Question 1

Gina Gemellus is practicing her Swedish massage techniques for an upcoming hands-on practical. She will be required to practice a routine for the back using all the Swedish massage strokes in their correct order. What will be the order of strokes she will use?

Accepted Answer

The correct order for Swedish massage is effleurage, petrissage, friction, vibration, and tapotement. Guidelines for Swedish massage are to use broad, lighter strokes, which lead to deeper, localized strokes. One generally does not use all the strokes that one learned in school during a single massage session. Therapists rarely use tapotement in a Swedish massage routine unless they plan to fully wake the client up at the end of the session.

Question 2

While working around the client's flexed elbow with deep friction, you find that you are continuously pressing on an area that is causing shooting pain in the client's arm. What nerve are you most likely impinging with your deep work?

Accepted Answer

When the elbow is in a flexed or bent position, the ulnar nerve becomes more exposed. This nerve is often called the "funny bone," although it doesn't feel funny when you bang your elbow. We have all struck our elbow and sent shooting, jarring pain through our arm at one time or another. Don't mistake the ulnar nerve for a bone and remember to keep the arm in a more extended position when working around the medial aspect of the elbow. By extending the elbow, the ulnar nerve tucks itself away in a groove called the cubital tunnel and remains well protected.

Question 3

What is the best way to position your client at the start of a Swedish massage session?

Accepted Answer

The best way to position your client at the beginning of your session is to position the client in a way that allows you to start the massage focusing on their problem areas. If the client is having a problem with their calf muscles, focus on the calf muscles first and proceed from there. Many therapists get caught up in a specific routine that doesn't allow them to work on specific areas of pain at the beginning of the massage. Keep in mind that clients often leave sessions not satisfied because their areas of pain are addressed too late in the massage or never fully addressed.

Question 4

While working on your client's legs you find that he has extremely tight I.T. bands. After you finish massaging the client's quadriceps, you decide to work on the two muscles that are attached to the I.T. band. Which two muscles will you work on?

Accepted Answer

The I.T. band or iliotibial band is a long ligament/tendon that is found on the lateral aspect of the leg. The gluteus maximus attaches to the I.T. band from the posterior aspect while the tensor fascia latae or TFL attaches from the anterior aspect. These two muscles share the common insertion of the I.T. band. The I.T. band functions as a knee stabilizer and assists in walking. The movements of hip flexion (tensor fascia latae) and hip extension (gluteus maximus) can cause the ligament/tendon to tighten, so it is important to include both these muscles in treatment.

Question 5

If a client is complaining about a tight bicep femoris, which muscle group should you stretch?

Accepted Answer

A client who is complaining about a tight bicep femoris is complaining about tight hamstrings. The therapist should focus their work on the posterior leg and stretch out the hamstrings at the end of the treatment by extending the hip and knee to a comfortable position which stretches the hamstring group. The client should be in a supine position on the table when stretching in the hamstrings.

Question 6

Just before starting to work on her client, massage therapist Mary Mastoid discovers several patches of dry, red, scaly and inflamed tissue on her client's back. After questioning her client about the rashes, her client tells her that he has just had an outbreak of psoriasis. How should Mary proceed?

Accepted Answer

Psoriasis is not a contagious skin disorder, and it is a common condition. There are many possible causes for psoriasis, including food and product allergies. The therapist does not need to wear gloves for the treatment, but since the psoriasis is in the acute stage and inflamed, the area should be avoided. Psoriasis is considered a site contraindication only.

Question 7

The phone rings in Catherine Trochanter's new massage studio. A new client wants to know if Catherine has a Jacuzzi tub available at the studio because heat really helps her low back. Since Catherine doesn't have a Jacuzzi tub available at the studio, what alternate solution can she give the client in order to secure the booking?

Accepted Answer

Offering the client either a hot stone massage or hot packs during the session allows the client a choice in heat therapy and increases Catherine's chances of securing a new client. Using either hot stone or heat packs will meet the client's needs for soothing heat, and since Catherine has both available, she can offer the client an option of treatments.

Question 8

Barry Bonehead arrives to the massage session with an extreme case of dandruff. He wants to make sure that he will be getting a scalp massage during the treatment. What would be the best course of action for the massage therapist?

Accepted Answer

Although you may feel uncomfortable, the best course of action is to wear a pair of latex gloves when providing a scalp massage. Disregarding the client's request is a sure way to lose the client for future sessions. It is not uncommon to come across conditions that you would rather avoid when doing massage, but it is best to be prepared to accommodate all clients and their conditions if you plan on building a client base.

Question 9

Darla Dilemma, licensed massage therapist, notices that every time she massages a certain area on the client, the client flinches in pain. What would be the best course of action to take while continuing the massage session?

Accepted Answer

Taking any and all of the above actions would be appropriate for this scenario. Always follow the comfort levels established by the client. Watch how the body responds to your treatment, and be prepared to make modifications as you move through your session. It is not uncommon for a client not to speak up about pain, pressure, or discomfort during the session. A good massage therapist will take the time to question their clients and evaluate all situations that may arise during a session.

Question 10

Before leaving the room to allow the client to undress to get on the table, the client informs you that they would like you to focus on a certain muscle that you have never heard of. What would be your best course of action in order to meet the client's needs?

Accepted Answer

Letting a client know that you have never heard of a specific muscle might indicate your inexperience in the field. Always reference a condition or an area that you are not sure of by looking up the area while you are waiting for the client to get on the table. If you are still not entirely sure of how to proceed, at least you will have some background and know the general area to work on. From there, take directions from the client to address their needs for that specific muscle. Be open to learning new information which will help you grow as a massage therapist.

Question 11

After finishing your massage session, your client asks to be helped into a seated position because they feel dizzy and disoriented. What would be your initial best course of action for this scenario?

Accepted Answer

It is never a good idea to leave a client who is not feeling well unattended. A client could hurt themselves by falling down, and it is best to monitor the client for signs that the condition is improving or worsening. A client may be experiencing dehydration or slight nausea due to a release of toxins in their system. Many times, clients just need a moment to regain their proprioception (knowing where their body is in time and space). If the condition worsens, it is best to keep the client seated or lie them down while you make an effort to reach the client's emergency contact or MD.

Question 12

Sally Sutures is working on a new client. During the session, the client starts to experience anxiety and begins to cry. What is the best course of action for this type of scenario?

Accepted Answer

Find out if the client is experiencing any type of physical emergency. If the client is experiencing an "emotional release" or having a sad moment, sit with the client and take directions from them. Often clients want to lie quietly in a comfortable position without being touched. Sometimes it's appropriate to move to the client's feet and gently hold them, which continues physical contact and creates a safe space/distance. It is out of our scope of practice and irresponsible to question or advise clients regarding their personal situations. By trying to be overly helpful, we often create worse scenarios. Be gentle and thoughtful in your approach.

Question 13

Valerie Vertebra, licensed massage therapist, has just learned that her client is experiencing shoulder bursitis. What would be the correct protocol for treating this common type of condition?

Accepted Answer

Bursitis is an inflammation of the bursa. Bursae are sacs of synovial fluid found throughout the body that provide cushioning for areas. Sometimes areas experience overuse and overstress, which can cause the bursae to inflame and create pain at the site of the structure/bursae. In this situation, movement is contraindicated, along with any type of deep work or heat. The best protocol would be ice at the site of the inflammation and light massage to reduce any type of muscle tightness in the area. Bursitis can only be alleviated by stopping the movement that is aggravating the bursae. Golfers, swimmers, carpenters, etc. often experience bursitis since their movement is repetitive, and repetitive movement is the primary cause for this condition.

Question 14

Frankie Femur is performing range-of-motion (ROM) exercises with his client. He is about to work with the medial deltoid muscle. What action will he need to do in order to assess the deltoid muscle?

Accepted Answer

To check the ROM of the medial deltoid, Frankie will need to move the client's arm into abduction. Abduction moves the arm away from mid-line horizontally and engages the medial fibers of the deltoid. The medial deltoid is a strong abductor muscle. The anterior deltoid offers flexion and medial rotation while the posterior deltoid offers extension and lateral rotation. The medial deltoid brings the humerus into abduction.

Question 15

Betty Bursa is screening a new client over the phone and gathering important information prior to scheduling the massage appointment. Which of the following questions is the most important to ask when speaking to a new client?

Accepted Answer

All of the questions are equally important when screening a client for the first time. If a client has never had a massage before you might take some extra time to answers any questions they may have or explain the massage session. You may also ask why they are choosing to book a session now if they have never had massage before. Medical conditions are equally important. Knowing that a client is pregnant or has edema indicates that you need to ask further questions before completing the screening. If a client has never been to your office before, it is a good idea to offer detailed location information and, if someone has referred you a client, it is a great idea to thank them for the new client.

Question 16

Maggie Mastoid, massage therapist, has been asked to work with a client who has a non-contagious skin disorder. Which of the following skin conditions is not contagious?

Accepted Answer

Eczema is a non-contagious skin disorder that cannot be spread from direct contact. Although it is not indicated to work directly on the irritated, red skin patches, it is not a condition that requires latex gloves while performing a massage. Athlete's foot, impetigo, and ring worm are all highly contagious skin conditions that are bacterial or fungal. These conditions are total contraindications for massage therapy because the conditions can be spread and contracted, even if you avoid the visually affected areas while giving a massage.

Question 17

While draping the legs on her client, Terry Tubercle finds that both of the client's lower legs are swollen from a condition known as edema. What type of massage therapy would be best to use on the lower legs?

Accepted Answer

Lymphatic drain techniques would be the best type of massage technique to use for this condition. Edema is a condition of excess fluid which accumulates in the tissue. It is usually found in the legs and feet, but can be found in areas throughout the body. Edema could be the result of conditions which are normal (pregnancy, excessive sitting, water retention) or from conditions which are more severe (diabetes, kidney disorder or venous obstructions). Using light techniques such as lymphatic drain or energy therapies such as reiki are indicated. Never use any deep forms of massage. Suggest that the client consult with an MD regarding the condition.

Question 18

Mark Cranium is working on a client that has to return to work directly following the massage session to attend an important meeting. What would be the best way for Mark to end the session to wake and stimulate the client?

Accepted Answer

The best form of therapy to end the massage would be to use various forms of tapotement. Tapotement stimulates the nervous system and will help the client become more alert. Ending with hacking, beating, or pounding will ensure that the client is ready to attend his important meeting. The other two forms of therapy are relaxing and would sooth the nervous system instead of stimulating the nervous system.

Question 19

While talking to a client about the benefits of massage therapy, a client informs you that the reason they avoid getting a massage is that they do not want to undress for the session even though they will remain covered. What types of therapies can you offer a client who wishes to remain clothed for the session?

Accepted Answer

The techniques of craniosacral, reiki, and shiatsu are all types of therapies that can be performed though the clothing. It is unnecessary for the client to undress for any of these treatments, since none of these treatments incorporate any types of oil or lotion. There are many treatments that can be done through the clothing including various types of sports massage.

Question 20

What type of massage therapy stroke would be best to use if you plan on compressing the superficial layers of tissue into underlying tissue and bone?

Accepted Answer

The techniques of friction compress superficial layers against deeper structures in order to broaden, flatten, and smooth out tissue. There are many types of friction including direct pressure, ironing, and CFF. No matter what the technique is named, if it is pressing tissue into underlying tissue, it is known as a friction type of technique.

Quiz 2: Application