22 Technique & Client Assessment Practice Questions & Answers

1. 1. A new client reports right shoulder pain that began gradually over several weeks, with no known trauma. After completing the intake interview and visual observation, which assessment should the therapist perform FIRST?

   • A.Resisted range of motion, with the therapist applying firm counterpressure
   • B.Deep cross-fiber friction over the rotator cuff tendons to locate the lesion
   • C.Active range of motion, with the client moving the shoulder unassisted✓ Answer
   • D.Passive range of motion, with the therapist taking the joint to its end range

   Active range of motion is always assessed first because the client controls the movement and will stop at their own pain or apprehension, which makes it the safest starting point. It also tells the therapist how much motion the client is willing and able to produce before the therapist moves the joint passively or loads it against resistance.

   Source: FSMTB MBLEx Content Outline — Client Assessment, Reassessment and Treatment Planning domain: range of motion assessment sequence (active before passive and resisted)Report a problem with this question

2. 2. During assessment, a client's elbow flexion is painful during active movement and painful again during resisted isometric contraction, but is pain-free when the therapist moves the relaxed arm through the same range. What does this pattern most strongly implicate?

   • A.The joint capsule or ligament, which are inert structures
   • B.Compression of a cervical nerve root
   • C.A bursa lying deep to the joint
   • D.Muscle or tendon, which are contractile structures✓ Answer

   Resisted isometric testing loads the contractile unit (muscle, tendon and its attachment) without moving the joint, while passive movement stresses the inert structures. Pain on active and resisted testing but not on passive testing therefore points to contractile tissue rather than to the capsule, ligaments or bursa.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: interpretation of active, passive and resisted range of motion (contractile vs. inert tissue)Report a problem with this question

3. 3. While taking a client's knee through passive range of motion, the therapist feels no tissue resistance at all, but the client abruptly stops the movement because of intense pain. How should the therapist interpret and respond to this finding?

   • A.It is a normal soft end feel from tissue approximation; the knee is healthy
   • B.It is an empty end feel; stop the test, do not force the range, and refer the client for medical evaluation✓ Answer
   • C.It is a normal firm end feel produced by capsular stretch; continue with deeper work
   • D.It is a normal hard end feel from bone contacting bone; proceed with the planned session

   An empty end feel means the client halts the motion because of pain before the therapist perceives any anatomical barrier, so nothing in the joint is limiting the range. Because pain without a physical restriction can signal serious underlying pathology, the correct action is to stop, avoid forcing the range, document the finding objectively, and refer.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: end feels in passive range of motion and referral for red-flag findingsReport a problem with this question

4. 4. A client states, "I have a 6 out of 10 aching pain in my right upper trapezius that gets worse by the end of my workday." In which section of a SOAP note does this statement belong?

   • A.O — objective
   • B.P — plan
   • C.A — assessment/analysis
   • D.S — subjective✓ Answer

   The subjective section records what the client reports in their own words, including pain location, quality, intensity rating and aggravating factors, because a self-reported pain score cannot be measured by the therapist. Objective is reserved for what the therapist observes, palpates or measures and for the techniques actually performed.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: written data collection and SOAP documentationReport a problem with this question

5. 5. Which entry correctly belongs in the "A" section of a SOAP note written by a massage therapist?

   • A.Rebook in one week, focus on scalenes, and give the client a doorway pectoral stretch to do daily
   • B.The client has cervical disc herniation at C5-C6
   • C.Cervical lateral flexion improved from restricted to near-full after treatment, and the client met the session goal of reduced neck tension✓ Answer
   • D.The client's description of when the pain started and what makes it worse

   The assessment section is the therapist's analysis of how the client responded to the treatment and how that response relates to the agreed goals, expressed as functional change rather than as a disease name. Naming a condition such as a disc herniation is a medical diagnosis and lies outside the massage therapist's scope of practice.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: SOAP documentation and the prohibition on diagnosingReport a problem with this question

6. 6. On lateral-view postural assessment, a client shows an anterior pelvic tilt with an exaggerated lumbar curve. Which muscular pattern best explains this presentation?

   • A.Weak hip flexors combined with shortened abdominals
   • B.Shortened hip flexors and lumbar erector spinae with lengthened, inhibited abdominals and gluteals✓ Answer
   • C.Shortened hamstrings with lengthened lumbar erector spinae
   • D.Shortened abdominals and gluteals with lengthened hip flexors

   Postural deviations follow a crossed pattern in which the muscles on one side of the joint shorten and become facilitated while their antagonists lengthen and become inhibited. An anteriorly tilted pelvis is pulled forward by short hip flexors working with short lumbar erectors, while the abdominals and gluteals that would posteriorly tilt the pelvis are lengthened and weak.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: postural assessment and crossed muscular patternsReport a problem with this question

7. 7. While observing a client walk, the therapist notices that each time the client bears weight on the left leg, the right side of the pelvis drops. How should this observation be described?

   • A.A Trendelenburg gait, in which the pelvis drops on the unsupported side because the gluteus medius on the weight-bearing side is not stabilizing it✓ Answer
   • B.An antalgic gait, in which time spent on the painful limb is shortened
   • C.An ataxic gait with a wide, unsteady base of support
   • D.A steppage (foot drop) gait caused by weak dorsiflexors

   The gluteus medius of the stance leg normally contracts to hold the pelvis level while the opposite leg swings. When it is weak or inhibited, the pelvis drops on the swinging, unsupported side, producing the characteristic pattern; the therapist describes the gait objectively and does not assign a medical diagnosis.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: gait observation and abnormal gait patternsReport a problem with this question

8. 8. A client twisted an ankle two days ago. On palpation the lateral ankle is warm, red, visibly swollen and very tender. What is the most appropriate action?

   • A.Avoid the local area, use cold rather than heat if a thermal application is indicated, work uninvolved regions, and document the findings✓ Answer
   • B.Apply deep cross-fiber friction directly over the site to prevent adhesions from forming
   • C.Perform vigorous petrissage directly over the swelling to disperse the fluid
   • D.Apply a moist hot pack to the ankle to increase circulation and speed healing

   Heat, redness, swelling and tenderness are the signs of acute inflammation, and tissue in the first roughly 24 to 72 hours after injury is a local contraindication. Heat and friction would increase circulation and inflammation at a site that still needs vasoconstriction and rest, so the therapist works elsewhere and reserves cold for the local area.

   Source: FSMTB MBLEx Content Outline — Client Assessment domain: palpation findings, tissue injury stages and local contraindicationsReport a problem with this question

9. 9. Before treatment, a therapist measured a client's cervical lateral flexion as clearly restricted to the left. What is the BEST way to determine whether the session produced an objective change?

   • A.Record in the chart that the planned techniques were performed correctly
   • B.Re-measure the same cervical lateral flexion after treatment and compare it directly with the pre-treatment measurement✓ Answer
   • C.Compare the client's posture with a photograph taken at the very first visit
   • D.Ask the client at the end of the session whether they feel better overall

   Reassessment means re-testing the identical objective measure that was taken before treatment so that any change can be attributed to the work performed. A general question about how the client feels is useful subjective information, but only the repeated measure gives comparable objective data to record and to guide the next session's plan.

   Source: FSMTB MBLEx Content Outline — Client Assessment, Reassessment and Treatment Planning domain: reassessment of objective findingsReport a problem with this question

10. 10. A client consented to work on the neck and shoulders. Midway through the session, the therapist's findings suggest that gluteal work would help the client's stated goal. What should the therapist do?

    • A.Proceed with the gluteal work, since the signed intake form covers the whole body
    • B.Skip the region permanently and never raise the subject with the client
    • C.Pause, explain the finding and the reason for proposing gluteal work, and obtain the client's specific consent before continuing✓ Answer
    • D.Work the region lightly over the drape without mentioning it, to avoid making the client uncomfortable

    Informed consent is ongoing rather than a one-time signature, so any change to the agreed plan, including working a new or sensitive region, requires that the therapist explain the rationale and obtain permission first. Proceeding without that conversation removes the client's right to decline and violates the consent that the treatment plan rests on.

    Source: FSMTB MBLEx Content Outline — Client Assessment and Treatment Planning domain: informed consent when the treatment plan changesReport a problem with this question

11. 11. A client arrives reporting pain in one calf that started without any injury. The calf is visibly swollen, warm and red compared with the other leg. What is the most appropriate action?

    • A.Apply a hot pack and gentle passive dorsiflexion to relieve the cramping
    • B.Do not perform massage today, and refer the client for prompt medical evaluation, documenting the findings and the referral✓ Answer
    • C.Apply light effleurage toward the heart to help move the swelling out of the calf
    • D.Massage only the uninvolved leg and record a diagnosis of deep vein thrombosis in the chart

    Unilateral calf pain with swelling, heat and redness and no mechanical cause is a classic red flag for a possible blood clot, which is a systemic contraindication because manipulation anywhere could dislodge it. The in-scope response is to withhold massage, refer to a qualified medical provider, and document the objective findings without naming a diagnosis.

    Source: FSMTB MBLEx Content Outline — Client Assessment and Treatment Planning domain: red flags, systemic contraindications and referralReport a problem with this question

12. 12. After a shoulder assessment, the client asks, "Based on what you found, do you think I have a torn rotator cuff?" What is the most appropriate response?

    • A.Tell the client the findings are consistent with a rotator cuff tear so they know what they are dealing with
    • B.Offer a package of six sessions and tell the client the tear will most likely resolve with regular deep tissue work
    • C.Tell the client that massage therapists are not permitted to discuss assessment findings at all
    • D.Describe the objective findings, such as limited and painful abduction with tenderness at the tendon, explain that diagnosing is outside the massage scope of practice, and recommend evaluation by a qualified health care provider✓ Answer

    Describing what was observed and measured is within the massage therapist's scope, but attaching a disease name to those findings is a medical diagnosis and is not. Sharing objective findings, stating the scope limitation clearly, and referring keeps the client informed and safe without the therapist practicing outside their license.

    Source: FSMTB MBLEx Content Outline — Client Assessment domain: describing findings vs. diagnosing, and referralReport a problem with this question

13. 13. A client rolled an ankle about 12 hours ago and asks for a hot pack because heat feels good to them. What should the therapist do?

    • A.Apply the hot pack, because the client's stated preference determines the choice of thermal modality
    • B.Apply the hot pack, but limit it to five minutes so the tissue does not overheat
    • C.Explain that cold, not heat, is indicated at this stage, because vasoconstriction limits further swelling during the acute inflammatory phase✓ Answer
    • D.Apply contrast therapy, alternating hot and cold and finishing with heat

    Thermal choice is determined by the stage of tissue injury, not by what feels pleasant. In the acute inflammatory phase, roughly the first 24 to 72 hours, cold produces vasoconstriction and slows local metabolic and nerve activity, controlling swelling and pain, whereas heat causes vasodilation and would increase the swelling the body is already producing.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: hot and cold applications matched to injury stageReport a problem with this question

14. 14. Which use of cross-fiber friction is appropriate for an entry-level massage therapist?

    • A.On a mature, well-healed scar or a chronic adhesion, to broaden and realign the fibers, usually followed by cold application or gentle stretching✓ Answer
    • B.As the opening stroke of a session, before any warming strokes have been applied
    • C.Immediately after an acute muscle strain, to prevent inflammation from developing
    • D.Over an area of fresh bruising, to break up and disperse the pooled blood

    Friction deliberately creates a small, controlled therapeutic inflammatory response in order to remodel collagen, so it is used only after the acute stage has passed and only on tissue that has already begun to heal. Applying it to acute injury or fresh bruising adds inflammation and tissue damage where the body is still in the protective phase.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: friction, therapeutic inflammation and stage of healingReport a problem with this question

15. 15. Which of the following is a REFLEXIVE (nervous-system mediated) effect of massage rather than a mechanical effect?

    • A.An increase in local tissue temperature and pliability produced by friction between the hand and the skin
    • B.Broadening and separation of adhered fascial layers by the pressure of the therapist's hands
    • C.Increased venous and lymphatic return produced by the direct pressure of gliding strokes
    • D.A decrease in heart rate, blood pressure and respiratory rate caused by a shift toward parasympathetic dominance✓ Answer

    Mechanical effects are direct physical changes produced by the force of the hands on the tissue, such as fluid movement, tissue broadening and increased temperature. Reflexive effects are mediated by the nervous system and appear away from the point of contact, so autonomic changes such as lowered heart rate, blood pressure and respiratory rate belong in that category.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: mechanical (direct) vs. reflexive (indirect) effectsReport a problem with this question

16. 16. An athlete requests massage 30 minutes before competing. Which approach is appropriate?

    • A.Long, slow, sedating effleurage to bring the athlete into full parasympathetic relaxation
    • B.Prolonged static stretches held for several minutes on each major muscle group
    • C.Brisk, short and stimulating work that warms the tissue — compression, light petrissage and jostling — with no deep or unfamiliar techniques✓ Answer
    • D.Deep, specific cross-fiber friction on chronic adhesions so the tissue is fully freed before the event

    Pre-event massage is meant to increase circulation, warm the tissue and raise readiness, so it is short, rhythmic and stimulating. Deep or unfamiliar work and prolonged sedating strokes can leave tissue sore, reduce muscle responsiveness and impair performance, which is why corrective work is reserved for maintenance sessions between events.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: effects for specific populations, pre-event vs. post-event sports massageReport a problem with this question

17. 17. A client in her third trimester of pregnancy arrives for a full-body session. Which positioning and pressure plan is most appropriate?

    • A.Prone the entire session, with a bolster placed under the abdomen for comfort
    • B.Side-lying with bolsters between the knees and supporting the abdomen, or a semi-reclined position, using gentle pressure and avoiding deep work on the medial leg✓ Answer
    • C.Seated in a chair only, because table work is contraindicated throughout pregnancy
    • D.Flat supine for the entire session, to allow the therapist full access to the front of the body

    Side-lying or semi-reclined positioning with bolstering keeps pressure off the abdomen and avoids prolonged supine positioning, in which the weight of the uterus can compress the inferior vena cava and reduce venous return. Deep pressure on the medial leg is avoided because pregnancy raises clotting risk, and gentle pressure with frequent comfort checks is the standard.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: effects and adaptations for pregnant clients; client positioning and bolsteringReport a problem with this question

18. 18. Which statement best describes the correct application of manual lymphatic drainage?

    • A.Vigorous tapotement over the lymph nodes to stimulate the production of lymphocytes
    • B.Deep, rapid strokes applied distal to proximal on the affected limb only
    • C.Very light, slow, rhythmic and directional strokes that clear the proximal nodes and trunk before the distal limb is addressed✓ Answer
    • D.Heavy compressive strokes that force fluid through the lymphatic capillaries

    Lymphatic capillaries sit just under the skin and are opened by very light stretch, so heavy pressure collapses them and defeats the technique. The proximal pathways and nodes must be cleared first to create somewhere for fluid to go, otherwise moving distal fluid proximally simply pushes it into an already congested area.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: overview of modalities, manual lymphatic drainage pressure and sequenceReport a problem with this question

19. 19. In muscle energy technique / PNF stretching, the client contracts the target muscle isometrically before the therapist lengthens it. Which mechanism explains why the muscle then stretches farther?

    • A.The contraction mechanically tears adhesions inside the muscle belly, freeing the fibers
    • B.The isometric contraction increases tension at the tendon, stimulating the Golgi tendon organ, and the resulting autogenic inhibition allows the muscle to relax into a greater stretch✓ Answer
    • C.The contraction flushes accumulated lactic acid out of the muscle so the fibers can slide farther
    • D.The contraction stretches the muscle spindle and triggers a stretch reflex that lengthens the muscle

    The Golgi tendon organ monitors tension at the musculotendinous junction, and a strong isometric contraction raises that tension enough to trigger autogenic inhibition, which reduces motor drive to the same muscle. The brief drop in tone that follows lets the therapist take the muscle into a longer range without provoking the protective stretch reflex.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: stretching techniques and proprioceptor mechanisms (Golgi tendon organ, autogenic inhibition)Report a problem with this question

20. 20. Tapotement is a stimulating percussive stroke. In which region is heavy tapotement MOST clearly inappropriate?

    • A.Over the upper trapezius of a healthy adult client
    • B.Over the mid-thoracic erector spinae during a general relaxation session
    • C.Over the gastrocnemius of a healthy athlete during a pre-event session
    • D.Over the kidney region below the floating ribs, which is an endangerment site where heavy percussion is avoided✓ Answer

    Endangerment sites are regions where vulnerable structures lie close to the surface with little bony protection, and the kidneys sitting beneath the floating ribs are one of them. Because forceful percussion there can transmit impact to the organ, pressure is reduced or the technique is omitted, in the same way that the anterior neck, axilla, cubital fossa, femoral triangle and popliteal fossa are treated with caution.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: tapotement, and areas of caution / endangerment sitesReport a problem with this question

21. 21. Which sequencing plan best reflects sound technique order when working an area of the back?

    • A.Begin with deep friction, then petrissage, and finish with effleurage only if time remains
    • B.Work distal to proximal along the limb before clearing the trunk when the goal is edema reduction
    • C.Begin with effleurage to warm, lubricate and assess the tissue, progress from superficial to deep and from general to specific, and close the area with effleurage✓ Answer
    • D.Begin with tapotement to alert the tissue, then move directly to the deepest work

    Effleurage warms tissue, spreads lubricant and lets the therapist palpate while working, which prepares the area and reduces guarding before deeper strokes are introduced. Working superficial to deep and general to specific respects tissue tolerance, and closing with effleurage integrates and soothes the area; edema work is the case where proximal must be cleared before distal.

    Source: FSMTB MBLEx Content Outline — Benefits and Physiological Effects of Soft Tissue Techniques domain: types of strokes and sequence of applicationReport a problem with this question

22. 22. A therapist finds that after several deep-tissue clients, their thumbs and shoulders ache. Which adjustment best reflects sound body mechanics?

    • A.Set the table height so that pressure is generated by a stable stance and transferred through stacked, aligned joints with the wrist near neutral, using forearm, elbow or fist instead of the thumbs for sustained depth✓ Answer
    • B.Rely on the thumbs for all deep work, since they give the greatest precision and control
    • C.Raise the table high enough that the shoulders stay elevated and the wrists stay hyperextended throughout the stroke
    • D.Keep the table at one fixed height for every client and every technique, regardless of the therapist's height

    Depth should come from the therapist's body weight moving through a stable stance and aligned joints, not from small muscles gripping and pushing, because force transmitted through stacked joints requires far less muscular effort. Table height is adjusted to the therapist and the technique, and using the forearm, elbow or a loose fist spares the vulnerable thumb and wrist joints from repetitive strain.

    Source: Massage therapy practice guidelines — body mechanics, table height and practitioner injury preventionReport 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 →