NPTE Practice Questions: Active vs Passive Insufficiency

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I have a question for you. Do you know the difference between what is active and passive insufficiency? Watch this video to find out how these two terms can help your patients heal faster!
The PT Hustle is dedicated to helping PT students, like you, prepare to take and pass the PT exam by reviewing NPTE practice questions. Today’s question: Active vs. Passive Insufficiency.
How well do you understand the concept of active and passive insufficiency? Let's test your understanding in this excellent episode.
NPTE Practice Question:
Nadine assesses her patient's hamstring strength in the sitting position and standing positions. The therapist finds that the patient's strength is significantly better in sitting when compared to the standing position. Which of the following is the MOST likely reason for the diminished end range knee flexion strength in standing?
Answer Choices:
A. Active insufficiency of the quadriceps
B. Active insufficiency of the hamstrings
C. Passive insufficiency of the quadriceps
D. Passive insufficiency of the hamstrings
Do you think you know which answer is correct? Watch the video to find out.
If you get it wrong, don’t worry. Dr. Kyle Rice, better known as “Coach K” doesn’t just give you the answer -- he breaks down the question so you know how to eliminate answers before getting to the right one.
NPTE practice questions are exactly that, practice. And at The PT Hustle, practice makes perfect. We exist to help students dominate the NPTE exam. If you need additional NPTE study guides, download our free cheat sheets here: www.nptecheatsheets.com. Our free cheat sheets feature the top 10 most challenging musculoskeletal NPTE topics.
For more ways to prepare for the NPTE exam and what NPTE practice questions you need to work on, visit www.thepthustl... to find a solution that can put you on the path to NPTE success.
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Disclaimer: The PT Hustle along with the contents of this video including the question and rationale are not affiliated with the National Physical Therapy Examination® (NPTE) or property of Federation of State Boards of Physical Therapy® (FSBPT). The information contained in this video should not be taken as medical advice. The information provided in this training should not be used as the sole source of clinical, legal, or medical advice. Please use sound clinical judgment based upon the best evidence when treating yourself or a patient.
Music credit: The Future Bass by Starjammusic

[@PoptartToppart]

I refuse to leave this video without understanding this Active and Passive insufficiency, thank you Dr Rice!!!!!!!

[@lindsaylewis2209]

Just want to say I've just recently found these videos but i find them super helpful as a quick review. Studying for the PTA exam, but aside from evaluations, treatments and thought processes are all the same. I have never struggled with active and passive insufficiency, and it may be due to the way my instructors explained it. Active insufficiency = muscle actively contracting/performing it's action at both joints. Passive insufficiency = muscle passively being stretched over both joints. It may be an oversimplification of the concept, but may be helpful to others that are having trouble with the differentiation.

[@benjaminduthu8996]

My guy. A genuine thank you for these videos. I’m only two terms in the PT school grind and finals are right now. As I’m going through and studying, I came across this explanation that breaks down this concept better than what was presented in class. Clicked that subscribe button bcuz I’m going to be coming back. Thanks again.

[@kylevincentmartos9855]

You really nailed it, saying that these concepts were all spoon-fed to most schools. To the point that each student does not understand on how to apply it.

[@ThePTHustle]

100!!

[@amandanissley2483]

I just had a good cry in my car during your rant! Blessings to you for this video and the encouragement you just gave me. Let's do this!!

[@ThePTHustle]

Let's freaking get it Amanda!

[@jambasjoe6045]

Man man, God bless you for real! THANK YOUUUUU! I mean my way of seen Active and passive is just with 4 steps: 1. pick a muscle: I pick hamstring 2. is it a two joint muscle? yes continue if not STOP. Only two joint muscles apply for this topic 3. action? Knee flexion and Hip extension 4. I divide it in 4a (active insufficiency this would be same action) and 4b (passive insufficiency opposite action) BUT, I didn't look at it in terms of force generation. SO, THANK YOUUUU COACH K

[@ThePTHustle]

Glad it helped! Keep it up!

[@bradleyroe9418]

Will you please come in to the NPTE with me and stand there and motivate me the whole time? Please and thank you. (Also thank you for FINALLY making this information understandable!!!)

[@GainzBroFitness]

Thank you for the explanation!

[@Chicharorones87]

Passed my exam after buying and studying your material!!! THANK YOU SO MUCH!

[@ThePTHustle]

YESS!! Let's go!!!!! Congratulations on your amazing accomplishment! Thank you so much for sharing this win with me!!! I am incredibly grateful for the opportunity to serve you and help you freaking DOMINATE your NPTE/NPTAE!!!

[@annar.9493]

I'm so glad I found this channel. I take the NPTE-PTA on July 8, so I'm trying to make sure I'm fully prepared for this exam. Thank you!!

[@ThePTHustle]

Thank you Anna!! Welcome!

[@Chicharorones87]

Same!!! And my anxiety is in 10! These videos are helping SO MUCH!

[@annar.9493]

Senorita Chicha You’ll be just fine! Good luck to you!

[@Chicharorones87]

Anna R. You toooo! Good luck!

[@lindsaylewis2209]

Anna, I will also be sitting for the PTA exam July 8. I was supposed to take it in April and it got cancelled. I think it' s been more stressful having more time to "forget" everything since I graduated in March. Good luck!!!

[@AbigailSnyder-js2mc]

❤ thank you!

[@Chicharorones87]

Your videos are going to be a MAJOR help for my test next weeeeeeek! 🙌🏾🙌🏾 THANK YOU!

[@ThePTHustle]

You're so welcome!!!

[@opistatic]

I love your channel man. You deserve lots of subscribers! I'm a PT student in the Philippines :D

[@opistatic]

This NPTE series will surely help a lot of people

[@ThePTHustle]

@@opistatic Thank you Jan

[@opistatic]

@@ThePTHustle no problem sir :)

[@jazzbunny9795]

I might take the NPTE this year and I'm hoping to pass it. Thank you for this.

[@ThePTHustle]

You are so welcome!

[@davidfriedlander9868]

I just want to say Thank you. I realize this video is a bit old, but you give me confidence. I am taking my boards for PTA, and all the struggles you named, I have. Any other advice on how to refresh this material without staring at books and notes? Thank you again.

[@ThePTHustle]

Hey David! We are opening this channel back up again! Thank you so much for this message! If you are not already in our private Facebook group check it out. We answer questions like this all of the time. Here it is: www.nptegroup.com

[@deepikageleda6750]

Love your enthusiasm, you have explained this so well.

[@ThePTHustle]

So glad that you enjoy it!! Keep crushing it!!

[@PaintingwithEnrique]

Thanks for the pep talk

[@ThePTHustle]

You got it Enrique! So glad you enjoyed this one!

[@Donfranchico]

Thank you so much for the lesson and motivational speech my brother

[@ThePTHustle]

My pleasure

[@amirahosnyibrahim3869]

Hi! can you do some movement analysis videos please? of common movement combinations e.g. squat, sit to stand, etc.) thanks!

[@JohnDoe-ef3nv]

Hustle gang, homie 🙌

[@sarathlectures]

Excellent gentleman..

[@ThePTHustle]

Thank you for the support Sarath!

[@hannahhowells9460]

So to make this even more shorten.. passive insufficiency is more ROM and active is more dealing with strength?

[@ThePTHustle]

Correct!

[@queensheba9792]

We are learning this WEEK 1 of PTA school. And I am struggling so bad. So is it fair to say AI is a matter of FORCE and PI is a matter of ROM? This video was very helpful. Still confused, but less so than before watching.

[@ThePTHustle]

Yes Ma'am!!

[@shamusmallon8560]

Hey there, this specific question is very confusing for me. Would you mind taking the time to clarify somethings? In standing, why are the hamstrings in more of a shortened position, with the knee flexed, than when in sitting? Often, in sitting the pelvis can posteriorly rotate to compensate for shortened hamstrings, but that can be true for standing as well. In my mind, the reduced end-range strength of the hamstrings in standing compared to sitting would be due to shortened quadriceps (which in sitting the rectus femoris is on slack, vs in standing where it is stretched). Shortened quads (passive insufficiency of the quads) would put a limitation on the ability for the hamstring to actively flex the knee. I think I am way over thinking this, HELP

[@ThePTHustle]

Shamus thanks for the question brother. Definitely overthinking this a little bit but don’t worry, we all are to blame for overthinking every now and then. I agree with your statement about the posterior pelvic tilting in sitting, however we would be assuming that is happening because it doesn’t happen in every case. In other words, we need to table the idea of tilting unless the question eludes to that. Since the hamstrings are knee flexors and hip extenders, standing knee flexion will place the hamstrings in the most “shortened position”. Plain old sitting (totally ignoring the presence of anterior or posterior tilting) includes hip flexion and knee flexion. Since the hip is flexed during sitting, this is not a shortened position of hamstrings. Hope this helps winner, Speak soon, Kyle

[@shamusmallon8560]

@@ThePTHustle YOU ARE AWESOME!

[@richmondsarpong4200]

@@ThePTHustle Exactly Kyle That’s the same line I thought along bro That since the Hamstrings is a 2-Joint muscle, In standing the hip will be in extension meaning the hamstrings would have been in some form of contraction already( ie shortened). This creates that inability to fully generate the force to achieve the full end of knee ROM strength in flexion right?? But my question is does this happen in everybody, even in a healthy population??

[@alexsamuel5267]

I thought active insufficiency will also apply if the two joint muscle is not able to generate force if it is too short OR too long?

[@ThePTHustle]

Alex Samuel that is correct! The other example of active insufficiency is when the muscle is too long and can’t generate enough force. The most common form of active insufficiency tested on is when the two joint muscle is too short. Thanks for the clarification question!

[@alexsamuel5267]

The PT Hustle appreciate your reply, thank you so much!!

[@mmunguia90]

I don't understand how the knees are going into flexion when standing....aren't they extended?

[@hwessel182]

I thought the same thing, but I’m thinking it’s because of the testing position. The patient would be standing with the knee being tested flexed, not fully extended. So then we’re just comparing hip position between sitting and standing, and hip extension (standing) will shorten the hamstrings compared to hip flexion (seated).

[@francinemathis7227]

AMEN TO U Dr. RICE!!!!! The system is misguiding and favor only certain peeps. Let's SLAY these Boards!!!

[@ThePTHustle]

RIP NPTE lets get it Francine!!!!

[@nataliecaruso7610]

Love you brother

[@nataliecaruso7610]

I willl win !

[@olaoluoje8588]

Considering the fact that the assessment was carried out by a therapist, shouldn't that make it passive muscle action?

[@ThePTHustle]

Hey Olaolu! No, it shouldn't actually. The therapist is checking for the patient's strength which is an active-based activity. If the therapist was passively moving the knee into flexion and checking the range of motion you would be correct!

[@ajmadachy]

Hi! Shouldn't you also add that active insufficiency occurs not only when the muscle is max shortened, but also when it is max lengthened? You stated that the hamstrings are max shortened when standing... this is false. They are lengthened. Still results in the same outcome, though, being actively insufficient, I just thought this was a bit misleading!

[@ThePTHustle]

Aliese Madachy during resisted testing of the hamstrings in standing they would be shortened not lengthened. If you stand and flex your knee, the hamstrings don't get longer... They contract!!

[@CPU2ube]

After reading this, and the part about the length of the hamstrings changing from sitting to standing due to going from hip flexion to relative extension, the answer to this question makes a lot more sense.

[@moosethephysio]

Question: why is there knee flexion with standing? I thought that would be in sitting.

[@ThePTHustle]

Patients can perform knee flexion in standing or sitting.

[@nonamepoeple123]

I understand patient can perform knee flexion in standing. But in standing, the knee should be in extension, not in flexion right?

[@kruttikawavade9588]

@@nonamepoeple123 you can simply stand and flex your knee actively by yourself