National Holistic Institute
A College of Massage Therapy
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Why should manual therapists thoroughly understand the structures and functions of the muscular system?
Muscular function can be an indicator for stress and disease on other body systems
The physiologic effects of all forms of manual therapy are achieved through the direct changes in the skeletal muscles
Muscle pain and tension may be the most common reasons people seek manual therapy treatments
It is the most important system of the body
You have a new massage client with diabetes that is treated with insulin. Which of the following is an important consideration?
Ensure that the client takes insulin immediately before receiving massage
Use techniques directly over insulin injection sites to improve absorption and help the skin stay healthy
Schedule the session to avoid times when insulin activity is at its peak
There are no special considerations for this client
A client reports having severe abdominal pain, bloody stools, bloating for 3 weeks. The client has had a fever for the past 24 hours. You tell the client:
to visit their doctor immediately to rule out more dangerous potential pathologies
that you will do reflexology since they cannot lay on their abdomen.
to decrease their consumption of spicy, oily foods
practice abdominal massage, moving in the direction following the flow of the intestines.
During a deep tissue session, your client says that you’re doing more good for him than his chiropractor. He also says that if you could just do one simple adjustment, which the chiropractor taught his wife, he wouldn't need to visit his chiropractor anymore…and he could tip you more. The best course of action is:
Explain your professional scope of practice.
Take the lesson, be a poor student, and explain that it is not safe for you to do, so you won’t.
Thank him, and explain that you’re not open to bribes.
Take the lesson to see if it really is simple and safe and if you could add it to your toolbox, but turn down the extra tip.
You ask your client to bend and touch their toes. The action at their hip is:
Which is a primary treatment for hypothyroidism?
Increasing dietary iodine
Killing or removing thyroid cells
Thyroid hormone supplement therapy
Which of the following statements could a therapists most benefit from when planning their private practice budget?
Budgets, while not always accurate, can be a good organizational tool
Budgets provide a realistic picture of what you need to earn to cover your expenses
Budgets aren’t practical considering how much unclaimed income a therapist can earn
Budgets help you become conscious of your financial decisions
A therapist’s plan of approach that includes herbs, fasting, and meditation to aid a client who cannot do their daily work is in accordance with what ancient practice?
At the end of your session, you would like to rebook your client for a series of sessions with detailed work on his/her hamstrings. Which of the following is most important?
Educating the client and asking them to rebook.
Speaking only in medical terminology.
Sharing comprehensive knowledge of Trigger Point referral patterns.
Giving your client an extra 10 minutes of work for free.
The law intended to protect client confidentiality and security is called:
The Massage Therapy Act
A long bone consists of the Diaphysis, Metaphysis, and the Epiphysis, what type of tissue covers the end of the Epiphysis?
Which of these bones is more prone to fracture related to osteoporosis?
Your client notates that they have Sciatica on their intake form. What is the first question you should ask them?
“Would you like me to focus on that area?”
“When were you diagnosed?”
“On which side is the sciatica located?”
No further questioning is needed.
Which of the following can be a massage risk for cancer?
Massage that disrupts a tumor site
Massage that increases metabolic rate
All of the above
Why are consistent draping techniques important as a professional massage therapist?
Clients get so cold on the table draping is essential to their comfort.
Consistency demonstrates professional boundaries while supporting client comfort.
It’s a legal requirement in most cities and for state credentials.
Most clients want a massage for sexual reasons so draping is important in addressing that assumption.
Which movement would lengthen the fibers of the biceps brachii?
pronation of the forearm
lateral rotation of the shoulder
You ask your client to bring their arm from 0-180 degrees away from their body, laterally. This is an example of which two actions?
Based on the understanding that dense, bony structures support while bone with specific shapes facilitate movement, choose the structure below that would be more responsible for accepting the weight of the upper body.
A: Superior articular facet
B: Vertebral body
A: Transverse process
B: Superior Inter-vertebral Process
Spinal nerves exit the Central Nervous System through the spinal cord, how many pairs of spinal nerves are in the human body.
When a threshold stimulus is applied to a motor unit, what is the result?
A small number of fibers in the unit contract strongly
All fibers in the unit contract fully
Some fibers in the unit contract partially
All fibers in the unit partially contract
Which layer of skin is primarily connective tissue and contains nerves, blood, and lymph vessels?
Your client is taking nonsteroidal anti-inflammatory medication everyday. What massage cautions or contraindications should be considered?
Use massage techniques as you would normally—no cautions are needed
Ask the client not to take any medication for a day or two before scheduled massage
Work conservatively to avoid over-treatment
Ask the client to reschedule massage after healing is complete and the medication is stopped
In the sub-acute state, rheumatoid arthritis is
Only advisable with a doctor’s referral
Indicated to promote mobility and maintain joint functions
Too painful to be able to work on locally
Which of the following is the best example of a condyloid joint?
A new client states that because of the draping, they don’t feel like they are getting the full benefit of the massage. They say it is distracting and would rather receive massage while not being draped at all. You should:
Do some discovery to see if your draping techniques are at fault.
Do discovery to see what benefits they feel are being missed and what specific parts of your draping techniques are distracting. Discuss the possibility of clothed massage perhaps using comfortable exercise/gym clothing and looking at other styles of massage in the future.
Explain that no other client feels this way and perhaps they should seek a new therapist.
Remind them of state & local laws and stop any further discussion.
You flex your right elbow, which type of contraction is being performed by the prime mover, biceps brachii?
Which of the following changes, when stimulated by manual therapy, is considered a structural, physiologic effect?
Enhancing digestion patterns
Improving blood flow
Loosening the fascia
A client has an emotional release and begins to cry. When you inquire if you should continue the massage, the client responds that she really needs a hug. You should:
Explain that hugs are not part of a therapeutic massage and that instead you could continue with gentle massage of the shoulders, hands, or feet if they need relaxing touch.
Make sure appropriate draping standards are maintained and give the hug.
Explain that hugs are inappropriate and depart the room to give them a moment alone.
Re-drape and hug the client because you already hug them on arrival and departure.
Even with light touch, causing a reflex contraction of the rectus femoris by touching the sole of a client’s foot can be considered:
Your client tells you they injured their ankle less than 24 hours before their Swedish session. Inflammation is present. What if any changes would you make to your plan based on this information?
You may work proximal to the injury, but not distal
This information would not change my treatment plan
You cannot perform any bodywork on them
You may work distal to the injury, but not proximal
What may occur if the pancreas is not able to release its secretions?
An increased risk of gallstones
Nausea and fever
A long term client suggests that their cash-flow is rather tight at the moment and asks you to accept marijuana as payment at 50% of its market value for today’s session and future sessions. You should:
Explain the risks to you of possessing it even for a brief time, and propose that if he delivers it directly to your friends using medical marijuana, then that would be a better plan.
Remind the client of your cash, check, or credit policy.
Accept the offer because you have friends using marijuana for medical issues and you can give it to tonight as the perfect gift.
Accept the client’s generosity of the 50% discount as a compliment to your work and proceed because possession is usually overlooked in your city and state.
A client experiences the outcomes of decreased anxiety and an improved sense of well-being as a result of receiving manual therapy. These are examples of:
Structural physiologic effects
Systemic physiologic effects
Which is the origin of the biceps brachii’s short head?
coracoid process of scapula
infraglenoid tubercle of scapula
acromion of scapula
supraglenoid tubercle of scapula
Before practicing massage in a state, a therapist should determine if they meet which of the following requirements:
All of the above
During what activity is the diaphragm’s central tendon pulled inferiorly?
Which bone in the lower extremity is not a weight bearing bone?
Which of the following signs and symptoms would cause you to refer your client to their doctor?
A large, multi colored, asymmetrical mole with an inconsistent border which has grown larger in diameter slowly over the last few months
A client’s calf muscles shortening suddenly, forcefully, and painfully when they perform plantar flexion of the ankle joint.
A pins and needles sensation that starts in the lateral hip and radiates down the back of leg and lateral side of lower leg when the client is in a seated position
A raised, brownish-black growth with well-defined border, which the client reports has been present since birth
Muscle spindles are most sensitive to what type of stimulus?
Alternating shortening and lengthening
Which statement most accurately describes the intention of a mission statement?
The purposes and values of your business
What clients should do for the company
What you as a business wish to accomplish
To prove how long you have been practicing massage
A long term client of your Eastern and Energy modalities confides that she feels great healing after each of your sessions, so much so that she’s added you to her “alternative medical team”. She has formed this team because she feels abused by the American medical system and does not want to return to the system under any circumstances. She is using her team to deal with “female problems” which she doesn’t want to describe further so as not to bias you in your treatment. You should:
Feel honored and refocus your efforts on sensing and healing her “female problems” energetically.
Explain that Eastern modalities and energetic massage does not offer treatment; these techniques provide bringing relaxation and palliative care to a client’s medical situation.
Insist on more specifics and the details of other team members before accepting the compliment and commission.
Explain that you’re sorry there has been such a miscommunication because Eastern and Energy modalities are all a fake and have no real benefit.
You have a new client whose hypertension is well controlled with medication. What cautions or contraindications should you observe for this client?
Any massage technique can be used normally except those that increase lymphatic drainage
The only cautions or contraindications relate to effects of the medication
You can provide massage normally with no cautions or contraindications
Any massage technique can be used normally except those that increase heart rate
The most effective type of manual therapy to assist in the reduction of swelling around an acutely sprained ankle is:
Deep tissue techniques
Neuromuscular therapy using trigger points on antagonist muscles
When assessing a client, how would you ask them to perform supination?
Stand with your arms bent at a 90 degree angle in front of you, and turn your palms downward.
Stand with your arms at your side, and bend your elbows.
Stand with your arms bent at a 90 degree angle in front of you, and turn your palms upward.
Bring your chin to your chest.
Your client reports that he is fully recovered from encephalitis? What massage accommodations should you make?
Avoid any massage to the head and neck
No massage accommodations are needed
Use only light techniques throughout the body
It is necessary to precisely follow the instructions of the client's healthcare provider
When should massage be locally contraindicated avoided for a client with a seborrheic keratosis lesion?
Local contraindication is required only in cases of a malignant lesion
Local contraindication is always required
Local contraindication is required only if the lesion is irritated or bleeding
Local contraindication is never required
You have a new client with dystonia. What implications for massage should you be aware of when planning treatment?
The mental deterioration caused by dystonia can lead to inappropriate behavior
Dystonia can cause reduced sensation and susceptibility to pain
Deep work is likely to exacerbate the symptoms of dystonia
Some drugs used for dystonia have implications for massage
While giving onsite chair massage at a company’s offices, the Human Resources manager, who approved your contract, comes to you with questions about employee behavior. Reminding you that it was he who approved you being here, he asks if you have seen or heard anything during your sessions with the staff that would impact company morale. You should:
Get angry and strongly inform the manager that under no circumstances would you do such a thing.
Ask for clarification as you understood you were here to do massage and not be a spy.
Share inconsequential stories that would get no one in trouble.
Be thankful that you remembered to include a paragraph on client confidentiality in the contract and remind him of its existence.
Why is it important for manual therapists to know the warning signs for skin cancer?
If warning signs are present manual therapy should not be performed
The holistic approach of manual therapy may help patients cope with cancer
Many manual therapy clients may not visit Western medical professionals
Regular inspection of large areas of skin can lead to early identification and treatment
When raising the rates in your own practice, which of the following is the most important step to maintain your credibility with your clients?
Begin the client’s session with an announcement of the new rates adding how long it has been since you last increased
Base your rates on other therapists in your area
Research salaries of the most successful practices in the country and post those figures in your waiting area
Do not raise your rates more than once a year and base your rates on a one-year financial forecast.
Apley’s Scratch Test and Phalen’s Test are examples of…
Resistive Range of Motion
None of the above
During a Reiki session, your client mentions how much your gentle touch reminds her of her mother’s touch when she was a child. She then becomes quiet again. Your best response is:
Ignore the comment and believing it will never come up again.
End the session normally, and then not accept future appointments from the client.
Switch to a deeper, less gentle, modality
Continue with the session and plan to end early to discuss the nature of a therapeutic relationship. Then, at the end of the discussion, decide on an appropriate course of action for this client.
Why would you repeat a Range of Motion assessment at the end of a session?
So the client can see improvement
So the therapist can document any changes
Both A and B
Neither A or B
Anatripsis was developed to promote healing, tighten, relax, and build muscles by:
Manipulating energy pathways
Rubbing toward the heart
Your client arrives for their Swedish Massage. Which of the following is a valuable client assessment tool?
All of the above
Polarity is a practice that encompasses theories based on Asian Medicine and Ayurveda developed by:
Dr. Leon Chaitons
Dr. Janet Travelle
Dr. Randolph Stone
You decide to run a gift certificate special for the holidays. Which is the best way to ensure that you as the therapist receive the full value of the gift certificate regardless of whether you change your price per treatment?
Gift certificates for massage are illegal in the state of California
Put a treatment type on the gift certificate
Put a dollar amount on the gift certificate
Put an expiration date on the gift certificate
Despite your website showing your posted working hours as 3:00 PM – 9:00 PM a regular client calls with a special request. This person wants to book a massage at midnight. What is your best response?
Direct the client to review your website for regular business hours and end the conversation feeling annoyed.
Remind the client that you follow the guidelines established by the state credentials and indicate that you can offer an appointment within your normal hours of business.
Do discovery to find out why in the world this client wants a massage at midnight to figure out how to react to this odd request.
You agree to the special request even though you’re tired and have worked a full day.
What are the therapeutic implications of fascial plasticity and the direct link between the autonomic nervous system and myofascial receptors?
Myofascial techniques are the most important form of manual therapy for chronic pain relief
Manual therapy should be considered a primary modality for chronic pain relief
The best therapeutic intervention for chronic pain patients is eliminating myofascial trigger points
Manual therapy is likely to stimulate an emotional release in addition to reducing pain
For the average massage therapist, whether they are working full or part-time, what percentage of income can be earned from gratuities?
15% - 20%
10% - 15%
Choose the avenues of massage more likely to accept insurance reimbursements therefore affecting your rate of pay:
Which muscle acts as a synergist with piriformis during lateral rotation of the hip?
tensor fasciae latae
Which of the following is an example of a muscle contraction triggered by the somatic nervous system.
Flexion of the biceps femoris
Digestion of food in the stomach
Contraction of the heart
Dilation of the blood vessels
The fastest route to remove edema from the ankle is:
Move it up the posterior leg
Direct it into the popliteal catchment
Move it across the peroneal watershed
Direct it away from the patellar catchments
While you are working on your client, she tells you she thinks her husband is cheating on her. She starts crying, shaking, and having a strong emotional reaction. How can you best react to her?
Tell her that’s terrible and then share how you had the same experience.
Be supportive, non-judgmental and determine if she wants to continue, take a short break, or end the session.
Ask her if she plans to leave him and mention the family attorney in your referral group.
Give her a hug and switch to a more nurturing technique like effleurage.
You ask your client to bring their chin to their chest. What type of assessment tool is this?
Passive Range of Motion
Resistive Range of Motion
Active Range of Motion
A technique using light touch to feel the rhythmic motion that is created by the cerebrospinal fluid was developed by:
Dr. James H. Cyriax
Dr. John Upledger
Dr. William Fitzgerald
Identify the muscles, which lie deep to the spine and span two or more vertebrae, acting to rotate the spinal column in a unilateral action but extend the vertebral column bilaterally.
None of the above
Which of the following taxation areas are more therapists likely to ignore?
Sales tax on products sold
W-9 as an independent contractor
1099 – MISC from clients who pay more than $600
Workmen’s Compensation insurance coverage
In your private practice you are responsible for maintaining proper documentation on all of your clients regardless of age or gender. Which is the primary reason to ensure their reliability?
Ensure data is documented and saved for as long as it has value
Hire someone to help when needed
Publish them regularly
Purge them monthly
When deciding whether to become an independent contractor or an employee, earning potential often becomes a factor. Which of the following is the best opportunity for an employee?
Annual salary increase or promotion
When you disinfect massage equipment, what are you doing?
Preventing future contamination of the equipment or surfaces with a protective seal
Destroying all microorganisms within range of the applied heat, pressure, or chemicals
Destroying most pathogenic organisms or their toxins with chemical or physical agents
Preventing infection by inhibiting the growth of any pathogens contacted by the chemical or physical agent
Which of the following outcomes of manual therapy is most likely to have a positive influence on urinary system functioning?
Improved local fluid flow
Decreased stress and anxiety
What characteristics of melanoma are described by the mnemonic ABCDE?
Asymmetry, bolus, clear, diameter, erythema
Abrasion, bulla, cold, diameter, ecchymosis
Abnormal, broad, coarse, dry, elevated
Asymmetry, borders, color, diameter, elevated
Why are MRSA infections particularly dangerous?
They are "invisible" because they cause no signs or symptoms
They are resistant to several commonly used antibiotics
They more rapidly cover large areas of the body
They are the only type of staph infection spread by indirect contact
After a Swedish session which you set up outside normal business hours, your client mentions that you seem like a smart business person. He invites you to come have a drink with him now and talk about growing your business even further. An appropriate way to handle this situation is:
Explain your business is everything you want and book his next appointment.
Decline and go home.
Book his next appointment and then go hear the business proposal, but not over drinks.
Explain that if you go listen to his proposal he would have to find another massage therapist.
Which type of glands are found primarily in the axilla and groin?
What triangular-shaped muscle is a weak elbow extensor located lateral to the olecranon process?
extensor carpi radialis brevis
flexor carpi ulnaris
Which movement of the vertebral column will shorten the fibers of the semispinalis capitis on the right side of the body?
lateral flexion to the left
rotation to the right
Your client complains of a stiff neck and frequent headaches. Where would you notate this in your professional chart?
The indicated muscle, commonly an issue for back pain, is also considered significant for the proper function of the torso related to “core muscles” for exercise, physical therapy, and balance. This muscle is the:
Inferior Latissimus Dorsi
What is central sleep apnea?
A transient form of insomnia often related to substance abuse
A central nervous system problem involving decreased respiratory drive
A form of narcolepsy involving sudden loss of tone in the muscles of breathing
A circadian rhythm disruption caused by a variable work schedule
During your initial intake interview with a client, the client explains that he/she will need to be in contact with you during the massage. You should:
Allow it because you sense this will be very healing to the client.
Explain that while it isn’t normal, you understand their insecurity and you will place their hand where appropriate.
Do discovery to determine if you should accept the appointment at all or refer the client to other professionals. In any event, explain the therapeutic relationship and that the touching the therapists is not be appropriate based on professional definitions.
Do discovery as to the historical reasons. If you find a history of abuse while a child, allow it. If you find the slightest sexual innuendo, explain that this is not allowed.
When working with tissue during an appointment, what key things can a therapist feel through skin?
Tissue temperature, tension, texture and rate of circulation
Texture, temperature, nerve sensitivity and general tissue physiology
Tissue temperature, tension, texture, and mobility
Subtle shifts in a client’s energy, circulation and tissue regeneration
A client was recently laid off. She has another job lined up but it won’t start for another two months. She wants to continue her treatments but is unable to afford them or barter. Which of the following options is best?
An IOU signed by both parties with a clear payment schedule laid out and what the consequences of nonpayment will be
Accept signed blank checks that you can deposit later
Verbal agreement and a handshake
After explaining his needs and details on a mature injury needing attention today, your client begins to read and respond to texts while you explain the approach and strategy for his session. You then:
Become quiet and wait for him to refocus on you because of the silence. Then explain the importance of his understanding and his agreement to today’s session plan. Also remind him that if he has important business or life tasks, you can stop the massage so he can accomplish them, and the time will count as part of his appointment.
Let him multi-task and begin the session on time: he’s expressed his trust of your abilities with previous injuries.
Begin on time and make a note to update your intake client policies. Then have him sign them at his next appointment.
Interrupt him and insist he turn off his phone before proceeding any further.
Your client arrives at her session with a list of complaints. When she identifies the treatment she is seeking and you repeat it back to her clearly in your own words, which type of communication model are you using to help ensure trust?
Unconditional positive regard
Which of the following is not a typical requirement for state credentials such as certification or licensure?
An up-to-date and current trade association membership
Passing mandated exams successfully
A minimum amount of education hours
Graduation from an approved school
You must decide what to wear for your private practice to establish professional boundaries. Your best options are:
Choosing closed toed shoes; full-length, solid-colored slacks, with long hair pulled back.
Professional black in a tank-top and yoga pants allowing full range of movement.
All solid, dark colors with little or no pattern to avoid visual distractions for your professional image.
Clothes that fit close to the body so they won’t accidentally brush the client while working.
You have a long-standing, regular appointment with a mother and her teenage, athlete son. Normally she receives a massage first and then stays in the room while you work on the son. One day the Mom dashes in to say that she needs to run a quick errand and that you can start on her son. She’ll be back in 15 minutes. She turns to leave. You should:
Start normally, but leave the massage room door open, and if she doesn’t return as promised, end the session.
Sit in the outer office with the son waiting for his mom’s return.
Allow him to get ready for a massage but explain to the mom that you’ll wait to enter the room with her.
Explain that they should both run the errand and return together. You’ll talk about adjusted times when they return.
Which movement of the vertebral column would lengthen the fibers of the external oblique on the right side of the body?
rotation to the right
lateral flexion to the right
rotation to the left
Which of the following is not one of the four basic types of tissue in the body.
What is the IRS’ general definition when determining whether a worker is an employee or an independent contractor?
If the employer controls only the session’s results, the worker is considered an independent contractor
If the employer controls how the worker performs the session or the session’s results, the worker is an independent contractor
If a worker is not allowed to work for another company or business, that worker is an employee
If the worker has to wear a company uniform, the worker is an employee
Standing in Western anatomical position, an anterior movement along the sagittal plane that decreases the angle between two bones is called:
Before asking your supine client to flex her neck to contract her sternocleidomastoid, how could you position the head to make the contraction even more visible?
turn head toward the side you are palpating
extend the head
rotate the head slightly away from the side you are palpating
laterally flex the head
You must quickly run a short distance to catch your bus before it leaves the bus stop, which method of energy production would your muscles use for contraction?
Anaerobic cellular metabolism
Aerobic cellular metabolism
Your client tells you she has eczema. The skin on her palms is itchy and covered with tiny fluid-filled blisters. What is your most appropriate action?
Avoid the local area to reduce the risk of infection
Ask her to reschedule until you receive a release from her physician
Work normally but wash your hands especially well with antibiotic soap afterwards
Use hypoallergenic lotion on the local area and work normally
When using your business plan to secure a loan, it is useful to include which supplements?
The resumes and letters of recommendation of potential employees
An executive summary, the financial analysis and references
Pamphlets and research on the benefits of massage
A mission statement and location analysis of potential sites
What does the S in SOAP stand for?
Where would you record that you assessed the client’s right shoulder as elevated?