, Question 1
During deep transverse friction massage over the lateral epicondyle, a therapist
notes the client's pain sharply increases and the tissue feels 'boggy.' Which
underlying structure is most likely being irritated, and what is the best
immediate action?
A. Radial nerve; continue with lighter pressure to desensitize.
B. Common extensor tendon; discontinue friction and reassess for acute
inflammation.
C. Bursa; apply ice and continue friction at reduced duration.
D. Periosteum; maintain pressure to stimulate remodeling.
Correct Answer: B - Common extensor tendon; discontinue
friction and reassess for acute inflammation.
RATIONALE
A boggy, painful response over the lateral epicondyle suggests acute
inflammation of the common extensor tendon (lateral epicondylitis).
Deep friction is contraindicated in acute inflammation; the therapist
should discontinue and reassess. Nerve irritation would present with
burning/tingling, not boggy tissue; periosteal pressure is not indicated.
Question 2
Which statement best explains why a client with decompensated heart failure
should not receive prolonged deep tissue massage of the lower extremities?
A. Massage increases venous return, which can overload the failing heart
and precipitate pulmonary edema.
B. Deep pressure may dislodge a deep vein thrombosis, causing
pulmonary embolism.
C. Massage stimulates the sympathetic nervous system, increasing
cardiac afterload.
D. Massage reduces lymphatic drainage, worsening peripheral edema.
Correct Answer: A - Massage increases venous return, which can
Page 2
,overload the failing heart and precipitate pulmonary edema.
RATIONALE
In decompensated heart failure, the heart cannot handle increased
venous return; massage-induced venous return can cause fluid
overload and pulmonary edema. While DVT risk is a concern, it is not
the primary reason for avoiding lower extremity massage in
decompensated heart failure. Sympathetic stimulation and lymphatic
reduction are not the main mechanisms.
Question 3
A client reports a history of recurrent herpes simplex lesions on the lips. They
present with a new vesicle and ask for a facial massage. What is the most
appropriate therapist response?
A. Proceed with massage, avoiding the lesion, as herpes is only
contagious when weeping.
B. Decline facial massage and refer to a physician; massage is
contraindicated during active herpes outbreak.
C. Perform massage with gloves and a mask to prevent transmission.
D. Apply a topical antiviral and proceed with light massage.
Correct Answer: B - Decline facial massage and refer to a
physician; massage is contraindicated during active herpes
outbreak.
RATIONALE
Active herpes simplex is a local contraindication for massage in the
affected area due to high contagion risk and potential spread. Referral
to a physician is appropriate. Gloves and mask do not eliminate risk,
and massage may exacerbate the outbreak. Topical antivirals are not a
substitute for avoiding massage.
Page 3
, Question 4
In a client with fibromyalgia, which massage approach is best supported by
current evidence to reduce pain and improve function?
A. Deep tissue massage at maximum tolerable pressure to release trigger
points.
B. Moderate-pressure Swedish massage with gradual progression and
frequent check-ins.
C. Myofascial release focusing on prolonged stretch of taut bands.
D. Hot stone massage to increase tissue temperature and reduce stiffness.
Correct Answer: B - Moderate-pressure Swedish massage with
gradual progression and frequent check-ins.
RATIONALE
Evidence supports moderate-pressure massage with gradual
progression and client feedback for fibromyalgia, as it reduces pain
without provoking flares. Deep tissue and prolonged myofascial
stretch can exacerbate symptoms. Hot stone may be too intense for
sensitive tissues.
Question 5
Which biomechanical principle explains why a therapist should maintain a
wide stance and use their legs rather than their back when performing deep
effleurage?
A. Wide stance increases the base of support, reducing shear forces on
lumbar vertebrae.
B. Using legs recruits larger muscle groups, generating force with less
spinal compression.
C. Wide stance allows for greater reach, reducing the need for trunk
rotation.
D. Leg use decreases heart rate, preventing fatigue during long sessions.
Correct Answer: B - Using legs recruits larger muscle groups,
Page 4
During deep transverse friction massage over the lateral epicondyle, a therapist
notes the client's pain sharply increases and the tissue feels 'boggy.' Which
underlying structure is most likely being irritated, and what is the best
immediate action?
A. Radial nerve; continue with lighter pressure to desensitize.
B. Common extensor tendon; discontinue friction and reassess for acute
inflammation.
C. Bursa; apply ice and continue friction at reduced duration.
D. Periosteum; maintain pressure to stimulate remodeling.
Correct Answer: B - Common extensor tendon; discontinue
friction and reassess for acute inflammation.
RATIONALE
A boggy, painful response over the lateral epicondyle suggests acute
inflammation of the common extensor tendon (lateral epicondylitis).
Deep friction is contraindicated in acute inflammation; the therapist
should discontinue and reassess. Nerve irritation would present with
burning/tingling, not boggy tissue; periosteal pressure is not indicated.
Question 2
Which statement best explains why a client with decompensated heart failure
should not receive prolonged deep tissue massage of the lower extremities?
A. Massage increases venous return, which can overload the failing heart
and precipitate pulmonary edema.
B. Deep pressure may dislodge a deep vein thrombosis, causing
pulmonary embolism.
C. Massage stimulates the sympathetic nervous system, increasing
cardiac afterload.
D. Massage reduces lymphatic drainage, worsening peripheral edema.
Correct Answer: A - Massage increases venous return, which can
Page 2
,overload the failing heart and precipitate pulmonary edema.
RATIONALE
In decompensated heart failure, the heart cannot handle increased
venous return; massage-induced venous return can cause fluid
overload and pulmonary edema. While DVT risk is a concern, it is not
the primary reason for avoiding lower extremity massage in
decompensated heart failure. Sympathetic stimulation and lymphatic
reduction are not the main mechanisms.
Question 3
A client reports a history of recurrent herpes simplex lesions on the lips. They
present with a new vesicle and ask for a facial massage. What is the most
appropriate therapist response?
A. Proceed with massage, avoiding the lesion, as herpes is only
contagious when weeping.
B. Decline facial massage and refer to a physician; massage is
contraindicated during active herpes outbreak.
C. Perform massage with gloves and a mask to prevent transmission.
D. Apply a topical antiviral and proceed with light massage.
Correct Answer: B - Decline facial massage and refer to a
physician; massage is contraindicated during active herpes
outbreak.
RATIONALE
Active herpes simplex is a local contraindication for massage in the
affected area due to high contagion risk and potential spread. Referral
to a physician is appropriate. Gloves and mask do not eliminate risk,
and massage may exacerbate the outbreak. Topical antivirals are not a
substitute for avoiding massage.
Page 3
, Question 4
In a client with fibromyalgia, which massage approach is best supported by
current evidence to reduce pain and improve function?
A. Deep tissue massage at maximum tolerable pressure to release trigger
points.
B. Moderate-pressure Swedish massage with gradual progression and
frequent check-ins.
C. Myofascial release focusing on prolonged stretch of taut bands.
D. Hot stone massage to increase tissue temperature and reduce stiffness.
Correct Answer: B - Moderate-pressure Swedish massage with
gradual progression and frequent check-ins.
RATIONALE
Evidence supports moderate-pressure massage with gradual
progression and client feedback for fibromyalgia, as it reduces pain
without provoking flares. Deep tissue and prolonged myofascial
stretch can exacerbate symptoms. Hot stone may be too intense for
sensitive tissues.
Question 5
Which biomechanical principle explains why a therapist should maintain a
wide stance and use their legs rather than their back when performing deep
effleurage?
A. Wide stance increases the base of support, reducing shear forces on
lumbar vertebrae.
B. Using legs recruits larger muscle groups, generating force with less
spinal compression.
C. Wide stance allows for greater reach, reducing the need for trunk
rotation.
D. Leg use decreases heart rate, preventing fatigue during long sessions.
Correct Answer: B - Using legs recruits larger muscle groups,
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