ABMP: Client Assessment and Session Planning
- Jun 8, 2023
- 1 min read
Health Intake
Terminology
Aggravating activities - Activities that increase the pain or intensity of a symptom.
Assessment - The process of collecting information about the client, interpreting that information, and using it to make safe and effective treatment plans.
Boundaries - Boundaries are conscious and subconscious imaginary lines that mark the limits of an individual's personal space or territory.
Boundary violation - When one person disregards another's personal space in a way that makes the other person uncomfortable.
Client intake - The process of the client filling out a health history form, conducting an initial client interview, answering questions from the client, and developing a plan for treatment.
Client interview - The initial interview in which the therapist gathers information about the client's state of health and the client expresses his/her wants and needs in order to develop an effective session plan.
Countertransference - The opposite of transference, in which a therapist tries to personalize an otherwise professional relationship with the client.
Dual relationship - A situation in which more than one relationship between therapist and client exists (e.g., the client is also a friend, etc.).
Follow-up questions - Questions asked by the therapist, in response to information given by a client, in order to clarify or obtain further information about a particular condition.
Freedom of movement - Observing the fluidity or rigidity of movement in a client's body during the initial interview.
Health history form - A document that clients complete before their first session that provides personal contact information, current health conditions, medications, past health conditions, and health-related goals.
Informed consent document - The process by which a fully informed client consents to participate in the massage treatment.
Physician's release - A written document produced by a physician clearing the client to receive a treatment like massage.
Post-session interview - A brief discussion after the massage in which the client is asked to describe any changes experienced in the body as a result of treatment and the therapist recommends pertinent self-care activities and additional sessions.
Power differential - The authority a massage therapist is granted by a client, based on the client's perception of the massage therapist as a knowledgeable and skilled health-care provider.
Referral - When a therapist directs a client toward another professional because it is reasonably assumed that person's services will benefit the client.
Relieving activities - Activities that reduce the pain or intensity of a symptom.
Session adaptations - Ways in which the sessions must be modified in order to accommodate contraindications or other qualities of a client's state of health that require caution.
Signs - The objective evidence of a disease, condition, or physical disturbance gathered through assessment by the practitioner.
Stress management - Methods for alleviating or minimizing the experience of stress in order to improve health and function.
Subjective data - Information that the client shares about his/her state of health, noticeable signs and symptoms, etc.
Symptoms - The subjective evidence of a disease, condition, or physical disturbance reported by the client.
Therapeutic relationship - A professional partnership between therapist and client where safe, structured touch helps the client achieve reasonable, well-defined goals.
Transference - A subconscious psychological phenomenon where the client places the therapist in a place of importance in his/her personal life, beyond professional boundaries.
Practice Quiz
1. What scenario would require a doctor’s prescription for massage therapy?
a. the client takes medication for anxiety and is looking for a way to relieve his constant low-grade stress
b. the client is in stage III breast cancer and is currently undergoing rounds of chemotherapy and radiation
c. the client is a 70-year-old woman with arthritis who has never had massage before
d. the client broke his femur 3 months ago and is going to physical therapy 3 times per week
2. During the initial interview, you should avoid:
a. offering your opinion when your client shares a previous therapist's or doctor's evaluations
b. asking your client about any questions from the intake form that may have been left blank
c. asking the client if she has any allergies or sensitivities to the product you will be using
d. reviewing the informed consent form to ensure your client has read and understands it
3. The practitioner welcomes a client into her office. The client fills out an intake form and notes his mailing address, phone number, emergency contact information, and general somatic complaints, as well as medications he’s taking. She guides the client into the prepared treatment room, where she instructs the client on disrobing to his level of comfort, where to put his things, and how to get on the table and drape himself under the sheet. What important step has the practitioner missed in her pre-massage process?
a. warmly shaking the client's hand to put him at ease
b. verifying the client's date of birth
c. going over cancellation policies
d. ruling out contraindications for massage
4. A conversation that occurs between the therapist and client to gather information used to plan a session is called:
a. the informed consent process
b. a client interview
c. the goal-setting process
d. the objective date process
5. Subjective data is that which comes from:
a. a prognostic test such as an MRI
b. the client's experience
c. the practitioner's evaluation
d. a physician's diagnosis
6. Which of the following is the most accurate scope of practice statement for a massage therapist?
a. As your massage therapist, I may practice a variety of techniques including, but not limited to, deep tissue massage, passive and active stretching, and nutritional or supplemental regimens
b. As your massage therapist, I do not diagnose medical conditions and cannot provide prescriptions. Massage therapy is not a substitute for medical evaluation or treatment
c. As an integrative massage therapist, I provide a comprehensive health-care plan and can assure you that every aspect of your health will be addressed in each session
d. A doctor's prescription for massage therapy is required to ensure the maximum benefit from your massage session and clarify that there are no contraindications for this treatment
7. This is the evaluation of a client's current condition and past experience in order to rule out contraindications and develop a treatment plan:
a. consultation
b. informed consent
c. palpation analysis
d. assessment
8. What is the most efficient way to organize the medical history portion of the intake form?
a. list conditions in order of relevance to the client's current complaint
b. as a list of conditions that the client can circle or check "Yes" or "no"
c. designate conditions as affecting the client in the past or present
d. into categories such as Musculoskeletal, Neurological, and Immune system
9. A client is reporting shooting pains in her shoulder and numbness down her arm. Which of the following questions is the most relevant follow-up?
a. how long has this been happening
b. has anyone else in your family been injured in this way
c. do you think this is the result of lack of exercise?
10. A health history form is used to gather:
a. activities that aggravate a client's condition
b. current health conditions
c. activities that relieve the client's condition
d. posture analysis findings
11. The client should fill out a health history intake form:
a. every time he/she gets a massage
b. before the first massage session
c. after the first massage session
d. every 3 months
12. A health history form is used to gather:
a. personal contact information
b. the type of massage modalities used during the session
c. planning date
d. self-care for the client
13. While the client fills out the health history form, the practitioner should:
a. ask questions such as "how did you hear about me?"
b. be available for questions and clarifications
c. tidy up the treatment room; adjust lighting and temperature
d. leave the room so that the client can relax
14. Information the client gives the practitioner that is based on experience, opinion, and feeling is referred to as:
a. subjective data
b. anecdotal evidence
c. objective data
d. comprehensive analysis
15. Which of the following is an example of objective data?
a. A colleague of yours, who is an acupuncturist, has referred a client to you. He mentions that the client is experiencing sciatic pain and cramping in her legs
b. Your teenage client comes in with her mother, who tells you her daughter has been feeling daily pain in her low back
c. Your client reports he has been having headaches, which he believes are due to tension in his neck and jaw
d. During your initial interview with a new client, you notice that she continually clenches her hands as she talks about the tension in her upper back
16. The practitioner welcomes a client into her office. The client fills out an intake form and notes his mailing address, phone number, emergency contact information, and general somatic complaints, as well as medications he’s taking. She guides the client into the prepared treatment room, where she instructs the client on disrobing to his level of comfort, where to put his things, and how to get on the table and drape himself under the sheet. What important step has the practitioner missed in her pre-massage process?
a. warmly shaking the client's hand to put him at ease
b. verifying the client's date of birth
c. going over cancellation policies
d. ruling out contraindications for massage
Practice Quiz Answer Key
1. B
2. A
3. D
4. B
5. B
6. B
7. D
8. B
9. A
10. B
11. B
12. A
13. B
14. A
15. D
16. D
Client level of Health
Terminology
Assessment - The process of collecting information about the client, interpreting that information, and using it to make safe and effective treatment plans.
Asymmetry - A lack or absence of symmetry including a lack of proportion between the parts of a thing, or when bilateral structures vary noticeably in size, shape, or position.
Attitude - The client's approach to the massage or bodywork session; can be indicated by body language or statements made in the initial interview.
Body language (client) - The way a client holds and moves his/her body that may indicate their openness or lack thereof and can influence how a therapist approaches that person.
Breathing patterns - The quality of a client's breath including pace, depth, emphasis of either inhalation or exhalation, and the corresponding effect on the body's structures and tissues.
Client interview - The initial interview in which the therapist gathers information about the client's state of health and the client expresses his/her wants and needs in order to develop an effective session plan.
Energy level - A subjective condition reported by the client, ranging from hyperenergetic to very lethargic.
Fitness - A measure of a person's physical well-being and ability to perform daily activities.
Freedom of movement - The fluidity or rigidity of movement in a client's body; first evaluated during the initial interview.
General observation - Gaining an overall picture of the client's state of health through visual assessment during the initial interview.
Good health - A general condition in which no signs or symptoms of dysfunction are observed and the client enjoys a comfortable physical existence.
Health maintenance - Treatment that is focused on maintaining the client's optimal state of health and function.
Level of sympathetic dominance - The level of stress clients indicate through their behaviors during a client interview.
Mental stimulation - Intellectual or cognitive stimulus that encourages a healthy mind.
Nutrition - What a person eats and drinks in order to nourish the body.
Optimal health - A general term describing a consistent experience of vitality and excellent function in daily activities.
Palliative Care - A multidisciplinary approach to health care for people facing serious illnesses.
Poor health - A negative state of health in which function and quality of life is limited.
Relationships - From a somatic perspective, noticeable cause-and-effect connections between one area of the body and another.
Symmetry - The quality of something that has two sides or halves that are the same or very close in size, shape, and position. For example, when a selected muscle is close to the same size and shape on both sides of the body, or when a bony landmark such as the clavicle appears to be situated evenly on both the right and left sides of the body.
Terminal illness - An illness which is expected to result in death in a relatively short period of time (generally 6–12 months).
Therapeutic change - A measurable improvement in a client's tissues, mobility, or function as a result of treatment.
Vitality - A lively, vigorous, and energetic quality that communicates the capacity to live fully.
Wellness - An overall state of physical, mental, emotional, and spiritual health.
Practice Quiz
1. A practitioner observes that a client continues to limp when walking into the office, even though his injury is completely healed. This is an example of:
a. ligament laxity
b. a trigger point pattern
c. a compensation pattern
d. acute inflammation
2. A practitioner observes that a client’s two ears are on the same horizontal plane, but the right ear is shifted in front of the left. This is an example of ____ of the head.
a. lateral deviation
b. lordosis
c. rotation
d. posterior deviation
3. Points on the body used to determine postural deviations that are both at the same horizontal level are called:
a. balance landmarks
b. bilateral landmarks
c. anatomical neutral points
d. equidistant points
4. In a kyphotic posture, the client’s head is shifted:
a. anteriorly
b. posteriorly
c. left
d. right
5. A client’s right shoulder is higher than his left. This is an example of deviation in which plane?
a. horizontal
b. frontal
c. sagittal
d. transverse
6. In order to get a reference point for viewing imbalances in the body, ask the client to:
a. stand in front of a door frame
b. lay prone on the table
c. stand against a wall
d. lay supine on the table
7. The process of evaluating a client’s condition to determine which areas to work on and which techniques to use is referred to as:
a. compensation
b. muscle testing
c. assessment
d. treatment plan
8. When the body attempts to correct an imbalance or protect an area from injury by offsetting the posture in some way, this is known as:
a. compromised gait
b. a compensation pattern
c. flawed range of motion
d. a correction impulse
9. When massage is used as a tool to promote alteration in the physical, mental, emotional, or spiritual health of the client, it is categorized as:
a. therapeutic change
b. comfort care
c. condition management
d. health maintenance
10. One shoulder is elevated higher toward the client's ear than the other. This is an example of:
a. lordosis
b. lack of tone
c. kyphosis
d. asymmetry
11. An imbalance in which area is most likely to affect the posture of the entire body?
a. head
b. rib cage
c. shoulders
d. feet
12. Lordosis in a client’s spine is easiest to see when viewing the client:
a. from the front
b. from the back
c. when seated
d. from the side
13. When massage is not expected to cure the pathology but is used to reduce some symptoms or improve the body's ability to cope, it is categorized as:
a. condition management
b. health maintenance
c. therapeutic change
d. comfort care
14. When massage is used to help the client preserve their present state of well-being as part of a healthy lifestyle, it is categorized as:
a. condition management
b. therapeutic change
c. health management
d. comfort care
15. A visual observation of the client can help a practitioner rule out all of the following EXCEPT:
a. skin conditions
b. postural imbalance
c. injury history
d. restrictions in range of motion
16. The findings of a visual assessment should be recorded in which section of the SOAP notes?
a. plan
b. objective data
c. subjective data
d. assessment
17. You notice that your client’s skin is pale, her eyes are downcast, her shoulders are rounded forward, she is speaking slowly, and she seems depressed. She expresses that she has been feeling unmotivated due to fatigue. Which of the following approaches would best support elevating her energy level?
a. slow vibration
b. deep friction
c. slow gliding
d. light tapotement
18. If a client's head shifts forward of the plumb line, all of the following muscles are likely to be shortened EXCEPT:
a. erector spinae
b. pectoralis minor
c. scalenes
d. sternocleidomastoid
19. Gentle massage or laying-on of hands to ease pain and provide reassurance for serious illness, terminal illness, or the dying process is categorized as:
a. Palliative care
b. condition management
c. health maintanence
d. therapeutic change
20. Whether a practitioner is performing a wellness massage or a therapeutic massage, the assessment begins with:
a. evaluating postural deviations
b. performing range of motion tests
c. evaluating gait
d. understanding the client's goals
21. Information obtained visually based on the client's freedom of movement, physical symmetry, breathing patterns, skin condition, level of sympathetic dominance, body language, and gestures is referred to as:
a. general observations
b. pain assessment
c. general visual cues
d. posture assessment
22. Gait is a description of how a person:
a. sits
b. stands
c. walks
d. compensates
Practice Quiz Answer Key
1. C
2. C
3. B
4. A
5. B
6. A
7. C
8. B
9. A
10. D
11. D
12. D
13. A
14. C
15. C
16. B
17. D
18. A
19. A
20. D
21. A
22. C
Palpation Assessment
Terminology
Adhesion - An area of connective tissue that is bound or restricted, or where ground substance is thick and stiff.
Asymmetry - A lack or absence of symmetry including a lack of proportion between the parts of a thing, or when bilateral structures vary noticeably in size, shape, or position.
Bilateral - A condition, quality, or structure that can be found on both sides of the body.
Bone - Firm connective tissue composed of cells, fibers, and ground substance.
Bony landmarks - Attachment points for muscles or passageways for blood vessels and nerves that are used as palpable reference points when locating structures during palpation or viewing the body during a posture assessment.
Breathing patterns - The quality of a client's breath including pace, depth, emphasis of either inhalation or exhalation, and the corresponding effect on the body's structures and tissues.
Communication skills - The ability to connect with another person by using effective language or touch.
Deep - The quality of a client's breath including pace, depth, emphasis of either inhalation or exhalation, and the corresponding effect on the body's structures and tissues.
Fascia - Multiple layers of connective tissue that surround and connect all structures of the body in a web-like unit.
Fiber direction - The orientation of muscle fibers; how they are arranged relative to the skeleton.
Hypertonic - Greater-than-normal tone in a muscle.
Hypotonic - Less-than-normal tone in a muscle.
Landmarks - Palpable or visible anatomical features that aid a massage practitioner in locating specific structures or tissues.
Layers of tissue - Overlapping tissues within the body, from superficial to deep.
Muscle belly - Largest middle portion of a muscle.
Origin - The more stable attachment site of a muscle.
Palpable findings - Information about the body that can be gained through palpation.
Palpate - To examine by means of touching.
Palpation - The skilled touch a massage practitioner uses to gain information about the quality of the body's tissues.
Palpation assessment - An assessment of the client's structures and tissues based on what is felt in the tissue.
Physical characteristics - Characteristics of the body that can be seen with visual observation, including height, weight, etc.
Qualitative measurement - Using descriptive adjectives to clarify the characteristics of a sign or symptom.
Quality of movement - Characteristics of joint movement (e.g., does the movement feel jumpy, jarring, smooth; is there crepitus in the joint, etc.)
Quantitative measurement - Using a numerical assessment or a scale of mild, moderate, and severe in order to measure the intensity of a sign or symptom.
Structural asymmetry - Imbalance or a noticeable difference in bilateral structures of the body.
Superficial - On the surface of the body.
Superficial fascia - Fascia in the superficial realm of the body; just beneath the skin.
Symmetry - The quality of something that has two sides or halves that are the same or very close in size, shape, and position. For example, when a selected muscle is close to the same size and shape on both sides of the body, or when a bony landmark such as the clavicle appears to be situated evenly on both the right and left sides of the body.
Temperature differences (palpation) - Noticing a warmer or cooler quality in an area of the body can provide information about the underlying tissues.
Tissue quality - The palpable characteristics of a certain tissue (e.g., hypertonic or hypotonic, warm or cool, etc.).
Tissue texture - The tactile sensation of palpating tissue (e.g., grainy, smooth, dense, etc.).
Visual findings - Information that a therapist can gather by looking at a client.
Practice Quiz
1. When palpating tendons, a practitioner is likely to notice that they:
a. feel denser than muscle tissue
b. feel more thixotropic than muscle tissue
c. feel more sol than muscle tissue
d. feel more pliable than muscle tissue
2. The practice of assessing a client’s tissues through touch is known as:
a. gait assessment
b. palpation assessment
c. structural assessment
d. functional assessment
3. If a client is experiencing edema, her tissue will feel:
a. spongy
b. toned
c. knotted
d. hard
4. When holding the hands just above the client's body, a practitioner can feel differences in:
a. soft tissue texture
b. skin conditions
c. left and right symmetry
d. temperature
5. During a health-care session, one objective of palpation assessment is to:
a. detect irregularity in tissue textures
b. palpate attentively and continuously in order to maintain a light and gentle touch
c. to palpate attentively and continuously in order to memorize muscle structures
d. detect irregularity in client expectations of massage and the limitations of massage
6. Palpation of bony landmarks, such as locating the superior spine of the scapula, can help a practitioner determine:
a. breathing patterns
b. range of motion
c. the degree of symmetry
d. the density of soft tissue
7. A practitioner with strong palpation skills:
a. feels nuances in his/her own physical body and adjusts body mechanics accordingly
b. feels nuances in tissue temperature, texture, hydration, tone, and depth
c. regularly gathers subjective data on SOAP forms and documents it correctly
d.
8. The subtle ebb and flow of cerebrospinal fluid is most easily felt at:
a. the abdomen
b. the heart
c. the posterior knee
d. the cranium
9. These will always feel taut, regardless of the position of a joint:
a. muscles
b. tendons
c. ligaments
d. fasciae
10. To palpate the piriformis you would:
a. drop through the gluteus maximus
b. drop through the biceps femoris
c. remain superficial to the biceps femoris
d. remain superficial to the gluteus maximus
11. During a wellness session, the objective of palpation is:
a. to palpate attentively and continuously in order to reduce adhesions and scar tissue
b. to palpate attentively and continuously in order to memorize muscle structures
c. to palpate attentively and continuously in order to adjust the depth and speed of strokes to ensure the client's comfort
12. Temperature differences felt on the client's skin can be an indication of differences in:
a. liver function
b. circulation
c. digestion
d. endocrine function
13. A practitioner's palpation skills rely on his/her responsiveness developed predominantly in:
a. nociceptors that reside in the skin
b. Krause's end bulbs that reside in the skin
c. mechanoreceptors that reside in the skin
d. muscle spindles that reside in the skin
14. If a client is tense and stressed, the practitioner may notice that the client’s breath:
a. noticeably fills the abdomen
b. is easily directed toward areas of tension
c. is concentrated in the upper chest
d. is deep and regular in rhythm
15. If a client’s muscles feel like they are dissolving or falling away under pressure, this is a sign of:
a. trigger points
b. scar tissue
c. hypertonicity
d. poor nutrition
16. Lymphatic tissue is accessible by palpating the
a. deep skeletal muscles
b. abdominal viscera
c. superficial fascia
d. deep fascia
17. When practicing palpation assessment to test for areas of tension, it is best to make contact:
a. by gently resting the surface of your palm on your client
b. at the deepest layers of muscle tissue
c. while instructing the client to actively tense the tested area
d. with a slow, gradual, and sustained pressure
18. When palpating the muscles of the upper back, the most superficial muscle is the:
a. rhomboid
b. erector
c. intercostal
d. trapezius
19. Slow, deep breathing is usually an indication of ___ nervous system activity.
a. sympathetic
b. parasympathetic
c. motor
d. sensory
Practice Quiz Answer Key
1. A
2. B
3. A
4. D
5. A
6. C
7. B
8. D
9. C
10. A
11. C
12. B
13. C
14. C
15. D
16. C
17. D
18. D
19. B
Posture Assessment
Terminology
Anterior pelvic tilt - A movement of the pelvis in the sagittal plane that occurs at the lumbosacral and/or hip joints where the pelvis tilts in an anterior direction. The posterior superior iliac spine (PSIS) rises superiorly and the anterior superior iliac spine (ASIS) moves inferiorly.
Anterior view - The view of the front of the body.
Assessment - The process of collecting information about the client, interpreting that information, and using it to make safe and effective treatment plans.
Asymmetry - A lack or absence of symmetry including a lack of proportion between the parts of a thing, or when bilateral structures vary noticeably in size, shape, or position.
Bony landmarks - Attachment points for muscles or passageways for blood vessels and nerves that are used as palpable reference points when locating structures during palpation or viewing the body during a posture assessment.
Cervical curve - The natural curve in the cervical spine located between the atlas and the seventh cervical vertebra.
Head tilted laterally - When the head tilts to the right or the left of midline.
Head-forward position - When the head shifts anteriorly in relation to the neck and shoulders.
Hyperkyphosis - An exaggerated outward curvature of the thoracic spine resulting in a rounded upper back.
Hyperlordosis - An exaggerated inward curvature of the lumbar spine resulting in a swayback.
Ideal posture - Describes an anatomically neutral posture in which all structures of the body are optimally placed in relation to each other so as to minimize impact on the tissue and maximize functionality.
Lateral pelvic tilt - When the pelvis tilts to the right or the left.
Lateral view - The view of the body from the right or left sides.
Lumbar curve - The natural curve in the lower spine (L1–L5).
Military neck - A postural dysfunction in which the cervical curve is abnormally decreased or absent, causing the posterior of the neck to appear elongated; comes from soldiers' position at attention.
Posterior pelvic tilt - When the pelvis tilts in a posterior direction; posterior superior iliac spine (PSIS) moves inferiorly and anterior superior iliac spine (ASIS) moves superiorly.
Posterior view - The view of the body from the back.
Postural dysfunction - Any position of the body that exerts undue strain on body structures or tissues.
Posture - The way in which a person holds the body's structures in space and in relation to each other.
Posture assessment - Evaluating a client's posture to determine where structures are experiencing undue strain.
Qualitative measurement - Using descriptive adjectives to clarify the characteristics of a sign or symptom.
Quantitative measurement - Using a numerical assessment (or sometimes a scale of mild, moderate, and severe) in order to measure the intensity of a sign or symptom.
Scoliosis - A lateral S-curve shape to the spine.
Spinal curves - The normal curves of the spine in the lumbar, thoracic, and cervical regions.
Symmetry - The quality of something that has two sides or halves that are the same or very close in size, shape, and position. For example, when a selected muscle is close to the same size and shape on both sides of the body, or when a bony landmark such as the clavicle appears to be situated evenly on both the right and left sides of the body.
Thoracic curve - The normal curve in the mid-back area from T1–T12.
Practice Quiz
1. If the spine has too little curve, it is likely to be:
a. more unstable
b. more rigid and inflexible
c. more prone to shear
d. more prone to torsion
2. Hypertonic iliopsoas muscles and rectus femoris muscles caused by prolonged postural positions such as slouching may lead to:
a. superlordosis
b. supralordosis
c. hyperlordosis
d. hypolordosis
3. In scoliosis, the muscles on the convex side of the curve will be:
a. shortened
b. hypertonic
c. overstretched
d. contracted
4. Muscles that are likely short and hypertonic when a lateral pelvic tilt is observed include:
a. gluteus medius, rectus abdominis, and abductors on the side with the elevation
b. rectus abdominis, gluteus maximus, and lateral rotators on the side with elevation
c. iliopsoas, rectus abdominis, and gluteus medius on the side with elevation
d. gluteus medius, quadratus lumborum, and abductors on the side with elevation
5. If the client has a posterior pelvic tilt, the anterior superior iliac spine (ASIS) will:
a. tip forward
b. tip backward
c. rotate medially
d. rotate laterally
6. A large, lined chart posted on a wall in the session room is a:
a. posture grid
b. footprint board
c. body board
d. plumb line
7. If the spine has too much curve, it is likely to be:
a. more unstable
b. more prone to shear
c. more prone to torsion
d. more rigid and inflexible
8. Postural muscles are:
a. composed of fast-twitch, gray fibers that sustain a fully contracted state for long periods of time
b. composed of slow-twitch, red fibers that sustain a fully contracted state for long periods of time
c. composed of slow-twitch, red fibers that sustain a semi-contracted state for long periods of time
d. composed of fast-twitch, gray fibers that sustain a semi-contracted state for long periods of time
9. The sternocleidomastoid muscles, upper trapezius, suboccipitals, levator scapulae, scalenes, and pectoralis major and minor are likely to be hypertonic with these related postural dysfunctions:
a. hyperlordosis and head-forward position
b. hyperkyphosis and military neck
c. hyperkyphosis and head-forward position
d. hyperlordosis and military neck
10. Spinal deformities, usually genetic or congenital, that cause vertebrae to rotate and the rib cage to shift cause:
a. structural scoliosis
b. functional kyphosis
c. structural kyphosis
d. functional scoliosis
11. The erector spinae, quadratus lumborum, iliopsoas, rectus femoris, tensor fasciae latae, and adductors are likely to be hypertonic with this postural dysfunction:
a. military neck
b. hyperlordosis
c. hyperkyphosis
d. scoliosis
12. In a dysfunctional posture:
a. trigger points in bilateral back muscles are reduced
b. trigger points in bilateral neck muscles are reduced
c. some muscles become balanced bilaterally and place vertical forces on certain joints
d. some muscles become chronically shortened and prone to the development of trigger points
13. Primary curves of the spine are:
a. the thoracic curve and the coccygeal curve
b. the cervical curve and the coccygeal curve
c. the thoracic curve and the lumbar curve
d. the lumbar curve and the cervical curve
14. The greater the lack of symmetry in the left and right sides of the body, the greater the potential for:
a. osteoporosis or bone diseases
b. health and wellness
c. injury and dysfunction
d. muscular imbalance and fascial health
15. The rhomboids, middle trapezius, erector spinae in the thoracic region, longus capitis, and longus cervicis are likely to be adapted, overstretched, and weakened with these related postural dysfunctions:
a. hyperlordosis and military neck
b. hyperlordosis and head-forward position
c. hyperkyphosis and military neck
d. hyperkyphosis and head-forward position
16. When the head is maintained to one side or the other with a slight lateral flexion it is called:
a. military neck
b. lateral head tilt
c. lateral retraction
d. flexed head tilt
17. From a lateral view, a practitioner can observe:
a. protracted or retracted shoulder
b. pes valgus and pes vargus of the patella
c. a shoulder elevation or depression
d. a protracted or retracted scapula
18. Abnormal muscle spindle reactions, imbalances in the labyrinth of the inner ear, or abnormally sized structures (e.g., the right halves of the vertebral bodies are larger than the left, etc.) are factors leading to:
a. functional kyphosis
b. structural kyphosis
c. structural scoliosis
d. functional scoliosis
19. During a posture assessment, the practitioner:
a. determines muscles that are weak and hypertonic
b. determines muscles that are long and hypertonic
c. determines muscles that are loose and hypertonic
d. determines muscles that are short and hypertonic
Practice Quiz Answer Key
1. B
2. C
3. C
4. D
5. B
6. A
7. A
8. C
9. C
10. A
11. B
12. D
13. A
14. C
15. D
16. B
17. A
18. C
19. D
Range of Motion Assessment
Terminology
Action - The skeletal movement created by a certain muscle.
Active range of motion - Range of motion that is actively performed by the client with no assistance from the massage practitioner.
Agonist - The muscle mainly responsible for a given movement; the prime mover.
Anatomical restrictions - Any condition that imposes a restriction on the function of the anatomical structure.
Antagonist - A muscle that acts in opposition to the agonist/prime mover.
End feel - A muscle that acts in opposition to the agonist/prime mover.
Firm end feel - When movement of a joint is limited by the resistance of soft tissue being stretched taut.
Freedom of movement - The fluidity or rigidity of movement in a client's body; first evaluated during the initial interview.
Hard end feel - The restricted motion felt in a joint upon approaching an anatomic or physiological barrier.
Joint - A place where two or more bones are joined together for the purpose of allowing body parts to move. Also called an articulation.
Joint capsule - A fibrous connective tissue sleeve that surrounds the articular cavity of a freely movable joint, is attached to the bones, completely encloses the joint, and is composed of an outer fibrous membrane and an inner synovial membrane.
Joint cavity - The closed sac formed by the joint capsule, which contains the synovial fluid.
Ligaments - Connective tissue that attaches bone to bone.
Passive range of motion - Range of motion that is performed by the massage practitioner with no effort by the client.
Primary function - The main function or action of a muscle.
Prime mover - Agonist; the muscle mainly responsible for a given movement.
Quality of movement - Characteristics of joint movement (e.g., does the movement feel jumpy, jarring, smooth; is there crepitus in the joint, etc.)
Range of motion - The amount of movement possible within a joint; measured in degrees.
Range of motion assessment - Assessing the range of motion in a given joint, including degrees of movement possible, the quality of end feel, and subjective information offered by the client.
Resisted range of motion - Range of motion exercise in which the client resists the practitioner's attempt to gently move a body part.
Restricted range of motion - Diminished range of motion in a joint or diminished extensibility in muscle tissue or fascia that limits joint movement.
Soft end feel - When joint movement is limited by soft tissues running into each other.
Synergists - Muscles that assist the prime mover to perform a certain action.
Synovial fluid - Fluid within the synovial cavity that lubricates the joint.
Synovial joint - A joint possessing a fluid-filled cavity separating bones.
Synovial membrane - Thin connective tissue lining of the fibrous capsule in diarthrotic joints and bursae.
Target muscle - The muscle that is isolated in a certain action or movement (e.g., the biceps is the target muscle of flexion at the elbow).
Practice Quiz
1. Evaluating a client's broad functional capacity is best done through ___ assessment.
a. resisted range of motion
b. assisted range of motion
c. active range of motion
d. passive range of motion
2. What should a therapist always do before asking a client to perform active-assisted range of motion?
a. perform deep compression to the area
b. perform full-body massage
c. demonstrate the movement himself
d. have the client perform active-resisted range of motion
3. When passively stretching a client, it is important to remember to:
a. begin the session with vigorous stretching to warm the tissues up
b. bounce the client's limb to encourage release of held tension
c. move quickly through the stretches to restore range of motion
d. stay in communication with the client about his comfort level
4. What type of tissue offers resistance to movement in a hard end feel?
a. organ
b. muscle
c. tendon
d. bone
5. Which of the following is NOT considered a normal end feel?
a. spasm
b. soft
c. hard
d. firm
6. A practitioner asks a client to abduct his arm while she provides pressure in the opposite direction. This technique is known as:
a. active-resisted range of motion
b. passive range of motion
c. active-assisted range of motion
d. assisted range of motion
7. One reason practitioners perform range of motion assessment is to:
a. identify any pathological restrictions present in a particular joint
b. identify if a joint has appropriate ligament strength based on its workload
c. identify if any bones are improperly formed in a particular joint
d. identify if the joint has appropriate lubrication with synovial fluid
8. For a full range of motion assessment, how should the client be dressed?
a. fully undressed and covered with a drape
b. wearing normal street clothes and everyday shoes
c. wearing loose, baggy clothing
d. undergarments/swimsuit and barefoot
9. One reason practitioners perform range of motion assessment is to:
a. evaluate the client's ability to move certain joints
b. evaluate the client's grace and style
c. evaluate the length of the client's long bones and joint capsules
d. evaluate the symmetry of the body's structures
10. While passively assessing the available range of extension in a client’s glenohumeral joint, you notice the movement is resisted due to hypertonic tissue. An example of:
a. soft end feel
b. firm end feel
c. hard end feel
d. empty end feel
11. Pivot joints allow for what type of motion?
a. rotation
b. flexion
c. abduction
d. adduction
12. What is an example of the type of tissue that would create a soft end feel?
a. muscle
b. joint capsule
c. bone
d. damaged tendon
13. The difference between the amount of movement a client can create in a joint and the extra amount of movement a therapist can create is a measure of:
a. flexibility
b. joint play
c. active resistance
d. passive resistance
14. The amount of movement possible within a joint, depending on structure and condition, is referred to as:
a. range of motion
b. degree of restriction
c. freedom of movement
d. joint play
15. What massage technique can be used effectively to treat joint capsule injury?
a. passive range of motion
b. joint capsule injury cannot be treated with massage
c. direction of ease
d. active range of motion
16. Joint movement performed by the practitioner while the client remains relaxed is called:
a. passive range of motion
b. assisted range of motion
c. partial range of motion
d. active range of motion
17. Passive range of motion assessment evaluates:
a. strength loss due to motor nerve compression
b. the client's pain level as he/she moves a particular joint
c. the client's broad functional capacity, including willingness to move
d. the quality of the movement and contractile tissue
18. To rebuild strength and re-educate muscle fibers after an injury, which type of ROM is most helpful?
a. passive-resisted
b. active-assisted
c. passive-assisted
d. active-resisted
19. Restrictions that are caused by the shape or function of structures that make up the joint itself are called ___ restrictions.
a. structural
b. pathological
c. fixation
d. anatomical
20. When a therapist feels the client's tissues "push back" when performing passive range of motion, this is known as the:
a. firm end feel
b. soft end feel
c. passive end feel
d. normal end feel
21. How does passive contraction affect the positioning of the origin and insertion of a muscle?
a. it does not affect their position
b. it moves them farther apart
c. it brings them closer together
d. it brings them into a superior alignment
22. When the shape of the bones stops a movement, as when a person extends his elbow all the way, this is classified as what type of end feel?
a. hard end feel
b. firm end feel
c. soft end feel
d. short end feel
23. The abbreviation ROM stands for:
a. range of metrics
b. restriction of movement
c. range of motion
d. restriction of muscle
24. Bringing a client's heel toward his glutes to stretch the quadriceps is an example of ____ range of motion.
a. abnormal
b. passive
c. active-assisted
d. active-resisted
25. When the normal amount of play possible in the joint capsule space is diminished, this is known as:
a. frozen joint
b. subluxation
c. short end feel
d. joint fixation
Practice Quiz Answer Key
1. C
2. C
3. D
4. D
5. A
6. A
7. A
8. D
9. A
10. B
11. A
12. A
13. B
14. A
15. B
16. A
17. D
18. D
19. D
20. A
21. C
22. A
23. C
24. B
25. D
Pain Assessment
Terminology
Acute pain - Pain that comes on quickly, can be severe, but lasts only as long as the reason for the pain is present.
Aggravating activities - Activities that increase the pain or intensity of a symptom.
Allodynia - A type of neuropathic pain in which stimuli that are not usually experienced as painful cause pain.
Alpha-beta axons - Myelinated afferent neurons that convey sharp, precise, acute pain quickly to the brain.
C-fiber axons - Unmyelinated afferent neurons that convey diffuse, throbbing pain more slowly to the brain.
Chronic pain - Pain that persists for a long period of time past the point of typical injury recovery or in relationship to a medical condition.
Focal pain - Pain restricted to one local region of the body. The pain is felt in only one place.
Idiopathic pain - Pain with an unknown cause that cannot be categorized or diagnosed.
Intractable pain - Chronic pain that persists despite treatment.
Malingering pain - Pain fabricated for the purposes of achieving personal reward or satisfaction.
Multifocal pain - Pain sensations are broadly distributed. Pain is felt in more than one place.
Neuropathic pain - Pain resulting from injury or malfunction in the peripheral or central nervous system.
Nociceptive pain - Pain caused by tissue injury or the potential for tissue injury detected by nociceptors.
Nociceptors - Sensory receptors that detect potentially damaging stimuli, often resulting in the perception of pain.
Pain - An unpleasant physical and emotional sensation associated with tissue damage or immediate potential for tissue damage.
Pain assessment - A number of methods used to capture a client's experience of pain at a given point in time.
Pain questionnaire - Questions asked by the therapist in order to evaluate the qualitative and quantitative experience of pain, as well as other details of the experience of pain.
Phantom pain - Pain experienced in a limb that has been amputated. It is believed to be caused by spontaneous nerve impulses generated due to damage from the amputation.
Psychogenic pain - Pain associated with psychological factors such as depression or anxiety.
Qualitative measurement - Using descriptive adjectives to clarify the characteristics of a sign or symptom.
Quantitative measurement - Using a numerical assessment (or sometimes a scale of mild, moderate, and severe) in order to measure the intensity of a sign or symptom.
Radiating pain - Pain that extends out from the injured area along specific spinal nerve root distributions (dermatomes).
Referred pain - Pain experienced at a site different from the injured or diseased organ or body part, with a nerve supply different from that of the source of pain, often with recognized referral patterns.
Relieving activities - Activities that reduce the pain or intensity of a symptom.
Somatic pain - Pain associated with structures of the body wall.
Visceral pain - Pain associated with internal organs of the body.
Visual analog measures - A way to qualitatively measure pain and other symptoms by asking a client to mark a specific point on a spectrum, choose a facial expression on a diagram, or indicate through other visual means the intensity of the symptom.
Practice Quiz
1. Pain that comes on quickly, can be severe, but lasts only as long as the reason for the pain is present is defined as:
a. chronic pain
b. focal pain
c. intractable pain
d. acute pain
2. One method of pain assessment is:
a. the use of trigger point methods
b. the use of a compass measure
c. the use of deep-tissue methods
d. the use of an analog measure
3. Pain with an unknown cause that cannot be categorized or diagnosed is called:
a. idiopathic pain
b. somatic pain
c. psychogenic pain
d. malingering pain
4. Massage reliably reduces pain for a wide variety of chronic conditions and special populations by:
a. using skin rolling and petrissage techniques
b. breaking the bonds between muscular structures that are stuck together
c. promoting relaxation
d. reducing deep, adhered tissue
5. Pain associated with stimuli that are not usually experienced as painful is called:
a. malingering pain
b. idiopathic pain
c. psychogenic pain
d. allodynia
6. The primary purpose of a pain assessment is to:
a. identify muscles that are long and weak and causing the client pain
b. document a client's experience of pain at a given point in time
c. identify muscles that are short and tight and causing the client pain
d. decrease sympathetic nervous system firing to decrease sensations of pain
7. Pain that extends out from the injured area along specific spinal nerve root distributions (dermatomes) is defined as:
a. chronic pain
b. intractable pain
c. radiating pain
d. multifocal pain
8. Pain associated with psychological factors such as depression or anxiety is called:
a. psychogenic pain
b. malingering pain
c. somatic pain
d. idiopathic pain
9. One benefit of conducting a pain assessment is:
a. it decreases sympathetic nervous system activation to promote relaxation
b. documentation helps to prove client injury to an insurance provider or court
c. it decreases sympathetic nervous system activation to promote relaxation
d. documentation reliably reduces the client's emotional connection to the pain
10. Pain stimuli are conveyed to the brain centers via two types of axons, one of which is:
a. P-fiber axons
b. Alpha-beta axons
c. allodynia axons
d. nociceptors
11. Pain is best described as:
a. a generalized experience that is easy to describe and document
b. an emotional experience that relates directly to levels of muscle tension in the body
c. a highly personal, individual experience that is perceived consciously and subconsciously
12. The intensity and quality of pain due to physical trauma vary among individuals because of all the following EXCEPT:
a. past experiences
b. nerve type
c. gender
d. ethnicity
13. Pain that persists for a long period of time, past the point of typical injury recovery or in relationship to a medical condition, is defined as:
a. chronic pain
b. intractable pain
c. acute pain
d. focal pain
14. Physically, pain results from:
a. golgi tendon stimulation
b. sensory nerve stimulation
c. muscle spindle stimulation
d. motor nerve stimulation
15. One benefit of conducting a pain assessment is:
a. documentation of regularly conducted pain assessments demonstrates the need for massage to other therapists at a massage clinic
b. to promote strength in lengthened muscles that will reduce sensations of pain
c. to promote length in shortened muscles that will reduce sensations of pain
d. documentation of regularly conducted pain assessments demonstrates the need for massage to referring physicians
16. Chronic pain that persists despite treatment is defined as:
a. radiating pain
b. intractable pain
c. acute pain
d. focal pain
17. One method of pain assessment is:
a. the use of trigger point methods
b. the use of deep-tissue methods
c. the use of an EEG reading
d. the use of pain and disability indexes
18. Pain associated with internal organs of the body is called:
a. nociceptive pain
b. maligering pain
c. phantom pain
d. visceral pain
19. Pain stimuli are conveyed to the brain centers via two types of axons, one of which is:
a. nociceptors
b. C-fiber axons
c. allodynia axons
d. P-fiber axons
20. The sensory receptors that transmit sensations of pain are:
a. motor nerves
b. P-receptors
c. C-fiber axons
d. nociceptors
21. Pain fabricated for the purposes of achieving personal reward or satisfaction is called:
a. malingering pain
b. aaoldynia
c. psychogenic pain
d. idiopathic pain
22. When pain is restricted to one local region of the body and felt in only one place, it is defined as:
a. radiating pain
b. intractable pain
c. focal pain
d. referred pain
23. When pain is restricted to one local region of the body and felt in only one place, it is defined as:
a. pain
b. fibromyalgia
c. depression
d. osteoarthritis
Practice Quiz Answer Key
1. D
2. D
3. A
4. C
5. D
6. B
7. C
8. A
9. B
10. B
11. C
12. B
13. A
14. B
15. D
16. B
17. D
18. D
19. B
20. D
21. A
22. C
23. A
Functional Limitations Assessment
Terminology
Activities of daily living - Actions a person performs every day in order to function.
Aggravating activities - Activities that increase the pain or intensity of a symptom.
Attainable (A-SMART goals) - When a functional goal is realistic in relationship to the client's current condition.
Functional goals - Goals related to the performance of functional activities.
Functional limitations - Common daily activities that are limited by a symptom or condition.
Functional limitations assessment - The process of determining the extent of a client's limitation to perform daily activities due to a symptom or condition.
Functional outcomes reporting - A form of SOAP or chart notes that focus on the client's ability to function in activities of daily life.
Measurable (M-SMART goals) - When a functional goal is quantified and qualified in order to demonstrate progress.
Relevant (R-SMART goals) - When a functional goal relates to an activity of daily life that is important to the client.
Relieving activities - Activities that reduce the pain or intensity of a symptom.
SMART goals - Characteristics of effective goal setting; goals should be specific, measurable, attainable, realistic, and time-bound.
Specific (S-SMART goals) - When a functional goal is explicit to an activity of daily life.
Time-bound (T-SMART goals) - When a functional goal is determined so that the client can reliably reach it within 14 days (short-term goal) or 60 days (long-term goal).
Practice Quiz
1. To qualify a goal:
a. describe what the client should feel like at the completion of the activity
b. describe how much of the activity should be performable
c. document progress on an analog measure to demonstrate progress
d. describe the specific activity to be achieved
2. Functional goals are written using the acronym SMART, which includes all of the following EXCEPT:
a. specific
b. measurable
c. assessment
d. time-bound
3. Carrying items, lifting items, walking up and down stairs, and grasping and holding objects are defined as:
a. psychological functions
b. basic functions
c. motor functions
d. physical functions
4. Functional limitations impact clients:
a. socially
b. physically
c. psychologically
d. on many levels
5. Which of these functional goals for the client is written with the correct degree of specificity?
a. participate in house-cleaning activities with mild pain
b. clean the house
c. participate in all aspects of cleaning the house
d. vacuum the floor 2 times a week with mild pain
6. Which of these functional goals is properly qualified?
a. life a 26-pound child in and out of a car seat 6 times a day with moderate pain
b. lift a 5-lb box onto a conveyer belt for 1 hour, three times during the day
c. life a 26-pound child in and out of a car seat 6 times a day
d. life 5-lb boxes onto a conveyer belt for work
7. A goal that is attainable is:
a. inspirational in that it conveys the idea the body is capable of amazing healing and change
b. realistic in that it never suggests the client will be pain-free with an activity
c. realistic in relationship to the client's current condition
d. inspirational and helps the client strive for excellence in the performance of an activity
8. A functional outcome is most likely documented like this:
a. with a gold star placed on the SOAP chart next to the functional goal
b. with a line through the functional goal
c. achieved 7/14/2015
d. with a check mark next to the functional goal
9. When the client reaches a short- or long-term functional goal:
a. a gold star is placed next to it in the P section of the SOAP chart
b. it is eliminated from the S section of the SOAP chart
c. it is documented in the A section of the SOAP chart
d. it is crossed out in the O section of the SOAP chart
10. Daily activities that are limited by a condition or a symptom are referred to as:
a. conditional limitation
b. daily limitations
c. symptom limitations
d. functional limitations
11. Which of these functional goals is properly time-bound?
a. by next year, be able to run 3 miles 3 times per week with mild-plus knee pain
b. in 14 days, be able to run 3 miles 3 times per week with mild-plus knee pain
c. by January, be able to run 3 miles 3 times per week with mild-plus knee pain
d. in 80 days, be able to run 3 miles with limited knee pain
12. Which of these functional goals for the client is written with the correct degree of specificity?
a. participate in child-care activities with moderate pain
b. be able to lift a child out of a car seat
c. lift a 26-pound child in and out of a car seat 6 times a day with moderate pain
d. take care of a child
13. Functional goals are:
a. the basic functions the client reports he/she can accomplish before the massage session starts
b. the basic functions the client reports he/she accomplished as a result of massage sessions
c. goals written before the session to define particular activities the client would most like to accomplish in daily life without a significant increase in symptoms
d. goals written after the session to define particular activities the client doesn't currently participate in as part of daily life
14. Functional goals are documented in this section of a SOAP chart:
a. S
b. O
c. A
d. P
15. Any restriction or impairment of basic physical function is called:
a. a functional limitation
b. a functional challenge
c. a psychological disability
d. a physical disability
16. A potential aggravating activity is:
a. soaking in a warm bath
b. using analgesics
c. gentle stretches
d. driving to work
17. A potential aggravating activity is:
a. list all activities that relieve the client's symptoms
b. list all work tasks in the order in which they cause the greatest increase in symptoms
c. list all child-care tasks that must be completed each day
d. prioritize two or three activities they find important
18. To quantify a goal:
a. describe how much of the activity should be performable
b. describe the specific activity to be achieved
c. describe what the client should feel like at the completion of the activity
d. document progress on an analog measure to demonstrate progress
19. A relevant goal is:
a. a goal the practitioner feels is especially important
b. a goal set by an insurance provider that ensures payment for treatment
c. a goal the client feels motivated to achieve
d. a goal set by a physician to ensure continued referrals
20. Which of these functional goals is measurable?
a. life a 5-lb box onto a conveyer belt for 1 hour three times during the day with mild-plus pain
b. lift boxes onto a conveyer belt during work
c. participate in all aspects of cleaning the house
d. participate in house-cleaning activities with mild pain
21. Clients feel motivated to participate in self-care activities and massage treatments when functional goals are:
a. relevant
b. quantifiable
c. measurable
d. specific
22. Seeing, hearing, speaking, walking, sitting or standing are defined as:
a. psychological functions
b. motor functions
c. basic functions
d. physical functions
Practice Quiz Answer Key
1. A
2. C
3. B
4. D
5. D
6. A
7. C
8. C
9. C
10. D
11. B
12. C
13. C
14. C
15. A
16. D
17. D
18. A
19. C
20. A
21. A
22. C
Session Planning
Terminology
Acute stage - The initial stage of the inflammatory response where the body aims to limit blood loss, inundate the injured area with healing components, and remove damaged tissue.
Assessment - The process of collecting information about the client, interpreting that information, and using it to make safe and effective treatment plans.
Client intake - The process of the client filling out a health history form, conducting an initial client interview, answering questions from the client, and developing a plan for treatment.
Client interview - The initial interview in which the therapist gathers information about the client's state of health and the client states his/her wants and needs in order to develop an effective session plan.
Follow-up questions - Questions asked by the therapist in response to information given by a client in order to clarify or obtain further information about a particular condition.
Functional goals - Goals related to the performance of functional activities.
Maturation stage - The final phase of the inflammatory response where scar tissue formation slows and the tissue is gradually able to withstand greater mechanical loads over time.
Repair stage - The second phase of the inflammatory response where new blood vessels develop and tissue regenerates.
SMART goals - Characteristics of effective goal setting; goals should be specific, measurable, attainable, realistic, and time-bound.
Session adaptations - Ways the sessions must be modified in order to accommodate contraindications or other qualities of a client's state of health that require caution.
Session planning - Using subjective and objective information to create a safe and effective plan for the performance of a massage or bodywork session.
Stress management - Methods for alleviating or minimizing the experience of stress in order to improve health and function.
Practice Quiz
1. In order to evaluate whether or not the treatment plan is effective, it is recommended to perform a thorough reassessment every:
a. session
b. 6-8 weeks
c. 2 weeks
d. 4-6 months
2. Which of the following is NOT a helpful question for determining a new client's expectations?
a. "What is your primary goal for this session?"
b. "How would you like to feel after the session?"
c. "Have you been satisfied with session you've had in the past?"
d. "What do you hope to achieve with this session?"
3. Which of the following is NOT a factor in deciding whether to start the client supine or prone?
a. the client remarks that he is most comfortable starting prone
b. the client request firm pressure throughout all areas of the body
c. the client wants to focus mainly on the back and posterior hips
d. the client has a sinus headache and significant congestion
4. Which of the following is NOT an example of quantitatively tracking a client's improvement?
a. documenting functional capabilities (e.g. "can wash dishes 10 minutes per day without pain")
b. documenting changes on a pain scale from 1-10
c. documenting range of motion on a percentage scale from 0-100%
d. taking subjective input such as "shoulder is feeling much better"
5. How can the practitioner reassure a first-time or modest client about her privacy in undressing?
a. tell her she can leave her clothes on if she prefers but that you strongly recommend that she remove all of her clothes
b. tell her it is normal to remove all clothing and she should not feel shy about it
c. tell her that her body is beautiful, and that massage is a celebration of that beauty
d. tell her you will knock before entering the room to ensure she is completely covered by the sheet
6. All of the following are appropriate ways to open a massage EXCEPT:
a. having the client perform breathing exercises
b. applying percussive strokes down the client's entire body
c. applying a resting stroke
d. ringing a chime
7. If a client has a rash on her lower leg, this is an example of a(n):
a. regional contraindication
b. indication
c. general indication
d. malignant condition
8. For which of the following clients would a condition management approach be most appropriate?
a. a client with a sprained ankle
b. a client with cerebral palsy
c. a client seeking stress relief
d. an athlete preparing for a marathon
9. If a general observation of the client reveals that the client has a medial shoulder rotation, the practitioner will want to address:
a. the adductor brevis, adductor magnus, sartorius, and pectineus fascial restrictions
b. the hypertonic erector spinae and paraspinal muscles in the lumbar region
c. chronically lengthened iliopsoas, rectus femoris, erector spinae, and quadratus lumborum muscles
d. the anterior deltoid, trapezius, pectoralis major and minor, teres major, and serratus anterior muscles
10. An elderly client returns for a second massage and complains that she felt uncomfortable lying prone for 45 minutes in her last session. How can the practitioner best address this issue?
a. suggest a shorter massage with no more than 20 minutes of prone work
b. advise the client that she should drink more water following the treatment
c. incorporate more rocking and range of motion into the prone massage routine
d. suggest she receive a 60-minute massage while seated in a chair
11. A client has been coming for monthly sessions for the past 6 months. In which of the following instances would the practitioner NOT recommend shifting to weekly sessions?
a. the client has been experiencing significantly more stress at work
b. the client is unable to perform the self-care recommendations
c. the client is beginning training to run in a marathon for the first time
d. the client is seeking rehabilitation for a broken leg, 8 weeks after the break
12. In the later subacute or repair stage of the healing process, a practitioner is planning a session to:
a. increasing sympathetic nervous system firing to stimulate the nervous system at the neuromuscular junction
b. reduce trigger points in the affected region and promote proper scar tissue formation
c. reduce tissue swelling and pain at the affected region and reduce sympathetic nervous system firing to support client recovery
d. reduce adhesions and scar tissue in the affected region and promote muscle strength
13. Deep breathing, visualization, or any conscious routine behavior that prepares the practitioner before the session is known as:
a. purging
b. focusing/ centering
c. releasing
d. meditation
14. All of the following are indications the practitioner may be using too much pressure EXCEPT:
a. the client's breathing becomes shallow or imperceptible
b. the affect muscle tightens under the practitioner's touch
c. the client winces and furrows her brow
d. the client sighs out a deep exhalation
15. If a general observation of a client reveals that the client has an elevated shoulder, the practitioner will want to address:
a. chronically lengthened iliopsoas, rectus femoris, erector spinae, and quadratus lumborum muscles
b. hypertonic scalenes, upper trapezius, and lower trapezius on the opposite side to the elevation
c. hypertonic scalenes, upper trapezius, and lower trapezius on the elevated side
d. cervical bursa that are hot, irritated, and causing trigger points
16. Where should the practitioner record the treatment plan for the next session?
a. as a separate document the client can take home
b. in the A section of the SOAP notes
c. in the P section of the SOAP notes
d. in a separate log devoted to the ongoing treatment plan
17. Which of the following is LEAST relevant in evaluating a change in the area of concern?
a. ask if the area felt better, worse, or no different after the last session
b. ask how long and relief or increased discomfort lasted
c. ask how much pain the client feels in that area today on a scale of 1-10
d. ask if the client has developed new pains or discomforts j
18. In the last 2 minutes of a massage session, a practitioner discovers an area of tension that seems to be the source of the client’s pain. Which of the following is NOT an appropriate treatment strategy?
a. tell the client this is an important area to address and ask her if she would like to focus there in the next session
b. work the area in a vigorous, therapeutic manner for the remainder of the massage session
c. tell the client this is an important area to address and give her some stretches to do at home that will target those muscles
d. ask the client if they would like to extend the session in order to address this area therapeutically
19. How can a practitioner best encourage a talkative, nervous client to relax?
a. ignore the client's monologue, and apply deep, slow pressure points to the feet until she relaxes
b. wait for the client to pause, then invite her to take 3 deep breaths, applying increased pressure on the exhalations
c. remind the client she is here to relax and this is a massage, not a therapy session
d. begin to respond more actively in the conversation, so that the client has less opportunity to talk
20. Before the client gets undressed, the practitioner should always remind each client to remove:
a. any hair ties
b. all jewelry
c. all undergarments
d. any medical devices
21. When is the best time to ask a client if he would like to schedule another appointment?
a. the next week during a follow-up phone call
b. before saying goodbye, immediately following the session
c. when the client arrives for his session
d. the next day during a follow-up phone call
22. If a posture assessment indicates that a client has a lateral head tilt, the practitioner would notice and want to address:
a. if the sternocleidomastoid, scalenes, upper trapezius, and levator scapula muscles on one side of the neck are hypertonic
b. chronically adapted and weakened rectus femoris, biceps femoris, semitendinosus, and vastus medialis muscles
c. chronically lengthened iliopsoas, rectus femoris, erector spinae, and quadratus lumborum
d. chronically shortened iliopsoas, rectus femoris, erector spinae, and quadratus lumborum
23. If the client reports that she woke up with a severe headache and neck pain, your treatment plan should be to:
a. reduce hypertonicities of the sternocleidomastoid, scalenes, upper trapezius, and levator scapula muscles
b. place a hot pack on the client's neck, massage the anterior upper chest muscles while the tissue warms up, and then proceed with a massage of the client's neck and scalp
c. place an ice pack on the client's neck and massage compensating structures
d. send the client to her primary care provider
24. If a posture assessment indicates that a client has "military neck," the practitioner would want to address:
a. hypertonic rectus femoris, biceps femoris, semitendinosus, and vastus medialis muscles
b. hypertonic iliopsoas and rectus femoris muscles
c. hypertonic sternocleidomastoid, longus capitis, and longus colli muscles
d. chronically lengthened iliopsoas, rectus femoris, erector spinae, and quadratus lumborum
25. The most appropriate treatment goal for terminally ill clients is to provide:
a. condition management
b. therapeutic change
c. health maintenance
d. palliative care
26. Is it ever OK to change the treatment plan in the middle of a massage?
a. no, but the practitioner can make recommendations for a different plan in the future
b. yes, but the practitioner should explain the reasoning to the client and get consent first
c. yes, if the practitioner believes it will benefit the client
d. no, the practitioner should always stick to the client's initial requests
27. In the acute stage of a healing process, a practitioner is planning a session to:
a. reduce adhesions and scar tissue in the affected region and promote muscle strength
b. reduce tissue swelling and pain at the affected region and reduce sympathetic nervous system firing to support client recovery
c. reduce trigger points in the affected region and promote proper scar tissue formation
d. increase range of motion in the affected region and reestablish muscular balance
28. A general contraindication requires ____ before any massage is performed.
a. complete resolution
b. a physician's evaluation
c. medication
d. muscle testing
29. If a practitioner is uncertain about the implications of a client’s condition, he should:
a. perform only energetic techniques with the client
b. obtain consent from treatment from the appropriate medical provider
c. see how the client responds after one session
d. refuse to see the client until the condition has resolved
Practice Quiz Answer Key
1. B
2. C
3. B
4. D
5. D
6. B
7. A
8. B
9. D
10. A
11. B
12. B
13. B
14. D
15. C
16. C
17. D
18. B
19. B
20. B
21. B
22. A
23. D
24. C
25. D
26. B
27. B
28. B
29. B
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