this evening, but I will be examining Mr Johnson.

In the example above, there are several grammatical components that occur at the same time: first,
there is an idea of plan or arrangement for the future, that is obtained by means of Will; second, the
idea of continuity, obtained through the use of the continuous aspect; and third, the sense of
determination, through to the use of Will as well.

• It is also commonly used when asking someone to do something for us:

- Will you be taking care of my rehab process? I have set my trust on you.

Future Perfect

The future perfect expresses the completion of an action in the future. In this particular case, the
modality of will is somewhat downtoned and the idea of future time prevails. Therefore, it is uncommon
to attach any other intentional meaning to the use of Will.

- If everything goes as planned, by next month you’ll have finished your treatment.

Form of the future perfect

As it has been said, the future perfect is a verbal structure that combines future and finiteness,
completion. To do so, the modal Will provides the verbal structure with the idea of future and the
perfect infinitive of the lexical verb the meaning of completion.

Will + perfect infinitive of the lexical verb.

- By the end of this semester, I will have been working in this department for three years.

Using the future perfect

• The future perfect is used to say that something will already have happened at or before a certain
time in the future; thus, it is accompanied by time expressions –adverbs, adverbial phrases or time
clauses:

- Hopefully, I will have fully recovered mobility in my hand by the time I go back to work.
Exercise 1. Verb tense review. Mixed tenses.

The patient {arrive} __________ at 9 pm in the emergency room with nausea and vomits. The patient
not {eat} __________ since the day before. The patient {report} __________ that the symptoms {come}
__________ on slowly over a period of 12 hours. He {recall} __________ that the first symptoms {occur}
__________ that morning. He {say} __________ he {feel} __________ a little nauseous when he first
{wake up} __________ and the feeling steadily {get} __________ worse. He {say} __________ his first
episode of vomiting {occur} __________ at 1 pm. He {report} __________ that the contents of his
stomach {appear} __________ to contain the previous evening’s meal. He {say} __________ that he
{vomit} __________ ever since.

He {say} __________ that on the previous night he and his wife {dine} __________ at a Sushi restaurant
in the central part of the city. He {have} __________ traditional sushi with rice wine and his wife {have}
__________ vegetarian sushi. She also {consume} __________ rice wine with her meal. They {eat}
__________ lunch around noon that day, although, they not {eat} __________ together. He {eat}
__________ at McDonalds and {have} __________ a Big Mac Menu with cola, while she {eat}
__________ at a Pizzeria near her office.

Since he first {vomit} __________ at 1 pm, he {say} __________ he {vomit} __________ 6 additional
times, at approximately 90 minute intervals. The other episodes of {vomit} __________ produced
mainly fluids with only small bits of solid matter. The patient’s wife {report} __________ no illness and
no nausea. She {concur} __________ with her husband’s assessment of his illness and the time line he
{describe} __________.

She {offer} __________ some additional information regarding what he {consume} __________ that
day. She {say} __________ that she {make} __________ him coffee for breakfast and {get} __________
him to drink several cups of tea before his first episode of vomiting. After that, she {able} __________
{get} __________ him {drink} __________ several glasses of water. She {guess} __________ that he
{have} __________ about 4 glasses of water since 1 pm.

The couple {say} __________ that they {make} __________ plans {go} __________ to Aruba, and
{schedule} __________ {leave} __________ in 3 days. They {concern} __________ that they {have}
__________ {cancel} __________ their flight. The patient’s mood somewhat {depress} __________,
{express} __________ that if they make plans, one of them ______ almost certainly end up {get}
__________ sick just before they {is} __________ {leave} __________.

The patient {admit} __________ to the hospital, put on IV hydration and {give} __________ antiemetics.
Food poisoning {suspect} __________. The patent’s condition {improve} __________ steadily over night
and he {discharge} __________ home the following afternoon.
Information regarding the case {pass} __________ along to the food safety department for
investigation.

Exercise 2. The words listed in the table below are useful nouns in PT. What are the verb forms of
these nouns?

abuse admission assessment

bandage blood breath
consultation continuation convalescence
exhalation extension finding
healing identification inhalation
intervention management movement
occurrence palpation perspiration
preparation prescription provision
reabsorption rehabilitation registration
removal repetition resuscitation
sedation separation stitch
soothingness stretching suffering
sweat treatment weight

Exercise 3. Column A contains useful verbs in medicine. In Column B there are definitions of the verbs.
Read the examples and match the verbs (in italics) with the definitions. Then write the infinitive forms
into the spaces in the definitions in Column B.

A B

Operate _________ means to walk awkwardly because of pain, stiffness or malformation of a

leg or foot
Prescribe _____________ means to identify a condition or illness, by examining the person and
noting symptoms
Transfer __________ means to cut off (all or part of a limb or digit of the body), as by surgery.

Bother ___________ means to move or bring (something) upward from the ground or other
support to a higher position; hoist.
Palpate _________ means to to use medical methods to cure a disease or help a sick or injured
person to recover
Examine _________ means to stop something from happening

Soothe _________ means to make someone healthy

Remove _____________ means to get up from a lying, sitting, or kneeling posture; assume an
upright position.
Harm _________ means to put someone or something at risk

Limp _________ means to give instructions for a person to get a specific dosage of a drug or
a specific form of therapeutic treatment
Faint _________ means to study or treat one particular disease or one particular type of
patient
Admit _________ means to damage or hurt someone or something
Amputate _________ means to treat a person for a condition by cutting open the body and
removing a part which is diseased or repairing a part which is not functioning correctly
Diagnose _________ means to observe, test, or investigate (a person's body or any part of it),
especially in order to evaluate general health or determine the cause of illness.
Treat _________ means to clean a wound and put a covering over it

Itch ___________ means to give trouble to; annoy; pester; worry

Endager _________ means to have an illness for a long period of time

Lift _________ means to pass from one place to another

Dress ___________ means to have or feel a peculiar tingling or uneasy irritation of the skin
that causes a desire to scratch the part affected
Rise ______________ means to examine by touch, especially for the purpose of diagnosing
disease or illness.
Specialise _________ means to relieve pain

Prevent _____________ means to take off or shed (an article of clothing).

Suffer ____________ means to register a patient in a hospital

Cure _________ means to stop being conscious for a short time and, usually, fall down

Exercise 4. All the verbs below relate to medical matters. Use them to complete the sentences. You
may have to change the forms of the verbs to fit the grammar of the sentences.

palpate overcome examine bruise heal prescribe undergo hurt progress rebuild

1. She ___________ her disabilities and now leads a normal life.

2. My mom says that my PT __________ probably my knee the next time I have a physical exam.
3. One of my patients had an accident and Dr. Smith __________ her hip a year ago now.
4. Beacuse her arm was in constant pain, she ___________________ several electrostimulation
treatments.
5. I ___________ my shinbone with a box that fell on it.
6. His shoulder is ___________ so much he can't lift any weight.
7. Any injury will ___________ faster if it is properly diagnosed and treated.
8. My PT asked me how I was ___________ . She seemed happy about the course of the treatment.
9. The swelling may be pedunculated; it is usually possible _________ the edges of the gap in the
bones.
10. Though I hardly ___________ any medications, there are PTs who use them along with any
treatment.

Exercise 5. Natural English conversation includes many phrasal verbs. Match Column A and Column B
in the table below.

Column A Column B
act up to medicate
break down to fall asleep
bring up to cough up material such as mucus from the lungs or throat
come down with to become ill with an illness that's not very serious
dose up with not to do something any more
drop off to faint
ease off to become smaller
get around to start an activity
get over to become inflated
get into to be admitted in hospital
give up to support a person, e.g. with pillows
go down to give basic medical care to someone that helps them temporarily
look after diminish, become more tolerable
pass outh to move about
patch up to start giving problems
prop up to remove something, especially clothes
swell up to become better after an illness or a shock
take off to start to cry and become upset
take up to take care of a person and attend to his or her needs

Exercise 6. Fill in the gaps with a phrasal verb from the previous exercise.

1. He was in such agony that he even _____________. We were all shocked and appalled.
2. He managed to __________________ hospital after his car crash, even when he carried no ID.
3. Most doctors _____________ 100 mg per day to patients who are unable to live in pain.
4. Mark needed six stitches to __________ a head wound after an accidental clash with substitute
Roger.
5. Since I inured my kneecap, I _______________ on crutches.
6. It took a couple of day before the swelling _____________ but now I’ve started my treatment.
7. Her shoulder _____________ so she decided to go and see her PT before it got worse.
8. The pain she felt was almost unbearable and she _____________ when she tried to explain it to her
PT.
9. We ____________ your bandages in our office a day or two after surgery. Then we’ll start your
rehab.
10. You may feel soreness in the muscles, similar to that which you experience when _________
exercise after a long period of inactivity.
11. In some cases, it’s not nurses but PTs themselves who ______________ their own patients.
12. Manipulation ____________ my back so I could walk home.
13. If you _________ the injured area, swelling and throbbing pains would be relieved
14. Even though she loved it, she __________________ jogging after the PT’s advice.
15. “You’ll need at least a month to ______________ your soreness and start your rehab.”
16. Chest congestion is also treated with PT, so the patient can ______________ the phlegm.
17. She arrived so tired from her massage that she _____________ on the couch.
18. Compression occurs when the tissues in the carpal tunnel ________________.
19. One of my patients couldn’t come to his session this afternoon because he _____________ with the
flu.

Exercise 7. Verb tenses. Fill in the blanks with one of the options
As physical therapists from time to time we (1) _______ (a) confront (b) are confronted (c) have being
confronted (d) confronted by a patient who is resistant to the idea of being involved with exercise.
When those times (2) __________ (a) occurs (b) occur (c) is occurred (d) are occurred I want you to be
prepared by giving them solid evidence as to why exercise is so important, starting with this. After age
45, muscle strength declines 8-10% every decade of life and (3) __________ (a) must decline (b) should
decline (c) decline (d) can decline as much as 30% in the eighth decade of life if an individual is not
involved with resistance exercise.

The World Health Organization (WHO) indicates that physical inactivity (4) _________ (a) has being (b)
is (c) were (d) have been the fourth leading risk factor for death worldwide. A recent study (5)
_________ (a) indicate (b) is indicating (c) have been indicated (d) has indicated that being sedentary
has such a high risk that those who sat an hour longer each day were at increased risk of mortality.
According to a 12-year study published in the New England Journal of Medicine, retired men who (6)
________ (a) walked (b) were walked (c) were walking (d) are walking more than 2 miles a day lived
longer than those who walked less than a mile a day.

So, it is ironic that in today’s high-tech health-care world something as simple as exercise (7) ______ (a)
created (b) create (c) creates (d) will create measurable health benefits. If I (8) _________ (a) tell (b)
had told (c) were told (d) was telling you that a certain pill could boost your immune system, lower the
risk of heart disease, cancer, high blood pressure, diabetes, obesity and osteoporosis, you (9) ________
(a) had said (b) will say (c) would say (d) are said, I’m interested! And if I tell you the same pill will also
boost brain power, reduce depression, improve feelings of well-being and improve your endurance and
strength, without any negative side effects, you (10) ________ (a) will probably take (b) have probably
taken (c) had probably taken (d) would probably take that pill, and then ask “How much (11) ________
(a) does it cost (b) it cost (c) it costs (d) costs it?” That pill is exercise! Exercise (12) _______ (a) has
being showed (b) has being shown (c) has been shown (d) has showing to produce all of the above
effects, and the best part about it… it’s free!!

If exercise (13) _____________ (a) is (b) was) (c) were (d) are a pill, we would not be able to
manufacture it fast enough. It would be available in every hospital, clinic, nursing home, and health care
facility around the world. The big pharmaceutical companies like Pfizer and Merck would charge over
$100 a pill for a drug that (14) ________ (a) produced (b) produce (c) produces (d) had produced all of
the above health benefits. So, why (15) _________ (a) don’t people exercise (b) people don’t exercise
(c) people not exercise (d) doesn’t people exercise?

In 2007 the American College of Sports Medicine (ACSM) (16) ___________ (a) team (b) has teamed (c)
teamed (d) have teamed with the American Medical Association (AMA) to start the Exercise is Medicine
initiative. This initiative (17) ____________ (a) had been promoted (b) promotes (c) promote (d) have
promoted exercise and physical activity in healthcare settings. They (18) ____________ (a) believed (b)
believe (c) are believing (d) were believing that exercise and physical activity are important to the
health, prevention and treatment of many chronic diseases. The American Physical Therapy Association
(19) ________ (a) belonged (b) is belonged (c) is belonging (d) belongs to a network member of the
Exercise is Medicine initiative and believes that it is the responsibility of every physical therapist to
address the health needs of society.
Research demonstrates strength deficits of 8-10% each decade of life that (20) _________ (a) is leaving
(b) left) (c) leaves (d) will leave many of our patients living at a marginal functional level. As physical
therapists we have the opportunity to make a positive difference in our patients’ lifestyle by giving them
information about the benefits of exercise and integrating exercise into their therapy.

Exercise 8. Fill in the blanks with the correct option: Living with Rheumatoid Arthritis

The first episode occurred when I [1] _________ (a) was (b) were (c) have been (d) have being 27years
old and my 2nd child was one year old; then, I [2] _________ (a) had noticed (b) notice (c) noticed (d)
notices one of my fingers was inflamed, swollen. The swelling [3] _________ (a) will not subside (b) did
not subside (c) has not subsided (d) had not been subsided, but I was just fine - jogged 5 miles each
day, helped my husband build a three story addition on to the house, worked on rebuilding player
pianos, [4] __________ (a) sew (b) sewed (c) sews (d) sewn for others, etc. However, I was in a very
stressful situation at work during the time and [5] ___________ (a) had been feeling (b) have been
feeling (c) have feeling (d) had being feeling overwhelmed and exhausted. After a while, I started
experiencing joint pain in my shoulder. Pretty soon it [6] _________ (a) has been (c) had been (c) was
(d) were being both shoulders, then my elbows, wrists, knees and ankles. The pain was intense but yet I
kept getting up and going to work.

One evening about 7 years ago, my fingers [7] _______ (a) begin (b) began (c) begins (d) begun to
tingle, an odd feeling. Then I [8] _______ (a) went (b) were gone (c) were going (d) was gone to get up
from the couch and my knees pained like someone [9] _______ (a) cuts (b) cut (c) was cut (d) was
cutting them off. By 4 AM, I [10] ________ (a) screamt (b) screamed (c) scream (d) was screaming to
my husband to "cut off my hands". The pain was unbearable and my wrists and fingers [11] _______ (a)
twisted (b) twist (c) were twisted (d) have been twisting to one side. He rushed me to the emergency
room and they [12] ________ (a) were thinking (b) were being thought (c) thought (d) were thought
maybe it was a spider bite or something. No one really knew what to do. They [13] ________ (a) was
sent (b) send (c) was sending (d) sent me home when the pain let me walk. The next night the same
thing, awake at 4 AM in agony. The next day I had an appointment with my psychiatrist as I [14]
_______ (a) have had (b) have (c) had had (d) have been had severe panic disorder and depression
since age 23 and needed a refill. He took one look at my twisted wrist and fingers and [15] _______ (a)
said (b) say (c) was said (d) was saying, "Oh my goodness, you [16] ________ (a) had (b) have had (c)
have (d) had had rheumatoid arthritis!" He pulled strings and got me into see a rheumatologist the next
day. I [17] _________ (a) was gone (b) was going (c) went (d) go to the doctor and had blood tests
done. It [18] _______ (a) came back (b) comes back (c) come back (d) was come back that I was anemic
so I started taking iron tablets. These [19] ______ (a) does not work (b) didn't work (c) was not worked
(d) was not being worked and I was still not feeling well so I went back to the doctors and she
investigated further. Being very active I [20] ________ (a) won’t understand (b) have not understand
(c) did not understand (d) was not understanding why all of the sudden I was feeling this way.
Exercise 9. Fill in the blanks with the correct option.

As I compete in a combat sport I (1) _____ (a) anticipated (b) anticipate (c) was anticipated (d) was
anticipating a higher injury rate than other sports, but with my 10+ years experience in strength and
conditioning, I was confident in my ability to rehabilitate myself from any injury that may occur.

At the beginning of 2014 I (2) _______ (a) begin (b) have begun (c) began (d ) begun to develop ongoing
neck pain, brought on by elements of the training I was involved in. After I (3) ______ (a) was (b) am (c)
have been (d) had being unable to rehabilitate the issue myself I turned to an old-fashioned physio who
(4) _______ (a) prescribed (b) prescribe (c) had been prescribing (d) was prescribed isolated neck
strengthening exercises. This did little to reduce the effects of the problem, so I then to turned to
another physiotherapist who (5) ______ (a) focused (b) has focused (c) had been focused (d) focuses
on adjustments of the spine and rib cage. I (6) ______ (a) experience (b) experienced (c) was
experienced (d) had been experienced short term relief from the issue through this form of treatment,
but the problem would reoccur at regular intervals. In the last 3 months of 2014 the issues (7) ______
(a) seem (b) had seemed (c) seemed (d) were seeming to be compounding, and despite weekly
adjustment, I was unable to go more than a few days without elements of training causing acute pain in
my neck. In November 2014 I (8) ______ (a) will experience (b) have experienced (c) experience (d)
experienced a suspected brachial-plexus impingement, leaving me basically unable to use my right arm
or rotate my head. A series of adjustments over a 7 day period (9) ________ (a) allow (b) was allowing
(c) has allowed (d) allowed me to regain the movement in my arm and head, but I was still constantly
experiencing referred pain down the right side of my neck and down through my right arm, which
interfered with my training and my day to day activities. At this point I was referred to John by a friend
who (10) ______ (a) experience (b) had experienced (c) was experiencing (d) experiences similar
symptoms as I had for the past 12 months.

In my first session I (11) ______ (a) had been expecting (b) expect (c) was expecting (d) was expected
John to ask me to lie down on the bed and assess me through methods such as manual muscle testing,
but instead he used movement based tests so he could see how my body actually (12) _______ (a) was
moved (b) moved (c) moves (d) had moved through different planes. He was immediately able to
identify the dysfunction that (13) _________ (a) happened (b) was happened (c) was happening (d) has
happened with the right side of my neck, upper back and right shoulder. Instead of manipulations, John
prescribed me a group of 5 exercises that primarily involved rotations, side flexion and arm extension
movements and I (14) _______ (a) asked (b) was asked (c) was asking (d) will be asked to do them 2-3
times per day. I was skeptical how seemingly simple movements could have any effect on my severe
cervical vertebrae problems. The positive effects of the movements (15) _________ (a) were (b) is (c)
has been (d) have been almost instantaneous. Within a week my general pain levels (16) ________ (a)
had dropped (b) had been dropped (c) were dropping (d) drop significantly and I had a much great
range of movement when rotating my neck. My upper back muscles were also in a constant hypertonic
state and this (17) ______ (a) was seeming (b) seems (c) seemed (d) had seemed to reduce greatly with
the exercises. I returned to my training with caution, but the increased range of movement of my neck
and the ability of my spine to now rotate segmentally (18) ______ (a) have contributed (b) contribute
(c) had been contributing (d) had contributed to me not sustaining my usually neck injury, which was
happening on a weekly basis.

After approximately 5 weeks of completing the movements, John called me back in for a reassessment.
My problem (19) ________ (a) have greatly improved (b) had greatly improved (c) improved greatly
(d) has been greatly improved but I was still experiencing muscle soreness and tightness in my neck,
tightness through my upper back and referred nerve symptoms (such as twitching and pins and needles)
in my right hand. John looked at how my neck, back and shoulder (20) ______ (a) moved now (b) have
now moved (c) were now moving (d) move now and prescribed a new group of additional exercises to
complement the exercises I was already doing.

These exercises (21) ______ (a) were focusing (b) focus (c) were been focused (d) had focused more
specifically on increasing the intensity of the dynamic stretches in relation to my neck, with some of
them adding resistance to the movements. The new movements were challenging but again I (22)
_______ (a) see (b) saw (c) had seen (d) will see immediate effects on the neck muscles I was feeling
soreness and tightness in. To complement John's exercises I also received weekly dry needling and
massage treatments.

After approximately 4 weeks following the new protocol my neck (23) __________ (a) is now feeling (b)
has now felt (c) has now been felt (d) was now feeling better than it had any time in the last 12
months. The muscle soreness in my neck and upper back is virtually gone, with only a very small amount
of referred nerve pain remaining in my right arm.

My issue is not completely resolved, but I (24) ________ (a) have been blown away (b) have blown
away (c) blew away (d) am blowing away by the improvement in my neck related symptoms. I (25)
_________ (a) had not missed (b) was not missing (c) have not missed (d) have not been missed one
training session due to injury in this period, when previously I was barely able to make it through a week
of training with out re-injuring my neck.