22 Pathology & Contraindications Practice Questions & Answers

1. 1. During intake, a client mentions that for the past two days one calf has been swollen, warm, red, and painful to touch, while the other leg looks normal. What is the appropriate action?

   • A.Withhold massage and refer the client for prompt medical evaluation✓ Answer
   • B.Massage the leg but avoid deep pressure directly over the painful area
   • C.Apply a cold pack to the calf and continue with the rest of the session
   • D.Apply light effleurage to the calf to encourage venous return

   Unilateral swelling, warmth, redness and pain in one calf are classic signs of a possible deep vein thrombosis. Even light mechanical pressure can dislodge a clot that then travels to the lungs and causes a pulmonary embolism, so massage is withheld; the therapist does not diagnose but recognizes the red flag and refers.

   Source: FSMTB MBLEx Content Outline — Pathology, Contraindications, Areas of Caution and Special Populations: pathology-related contraindications (deep vein thrombosis / thromboembolism)Report a problem with this question

2. 2. A client arrives with a round, scaly, itchy patch with a raised red border on the forearm, consistent with a fungal skin infection. What is the primary reason massage is contraindicated?

   • A.Fungal skin patches are an early sign of malignancy and require immediate biopsy
   • B.The organism can be transmitted to the therapist, to other clients, and onto linens through direct contact✓ Answer
   • C.Increased circulation would push the fungus into the bloodstream and cause a systemic infection
   • D.Massage lubricants react chemically with fungal organisms and worsen the rash

   Contagious skin conditions are contraindicated first and foremost to interrupt transmission: they spread by direct skin contact and by contaminated linens and hands, putting the therapist and later clients at risk. Standard precautions and hand hygiene reduce but do not eliminate that risk during hands-on work, so the client is referred for treatment and rescheduled.

   Source: FSMTB MBLEx Content Outline — Contraindications: pathology-related contraindications (contagious integumentary conditions) and standard precautions for disease transmissionReport a problem with this question

3. 3. A generally healthy client has prominent, ropy varicose veins on the posterior lower leg. What is the appropriate approach?

   • A.Apply vigorous tapotement over the veins to stimulate the vessel walls
   • B.Cancel the session, because varicose veins are a total contraindication to massage
   • C.Work the rest of the body normally and avoid pressure or stripping strokes over the veins✓ Answer
   • D.Use deep distal-to-proximal stripping directly over the veins to help drain them

   Varicose veins are a local (regional) contraindication, not a systemic one: the vessel walls and valves are already weakened, so direct pressure or stripping can damage the vein or disturb a clot that has formed in it. The correct reasoning is avoid the site and treat the rest of the body, rather than refusing the whole session.

   Source: FSMTB MBLEx Content Outline — Contraindications: site-specific contraindications (varicosities); local versus absolute contraindication reasoningReport a problem with this question

4. 4. A client arrives with chills, body aches, and a temperature of about 101°F (38.3°C). What is the correct response?

   • A.Reschedule the session until the fever and the underlying illness have resolved✓ Answer
   • B.Perform a short, light session to help the client relax
   • C.Massage only the extremities and avoid the trunk
   • D.Apply hot packs to help break the fever, then perform a full session

   Fever signals an acute systemic infection, which is an absolute (whole-body) contraindication: massage increases circulation and metabolic demand on a body already working hard to fight the infection, and the illness may be communicable to the therapist and other clients. No amount of local modification makes the session appropriate.

   Source: FSMTB MBLEx Content Outline — Contraindications: absolute/systemic contraindications (fever and acute systemic infection)Report a problem with this question

5. 5. A client currently in treatment for breast cancer asks whether massage is allowed. Which statement reflects current standards of practice?

   • A.Massage may proceed with lighter pressure while avoiding tumor sites, radiation fields, ports, and lymph node dissection areas✓ Answer
   • B.Massage is permitted only after the client has been cancer-free for five years
   • C.Deep tissue work is encouraged so the body can eliminate cancer cells faster
   • D.Massage is absolutely contraindicated for anyone with a cancer diagnosis

   Cancer is no longer treated as a blanket contraindication; the concern is mechanical and tissue-specific rather than a belief that massage spreads disease. Pressure and sites are modified because of fragile irradiated skin, possible bone metastases and fracture risk, low platelet counts, indwelling devices, and lymphedema risk, with communication with the health care team.

   Source: FSMTB MBLEx Content Outline — Contraindications and Special Populations: oncology clients (pressure- and site-modified massage)Report a problem with this question

6. 6. While working the upper back, the therapist palpates a firm lump the client says she was not aware of. What should the therapist do?

   • A.Avoid the area, complete the rest of the session as tolerated, and advise the client to have it evaluated by a physician✓ Answer
   • B.Reassure the client that it is most likely a harmless fatty lump
   • C.Apply sustained deep pressure to break down what is probably fibrous scar tissue
   • D.Stop providing massage permanently until the client supplies a written diagnosis

   An undiagnosed mass is a site-specific contraindication because its nature is unknown and pressure could damage tissue or an underlying structure. Massage therapists are not licensed to diagnose or to name a probable condition to a client, so the tested behavior is avoid the site, continue elsewhere, and refer.

   Source: FSMTB MBLEx Content Outline — Contraindications: site-specific contraindications (undiagnosed lumps or masses); recognize-and-refer, scope of practice excludes diagnosisReport a problem with this question

7. 7. The popliteal fossa is treated as an area of caution because it contains which structures?

   • A.The brachial artery and the median nerve
   • B.The vertebral artery and the greater occipital nerve
   • C.The popliteal artery and vein and the tibial and common fibular nerves✓ Answer
   • D.The femoral artery, femoral vein, and femoral nerve

   Behind the knee the neurovascular bundle lies superficially with very little muscular or bony protection, so sustained or deep pressure can compress the popliteal vessels and the tibial and common fibular nerves. The general rule for areas of caution applies: if a pulse can be palpated, do not apply focused pressure there.

   Source: FSMTB MBLEx Content Outline — Areas of Caution: endangerment sites (popliteal fossa)Report a problem with this question

8. 8. Deep or sustained pressure in the anterior triangle of the neck is avoided mainly because of which underlying structures?

   • A.The common carotid artery, the internal jugular vein, and the vagus nerve✓ Answer
   • B.The axillary artery and the axillary lymph nodes
   • C.The abdominal aorta and the inferior vena cava
   • D.The brachial plexus and the subclavian artery

   The anterior cervical triangle carries the common carotid artery, internal jugular vein and vagus nerve close to the surface. Pressure over the carotid sinus can stimulate baroreceptors and trigger a reflex drop in heart rate and blood pressure, so only light, broad, non-occlusive contact is used in this region.

   Source: FSMTB MBLEx Content Outline — Areas of Caution: endangerment sites (anterior triangle of the neck, carotid sinus)Report a problem with this question

9. 9. Which endangerment site contains the femoral artery, femoral vein, femoral nerve, and inguinal lymph nodes?

   • A.The popliteal fossa
   • B.The cubital fossa
   • C.The suboccipital region
   • D.The femoral (inguinal) triangle✓ Answer

   The femoral triangle, bounded by the inguinal ligament, sartorius and adductor longus, allows the femoral vessels and nerve and the inguinal nodes to lie superficially. Focused pressure there risks vascular and nerve compression, and the location also demands careful draping and consent.

   Source: FSMTB MBLEx Content Outline — Areas of Caution: endangerment sites (femoral/inguinal triangle)Report a problem with this question

10. 10. Why is heavy tapotement avoided over the region just below the twelfth rib on either side of the spine?

    • A.The kidneys lie beneath that area with little bony protection, and percussion can bruise them✓ Answer
    • B.The spinal cord ends at that level and could be jarred by percussion
    • C.That area holds the largest concentration of lymph nodes in the body
    • D.The liver and spleen lie directly beneath the skin at that level

    The kidneys sit high in the posterior abdominal wall and are only partly shielded by the eleventh and twelfth ribs, which are floating ribs with no anterior attachment. Percussive force transmits directly into the organ, so this region is worked with broad, gentle pressure rather than tapotement.

    Source: FSMTB MBLEx Content Outline — Areas of Caution: endangerment sites (kidney region, floating ribs 11 and 12)Report a problem with this question

11. 11. A client sprained an ankle 24 hours ago; the joint is red, hot, swollen, painful, and difficult to move. Which approach is appropriate at this stage?

    • A.Vigorous heat application followed by passive forced stretching
    • B.Avoid the injured site, work proximally and elsewhere, and refer if the injury has not been evaluated✓ Answer
    • C.Sustained deep compression over the joint to disperse the swelling
    • D.Deep cross-fiber friction directly over the injured ligament

    Redness, heat, swelling, pain and loss of function are the five cardinal signs of acute inflammation, which lasts roughly the first 72 hours. Deep friction, heat and forced stretching during this stage increase bleeding and edema and prolong healing, so local work waits until the subacute and remodeling stages.

    Source: FSMTB MBLEx Content Outline — Overview of Pathologies: cardinal signs of inflammation and acute versus subacute versus chronic tissue-healing stagesReport a problem with this question

12. 12. Which finding most suggests rheumatoid arthritis rather than osteoarthritis?

    • A.Pain in one hip that worsens with weight bearing after years of heavy labor
    • B.Symmetrical involvement of the same joints on both sides, with fatigue and low-grade fever during flares✓ Answer
    • C.Bony enlargement of the finger joints in an older client with no systemic symptoms
    • D.Stiffness limited to a single knee that was injured years earlier

    Rheumatoid arthritis is a systemic autoimmune disease that typically affects joints symmetrically and produces whole-body signs such as fatigue and low-grade fever during flares; osteoarthritis is localized wear-and-tear damage that is usually asymmetrical. The distinction matters because massage is contraindicated over joints during an acute rheumatoid flare and is kept gentle between flares.

    Source: FSMTB MBLEx Content Outline — Overview of Pathologies: musculoskeletal and autoimmune conditions (rheumatoid arthritis versus osteoarthritis)Report a problem with this question

13. 13. A client in her third trimester of pregnancy becomes dizzy, nauseated, and short of breath after several minutes lying supine. What is the most likely explanation and the correct response?

    • A.The uterus is compressing the inferior vena cava and reducing venous return; reposition her side-lying✓ Answer
    • B.Low blood sugar; give her juice and keep her supine
    • C.A normal relaxation response; reassure her and continue
    • D.An allergic reaction to the lubricant; wipe it off and continue supine

    These are the signs of supine hypotensive syndrome, which can appear from roughly the midpoint of pregnancy onward when the weight of the uterus compresses the inferior vena cava against the spine and cardiac output falls. Turning the client onto her side, or elevating her into a semi-reclined position, relieves the compression immediately.

    Source: FSMTB MBLEx Content Outline — Special Populations: prenatal positioning (supine hypotensive syndrome, side-lying with bolstering)Report a problem with this question

14. 14. A pregnant client reports new swelling in her hands and face, headaches, and visual disturbances. What should the therapist do?

    • A.Position her prone on a pregnancy cushion and work the low back
    • B.Withhold massage and advise her to contact her prenatal care provider promptly✓ Answer
    • C.Perform lymphatic-style strokes on the hands and face to reduce the swelling
    • D.Apply a hot pack to the neck for the headache and then continue the session

    Sudden swelling of the hands and face together with headache and visual changes are recognized warning signs of a hypertensive disorder of pregnancy such as preeclampsia, which can deteriorate quickly. Massage does nothing to address the underlying cause and delays care, so the therapist recognizes the red flag, withholds the session, and refers without naming a diagnosis.

    Source: FSMTB MBLEx Content Outline — Contraindications and Special Populations: high-risk pregnancy requiring medical referralReport a problem with this question

15. 15. Which set of modifications is most appropriate for a frail 84-year-old client with thin skin and diagnosed osteoporosis?

    • A.A full-length session of deep tissue work and joint mobilization to help maintain bone density
    • B.A shorter session with lighter pressure, careful bolstering, and assistance rising slowly from the table✓ Answer
    • C.Vigorous tapotement along the thoracic spine to stimulate circulation
    • D.Declining the session, because advanced age is itself a contraindication to massage

    Age by itself is never a contraindication; the specific risks are what drive the modifications. Osteoporosis makes bone vulnerable to fracture from heavy pressure, percussion and joint mobilization, thin skin bruises and tears easily, and slowed vascular reflexes make the client prone to dizziness when standing up.

    Source: FSMTB MBLEx Content Outline — Special Populations: geriatric clients (osteoporosis, fragile skin, orthostatic hypotension)Report a problem with this question

16. 16. A client had axillary lymph nodes removed during cancer surgery two years ago. What precaution applies to the arm on that side?

    • A.Hot stones should be applied to the arm to speed lymph flow
    • B.Avoid heavy pressure and heat on that limb indefinitely, and refer for specialized care if swelling appears✓ Answer
    • C.Deep, brisk strokes should be used to force lymph out of the arm
    • D.No precaution is needed once the surgical site has fully healed

    Removing lymph nodes permanently reduces the drainage capacity of that limb, so the risk of lymphedema is lifelong rather than temporary. Heavy pressure, heat and constriction increase fluid load and inflammation in a system that can no longer clear it, and established swelling belongs with a certified lymphedema therapist.

    Source: FSMTB MBLEx Content Outline — Contraindications and Special Populations: lymph node dissection and lymphedema riskReport a problem with this question

17. 17. A client takes a prescribed blood-thinning medication. Which session modification is most appropriate?

    • A.Use lighter pressure and avoid deep friction and percussion because of bruising and bleeding risk✓ Answer
    • B.Use deeper pressure, since thinner blood protects the tissues from bruising
    • C.Make no changes, as long as the client reports no pain during the session
    • D.Suggest the client skip the medication on the day of the massage

    Anticoagulant and antiplatelet medications prolong clotting time, so the small capillary damage that deep friction or percussion normally causes can turn into visible bruising or a hematoma. The therapist modifies pressure and documents it, and never advises a client to change, skip or stop a prescribed medication, which is outside the scope of practice.

    Source: FSMTB MBLEx Content Outline — Classes of Medications: anticoagulants and antiplatelet agents (bruising and bleeding risk)Report a problem with this question

18. 18. Why should a therapist use conservative pressure when a client has taken a strong pain reliever before the session?

    • A.Pain feedback is blunted, so the client may not notice pressure that is damaging tissue✓ Answer
    • B.Pain medication makes muscle tissue physically harder to affect
    • C.The medication heightens sensitivity, so any pressure feels twice as strong
    • D.Pain medication prolongs bleeding time in the same way anticoagulants do

    Pain is the protective feedback loop that tells the therapist when pressure has crossed from therapeutic to injurious. Analgesics and opioids dull that signal, so the client may tolerate pressure that bruises or strains tissue; opioids also cause drowsiness, so extra care is needed when the client gets off the table.

    Source: FSMTB MBLEx Content Outline — Classes of Medications: analgesics and opioids (masked pain feedback)Report a problem with this question

19. 19. A client takes medication for high blood pressure along with a diuretic. Which end-of-session precaution is most relevant?

    • A.Assist the client in sitting up and standing slowly, because these medications increase the risk of dizziness from orthostatic hypotension✓ Answer
    • B.Advise the client to stop the diuretic so massage does not dehydrate them
    • C.Have the client sit up quickly to bring blood pressure back up
    • D.Apply a hot pack before standing to raise the client's blood pressure

    Antihypertensives blunt the heart-rate and vasoconstriction response that normally compensates when a person stands, and diuretics reduce circulating fluid volume; massage itself shifts the client toward a parasympathetic, vasodilated state. Together these make fainting on standing a real risk, so transitions are slow and assisted, and medication advice is left to the prescriber.

    Source: FSMTB MBLEx Content Outline — Classes of Medications: antihypertensives and diuretics (orthostatic hypotension, fluid and electrolyte loss)Report a problem with this question

20. 20. A client with diabetes reports reduced sensation in both feet. Which application is contraindicated?

    • A.Working the calves with moderate pressure that the client can clearly feel
    • B.Checking in with the client about pressure throughout the session
    • C.Light effleurage to the feet with visual inspection of the skin
    • D.Hot stones or a heated pack applied to the feet✓ Answer

    Thermal tools and applications require intact protective sensation, because the client's report of discomfort is the only safeguard against a burn. Diabetic peripheral neuropathy removes that feedback, and the accompanying circulatory changes both reduce heat dissipation and slow wound healing, so heat is withheld from the affected area.

    Source: FSMTB MBLEx Content Outline — Contraindications: tools and special applications (thermal modalities with impaired sensation); diabetic peripheral neuropathyReport a problem with this question

21. 21. Which situation is a contraindication to applying a hot pack?

    • A.Long-standing morning stiffness that eases with gentle movement
    • B.A client warming up before stretching a strain that healed long ago
    • C.Chronic tightness in the upper back with no signs of inflammation
    • D.An acutely inflamed, swollen joint that was injured earlier the same day✓ Answer

    Heat produces vasodilation and increased capillary permeability, which adds fluid and bleeding to a site that is already inflamed and swollen, worsening pain and prolonging the inflammatory stage. Cold, which causes vasoconstriction and provides analgesia, is the appropriate thermal choice in the acute window; heat belongs with subacute and chronic presentations.

    Source: FSMTB MBLEx Content Outline — Contraindications: special applications (hydrotherapy and thermal contraindications in acute inflammation)Report a problem with this question

22. 22. An athlete requests massage 20 minutes before competing. Which approach is appropriate?

    • A.Slow, deep, specific work to release long-standing adhesions
    • B.Sustained forced stretching to the end of range for maximum flexibility
    • C.A long, sedating full-body session to calm competition nerves
    • D.A short, brisk, stimulating session over the muscles about to be used, with no deep or painful work✓ Answer

    Pre-event work aims to warm the tissue and raise readiness without creating micro-trauma, soreness, or a drop in muscle tone that would impair performance. Deep specific work and aggressive end-range stretching immediately before activity increase injury risk, so corrective techniques are reserved for maintenance sessions well away from competition.

    Source: FSMTB MBLEx Content Outline — Special Populations: athletes (pre-event versus post-event and maintenance session modifications)Report 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 →