Massage and Bodywork Licensing Examination MBLEx Test Pathology and Contraindications 1 — Questions and Answers
Question 1: A client arrives for a massage and mentions they are currently undergoing chemotherapy for breast cancer. Which approach is most appropriate for the massage therapist?
- Refuse to work with the client until chemotherapy is complete
- Perform a full-pressure massage focusing on lymphatic drainage
- Obtain physician clearance and modify pressure, avoiding treatment sites and compromised areas (Correct answer)
- Proceed normally since cancer itself is not a contraindication to touch
Correct answer: Obtain physician clearance and modify pressure, avoiding treatment sites and compromised areas
Clients undergoing chemotherapy require physician clearance and significant modifications including reduced pressure, avoidance of treatment sites, and attention to immunocompromised status. Massage can still be beneficial but must be adapted to the client's current condition and tolerance.
Question 2: A client reports a recent diagnosis of uncontrolled hypertension with a resting blood pressure of 180/110 mmHg. What is the most appropriate action?
- Proceed with a relaxation massage focused on the lower extremities only
- Refer the client to their physician before providing massage and reschedule (Correct answer)
- Apply deep tissue techniques to reduce sympathetic nervous system activity
- Perform massage but avoid the neck and head region
Correct answer: Refer the client to their physician before providing massage and reschedule
Uncontrolled hypertension at this severity (stage 2) is a systemic contraindication requiring medical clearance before massage. Massage can influence blood pressure and could pose a risk to a client with dangerously elevated, unmanaged hypertension.
Question 3: Which of the following skin conditions represents a local contraindication requiring the therapist to avoid only the affected area rather than canceling the entire session?
- Systemic lupus erythematosus with active flare
- A small area of psoriasis on the client's elbow (Correct answer)
- Shingles (herpes zoster) with widespread active lesions
- Severe peripheral vascular disease affecting both legs
Correct answer: A small area of psoriasis on the client's elbow
A localized patch of psoriasis is a local contraindication — the therapist should avoid massaging the affected skin directly but can safely work the rest of the body. Systemic diseases in active flare, widespread infectious lesions, and severe vascular conditions affecting large regions require broader precautions.
Question 4: A client with type 1 diabetes asks about massage. Which precaution is most important for the therapist to implement?
- Avoid all massage of the lower extremities due to circulation risk
- Check for peripheral neuropathy and avoid deep pressure on insensate areas (Correct answer)
- Apply heat packs to stimulate insulin production before the session
- Perform only Swedish effleurage since diabetes contraindicates all other techniques
Correct answer: Check for peripheral neuropathy and avoid deep pressure on insensate areas
Peripheral neuropathy is common in diabetes and reduces the client's ability to provide accurate pressure feedback. The therapist must assess sensation, use lighter pressure on affected areas, and monitor for skin integrity issues. Massage is not contraindicated for diabetes but requires informed modifications.
Question 5: A massage therapist notices that a client's lower leg is significantly swollen, warm to the touch, and reddened compared to the other leg, and the client mentions pain with dorsiflexion. What should the therapist do?
- Apply lymphatic drainage massage to reduce the edema
- Elevate the leg and apply gentle compressive strokes to promote fluid return
- Immediately stop the session and refer the client for emergency medical evaluation (Correct answer)
- Reduce pressure but continue the session since edema is a common benign condition
Correct answer: Immediately stop the session and refer the client for emergency medical evaluation
The signs described — unilateral swelling, warmth, redness, and pain with dorsiflexion (Homan's sign) — are classic indicators of deep vein thrombosis (DVT). Massaging over a suspected DVT can dislodge the clot, causing a potentially fatal pulmonary embolism. The session must stop and the client must seek immediate medical care.
Question 6: A client recovering from a mild ischemic stroke three months ago has residual weakness on one side and takes blood-thinning medication. What is the most appropriate modification for massage?
- Avoid massage entirely until the client has been symptom-free for one full year
- Use light to moderate pressure, avoid aggressive circulatory techniques, and watch for bruising due to anticoagulants (Correct answer)
- Focus deep tissue work on the affected side to help restore muscle tone and strength
- Perform vigorous tapotement on the unaffected side to stimulate the nervous system
Correct answer: Use light to moderate pressure, avoid aggressive circulatory techniques, and watch for bruising due to anticoagulants
A post-stroke client on anticoagulant medication is at increased risk for bruising and bleeding with deep pressure. Light to moderate techniques are appropriate to support relaxation and circulation, but aggressive or deep work should be avoided. Medical clearance and close communication with the client's care team are essential.
