Step 2: Know What to Study

As you start to think about sitting for the Massage & Bodywork Licensing Exam (MBLEx), you might feel overwhelmed. Massage and bodywork is diverse! What will be on the test? The Federation of State Massage Therapy Boards (FSMTB) offers a one-page content outline at www.fsmtb.org, but an outline doesn’t always give you the details you need. What follows is a detailed, albeit lengthy, accounting of what you will see on the MBLEx. You might also want to explore ABMP Exam Coach, which is an exam preparation tool developed by ABMP to help massage and bodywork students master the content on the MBLEx.

Action Item: Go to the Federation of State Massage Therapy Boards and click on the link for the MBLEx. Download the MBLEx content outline and use it as an overview during study. Continue reading for more details about MBLEx content.

What’s on the MBLEx?

The MBLEx covers seven broad areas of content and has a total of 100 questions. So, when you see the particular percentage (weight) of a content area, you can determine how many questions you might see in a particular subject. For example, Anatomy & Physiology comprises 11% of the MBLEx, so you can expect to see 11 total anatomy and physiology questions on the test. Let’s look at each content area in more depth and think about the types of questions you might see.

Client Assessment, Reassessment & Treatment Planning (17%)

This is the most heavily weighted content area on the MBLEx. You can expect to see 17 questions that relate to these topics:

• Organization of a massage or bodywork session: This topic area relates to overall session planning and the sequence of events in a session. For example, you wouldn’t administer a health form after the massage session. You administer a health form first and use it to rule out contraindications. You probably wouldn’t conduct a posture assessment or range of motion assessment for a relaxation massage delivered at a spa, but you might for a treatment or clinical massage on a client with a soft-tissue injury.
• Client consultation and evaluation: This topic refers to the administration of a health form and the use of a client interview to understand a client’s unique health picture. For example, you might be asked the primary purpose of a health history form. As you already know, the answer is to rule out contraindication and identify if session adaptations are required.
• Written data collection: This topic refers to accepted methods for documentation of sessions, such as the use of a SOAP form and the types of information that would occur in each section of the SOAP form.
• Visual assessment: In this topic you will be asked questions about general observations you might make about a client during a client interview, such as overall freedom of movement or vitality level, and about how to conduct and document a formal posture assessment.
• Palpation assessment: Questions related to this topic will ask you about methods to assess soft tissue using palpation techniques and why you might use this type of assessment. For example, palpation of bony landmarks, such as locating the superior spine of the scapula on both the left and right sides, can help a practitioner determine symmetry or asymmetry in the region and recognize related muscular imbalances.
• Range of motion assessment: Questions related to this topic will likely ask about methods for conducting a range of motion assessment. For example, to assess muscular strength, you would use resisted range of motion, while active range of motion would be used to assess a client’s overall willingness and ability to move. 
• Clinical reasoning: Questions related to this topic will check your ability to rule out contraindications, work with a client to set goals for the session, formulate a treatment strategy, and evaluate the client’s response to the work for future sessions. For example, if the client wants work on his or her low back, neck, and shoulders, your treatment strategy would focus on the muscles of these regions—you wouldn’t spend your time massaging the client’s feet.

Ethics, Boundaries, Laws, Regulations (16%)

This is the second-largest content area on the MBLEx, representing 16 of the 100 total questions on the test. You won’t need to know specific laws or regulations that are unique to your state. Instead, focus on broad principles. For example, every state that regulates massage has a scope of practice. You want to be able to define the term “scope of practice” and understand the core items covered by the scope of practice for massage therapy (e.g., soft-tissue manipulation). Let’s look more closely at these topic areas:

• Ethical behavior: Questions in this topic will test your knowledge about appropriate and professional interactions with clients and colleagues. For example, if you deny massage to a client based on his or her religion, you have acted unethically. If you work aggressively on a client when he or she tells you that the technique is too painful, you have behaved unethically.
• Professional boundaries: Questions related to this topic will ask you about the forms and types of boundaries people use in their interactions, and behaviors that help you establish and maintain professional boundaries during massage sessions. For example, one way to establish a professional boundary is to share clinic policies in a written format with clients as part of an informed consent process.
• Code of ethics violations: You will want to be able to recognize code of ethics violations to answer questions in this topic. For example, if you fail to properly launder your massage linens, or if you tell a joke of a sexual nature to a client during a session, you have violated the massage therapy code of ethics.
• The therapeutic relationship: Questions in this topic will ask you about methods to establish and maintain a positive therapeutic relationship. You are likely to see questions related to the power differential, transference, countertransference, client rights, client autonomy, and professional communication.
• Dual relationships: For this topic you will want to be able to define the term “dual relationship” and recognize dual relationships when they are described in a test question.
• Sexual misconduct: This topic will test you on behaviors that are inappropriate in a massage setting (e.g., using a nickname that has a sexual connotation, like calling a client “honey”), and the differences between sexual impropriety, sexual innuendo, sexual harassment, and sexual assault.
• Laws and regulations: Questions related to this topic will ask you about general laws and regulations, such as informed consent, failure to obtain necessary continuing education to maintain your license, provisions such as “grandfathering,” and technique exemptions. Focus on common regulations, as specific regulations unique to an individual state will not be on this national examination.
• Scope of practice: You’ll need to know the techniques and methods that are usually covered under the massage scope of practice, and also activities that are not part of the massage scope, such as chiropractic adjustment, diagnosis, and prescribing vitamins or pain relievers.
• Professional communication: This section will test your knowledge of interpersonal skills related to communication, such as relating styles, communication blockers, active listening skills, use of body language, and conflict resolution processes.
• Confidentiality: Questions related to establishing, maintaining, and protecting client information and records are asked in this topic.
• Ethical principles: In this topic you’ll be asked to demonstrate your understanding of common ethical principles, such as “do no harm” and “practice confidentiality.”

Benefits and Physiological Effects of Techniques that Manipulate Soft Tissue (15%)

In this subject, you will see 15 total questions in these topic areas:

• Identification of physiological effects of soft-tissue manipulation: Questions in this topic will ask you to demonstrate your knowledge of the types of effects that occur in tissue (e.g., mechanical, reflexive, structural, systemic, primary, secondary, etc.) and the ways massage work affects the body. A sample question might look like, “This chemical, released when soft tissue is manipulated, causes local blood vessels to dilate, thus increasing local circulation in a particular area.” You likely know that the correct answer is “histamine.”
• Psychological aspects and benefits of touch: Questions related to this topic ask you to demonstrate your knowledge of the positive mental and emotional reactions that people have to massage.
• Benefits of soft-tissue manipulation for specific client populations: A body of research demonstrates that massage supports various client populations. For example, research indicates massage positively influences serotonin and dopamine levels in the body and is associated with increased well-being. Based on this research, massage is beneficial for clients living with depression. Questions in this topic will ask you to demonstrate a basic understanding of massage for special populations.   
• Soft-tissue techniques: You know that a long, gliding stroke is called effleurage in the Swedish massage system, or that trigger-point work uses a predominance of static compression techniques. You also know that you would avoid the use of passive stretching on pregnant clients because of the presence of relaxin in the client’s body. This is the type of information you will want to know to answer questions in this topic area.
• Hot and cold applications: Questions in this topic ask you to demonstrate knowledge of the correct use of hot and cold applications such as ice packs, hot packs, and hydrotherapy. For example, you know that you would not place a hot pack on an acute soft-tissue injury—it’s contraindicated! You would use an ice pack instead. 
• Overview of massage/bodywork modalities: Questions in this topic will ask you to demonstrate an awareness of the many different forms of massage and bodywork you might practice. A question might look like this: "When water in one of its three forms is used for healing, it is called what?"

Guidelines for Professional Practice (15%)

In this subject, you will see 15 total questions in these topic areas:

• Proper and safe use of equipment and supplies: Can you explain why bolsters are used during a session or why practitioners always tighten the leg bolts of massage tables between sessions? Do you know the proper way to launder and store sheets and other linens?
• Therapist hygiene: Questions in this topic will ask you to demonstrate your knowledge of hygienic practices in alignment with your role as a health-care provider. For example, you know that you must remove your rings and watches because jewelry can harbor pathogens that might be transported to a client during a massage.
• Sanitation and cleanliness: These questions will deal with the proper cleaning and sanitation of a massage business facility. You’ll want to know about the different types of approved cleaning agents and how to use them properly. You’ll want to know the difference between sanitation tasks performed between clients and on a daily or weekly “housekeeping” schedule.
• Safety practices: In this topic you will see questions about maintaining a safe facility (e.g., identifying items, like a loose area rug, that might cause a client to trip and fall), and maintaining your personal safety as a therapist (e.g., client screening practices, protecting yourself from harsh cleaning supplies, etc.).
• Therapist care: Questions in this topic will ask you to demonstrate your knowledge of self-care, including the proper use of body mechanics, the use of protective gear, such as gloves, and methods to prevent personal injury while on the job. 
• Draping: For questions in this topic, you’ll want to know the different types of draping that might be used to protect a client’s modesty and about communication between client and practitioner while draping. 
• Business practices: This is a broad topic area that will ask you to demonstrate your knowledge about the basics of running a business. For example, you might be asked about business planning, strategic planning, office management, marketing, hiring/interviewwing, maintaining client records, and maintaining business records.
• Health-care and business terminology: In this topic you will be asked questions related to specific language used in the health-care field for session documentation, insurance billing, and communication with other health-care professionals.

Pathology, Contraindications, Areas of Caution, Special Populations (14%)

In this subject, you will see 14 total questions in these topic areas:

• Overview of pathologies: This topic will ask you some basic questions like, “What is inflammation?” “What is the definition of disease?” “What is the difference between acute and chronic?” and, “What are signs and symptoms?” Focus on being able to define key terms related to pathology.
• Contraindications: Plan to see a number of questions related to contraindications. You’ll want to know about different types of contraindications, such as the difference between conditions that are absolutely contraindicated or locally contraindicated. For example, if the client received a local injection, the injection site is contraindicated but the rest of the body can receive massage. Be sure you recognize pathologies or conditions that are absolute contraindications, such as a client with a fever, ringworm, or lice.
• Areas of caution: For this topic, you want to know the areas where cautious work is applied, such as the anterior and posterior triangles of the neck. You’ll want to have an idea of the key structures that run through each area. For example, a question might read like this: “The temporal artery requires caution when a practitioner is working on the: _____.” You want to know that the correct answer is “face.”
• Special populations: For questions in this section, you’ll want to know the cautions and contraindications that are specific to older adults, children, pregnant women, athletes, and clients with disabilities.
• Classes of medication: Classes of medicines refer to broad medicine categories like antidepressant medications, antidiabetic medications, antihistamines, diuretics, and analgesics. For example, you might see a question like, “This drug is commonly taken by diabetic people and is administered either by multiple daily injections or through a pump: _____.” You know the answer is “insulin.” Or: “When working with clients taking these drugs, practitioners should exercise caution because of the risk of bruising: _____.” The answer, of course, is “anticoagulant medications.”

Anatomy & Physiology (11%)

In this subject, you will see 11 total questions on the MBLEx. You will want to know the basic structure and function of these body systems:

• Cardiovascular
• Digestive
• Endocrine
• Integumentary
• Lymphatic
• Muscular
• Nervous
• Reproductive
• Respiratory
• Skeletal
• Special Senses
• Urinary

Focus on being able to define key terms and know which organs belong to which systems. For example, you would want to be able to define the kidneys and know that they belong to the urinary system. Pay special attention to the muscular, skeletal, and nervous systems because these systems are of particular importance to massage practitioners.

In Anatomy & Physiology, you will also see questions related to tissue injury and repair. Tissue injury and repair will focus on the stages of inflammation and the physiological events occurring during each stage. For example, key physiological responses that occur during the repair stage associated with subacute inflammation include the development of new blood vessels, granulation, and collagen remodeling.

You might also get one or two questions related to concepts of energetic anatomy where you would want to be able to define terms such as “chakra,” “meridian,” or “qi.” This topic acknowledges that massage and bodywork are diverse, and that some systems don’t view the body from a Western or scientific perspective.

Kinesiology (12%)

In this subject, you will see 12 total questions on the MBLEx in these topic areas:

• Components and characteristics of muscles: For this topic you will want to know things like the fact that skeletal muscle tissue is striated and under voluntary control. You will want to be able to define and differentiate between terms like fascia, endomysium, perimysium, and epimysium, and know what terms like extensibility, elasticity, excitability, conductivity, and contractility mean. 
• Concepts of muscle contractions: This topic will ask questions about motor unit recruitment, and require you to know how to define and differentiate types of muscle contractions like isometric and isotonic, including concentric and eccentric contractions, and muscle relationships like agonists, synergists, and antagonists.
• Proprioceptors: Questions in this topic will ask about muscle spindles, Golgi tendon organs, and mechanoreceptors, and how they function in coordinated movement.
• Locations, attachments, actions, and fiber directions of muscles: These questions will test your knowledge of individual muscles. For example, you might be asked, “Which muscle name refers to the flexor just deep to the biceps brachii?” or, “The deep muscle group that fills most of the lamina groove is what?” Make sure you also know your planes, axis, and movements, as this question demonstrates: “Which term best describes movement of the upper extremity in the frontal plane away from the midline of the body?”
• Joint structure and function: For questions in this topic, focus on synovial joint anatomy and types, but know all of your basic terms, such as fibrous, cartilaginous, synovial, synarthrotic, amphiarthrotic, and diarthrotic. You may see questions like this: “Which term refers to the functional classification of a joint that is slightly moveable?” or, “Which term best describes the gap between two or more bones, often encapsulated by a synovial membrane?”
• Range of motion: Be ready to answer questions about active, passive, and resisted range of motion, and end-feel. 

What to Do Next

You now have a much better idea about what to study in preparation for the MBLEx. Because there is diversity in massage and bodywork training, there are likely a small number of questions that will come up on the test that are outside your training. The number of these questions is unlikely to pose a barrier to passing the examination. In upcoming newsletters, we will identify effective study methods, help you create a study plan, and walk you through the application process.

Action Item: Compile your completed exams and quizzes from your training program into a binder and add any particularly useful notes or handouts. Now your study materials are in one organized place for use in exam preparation.