22 Pathology & Contraindications Practice Questions & Answers

1. 1. A client arrives with a small scabbed abrasion on the left shin. She has no fever and feels well otherwise. What is the appropriate response?

   • A.Massage the rest of the body and leave the abrasion and the skin around it untouched✓ Answer
   • B.Postpone all massage until a physician examines and clears the healing abrasion
   • C.Work directly over the abrasion with light gliding strokes and extra lubricant
   • D.Cancel the session, since any break in the skin rules out massage for that day

   An open or healing skin lesion is a local (site) contraindication: the protective barrier is broken at that one spot, so the risk stays at that spot. The rest of the body is worked normally while hands, linens and lubricant stay off the lesion.

   Source: FSMTB MBLEx Content Outline, site-specific contraindications; Werner, A Massage Therapist's Guide to Pathology, open woundsReport a problem with this question

2. 2. A client reports that over the past two days her left calf has become swollen, warm, red and tender, while the right calf looks normal. What should the therapist do?

   • A.Dorsiflex her foot to see whether the calf pain increases, then decide
   • B.Apply gentle effleurage toward the heart to help the trapped swelling drain
   • C.Leave that limb alone and refer her for medical evaluation the same day✓ Answer
   • D.Apply cold packs to the calf and continue with the rest of the session

   Swelling, warmth, redness and pain in one calf only suggests deep vein thrombosis. Pressure on that limb can dislodge the clot into the pulmonary circulation, so no work is done on the leg and the client is referred promptly. Provocative manoeuvres such as Homan's sign are unreliable and outside a therapist's scope.

   Source: FSMTB MBLEx Content Outline, pathology-related contraindications; standard massage pathology texts on deep vein thrombosisReport a problem with this question

3. 3. The popliteal fossa is listed as an area of caution. Which structures lying in it make sustained deep pressure there risky?

   • A.The femoral artery and vein together with the great saphenous vein and lymph nodes
   • B.The popliteal artery and vein together with the tibial and common fibular nerves✓ Answer
   • C.The anterior tibial artery and deep fibular nerve as they cross the ankle retinaculum
   • D.The sciatic nerve and inferior gluteal vessels as they pass beneath the piriformis

   The popliteal fossa is a shallow hollow with almost no muscular padding, so the popliteal vessels and the tibial and common fibular nerves lie close to the surface. Focused pressure compresses them directly, which is why broad, light contact is used behind the knee.

   Source: FSMTB MBLEx Content Outline, areas of caution and endangerment sites; standard massage anatomy texts on the popliteal fossaReport a problem with this question

4. 4. Why is sustained deep pressure in the anterior triangle of the neck considered dangerous?

   • A.The thoracic duct empties there and pressure backs lymph up into the arm and trunk
   • B.The carotid artery and its baroreceptors sit there, and pressure can drop blood pressure✓ Answer
   • C.The vertebral artery runs through the transverse foramina there and supplies the face
   • D.The brachial plexus roots cross there and pressure numbs the entire shoulder girdle

   The carotid artery, the carotid sinus baroreceptors and the jugular vein lie superficially in the anterior triangle with little protective cover. Pressure on the sinus is read as a rise in blood pressure, and the reflex answer slows the heart and lowers pressure, producing dizziness or fainting.

   Source: FSMTB MBLEx Content Outline, areas of caution; standard massage anatomy texts on the anterior cervical triangleReport a problem with this question

5. 5. A therapist plans to finish a session with heavy tapotement over the posterior lower thoracic region. Why is that area avoided for percussion?

   • A.The descending aorta lies there under the erectors and can rupture under blows
   • B.The kidneys lie there behind the lowest ribs and take the impact almost directly✓ Answer
   • C.The lowest ribs join the sternum there and crack under this kind of impact
   • D.The spleen lies there on both sides and tears easily when it is struck repeatedly

   The kidneys sit against the posterior wall at about the level of the lowest ribs, which are floating and give the organ very little shielding. Percussion transmits force straight into kidney tissue, so tapotement and percussive tools are kept off this region.

   Source: FSMTB MBLEx Content Outline, areas of caution and contraindications arising from tools; standard massage texts on the kidney regionReport a problem with this question

6. 6. During a session the therapist feels a firm, painless lump in the client's upper arm that the client has never mentioned to a physician. What should the therapist do?

   • A.End the session, since an undiagnosed growth rules out massage anywhere on the body
   • B.Tell the client it is most likely a harmless fatty deposit and work lightly over it
   • C.Avoid the lump and the tissue around it, and advise the client to have it examined✓ Answer
   • D.Apply cross-fiber friction to the lump to soften the fibrous tissue inside it

   An undiagnosed mass is a site contraindication: nobody knows what it is, so pressure on it could do harm, while the rest of the body is unaffected. Naming the lump would be diagnosing, which is outside the therapist's scope; describing the finding and referring is not.

   Source: FSMTB MBLEx Content Outline, site-specific contraindications and referral; standard massage pathology texts on undiagnosed massesReport a problem with this question

7. 7. A therapist notices a red, scaly, ring-shaped patch on a client's forearm that looks like a fungal infection. What may the therapist appropriately say?

   • A.Recommend an antifungal powder and rebook the client for the following week
   • B.Name the fungal infection so the client can buy the correct cream today
   • C.Describe what she sees on the skin and ask the client to have it looked at✓ Answer
   • D.Say nothing about the patch and quietly work the other areas of the body

   Therapists recognize and refer, but they do not diagnose. Reporting an observation is within scope, while naming a condition or recommending a medication is not. Saying nothing also fails the client, because the finding bears on her health and on whether the session is safe for both of them.

   Source: FSMTB MBLEx Content Outline, pathology recognition and referral; scope of practice in standard massage textsReport a problem with this question

8. 8. A client condition that does not stop the session but requires the therapist to change pressure, position or duration is best described as which of the following?

   • A.An absolute contraindication, often called a total one
   • B.A local contraindication, often called a regional one
   • C.An endangerment site, often called an area of caution
   • D.A relative contraindication, often called a precaution✓ Answer

   A relative contraindication is a client condition that makes massage safe only with modification or medical clearance. Absolute means no massage at all right now, local means one site is avoided, and an endangerment site is an anatomical region handled carefully on every client rather than a condition of one client.

   Source: FSMTB MBLEx Content Outline, types of contraindications; standard massage texts on absolute, relative and local contraindicationsReport a problem with this question

9. 9. A client arrives with several oozing sores covered by honey-colored crusts around the mouth and nose. Why does this cancel the whole session rather than just the face?

   • A.The sores shed bacteria that transfer by contact to hands, linens and the table✓ Answer
   • B.Lesions this close to the face fall inside an endangerment site and cannot be worked
   • C.The infection has entered the bloodstream and now circulates through every tissue
   • D.Skin over the entire body becomes too fragile to tolerate lubricant and pressure

   Contagious skin conditions become general contraindications because of transmission risk, not because the rest of the body cannot tolerate touch. Hands, linens and equipment carry the organism to the therapist and to later clients, so the session is rescheduled until the lesions are treated and no longer infectious.

   Source: FSMTB MBLEx Content Outline, contraindications and infection control; standard massage pathology texts on contagious skin conditionsReport a problem with this question

10. 10. A client arrives with body aches, chills and a temperature of 101°F. What is the reason the session is rescheduled?

    • A.Massage strokes move the infection out of the blood and into the lymph nodes
    • B.A raised temperature stiffens muscle tissue so that techniques cannot reach it
    • C.The body is fighting a systemic infection and the session adds circulatory demand✓ Answer
    • D.The sheets trap tissue heat during the session and drive the temperature higher

    Fever signals an active systemic infection, which is a general contraindication. Massage raises circulatory and metabolic demand at the moment the body's resources are committed to the immune response, and a contagious illness also puts the therapist and later clients at risk.

    Source: FSMTB MBLEx Content Outline, pathology-related contraindications; standard massage pathology texts on fever and acute infectionReport a problem with this question

11. 11. A client has ropy, distended surface veins along the back of the lower leg. How should the therapist work that area?

    • A.Keep contact light and superficial nearby, with no deep stripping over the veins✓ Answer
    • B.Use deep stripping from the ankle to the knee along the veins to move the blood
    • C.Avoid the entire leg, since distended veins put the whole limb out of bounds
    • D.Hold firm static compression over the veins so the failing valves close again

    In varicose veins the valves no longer close and the vessel wall is stretched and weakened, so deep or stripping pressure over them can damage the vessel. The veins themselves are treated as a site to avoid, while the surrounding leg tolerates light superficial work.

    Source: FSMTB MBLEx Content Outline, site-specific contraindications; standard massage pathology texts on varicose veinsReport a problem with this question

12. 12. A client in her third trimester asks to lie face up for most of the session. What is the physiological reason for limiting time in that position?

    • A.The uterus compresses the abdominal aorta and blood is forced into the placenta
    • B.The diaphragm is pushed upward so far that the lungs can no longer expand at all
    • C.The lumbar curve deepens in that position and the discs are compressed further
    • D.The uterus compresses the inferior vena cava and return of blood to the heart falls✓ Answer

    Late in pregnancy the weight of the uterus can press the inferior vena cava against the spine while the client is supine, cutting venous return and cardiac output. That is supine hypotensive syndrome, which is why side-lying or semi-reclined positioning is the default.

    Source: FSMTB MBLEx Content Outline, special populations and pregnancy; standard massage texts on supine hypotensive syndromeReport a problem with this question

13. 13. A client is halfway through a course of chemotherapy and asks for massage. Which statement reflects current practice?

    • A.Massage is allowed only after five years of remission documented by a physician
    • B.Massage may proceed at any depth, since the side effects of treatment respond to it
    • C.Massage is declined because added circulation carries cancer cells to new sites
    • D.Massage may proceed with modified pressure and positioning once the care team agrees✓ Answer

    Cancer is a relative contraindication rather than a blanket ban. Oncology massage with reduced pressure, careful positioning and avoidance of tumor sites, radiation fields, ports and areas of bone metastasis is appropriate when the medical team concurs; the claim that massage spreads cancer has been discredited.

    Source: FSMTB MBLEx Content Outline, pathology-related contraindications and special populations; oncology massage guidance in standard massage pathology textsReport a problem with this question

14. 14. A client with long-standing diabetes says his feet feel numb much of the time. What does that mean for the session?

    • A.Reduce depth on the feet and inspect the skin, because pain feedback is unreliable✓ Answer
    • B.Work the feet before meals, because insulin is absorbed faster from numb tissue
    • C.Increase depth on the feet, because numb tissue needs stronger input to respond
    • D.Omit the feet entirely, because neuropathy is an absolute contraindication to touch

    Peripheral neuropathy removes the warning system: the client cannot reliably report pressure that is damaging tissue, and unnoticed skin breakdown heals poorly in diabetes. The answer is lighter, visually monitored work on the feet, not abandoning them altogether.

    Source: FSMTB MBLEx Content Outline, pathology-related contraindications; standard massage pathology texts on diabetic peripheral neuropathyReport a problem with this question

15. 15. A client takes a prescribed anticoagulant. Why does the therapist lighten pressure for this client?

    • A.The drug thins the skin itself, so ordinary friction tears the surface layers
    • B.Blood moves faster on the drug, so firm pressure can dislodge existing clots
    • C.Clotting is slowed, so minor vessel injury bleeds into the tissue as large bruises✓ Answer
    • D.The drug lowers blood pressure, so deep work will make the client feel faint

    Anticoagulants lengthen the time blood takes to clot, so the tiny vessel damage that ordinary pressure causes keeps bleeding and produces extensive bruising or hematoma. Pressure is reduced accordingly, and the medication itself is never adjusted or discussed as treatment.

    Source: FSMTB MBLEx Content Outline, classes of medications; standard massage texts on anticoagulant therapy and pressureReport a problem with this question

16. 16. A client mentions he took a prescribed muscle relaxant an hour before arriving. How should the therapist adjust?

    • A.Moderate the depth and skip aggressive stretching, since pain feedback is dulled✓ Answer
    • B.Deepen the work and stretch further, since the muscle can finally let go
    • C.Cancel the session, since any prescription medication contraindicates massage
    • D.Keep pressure normal and tell him to skip the dose before the next appointment

    Muscle relaxants, analgesics and sedatives blunt the client's ability to feel and report pain, and that feedback is the therapist's main guide to safe depth and range. Work stays conservative. Telling a client to change how he takes a prescription is outside the therapist's scope.

    Source: FSMTB MBLEx Content Outline, classes of medications and scope of practice; standard massage texts on muscle relaxants and analgesicsReport a problem with this question

17. 17. A client takes a beta blocker and a diuretic for blood pressure. Which end-of-session precaution matters most?

    • A.Place cold towels on his face so that his blood pressure rebounds quickly
    • B.Have the client sit and stand quickly so any drop in pressure stays brief
    • C.Finish with brisk tapotement so that his heart rate climbs before he stands
    • D.Bring the client upright in stages and stay beside the table as he stands✓ Answer

    These drug classes blunt the cardiovascular reflexes that normally hold blood pressure steady on standing, and the relaxed state after massage adds to that effect. Orthostatic hypotension makes dizziness and falls the real risk, so transitions are slow and supervised.

    Source: FSMTB MBLEx Content Outline, classes of medications; standard massage texts on antihypertensives and orthostatic hypotensionReport a problem with this question

18. 18. A client asks for deep pressure high on the inner thigh where it meets the trunk. Which structures make that request unsafe?

    • A.The obturator nerve and the popliteal vessels behind the knee joint capsule
    • B.The femoral artery, vein and nerve along with the inguinal lymph nodes✓ Answer
    • C.The lumbar plexus roots and the psoas attachments on the iliac crest
    • D.The sciatic nerve and inferior gluteal artery deep to the piriformis muscle

    The femoral triangle carries the femoral artery, vein and nerve plus a cluster of lymph nodes close to the surface with very little muscular cover. A pulse that can be felt is the signal to use broad, light contact instead of sustained specific pressure.

    Source: FSMTB MBLEx Content Outline, areas of caution and endangerment sites; standard massage anatomy texts on the femoral triangleReport a problem with this question

19. 19. While working just below the outer side of a client's knee, the client reports a sharp electric sensation shooting down the outer leg. What is the correct immediate response?

    • A.Hold the point longer so the nerve adapts and the sensation settles down
    • B.Release the pressure at once, move off that spot and change the approach✓ Answer
    • C.Keep the depth and have the client breathe until the sensation fades away
    • D.Increase the depth briefly to free the fascia that is binding that nerve

    Sharp, electric, shooting or burning sensations, numbness and tingling signal nerve compression and are never a normal response to pressure. At the neck of the fibula the common fibular nerve lies against bone with almost no padding, so the pressure comes off immediately.

    Source: FSMTB MBLEx Content Outline, areas of caution and endangerment sites; standard massage anatomy texts on the common fibular nerve at the fibular headReport a problem with this question

20. 20. A client sprained her ankle yesterday; it is swollen, warm and painful, and she wants her usual full-body session. What is the best plan?

    • A.Apply heat to the ankle first so the tissue softens before it is worked
    • B.Cancel the session, since acute inflammation rules out massage of any kind
    • C.Use deep friction on the ankle to break up scar tissue while it is forming
    • D.Work the rest of the body and leave the inflamed, swollen ankle alone✓ Answer

    Acute inflammation is a local contraindication, not a systemic one. Pressure and heat at the injury add to swelling and tissue damage during the inflammatory stage, while the rest of the body benefits as usual; the site itself is addressed once it reaches the subacute stage.

    Source: FSMTB MBLEx Content Outline, acute versus chronic stages and site-specific contraindications; standard massage pathology texts on acute injuryReport a problem with this question

21. 21. A client with peripheral neuropathy from diabetes asks for hot stone work on the legs and feet. What is the safety concern?

    • A.He cannot feel that a stone is too hot, so a burn happens before he reacts✓ Answer
    • B.Heat raises the metabolic rate, so his blood sugar drops during the session
    • C.The stones weigh enough to press on the veins, so clots form in the lower leg
    • D.Heat dissolves the lubricant on the skin, so the stones drag and tear it

    Every heat application depends on the client being able to feel and report temperature. Impaired thermal sensation removes that safeguard, and diabetic tissue with reduced circulation heals a burn slowly, so heated tools are kept off the affected areas.

    Source: FSMTB MBLEx Content Outline, contraindications arising from tools and special applications; standard massage texts on hydrotherapy and impaired sensationReport a problem with this question

22. 22. A client has advanced osteoporosis. Which adjustment addresses the mechanism of that condition?

    • A.Use traction on the neck and low back to decompress the thinning vertebrae
    • B.Use moderate pressure and skip joint mobilization and end-range stretching✓ Answer
    • C.Use deep pressure on the spine, since loading bone builds its density back
    • D.Use vigorous tapotement on the ribs, since impact stimulates bone formation

    Osteoporosis lowers bone mineral density, so bone fractures under loads that healthy bone tolerates, especially in the ribs and vertebrae. Heavy pressure, percussion, forced stretching and joint mobilization all impose exactly those loads, so gentler work replaces them.

    Source: FSMTB MBLEx Content Outline, pathology-related contraindications and special populations; standard massage pathology texts on osteoporosisReport a problem with this question

Practice questions based on the FSMTB MBLEx content outline and standard massage therapy curriculum. MBLEx is a mark of the Federation of State Massage Therapy Boards; this site is not affiliated with or endorsed by FSMTB. Licensing requirements — education hours, license title, continuing education, and fees — are set by each state board, so confirm your own state's rules before you apply. Nothing here is medical advice. About the MBLEx →