Texas Massage Therapist Licensing
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A client presents with acute low back pain that began after lifting a heavy
object. The pain is localized to the right sacroiliac joint and radiates into the
right gluteal region. During the postural assessment, you note that the
client's right iliac crest is higher than the left. Which of the following muscle
groups is most likely shortened and contributing to this pelvic asymmetry?
A. Right hip adductors
B. Right quadratus lumborum
C. Left gluteus maximus
D. Left erector spinae
Answer: B
Rationale: The quadratus lumborum originates on the iliac crest and
inserts on the 12th rib and transverse processes of the lumbar vertebrae.
When unilaterally shortened, it elevates the ipsilateral iliac crest, creating
the pelvic hike observed. Hip adductors primarily influence femoral
adduction, not pelvic height. The contralateral gluteus maximus and
erector spinae would not be the primary muscles causing an elevated
ipsilateral crest, though they may be involved in compensatory patterns.
2. In the state of Texas, which of the following actions constitutes a violation
of the Massage Therapy Practice Act regarding the use of the title "Licensed
Massage Therapist"?
A. Using the title while awaiting renewal of a license that expired less than
30 days ago
, B. Using the title after completing 500 hours of education but before
passing the licensing exam
C. Using the title when providing voluntary massage services at a charity
event without charging a fee
D. Using the title while working under the direct supervision of a physician
in a clinical setting
Answer: B
Rationale: Texas Occupations Code Chapter 455 strictly prohibits any
person from using the title "Licensed Massage Therapist" or "Massage
Therapist" unless they hold a current, valid license issued by the Texas
Department of Licensing and Regulation (TDLR). Completion of
educational hours alone, even if 500 hours are met, does not grant the
right to use the title until the examination is passed and the license is
issued. Expired licenses, voluntary services, or supervision do not
circumvent this legal requirement.
3. During a lymphatic drainage session, you are working on the cervical lymph
nodes. In which direction should the manual pressure be applied to
facilitate optimal lymphatic flow?
A. Medially toward the thyroid cartilage
B. Superiorly toward the angle of the mandible
C. Inferiorly toward the clavicle and venous angle
D. Posteriorly toward the cervical transverse processes
Answer: C
Rationale: The lymphatic system drains toward the venous angle, which is
the junction of the internal jugular and subclavian veins. In the cervical
region, superficial and deep lymphatics ultimately drain inferiorly to
empty into the thoracic duct on the left or the right lymphatic duct.
Applying pressure in an inferior direction toward the clavicle promotes
this natural drainage pathway. Medial, superior, or posterior directions
are not consistent with the primary anatomical drainage pattern of
cervical lymphatics.
,4. A massage therapist is treating a client with chronic tension headaches.
Which of the following muscles, when hypertonic, is most frequently
implicated in the referral of pain to the temporal region and behind the
eye?
A. Splenius capitis
B. Semispinalis capitis
C. Temporalis
D. Sternocleidomastoid
Answer: C
Rationale: The temporalis muscle is a major muscle of mastication. Its
trigger points commonly refer pain to the ipsilateral temporal area and
the eye, which is characteristic of a tension headache. While the splenius
capitis and semispinalis capitis are involved in neck pain and headaches,
their referral patterns are typically more occipital or vertex. The
sternocleidomastoid can refer pain to the forehead, ear, and eye, but the
temporalis is the classic muscle for temporal headache pain.
5. In accordance with Texas administrative rules, what is the minimum number
of continuing education (CE) hours required for a massage therapist to
renew their license, and what is the maximum number of hours that can be
completed through distance learning?
A. 24 total hours, with a maximum of 12 distance learning hours
B. 12 total hours, with a maximum of 6 distance learning hours
C. 24 total hours, with a maximum of 24 distance learning hours
D. 12 total hours, with a maximum of 12 distance learning hours
Answer: A
Rationale: Texas Administrative Code, Rule 117.40, requires licensees to
complete 24 hours of continuing education during each two-year renewal
period. Of these 24 hours, at least 12 hours must be obtained through in-
person, live instruction. This specifically limits distance learning (online,
home study, etc.) to a maximum of 12 hours per renewal cycle. The other
options are incorrect based on the specific hour requirements and
restrictions set by TDLR.
, 6. A client reports a history of deep vein thrombosis (DVT) in the left leg. The
therapist observes that the leg is swollen, warm, and slightly discolored.
The client mentions they stopped taking their blood thinner a week ago.
What is the most appropriate action for the therapist?
A. Proceed with a very light, superficial massage to avoid dislodging a clot
B. Use gentle stretching and range of motion to improve venous return
C. Avoid the affected leg and massage the rest of the body
D. Refuse to perform massage and refer the client to a physician
immediately
Answer: D
Rationale: The signs of swelling, warmth, discoloration, and a history of
DVT, combined with the cessation of anticoagulant medication, present a
high risk of an existing or new thrombus. Massage over an area with a
DVT poses a serious risk of thromboembolism. The therapist must
recognize this absolute contraindication, refuse treatment, and make an
immediate referral to a physician for medical evaluation. Modifying the
massage or avoiding only the leg is not sufficient or safe, as the risk of
embolization is too great.
7. The primary action of the serratus anterior muscle is to:
A. Retract and elevate the scapula
B. Protract and upwardly rotate the scapula
C. Depress and adduct the scapula
D. Rotate the scapula inferiorly
Answer: B
Rationale: The serratus anterior originates on the lateral surfaces of the
upper eight ribs and inserts on the medial border of the scapula. Its
primary actions are protraction (pulling the scapula forward and laterally)
and upward rotation of the glenoid fossa. This is essential for shoulder
flexion and abduction above 90 degrees. Retraction is performed by the
rhomboids, while depression is largely a function of the lower trapezius
and pectoralis minor.
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A client presents with acute low back pain that began after lifting a heavy
object. The pain is localized to the right sacroiliac joint and radiates into the
right gluteal region. During the postural assessment, you note that the
client's right iliac crest is higher than the left. Which of the following muscle
groups is most likely shortened and contributing to this pelvic asymmetry?
A. Right hip adductors
B. Right quadratus lumborum
C. Left gluteus maximus
D. Left erector spinae
Answer: B
Rationale: The quadratus lumborum originates on the iliac crest and
inserts on the 12th rib and transverse processes of the lumbar vertebrae.
When unilaterally shortened, it elevates the ipsilateral iliac crest, creating
the pelvic hike observed. Hip adductors primarily influence femoral
adduction, not pelvic height. The contralateral gluteus maximus and
erector spinae would not be the primary muscles causing an elevated
ipsilateral crest, though they may be involved in compensatory patterns.
2. In the state of Texas, which of the following actions constitutes a violation
of the Massage Therapy Practice Act regarding the use of the title "Licensed
Massage Therapist"?
A. Using the title while awaiting renewal of a license that expired less than
30 days ago
, B. Using the title after completing 500 hours of education but before
passing the licensing exam
C. Using the title when providing voluntary massage services at a charity
event without charging a fee
D. Using the title while working under the direct supervision of a physician
in a clinical setting
Answer: B
Rationale: Texas Occupations Code Chapter 455 strictly prohibits any
person from using the title "Licensed Massage Therapist" or "Massage
Therapist" unless they hold a current, valid license issued by the Texas
Department of Licensing and Regulation (TDLR). Completion of
educational hours alone, even if 500 hours are met, does not grant the
right to use the title until the examination is passed and the license is
issued. Expired licenses, voluntary services, or supervision do not
circumvent this legal requirement.
3. During a lymphatic drainage session, you are working on the cervical lymph
nodes. In which direction should the manual pressure be applied to
facilitate optimal lymphatic flow?
A. Medially toward the thyroid cartilage
B. Superiorly toward the angle of the mandible
C. Inferiorly toward the clavicle and venous angle
D. Posteriorly toward the cervical transverse processes
Answer: C
Rationale: The lymphatic system drains toward the venous angle, which is
the junction of the internal jugular and subclavian veins. In the cervical
region, superficial and deep lymphatics ultimately drain inferiorly to
empty into the thoracic duct on the left or the right lymphatic duct.
Applying pressure in an inferior direction toward the clavicle promotes
this natural drainage pathway. Medial, superior, or posterior directions
are not consistent with the primary anatomical drainage pattern of
cervical lymphatics.
,4. A massage therapist is treating a client with chronic tension headaches.
Which of the following muscles, when hypertonic, is most frequently
implicated in the referral of pain to the temporal region and behind the
eye?
A. Splenius capitis
B. Semispinalis capitis
C. Temporalis
D. Sternocleidomastoid
Answer: C
Rationale: The temporalis muscle is a major muscle of mastication. Its
trigger points commonly refer pain to the ipsilateral temporal area and
the eye, which is characteristic of a tension headache. While the splenius
capitis and semispinalis capitis are involved in neck pain and headaches,
their referral patterns are typically more occipital or vertex. The
sternocleidomastoid can refer pain to the forehead, ear, and eye, but the
temporalis is the classic muscle for temporal headache pain.
5. In accordance with Texas administrative rules, what is the minimum number
of continuing education (CE) hours required for a massage therapist to
renew their license, and what is the maximum number of hours that can be
completed through distance learning?
A. 24 total hours, with a maximum of 12 distance learning hours
B. 12 total hours, with a maximum of 6 distance learning hours
C. 24 total hours, with a maximum of 24 distance learning hours
D. 12 total hours, with a maximum of 12 distance learning hours
Answer: A
Rationale: Texas Administrative Code, Rule 117.40, requires licensees to
complete 24 hours of continuing education during each two-year renewal
period. Of these 24 hours, at least 12 hours must be obtained through in-
person, live instruction. This specifically limits distance learning (online,
home study, etc.) to a maximum of 12 hours per renewal cycle. The other
options are incorrect based on the specific hour requirements and
restrictions set by TDLR.
, 6. A client reports a history of deep vein thrombosis (DVT) in the left leg. The
therapist observes that the leg is swollen, warm, and slightly discolored.
The client mentions they stopped taking their blood thinner a week ago.
What is the most appropriate action for the therapist?
A. Proceed with a very light, superficial massage to avoid dislodging a clot
B. Use gentle stretching and range of motion to improve venous return
C. Avoid the affected leg and massage the rest of the body
D. Refuse to perform massage and refer the client to a physician
immediately
Answer: D
Rationale: The signs of swelling, warmth, discoloration, and a history of
DVT, combined with the cessation of anticoagulant medication, present a
high risk of an existing or new thrombus. Massage over an area with a
DVT poses a serious risk of thromboembolism. The therapist must
recognize this absolute contraindication, refuse treatment, and make an
immediate referral to a physician for medical evaluation. Modifying the
massage or avoiding only the leg is not sufficient or safe, as the risk of
embolization is too great.
7. The primary action of the serratus anterior muscle is to:
A. Retract and elevate the scapula
B. Protract and upwardly rotate the scapula
C. Depress and adduct the scapula
D. Rotate the scapula inferiorly
Answer: B
Rationale: The serratus anterior originates on the lateral surfaces of the
upper eight ribs and inserts on the medial border of the scapula. Its
primary actions are protraction (pulling the scapula forward and laterally)
and upward rotation of the glenoid fossa. This is essential for shoulder
flexion and abduction above 90 degrees. Retraction is performed by the
rhomboids, while depression is largely a function of the lower trapezius
and pectoralis minor.
