NCBTMB Pathology and Contraindications 5 — Questions and Answers
Question 1: A pregnant client in her second trimester requests massage. Which position is SAFEST for this client?
- Prone with a standard flat table
- Supine with legs elevated above heart level
- Side-lying with support bolsters (Correct answer)
- Seated upright in a chair massage position only
Correct answer: Side-lying with support bolsters
Side-lying is the safest and most comfortable position for pregnant clients as it avoids uterine pressure on the vena cava and accommodates the growing abdomen.
Question 2: Which of the following describes a RELATIVE contraindication to massage?
- A condition where massage is always forbidden under all circumstances
- A condition requiring special precautions, modifications, or physician clearance (Correct answer)
- A condition that only affects massage technique but never prevents massage
- A local area to completely avoid during an otherwise normal session
Correct answer: A condition requiring special precautions, modifications, or physician clearance
A relative contraindication means massage may be performed with appropriate modifications, precautions, or medical clearance rather than being absolutely forbidden.
Question 3: Massage is contraindicated over varicose veins primarily because:
- It causes the veins to rupture and bleed into surrounding tissue
- Pressure can damage already weakened venous valves and potentially dislodge clots (Correct answer)
- It permanently darkens the skin over the vein
- It causes painful venous spasms during the session
Correct answer: Pressure can damage already weakened venous valves and potentially dislodge clots
Varicose veins have incompetent valves and fragile walls; direct massage pressure risks valve damage and could mobilize any thrombus present.
Question 4: A client with fibromyalgia reports an 8/10 pain level and severe fatigue today. The therapist should:
- Proceed with deep tissue work to break up fibrous tissue causing the pain
- Modify the session to very gentle techniques or reschedule if the client is in a flare (Correct answer)
- Decline all massage until the client's fibromyalgia is in remission
- Focus only on the most painful areas with sustained compression
Correct answer: Modify the session to very gentle techniques or reschedule if the client is in a flare
Fibromyalgia flares warrant reduced pressure and gentler techniques, as aggressive massage during a flare can worsen symptoms significantly.
Question 5: Which of the following BEST describes why massage is contraindicated with acute appendicitis?
- The appendix contains bacteria that massage can spread to the bloodstream
- Abdominal massage could rupture the inflamed appendix, causing peritonitis (Correct answer)
- Massage accelerates white blood cell activity worsening the infection
- It causes referred pain patterns that mask the diagnostic symptoms
Correct answer: Abdominal massage could rupture the inflamed appendix, causing peritonitis
Abdominal massage over an acutely inflamed appendix risks rupture, which would spill intestinal contents into the peritoneal cavity causing life-threatening peritonitis.
Question 6: A client with high blood pressure (hypertension) managed by medication seeks massage. The therapist's BEST approach is:
- Avoid all massage as hypertension is an absolute systemic contraindication
- Obtain physician clearance and use relaxation-focused techniques while monitoring the client (Correct answer)
- Apply deep tissue massage to stimulate circulation and lower blood pressure
- Only massage the hands and feet to avoid any cardiovascular effects
Correct answer: Obtain physician clearance and use relaxation-focused techniques while monitoring the client
Medically controlled hypertension is a relative contraindication; relaxation massage with physician clearance is generally appropriate and may help reduce blood pressure.
Question 7: A client has an open skin abrasion on the knee from a fall yesterday. The CORRECT action is:
- Apply massage oil over the abrasion to keep it moisturized during the session
- Avoid the local area entirely but continue the session elsewhere on the body (Correct answer)
- Postpone the entire session until the abrasion is fully healed
- Cover the abrasion with a bandage and massage directly over it
Correct answer: Avoid the local area entirely but continue the session elsewhere on the body
An open abrasion is a local contraindication; the therapist should avoid only that area while safely continuing massage on unaffected regions.
NCBTMB Pathology and Contraindications 5
A pregnant client in her second trimester requests massage.
Which position is SAFEST for this client?