Anatomy & Physiology
11%of exam
Kinesiology
12%of exam
Pathology, Contraindications, Special Populations
14%of exam
Benefits & Effects of Soft Tissue Manipulation
15%of exam
Client Assessment, Reassessment & Treatment Planning
17%of exam
Ethics, Boundaries, Laws, Regulations
16%of exam
Guidelines for Professional Practice
15%of exam
Quick Facts
- Exam
- MBLEx
- Body
- FSMTB
- Questions
- 100 multiple-choice
- Exam time
- 110 minutes
- Appointment
- 120 minutes total
- Format
- Fixed-length adaptive CAT
- Result
- Pass or Fail only
- Fee
- $265 per attempt
- Delivery
- Pearson VUE test centers
- Retake
- Reapply immediately, no wait
- ATT window
- 120 days
- Outline
- July 2023, 2022 JTA
Body Systems Snapshot
- Cardiovascular
- Heart, vessels, blood transport
- Lymphatic & Immune
- Fluid balance, infection defense
- Musculoskeletal
- Support, movement, mineral storage
- Nervous
- Senses, integrates, sends signals
- Endocrine
- Hormones regulate slower processes
- Integumentary
- Skin barrier, temperature control
- Respiratory
- Gas exchange, oxygen delivery
- Urinary
- Filters blood, balances fluid
- Digestive
- Breaks down, absorbs nutrients
Tissue Injury & Repair
- Acute phase
- Inflammation, first 72 hours
- Subacute phase
- Repair, new collagen laid
- Maturation phase
- Remodeling, scar strengthens slowly
- Scar tissue
- Weaker, less elastic collagen
- Adhesion
- Tissue layers stuck together
- Energetic anatomy
- Meridians, chakras, subtle concepts
Planes and Motions
Sagittal flexes, frontal abducts, transverse rotates
Sagittal: flexion, extensionFrontal: abduction, adductionTransverse: rotation
Origin vs Insertion
Origin
- Fixed/proximal attachment
- Moves less
- Usually the larger bone
Insertion
- Mobile/distal attachment
- Moves toward origin
- Usually the smaller bone
Anchor vs mover
Muscle Origins & Insertions
- Trapezius
- Occiput, C7-T12 to scapula
- Latissimus dorsi
- Lower spine to humerus groove
- Pectoralis major
- Sternum, clavicle to humerus
- Sternocleidomastoid
- Sternum, clavicle to mastoid
- Deltoid
- Shoulder girdle to deltoid tuberosity
- Biceps brachii
- Scapula to radial tuberosity
- Psoas major
- Lumbar spine to lesser trochanter
- Gluteus maximus
- Ilium, sacrum to femur
- Rectus femoris
- AIIS to tibial tuberosity
- Gastrocnemius
- Femoral condyles to calcaneus
- Piriformis
- Anterior sacrum to greater trochanter
- Levator scapulae
- C1-C4 to superior medial scapula
- Rhomboids
- C7-T5 to medial scapular border
- Quadratus lumborum
- Iliac crest to 12th rib
Muscle Actions
- Upper trapezius
- Elevates and upwardly rotates scapula
- Latissimus dorsi
- Extends, adducts, medially rotates
- Pectoralis major
- Adducts, medially rotates humerus
- Sternocleidomastoid
- Flexes neck, rotates opposite
- Psoas major
- Primary hip flexor
- Piriformis
- Laterally rotates extended hip
- Hamstrings
- Flex knee, extend hip
- Quadriceps
- Extend knee; rectus flexes hip
- Deltoid
- Abducts arm at shoulder
- Gastrocnemius
- Plantar flexes ankle, flexes knee
Proprioceptors & Contractions
- Muscle spindle
- Senses stretch; triggers contraction
- Golgi tendon organ
- Senses tension; triggers relaxation
- Concentric
- Muscle shortens under load
- Eccentric
- Muscle lengthens under load
- Isometric
- Tension, no length change
- Reciprocal inhibition
- Agonist contracts, antagonist relaxes
- Agonist
- Prime mover of action
- Antagonist
- Opposes the prime mover
Endangerment Sites
Neck, axilla, elbow, umbilicus, groin, popliteal
Neck: carotid, vagusAxilla: brachial plexusElbow: ulnar nerveUmbilicus: abdominal aortaGroin: femoral vesselsPopliteal: tibial nerve
Absolute vs Local Contraindication
Absolute
- No massage at all
- Systemic or serious risk
- Refer out
Local
- Avoid one site
- Rest of body fine
- Site-specific caution
Whole body vs one site
Contraindicated or Adapt?
- Suspected DVT→No massage(Refer immediately)
- Fever or acute infection→Postpone session(Systemic contraindication)
- Contagious skin lesion→Avoid that site(Local contraindication)
- Acute inflammation, first days→Avoid; use cold(Within 72 hours)
- Varicose veins→Work around site(No deep pressure)
- Osteoporosis history→Light pressure only(No joint mobilization)
- Uncontrolled hypertension→Refer to physician(Gentle once cleared)
- Active cancer treatment→Physician clearance first(Then adapt pressure)
- Pregnant client→Side-lying, gentle(Check state rules)
- Recent surgery site→Avoid the area(Clearance needed)
- Undiagnosed pain→Refer for diagnosis(Never diagnose)
Common Pathologies
- DVT
- No massage; refer immediatelyAbsolute
- Fever or acute infection
- Postpone the entire sessionAbsolute
- Cellulitis
- Spreading skin infection; refer
- Varicose veins
- Avoid site; no pressureLocal
- Osteoporosis
- Light pressure; no mobilization
- Rheumatoid arthritis flare
- No massage during flare
- Osteoarthritis
- Gentle work around joint
- Fibromyalgia
- Light pressure, shorter session
- Diabetes
- Check sensation; watch hypoglycemia
- Uncontrolled hypertension
- Refer before massaging
- Cancer
- Physician clearance; adapt pressure
- Pregnancy
- Side-lying; avoid deep abdominal
- Shingles or herpes
- Contagious lesions; avoid site
- Acute bursitis
- Local contraindication while inflamed
Signs of Inflammation
Heat, redness, swelling, pain, lost function
Calor: heatRubor: rednessTumor: swellingDolor: painFunctio laesa: lost function
Acute vs Chronic
Acute
- First 72 hours
- Hot, swollen, inflamed
- Cold; avoid the site
Chronic
- Long-standing pattern
- Adhesions and restriction
- Heat; deeper work allowed
Cold acute, heat chronic
Endangerment Sites
- Anterior neck triangle
- Carotid artery, vagus nerve
- Posterior neck triangle
- Brachial plexus, subclavian artery
- Axilla
- Axillary artery, brachial plexus
- Medial epicondyle
- Ulnar nerve, funny bone
- Cubital fossa
- Median nerve, brachial artery
- Umbilicus area
- Abdominal aorta lies deep
- Femoral triangle
- Femoral artery, vein, nerve
- Popliteal fossa
- Popliteal artery, tibial nerve
- 12th rib area
- Kidney sits underneath
- Sternal notch
- Trachea and thyroid gland
- Eyes and orbit
- No direct pressure
Medication Classes
- Anticoagulants
- Bruising risk; lighter pressure
- Antihypertensives
- Dizziness; help client rise
- Opioid analgesics
- Masked pain; reduce pressure
- Muscle relaxants
- Reduced protective muscle guarding
- Corticosteroids
- Fragile skin and tissue
- Diuretics
- Dehydration; frequent bathroom breaks
- Antidiabetics
- Watch for low blood sugar
Swedish Stroke Order
Effleurage, petrissage, friction, tapotement, vibration
Effleurage: glidePetrissage: kneadFriction: cross-fiberTapotement: percussionVibration: shake
Effleurage vs Petrissage
Effleurage
- Gliding strokes
- Warms and assesses tissue
- Applied toward the heart
Petrissage
- Kneading and lifting
- Milks metabolic waste out
- Separates muscle fibers
Glide vs knead
Strokes & Techniques
- Effleurage
- Gliding; warms and assesses
- Petrissage
- Kneading; lifts and squeezes
- Friction
- Cross-fiber; breaks down adhesions
- Tapotement
- Percussion; stimulating, loosens congestion
- Vibration
- Shaking; sedates or stimulates
- Compression
- Rhythmic pressing; creates hyperemia
- Myofascial release
- Slow, sustained fascial stretch
- Trigger point work
- Sustained pressure; referred pain
- Lymphatic drainage
- Light, slow, toward nodes
- Muscle energy technique
- Contract, then relax and lengthen
- Rocking
- Rhythmic; sedates nervous system
Sympathetic vs Parasympathetic
Sympathetic
- Fight or flight
- Raises heart rate
- Fast tapotement stimulates
Parasympathetic
- Rest and digest
- Lowers heart rate
- Slow effleurage sedates
Stimulate vs sedate
Physiological Effects
- Mechanical effect
- Direct physical tissue change
- Reflexive effect
- Nervous system mediated response
- Hyperemia
- Increased local blood flow
- Parasympathetic shift
- Rest and digest response
- Thixotropy
- Ground substance gel to sol
- Increased ROM
- Tissue lengthens, joints move
- Pain gate theory
- Touch input dampens pain
- Psychological effects
- Reduced anxiety, better body awareness
Hot & Cold Applications
- Cold application
- Vasoconstriction; use for acute
- Heat application
- Vasodilation; use for chronic
- Contrast therapy
- Alternating heat and cold
- Acute injury window
- First 72 hours; cold
- Never heat
- Acute inflammation or swelling
- Sensation check
- Confirm before any thermal
SOAP Notes
Subjective, Objective, Assessment, Plan
S: client saysO: you observeA: your findingsP: next steps
Active vs Passive ROM
Active (AROM)
- Client moves alone
- Tests willingness and strength
- Contractile tissue
Passive (PROM)
- Therapist moves limb
- Tests joint end feel
- Inert tissue
Who moves the joint
Which Assessment Tool?
- Need symptom history→Verbal intake(Subjective data)
- Screening for red flags→Health history form(Written intake)
- Checking standing alignment→Postural assessment(Visual)
- Watching client walk→Gait assessment(Visual)
- Feeling tissue texture→Palpation(Objective)
- Client moves the joint→Active ROM(Willingness, strength)
- You move the joint→Passive ROM(End feel, inert)
- Client resists your force→Resisted ROM(Contractile tissue)
Assessment & Documentation
- Verbal intake
- Client-reported history and goals
- Health history form
- Written screening for contraindications
- Postural assessment
- Standing alignment and landmarks
- Gait assessment
- Walking pattern observation
- Palpation
- Touch-based tissue evaluation
- AROM
- Client moves; willingness, strength
- PROM
- You move; joint end-feel
- RROM
- Resisted; tests contractile tissue
- End feel
- Quality at motion limit
- SOAP note
- Subjective, Objective, Assessment, Plan
- Subjective data
- What the client reports
- Objective data
- What you observe, measure
Domain Weight Order
Assessment 17 highest, anatomy 11 lowest
Assessment: 17%Ethics: 16%Benefits and Practice: 15%Pathology: 14%Kinesiology: 12%Anatomy: 11%
Clinical Reasoning & Planning
- Rule out contraindications
- First step before treating
- Treatment goals
- Client-centered, measurable outcomes
- Treatment strategy
- Techniques, pressure, sequence, duration
- Reassessment
- Compare against prior session
- Referral
- Send out; never diagnose
- Session organization
- Intake, treatment, closure, notes
Scope vs Ethics Violation
Scope violation
- Breaks state law
- Diagnosing or prescribing
- License is at risk
Ethics violation
- Breaks professional code
- Dual relationship, gossip
- May still be legal
Law vs code
Draping & Boundary Decisions
- Client requests sexual contact→End session immediately(Document and report)
- Client declines undressing→Work over clothing(Consent respected)
- Uncovering gluteal area→Get verbal consent(Re-drape after)
- Working near breast tissue→Keep breasts draped(Check state law)
- Client is a minor→Guardian consent required(Follow state law)
- You feel attraction→Countertransference; seek supervision(Never act)
- Client asks you out→Decline; dual relationship(Boundary violation risk)
- Client requests diagnosis→Refer to physician(Outside scope)
- Client asks about others→Confidentiality; say nothing(No exceptions)
Ethics & Boundaries Terms
- Scope of practice
- Legally allowed services boundary
- Code of ethics
- Professional conduct standards
- Informed consent
- Agreement after clear explanation
- Confidentiality
- Protect client information always
- HIPAA
- Health information privacy law
- Dual relationship
- Second role with client
- Transference
- Client projects onto therapist
- Countertransference
- Therapist projects onto client
- Boundary crossing
- Minor, often harmless deviation
- Boundary violation
- Harmful breach causing damage
- Sexual misconduct
- Never acceptable; license loss
- Power differential
- Therapist holds more power
- Right of refusal
- Either party may stop
Transference vs Countertransference
Transference
- Client projects feelings
- Onto the therapist
- Manage with boundaries
Countertransference
- Therapist projects feelings
- Onto the client
- Seek supervision
Client projects vs therapist
Outside Massage Scope
- Diagnosing conditions
- Licensed medical provider only
- Prescribing medication
- Outside massage scope
- Spinal adjustment
- Chiropractic scope only
- Physical therapy claims
- Do not advertise them
- Nutrition prescriptions
- Dietitian scope, not massage
- Psychotherapy
- Refer to mental health
- Interpreting imaging
- Outside massage scope
- Breast massage rules
- Vary by state law
Sanitize vs Disinfect
Sanitize
- Lowers microbe count
- To a safe level
- Soap and water
Disinfect
- Kills most pathogens
- Hard surfaces only
- EPA-registered product
Reduce vs kill
Sanitation & Infection Control
- Standard precautions
- Treat all fluids as infectious
- Hand hygiene
- Wash before and after
- Sanitize
- Reduces microbes to safe
- Disinfect
- Kills most surface pathogens
- Sterilize
- Destroys all microorganisms
- Linens
- Fresh set every client
- Bloodborne pathogens
- HBV, HCV, HIV
- PPE
- Gloves, mask when indicated
- Broken skin
- Cover or avoid site
Draping & Body Mechanics
- Draping purpose
- Warmth, privacy, clear boundaries
- Gluteal draping
- Consent first, then re-drape
- Breast draping
- Female breasts draped; state-specific
- Undressing
- Client chooses, done privately
- Table height
- Hip to knuckle height
- Body mechanics
- Stacked joints; power from legs
- Horse stance
- Wide, stable, square base
- Self-care
- Prevents practitioner overuse injury
- Client safety
- Bolster, secure table, check
MBLEx Test Day Rules
- Arrival
- 30 minutes before appointment
- Identification
- Two IDs; names must match
- Question order
- One at a time, forward
- Unfinished exam
- All 100 or fail
- Breaks
- None scheduled; clock keeps running
- Prohibited items
- No phone, notes, or watch
- Note board
- No writing before exam
- Result display
- Pass message or diagnostic report
- Reschedule fee
- $50 within 60 days
- ATT window
- 120 days to test
Common Traps
Pass/Fail vs scaled score
FSMTB reports pass or fail ≠ No 630 scaled score published
Appointment vs testing time
Appointment is 120 minutes ≠ Scored exam is 110
Retake wait vs immediate
FSMTB sets no waiting period ≠ Reapply and pay again
Adaptive vs skippable
One question at a time ≠ No skipping, no review
Absolute vs local contraindication
Absolute stops the session ≠ Local avoids one area
Origin vs insertion
Origin is the fixed end ≠ Insertion moves toward origin
Heat vs cold timing
Cold for acute inflammation ≠ Heat for chronic tension
Scope vs ethics
Diagnosing breaks state law ≠ Dual roles break the code
Sanitize vs sterilize
Sanitize lowers microbe counts ≠ Sterilize destroys all microorganisms
Last Minute
- 1.100 questions in 110 minutes
- 2.Appointment block is 120 minutes
- 3.Fixed-length CAT; no skipping
- 4.Unanswered items = automatic fail
- 5.Result is Pass/Fail only
- 6.Fee is $265 per attempt
- 7.Retake: reapply immediately, no wait
- 8.Assessment 17% is largest domain
- 9.Anatomy 11% is smallest domain
- 10.Absolute = no massage; local = site
- 11.Origin fixed; insertion moves
- 12.Cold acute; heat chronic
- 13.Effleurage glides; petrissage kneads
- 14.Transference client; countertransference therapist
- 15.Diagnosing is outside massage scope
- 16.Kidneys sit near 12th rib
- 17.Bring two IDs, arrive early
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