Your FREE MBLEx Flashcards 2026 – 300+ Cards

MBLEx Flashcards

What is effleurage?

Long, gliding strokes (usually toward the heart) that warm tissue, spread lubricant, soothe, and aid venous and lymphatic return.

Anatomical position

Standing erect, facing forward, arms at the sides with palms facing forward and feet together — the reference posture for all directional terms.

Sagittal plane

Divides the body into left and right halves; the plane of flexion and extension.

Frontal (coronal) plane

Divides the body into front (anterior) and back (posterior) halves; the plane of abduction and adduction.

Transverse (horizontal) plane

Divides the body into upper (superior) and lower (inferior) halves; the plane of rotation.

Superior vs inferior

Superior = toward the head (above); inferior = toward the feet (below).

Anterior vs posterior

Anterior (ventral) = front of the body; posterior (dorsal) = back of the body.

Medial vs lateral

Medial = toward the midline; lateral = away from the midline.

Proximal vs distal

Proximal = closer to the trunk/point of attachment; distal = farther from it.

Superficial vs deep

Superficial = nearer the surface; deep = farther from the surface.

Three types of muscle tissue

Skeletal (voluntary, striated), cardiac (involuntary, striated, in the heart), and smooth (involuntary, in organs and vessels).

Origin vs insertion

Origin = the muscle's fixed (usually proximal) attachment; insertion = the movable (usually distal) attachment that moves toward the origin.

Skeletal muscle function

Produces movement, maintains posture, stabilizes joints, and generates heat. It contracts when stimulated by motor neurons.

Tendon vs ligament

A tendon attaches muscle to bone; a ligament attaches bone to bone.

Fascia

A continuous sheet of connective tissue that wraps and connects muscles, organs, and structures throughout the body.

Types of joints (by movement)

Synarthrosis (immovable, e.g. skull sutures), amphiarthrosis (slightly movable, e.g. pubic symphysis), and diarthrosis (freely movable synovial joints).

Synovial joint

A freely movable joint with a fluid-filled capsule — e.g. the shoulder, hip, knee, and elbow. Synovial fluid lubricates and nourishes the joint.

Axial vs appendicular skeleton

Axial = skull, spine, ribs, and sternum (80 bones); appendicular = limbs and the shoulder/pelvic girdles (126 bones).

Number of bones in the adult body

206 bones.

Five regions of the spine

Cervical (7), thoracic (12), lumbar (5), sacral (5 fused), and coccygeal (3-4 fused).

Function of the circulatory system

The heart pumps blood through arteries, capillaries, and veins to deliver oxygen and nutrients and remove waste.

Arteries vs veins

Arteries carry blood away from the heart (usually oxygenated); veins carry blood back to the heart (usually deoxygenated) and have one-way valves.

Pulmonary vs systemic circulation

Pulmonary circulation moves blood between the heart and lungs; systemic circulation moves blood between the heart and the rest of the body.

Function of the lymphatic system

Returns excess interstitial fluid to the bloodstream, absorbs dietary fats, and supports immunity through lymph nodes and lymphocytes.

Direction of lymph flow

Lymph flows one way, toward the heart, returning to the bloodstream near the subclavian veins. Massage toward the nearest proximal nodes assists drainage.

Central vs peripheral nervous system

CNS = brain and spinal cord; PNS = the nerves outside the CNS that carry signals to and from the body.

Autonomic nervous system divisions

Sympathetic ('fight or flight') and parasympathetic ('rest and digest'). Massage tends to shift the body toward parasympathetic dominance.

Function of the integumentary system

The skin, hair, and nails — protects the body, regulates temperature, provides sensation, and contains receptors massage stimulates.

Three layers of skin

Epidermis (outer), dermis (middle, with blood vessels and nerves), and the subcutaneous/hypodermis layer (fat and connective tissue).

Function of the respiratory system

Brings oxygen into the blood and removes carbon dioxide through the lungs; the diaphragm is the primary muscle of breathing.

Homeostasis

The body's maintenance of a stable internal environment (temperature, pH, fluid balance) despite external change.

Rotator cuff muscles (SITS)

Supraspinatus, Infraspinatus, Teres minor, Subscapularis — they stabilize the glenohumeral (shoulder) joint.

Diaphragm

The dome-shaped muscle between the chest and abdomen; the primary muscle of inspiration. It contracts and flattens to draw air in.

Flexion

A movement that decreases the angle of a joint, such as bending the elbow. Occurs in the sagittal plane.

Extension

A movement that increases the angle of a joint, such as straightening the elbow. Occurs in the sagittal plane.

Abduction

Moving a limb away from the midline of the body, such as raising the arm out to the side. Occurs in the frontal plane.

Adduction

Moving a limb toward the midline of the body, such as lowering a raised arm. Occurs in the frontal plane.

Medial (internal) rotation

Rotating a bone toward the midline of the body. Occurs in the transverse plane.

Lateral (external) rotation

Rotating a bone away from the midline of the body. Occurs in the transverse plane.

Pronation vs supination

Pronation turns the palm down (or backward); supination turns the palm up (or forward).

Inversion vs eversion

Inversion turns the sole of the foot inward (medially); eversion turns it outward (laterally).

Dorsiflexion vs plantar flexion

Dorsiflexion lifts the foot toward the shin; plantar flexion points the toes downward (as in standing on tiptoe).

Circumduction

A cone-shaped movement combining flexion, extension, abduction, and adduction — e.g. circling the arm at the shoulder.

Agonist (prime mover)

The muscle chiefly responsible for producing a movement. In elbow flexion, the biceps brachii is the agonist.

Antagonist

The muscle that opposes the agonist and relaxes (lengthens) during the movement. In elbow flexion, the triceps brachii is the antagonist.

Synergist

A muscle that assists the agonist or refines/stabilizes the movement. The brachialis assists elbow flexion.

Fixator (stabilizer)

A muscle that steadies the origin so the prime mover can act efficiently — e.g. the rotator cuff stabilizing the shoulder.

Concentric vs eccentric contraction

Concentric = the muscle shortens while contracting (lifting a weight); eccentric = the muscle lengthens while contracting (lowering a weight).

Isometric contraction

The muscle generates tension without changing length and without joint movement — e.g. holding a plank.

Range of motion (ROM)

The full movement available at a joint. Active ROM is performed by the client; passive ROM is performed by the therapist.

Deltoid — O / I / A

Origin: clavicle, acromion, scapular spine. Insertion: deltoid tuberosity of the humerus. Action: abducts the shoulder (also flexes/extends/rotates).

Biceps brachii — O / I / A

Origin: scapula (supraglenoid tubercle and coracoid). Insertion: radial tuberosity. Action: flexes the elbow and supinates the forearm.

Triceps brachii — O / I / A

Origin: scapula and posterior humerus. Insertion: olecranon of the ulna. Action: extends the elbow.

Pectoralis major — O / I / A

Origin: clavicle, sternum, upper ribs. Insertion: greater tubercle/intertubercular groove of the humerus. Action: adducts and medially rotates the arm; flexes the shoulder.

Latissimus dorsi — O / I / A

Origin: lower thoracic/lumbar spine, sacrum, iliac crest. Insertion: intertubercular groove of the humerus. Action: extends, adducts, and medially rotates the arm.

Trapezius — O / I / A

Origin: occiput and spinous processes C7-T12. Insertion: clavicle, acromion, scapular spine. Action: elevates, retracts, depresses, and upwardly rotates the scapula.

Rectus abdominis — O / I / A

Origin: pubic crest and symphysis. Insertion: xiphoid process and ribs 5-7. Action: flexes the trunk (and compresses the abdomen).

Erector spinae — O / I / A

A group running along the spine. Action: extends and laterally flexes the vertebral column; maintains upright posture.

Gluteus maximus — O / I / A

Origin: ilium, sacrum, coccyx. Insertion: gluteal tuberosity of the femur and iliotibial band. Action: extends and laterally rotates the hip.

Quadriceps femoris — O / I / A

Four muscles on the front of the thigh. Insertion: tibial tuberosity via the patellar tendon. Action: extends the knee (rectus femoris also flexes the hip).

Hamstrings — O / I / A

Biceps femoris, semitendinosus, semimembranosus. Origin: ischial tuberosity. Insertion: tibia/fibula. Action: flex the knee and extend the hip.

Gastrocnemius — O / I / A

Origin: condyles of the femur. Insertion: calcaneus via the Achilles tendon. Action: plantar flexes the foot and flexes the knee.

Sternocleidomastoid (SCM) — O / I / A

Origin: sternum and clavicle. Insertion: mastoid process. Action: bilaterally flexes the neck; unilaterally rotates the head to the opposite side.

Quadratus lumborum — action

Laterally flexes the trunk and elevates (hikes) the hip; a common source of low-back pain.

Psoas major / iliopsoas — action

The primary hip flexor; tightness is associated with anterior pelvic tilt and low-back discomfort.

Absolute (total) contraindication

A condition in which massage should NOT be performed at all — refer or reschedule. Examples: fever, acute contagious infection, DVT, shock.

Local (regional) contraindication

Massage is safe elsewhere but the affected AREA must be avoided. Examples: open wounds, bruises, varicose veins, recent fracture, localized rash.

Deep vein thrombosis (DVT)

A blood clot in a deep vein (usually the leg). An ABSOLUTE contraindication — massage could dislodge the clot, causing a life-threatening embolism.

Fever and massage

Fever is an absolute contraindication. Massage may raise circulation and stress the body fighting infection, and a fever may signal a contagious illness.

Varicose veins and massage

A local contraindication — avoid direct, deep pressure over distended varicose veins; light work proximal to the area may be acceptable.

Acute inflammation and massage

Avoid the acutely inflamed area (heat, redness, swelling, pain). Massage can worsen acute inflammation; wait until the acute phase resolves.

Contagious skin conditions

Local contraindication (and an infection-control concern): avoid areas with impetigo, ringworm, scabies, active herpes, or open lesions to prevent spread.

Cancer and massage

Massage may be appropriate with physician clearance and modification. Avoid deep pressure over tumor sites and radiation areas; gentle work can ease comfort.

Pregnancy precautions

Massage can be beneficial but requires modification: side-lying positioning, avoid deep abdominal work, and use caution with certain pressure points; get clearance for high-risk pregnancy.

Uncontrolled hypertension

Severe, uncontrolled high blood pressure is a caution/contraindication. Use lighter, relaxing techniques and get physician clearance.

Osteoporosis and massage

Use lighter pressure and avoid vigorous techniques (deep friction, tapotement) over fragile bones to prevent fracture.

Diabetes and massage

Proceed with caution: check for reduced sensation and skin integrity, avoid recent injection sites, and watch for signs of hypoglycemia.

Bruise (contusion) and massage

A local contraindication — avoid direct pressure over a fresh bruise; working it can increase bleeding and pain.

Edema (general)

Swelling from excess fluid. Pitting edema may indicate a systemic problem — refer if undiagnosed. Lymphatic-style work may help cleared cases.

Endangerment sites

Areas where vulnerable nerves, vessels, or organs lie near the surface — avoid deep pressure. Examples: anterior neck, axilla, femoral triangle, kidney area, popliteal fossa.

Anterior triangle of the neck

An endangerment site containing the carotid artery and jugular vein — avoid deep or sustained pressure.

'When in doubt, refer out'

If you are unsure whether a condition is safe to massage, do not massage and refer the client to a physician.

Acute vs chronic condition

Acute = recent, with active inflammation (avoid the site); chronic = long-standing and stable (massage is often appropriate and helpful).

Special populations

Clients needing modified care — pregnant, elderly, pediatric, athletes, clients with disabilities, or those with chronic illness — require adapted technique and positioning.

Elderly clients

Use gentler pressure and careful positioning; watch for thin skin, osteoporosis, medications, and reduced sensation.

Whiplash / recent injury

Avoid massage during the acute inflammatory phase of a recent injury; gentle work may help once the acute phase passes and with clearance.

Open wound and massage

A local contraindication and infection-control issue — never massage over an open wound, sore, or recent surgical site.

High-risk endangerment: popliteal fossa

Behind the knee — contains the popliteal artery, vein, and tibial/common fibular nerves. Avoid deep pressure.

Inflammation signs (cardinal)

Redness, heat, swelling, pain, and loss of function — the local signs of acute inflammation that signal you to avoid the area.

Pétrissage

Kneading: lifting, squeezing, and rolling tissue. Improves local circulation, helps clear metabolic waste, and relaxes tight muscle.

Friction

Deep, focused circular or cross-fiber pressure. Breaks down adhesions, softens scar tissue, and generates local heat.

Tapotement

Rhythmic percussion (hacking, cupping, beating). Stimulating; tones muscle and can help loosen chest congestion.

Vibration

Fine trembling or shaking applied to tissue. Can be soothing or stimulating depending on speed; affects the nervous system.

Mechanical vs reflexive effects

Mechanical effects come from physical pressure on tissue (moving fluid, stretching fascia); reflexive effects come from the nervous system's response (relaxation).

Effect of massage on circulation

Increases local blood flow, helping deliver oxygen/nutrients and remove metabolic waste; it can also support venous and lymphatic return.

Effect of massage on the nervous system

Generally promotes a parasympathetic ('rest and digest') response — lowering heart rate, slowing breathing, and reducing the stress response.

Effect of massage on muscle tissue

Reduces muscle tension and spasm, increases flexibility and range of motion, and can relieve trigger points and adhesions.

Effect of massage on the lymphatic system

Light, directional strokes toward proximal lymph nodes can assist lymph movement and reduce certain non-pathological edema.

Effect on the skin (integumentary)

Improves circulation to the skin, aids exfoliation of dead cells, stimulates sebaceous/sweat glands, and increases skin temperature and tone.

Trigger point

A hyperirritable spot in a taut band of muscle that can refer pain to another area. Sustained pressure (ischemic compression) can release it.

Adhesion

An abnormal sticking-together of tissue fibers (e.g. from injury or overuse). Friction and cross-fiber techniques help break adhesions down.

Parasympathetic response

The 'rest and digest' state — relaxation massage aims to activate it, lowering heart rate, blood pressure, and stress hormones.

Hyperemia

Increased blood flow to an area — the local reddening and warmth that massage produces, bringing nutrients and removing waste.

Stretching / range-of-motion benefits

Massage and assisted stretching lengthen shortened muscles, reduce stiffness, and restore joint range of motion.

Psychological benefits of massage

Reduces anxiety and stress, improves mood and sleep, increases body awareness, and can lower perceived pain.

Direction of effleurage

Generally applied toward the heart (centripetally) to support venous and lymphatic return.

Ischemic compression

Sustained pressure on a trigger point to reduce blood flow briefly, then release — flooding the area with fresh blood to relieve the point.

Effect of massage on pain (gate control)

Soothing touch can 'close the gate' on pain signals in the spinal cord, reducing the perception of pain.

Reciprocal inhibition

When a muscle contracts, its antagonist reflexively relaxes — a principle used in some stretching/release techniques.

Cross-fiber friction

Friction applied across the direction of muscle/tendon fibers to break adhesions and realign healing tissue.

Local vs general (systemic) effects

Local effects occur at the area worked (hyperemia, reduced tension); systemic effects involve the whole body (relaxation, lowered heart rate).

SOAP notes

The standard documentation format: Subjective (what the client reports), Objective (what you observe/measure), Assessment (your analysis), Plan (next steps).

Subjective (S) data

Information the client reports — symptoms, pain, goals, and history. It cannot be measured directly by the therapist.

Objective (O) data

Information the therapist observes or measures — posture, range of motion, palpation findings, swelling, gait.

Client intake form

A written health-history form completed before the session to identify goals, medications, conditions, and contraindications.

Postural assessment

Observing the client's standing alignment from front, back, and side to identify imbalances such as forward head, rounded shoulders, or pelvic tilt.

Palpation

Using the hands to feel tissue for temperature, texture, tension, tenderness, swelling, and the location of structures.

Active vs passive ROM assessment

Active ROM: the client moves the joint (tests willingness/strength). Passive ROM: the therapist moves it (tests the joint itself).

Gait assessment

Observing the client walking to spot asymmetries, limps, or compensations that point to areas needing work.

Treatment plan

A goal-directed plan of techniques, pressure, frequency, and areas of focus, set with the client and within scope of practice.

Reassessment

Re-evaluating the client's condition after treatment (and over sessions) to measure progress and adjust the plan.

Setting client goals (short vs long term)

Short-term goals address immediate relief (reduce tension today); long-term goals address ongoing outcomes (restore full ROM over weeks).

Red flags requiring referral

Findings that need a physician — undiagnosed lumps, severe/unexplained pain, signs of DVT, numbness/tingling, or possible fracture.

Pain scale

A 0-10 self-report scale used to record the client's pain intensity at intake and to track change.

Anterior pelvic tilt

A postural pattern where the pelvis tips forward (tight hip flexors/erectors, weak abdominals/glutes), exaggerating the lumbar curve.

Forward head posture

The head sits anterior to the shoulders, overloading the cervical extensors and upper trapezius — a common assessment finding.

Kyphosis vs lordosis

Kyphosis = excessive outward (posterior) curve of the thoracic spine ('hunchback'); lordosis = excessive inward (anterior) lumbar curve ('swayback').

Scoliosis

A lateral (sideways) curvature of the spine; assess for and document, and work within scope.

Endangerment screening

Part of assessment — identifying contraindications and endangerment sites before deciding technique and pressure.

Documentation purpose

Records protect the client and therapist, track progress, support continuity of care, and may be required for insurance/legal purposes.

Informed consent in planning

Before treatment, explain the plan, get the client's agreement, and confirm they understand and consent to the techniques and areas.

Tissue 'end feel'

The quality of resistance felt at the end of passive range of motion — soft, firm, or hard — that helps assess a joint's limitation.

Centering / pressure adjustment

Continually checking in and adjusting pressure to the client's comfort and feedback during the session.

Scope of practice

The services a massage therapist is trained, licensed, and legally permitted to provide — and the boundaries of what they may NOT do (e.g. diagnose).

Can a massage therapist diagnose?

No. Diagnosing a medical condition is outside a massage therapist's scope of practice; they may assess soft tissue and refer, but not diagnose or prescribe.

Dual relationship

A second relationship with a client beyond therapist-client (friend, business partner, romantic) that can blur boundaries and create conflicts — generally avoided.

Transference

When a client unconsciously projects feelings about someone else onto the therapist. The therapist should recognize it and maintain professional boundaries.

Countertransference

When the therapist projects their own feelings onto the client. Awareness and boundaries (and supervision) help manage it.

Informed consent

The client's voluntary agreement to treatment after being told the techniques, benefits, risks, and their right to stop at any time.

Confidentiality / HIPAA

Client health information must be kept private and secure, shared only with consent or as legally required. HIPAA governs protected health information.

Proper draping

Keeping the client covered with a sheet/towel, exposing only the area being worked, and never exposing the genitals or (for women) breasts — protects privacy and trust.

Purpose of draping

To ensure client safety, privacy, warmth, and comfort, and to clearly define professional boundaries during the session.

Sexual misconduct boundary

Any sexual behavior with a client is unethical and illegal. The therapeutic relationship must remain strictly professional at all times.

Therapeutic relationship

The professional, trust-based relationship between therapist and client, centered on the client's wellbeing and bounded by ethics.

Boundaries

The limits that keep the relationship professional — physical, emotional, time, and self-disclosure limits that protect both parties.

When confidentiality may be broken

Only with the client's written consent, by court order/legal requirement, or when there is risk of serious harm to the client or others.

Right of refusal

Both the client and the therapist have the right to refuse or end a session — e.g. if a client behaves inappropriately.

Dual-relationship example

Treating a close family member or a business partner — the overlapping roles can compromise objectivity and professional judgment.

Code of ethics

A set of professional standards (e.g. from a state board or association) governing honesty, respect, confidentiality, and client welfare.

Licensing and regulation

Massage therapy is regulated at the state level; therapists must meet education, exam (often the MBLEx), and licensing requirements to practice legally.

Mandatory reporting

Therapists may be legally required to report suspected abuse or neglect of vulnerable persons, depending on state law.

Conflict of interest

A situation where personal interest could improperly influence professional judgment; disclose and avoid it.

Professional ethics vs law

Law is the legal minimum (licensing, scope); ethics are professional standards of right conduct that often exceed legal requirements.

Power differential

The inherent imbalance of power favoring the therapist (clothed, in control of the session); it obligates the therapist to protect the vulnerable client.

Maintaining boundaries with self-disclosure

Limit personal sharing; the session is centered on the client, not the therapist's life and problems.

Therapist body mechanics

Using proper alignment and leverage — stacked joints, a stable base, and bodyweight rather than muscle force — to apply pressure safely and prevent injury.

Why good body mechanics matter

They let the therapist apply effective pressure with less effort and protect the therapist's hands, wrists, and back from overuse injury, extending their career.

Standard (universal) precautions

Treating all blood and body fluids as potentially infectious: hand hygiene, gloves when needed, and cleaning equipment between clients.

Hand hygiene

Washing hands before and after every client is the single most important measure to prevent the spread of infection.

Sanitation between clients

Change linens for every client and disinfect the table, face cradle, bolsters, and bottles/equipment between sessions.

Proper table height

Set so the therapist can apply pressure with good body mechanics — commonly around the level of the therapist's hip/knuckles when standing relaxed.

Asepsis

Practices that keep the environment free of pathogens — clean linens, sanitized surfaces, hand hygiene, and proper supply storage.

Sharps / contraindicated practice

Massage therapists do not perform invasive procedures; any sharps or broken-skin situations follow universal precautions and are outside hands-on massage scope.

Client positioning

Safe, comfortable positioning (prone, supine, side-lying, seated) with bolsters to support the body and protect joints.

Bolstering

Placing cushions to support the body — e.g. under the ankles when prone or under the knees when supine — for comfort and proper alignment.

Professional appearance and hygiene

Clean clothing, short clean nails, no strong scents, good personal hygiene, and a professional demeanor.

Self-care for the therapist

Stretching, strengthening, rest, and good body mechanics to prevent repetitive-strain injury and burnout.

Lubricant selection

Choose oils/lotions/creams based on glide needed and client allergies/skin type; check for nut or other allergies before use.

Maintaining a safe environment

Comfortable room temperature, clean and clutter-free space, accessible exits, and appropriate lighting and sound.

Record keeping (business)

Maintain accurate client records, consent forms, and SOAP notes securely and confidentially.

Draping technique competence

Securely draping and undraping only the area being worked, keeping the client covered and warm throughout.

Hand-washing vs gloves

Hand-washing is routine for every client; gloves are added when contact with broken skin or body fluids is possible.

Posture/stance for deep work

Use a lunge/archer stance with bent knees and a straight back, driving pressure from the legs and bodyweight, not the thumbs.

Linen handling

Used linens go directly into a covered hamper; never reuse linens between clients. Handle soiled linens away from the body.

Communication during the session

Check in on pressure, comfort, and temperature; respect the client's feedback and right to adjust or stop.

Continuing education / licensure renewal

Therapists complete continuing-education requirements to keep their license current and maintain competent, up-to-date practice.

Time and session management

Begin and end on time, allow the client privacy to dress/undress, and manage the session professionally.

Function of the skeletal system

Supports and shapes the body, protects organs, allows movement (with muscles), stores minerals (calcium), and produces blood cells in marrow.

Function of the muscular system

Produces movement and posture, stabilizes joints, moves substances through the body, and generates heat.

Function of the digestive system

Breaks down food, absorbs nutrients, and eliminates waste through a tract from the mouth to the anus.

Function of the endocrine system

Glands release hormones into the blood to regulate metabolism, growth, mood, and homeostasis.

Function of the urinary system

Filters blood, removes waste as urine, and balances fluids and electrolytes (kidneys, ureters, bladder, urethra).

Function of the reproductive system

Produces offspring; differs by sex and includes the organs and hormones of reproduction.

Capillaries

The smallest blood vessels, where oxygen, nutrients, and waste are exchanged between blood and tissues.

Lymph node

A small filtering organ along lymph vessels that traps pathogens and houses immune cells; massage moves lymph toward nodes.

Neuron

A nerve cell that transmits electrical and chemical signals; the basic unit of the nervous system.

Motor vs sensory neurons

Motor (efferent) neurons carry signals from the CNS to muscles/glands; sensory (afferent) neurons carry signals from receptors to the CNS.

Sympathetic nervous system

The 'fight or flight' division — raises heart rate, dilates pupils, and prepares the body for action.

Parasympathetic nervous system

The 'rest and digest' division — slows heart rate and promotes relaxation and digestion; massage favors this state.

Cardiac muscle

Involuntary, striated muscle found only in the heart; it contracts rhythmically without conscious control.

Smooth muscle

Involuntary, non-striated muscle in the walls of organs and blood vessels.

Ligament

Tough connective tissue connecting bone to bone, stabilizing joints.

Tendon

Tough connective tissue connecting muscle to bone, transmitting the muscle's pull.

Bursa

A fluid-filled sac that reduces friction between tissues around a joint; inflammation is bursitis.

Cartilage

Firm, flexible connective tissue that cushions joints and shapes structures (e.g. the ears and nose).

Origin of a muscle

The more fixed, usually proximal attachment that stays relatively still during contraction.

Insertion of a muscle

The more movable, usually distal attachment that moves toward the origin during contraction.

Elevation vs depression

Elevation lifts a part upward (shrugging the shoulders); depression lowers it.

Protraction vs retraction

Protraction moves a part forward/anteriorly (rounding the shoulders); retraction pulls it back (squeezing shoulder blades).

Opposition

Bringing the thumb to touch the fingertips — a movement unique to the thumb.

Lateral (side) flexion

Bending the trunk or neck sideways toward the shoulder; occurs in the frontal plane.

Hyperextension

Extending a joint beyond its normal anatomical range.

Prime mover example: elbow flexion

The biceps brachii is the agonist; the triceps brachii is the antagonist; the brachialis is a synergist.

Pectoralis minor — action

Stabilizes and protracts/depresses the scapula; tightness contributes to rounded shoulders.

Serratus anterior — action

Protracts and upwardly rotates the scapula ('boxer's muscle'); holds the scapula against the rib cage.

Rhomboids — action

Retract (and downwardly rotate) the scapula, pulling the shoulder blades together.

Levator scapulae — action

Elevates the scapula and laterally flexes the neck; a common site of neck tension.

Soleus — action

Plantar flexes the foot; works with the gastrocnemius and inserts via the Achilles tendon (active in standing).

Tibialis anterior — action

Dorsiflexes and inverts the foot; located on the front of the shin.

Iliopsoas — O / I / A

Origin: lumbar spine and iliac fossa. Insertion: lesser trochanter of the femur. Action: the primary hip flexor.

Adductors of the hip — action

Adduct the thigh (bring the leg toward the midline); the inner-thigh muscle group.

Hip abductors (gluteus medius/minimus)

Abduct the hip and stabilize the pelvis during walking; weakness causes a pelvic drop (Trendelenburg).

Masseter — action

Elevates the mandible (closes the jaw); a chewing muscle and a common site of TMJ tension.

Active range of motion (AROM)

Movement the client produces on their own; tests muscle strength and willingness to move.

Passive range of motion (PROM)

Movement the therapist produces while the client relaxes; isolates the joint and its non-contractile tissues.

Resisted range of motion

The client moves against the therapist's resistance; tests muscle/tendon strength and can reveal injury.

Goniometer

An instrument used to measure the angle (degrees) of a joint's range of motion.

Phlebitis

Inflammation of a vein, often with a clot. Avoid the area; if a deep clot (DVT) is suspected it is an absolute contraindication.

Hematoma

A localized collection of blood outside vessels (a deep bruise). A local contraindication — avoid direct pressure.

Acute vs subacute vs chronic injury

Acute = first ~72 hours (inflammation, avoid the site); subacute = healing/repair; chronic = long-standing and stable (often appropriate to massage).

Massage and the immune system

Massage may support immune function via relaxation, but during active infection/fever it is an absolute contraindication.

Heart conditions and massage

Significant cardiac disease requires physician clearance and caution; vigorous circulatory work may overload a compromised heart.

Recent surgery

Avoid the surgical site until healed and cleared; massage elsewhere may be fine with physician approval.

Skin cancer / suspicious moles

Do not massage over undiagnosed lumps, suspicious moles, or skin lesions; refer the client to a physician.

Atherosclerosis

Plaque in the arteries. Avoid deep pressure over major arteries; get clearance for significant cardiovascular disease.

Aneurysm

A weakened, bulging artery wall — a contraindication for pressure over the area; refer if suspected.

Fibromyalgia

A chronic widespread pain condition; massage may help with gentle pressure, adjusting to the client's high sensitivity.

Multiple sclerosis (MS)

A chronic neurological condition; gentle massage may help, avoiding overheating and adapting to the client's fatigue and sensation.

Arthritis (osteo/rheumatoid)

Massage around (not directly on) acutely inflamed joints can help; avoid deep work on actively inflamed rheumatoid joints.

Edema vs lymphedema

Edema is general fluid swelling; lymphedema is swelling from lymphatic blockage — refer/clear before specialized work.

Contagious conditions and infection control

Conditions like the flu, lice, scabies, ringworm, and active herpes risk spreading — reschedule or avoid the area and disinfect.

Endangerment site: axilla (armpit)

Contains the axillary artery, vein, and brachial plexus — avoid deep pressure.

Endangerment site: femoral triangle

In the upper inner thigh — contains the femoral artery, vein, and nerve — avoid deep pressure.

Endangerment site: kidney area

The lower back below the ribs — avoid heavy percussion/deep pressure over the kidneys.

Endangerment site: umbilicus / abdomen

Use caution over the abdomen, especially the aorta in the midline; keep pressure light and appropriate.

Bell's palsy

Facial nerve paralysis; gentle facial massage may be appropriate within scope and with care.

Pregnancy positioning

Side-lying or semi-reclined positioning is preferred, especially later in pregnancy, to avoid pressure on the vena cava.

First-trimester caution

Use conservative, gentle work in early pregnancy and obtain clearance for high-risk pregnancies.

Numbness or tingling (paresthesia)

An undiagnosed neurological symptom — a red flag to refer rather than treat aggressively.

Thrombus vs embolus

A thrombus is a clot that forms in place (e.g. DVT); an embolus is a clot that has traveled — both are reasons to never massage a suspected DVT.

Fracture (recent)

A local contraindication — avoid the area of a recent or unhealed fracture entirely.

Centripetal (toward heart) strokes

Effleurage applied toward the heart supports venous return because veins carry blood back to the heart.

Compression

Rhythmic pressing into muscle (often through clothing); increases circulation and warms tissue without gliding.

Rocking and shaking

Gentle passive movements that relax the nervous system and the client, reducing muscular guarding.

Stripping (longitudinal friction)

Gliding deep pressure along the length of a muscle fiber to release tension and lengthen the muscle.

Effect of massage on flexibility

By reducing muscle tension and lengthening tissue, massage improves flexibility and joint range of motion.

Effect of massage on metabolic waste

Improved local circulation helps flush metabolic byproducts (like lactic acid) from worked muscle.

Effect of massage on blood pressure

Relaxation massage can transiently lower heart rate and blood pressure via the parasympathetic response.

Effect of massage on stress hormones

Massage is associated with reduced cortisol and increased relaxation, contributing to lower stress.

Effect of massage on scar tissue

Friction and cross-fiber techniques can soften and remodel mature scar tissue and reduce adhesions.

Effect of massage on sleep

By reducing stress and promoting relaxation, massage can improve sleep quality.

Effect of massage on digestion

The parasympathetic ('rest and digest') shift and gentle abdominal work may support healthy digestion.

Mechanical effect example

Physically moving fluid (blood/lymph) and stretching fascia and muscle fibers with pressure.

Reflexive effect example

Triggering a nervous-system response such as relaxation, reduced pain perception, or muscle release.

Hyperemia purpose

The increased blood flow delivers oxygen and nutrients and removes waste, aiding tissue recovery.

Myofascial release

Sustained gentle pressure into fascial restrictions to release tension and restore tissue mobility.

Lymphatic drainage technique

Light, slow, rhythmic strokes directed toward lymph nodes to encourage lymph movement.

Why warm tissue first

Warming with effleurage increases circulation and pliability, making deeper work safer and more effective.

Pain-spasm-pain cycle

Pain causes muscle guarding/spasm, which causes more pain; massage can interrupt this cycle by relaxing the muscle.

Health history review

Reviewing the intake form for conditions, medications, surgeries, and goals before deciding the treatment approach.

Visual (observational) assessment

Observing skin, posture, swelling, symmetry, and movement before and during the session.

Functional assessment

Evaluating how the client moves and performs activities to identify limitations and treatment targets.

Orthopedic tests (within scope)

Basic movement/ROM screens to identify the source of soft-tissue complaints; massage therapists do not diagnose.

Subjective vs objective example

Subjective: 'my neck hurts when I turn left.' Objective: 'cervical rotation limited to 45 degrees on the left.'

Assessment (A) in SOAP

The therapist's professional analysis of the subjective and objective findings and the response to treatment.

Plan (P) in SOAP

The proposed next steps — techniques, frequency, home care, and goals for future sessions.

Home care recommendations

Stretches, hydration, and self-care a therapist may suggest within scope to support results between sessions.

Contraindication screening

Reviewing the intake and assessment specifically for absolute, local, and general contraindications before treatment.

Tracking progress over sessions

Comparing reassessment findings (ROM, pain, posture) across visits to measure improvement and adjust the plan.

Symmetry assessment

Comparing left to right sides for differences in muscle bulk, tension, and alignment.

Pain quality descriptors

Sharp, dull, aching, burning, or radiating — descriptors that help characterize the client's complaint.

Acute vs chronic in planning

Acute complaints call for gentle, conservative work; chronic, stable complaints can tolerate more focused therapeutic work.

Client goals drive the plan

The treatment plan is built around the client's stated goals (relaxation vs pain relief vs improved ROM).

Referral decision

If findings are outside scope or show red flags, document and refer the client to the appropriate provider.

Re-evaluation timing

Reassess at the end of each session and periodically over a course of care to confirm the plan is working.

Posture deviations to note

Forward head, rounded shoulders, anterior pelvic tilt, and uneven shoulders/hips are common documented findings.

Importance of consent before assessment touch

Explain and get consent before palpating or moving the client during assessment.

Maintaining confidentiality of records

Store client records securely and share only with consent or legal requirement; protect privacy per HIPAA.

Avoiding inappropriate self-disclosure

Keep the focus on the client; excessive sharing of personal details breaches professional boundaries.

Recognizing transference signs

A client treating the therapist as a parent, partner, or authority figure — respond with clear, professional boundaries.

Managing countertransference

Notice your own emotional reactions to a client and keep the relationship professional; seek supervision if needed.

Reporting unethical conduct

Therapists have an ethical duty to report colleagues' unethical or illegal behavior per the code of ethics and law.

Truth in advertising

Represent your training, credentials, and services honestly; do not claim to cure or diagnose.

Right to stop the session

The client may stop or modify the session at any time, and the therapist must honor that immediately.

Cultural sensitivity

Respect clients' cultural backgrounds, beliefs, and comfort with touch and draping.

Scope: referral vs treatment

Recognizing when a client's needs exceed massage scope and referring out is itself an ethical and legal obligation.

Professional draping ethics

Proper draping is both an ethical boundary and a legal/professional standard protecting client dignity.

Boundaries on touch

Only touch areas appropriate to the treatment and consent; never the genitals, and breasts only where state law and consent allow with proper draping.

Gift and dual-relationship caution

Be cautious accepting significant gifts or entering personal/business relationships that compromise objectivity.

Consent must be ongoing

Consent is not one-time; check in and confirm the client is comfortable with areas and pressure throughout.

Documentation as ethical practice

Accurate, honest records protect the client and demonstrate ethical, accountable practice.

Non-discrimination

Provide services without discriminating based on race, sex, religion, disability, or other protected characteristics.

Maintaining competence

Practice only techniques you are trained in, and pursue continuing education to stay competent — an ethical duty.

Client autonomy

Respect the client's right to make decisions about their own care and body.

Financial integrity

Charge fairly and transparently, and bill honestly for services actually provided.

Lunge/archer stance

A staggered-foot stance with bent knees that lets the therapist drive pressure from bodyweight and legs, protecting the back.

Stacking joints

Aligning wrist, elbow, and shoulder over the point of pressure so force transmits through bone, not muscle/joints.

Avoiding thumb overuse

Use forearms, fists, or elbows for deep pressure to spare the thumbs and prevent repetitive-strain injury.

Keeping the back straight

Maintain a neutral spine and hinge from the hips/legs rather than rounding the back to reach.

Disinfecting equipment

Wipe down the table, face cradle, bolsters, and bottles with an appropriate disinfectant between every client.

Linen change policy

Provide fresh, clean linens for each client; never reuse linens between clients.

Hand-washing technique

Wash with soap and water for at least 20 seconds, including between fingers and under nails, before and after each client.

Personal protective measures

Cover any cuts, wear gloves when contact with broken skin/fluids is possible, and stay home when ill.

Room setup

A clean, warm, quiet, private room with the table positioned for safe access and good body mechanics.

Bolster placement (prone)

Place a bolster under the ankles when the client is face-down to reduce strain on the low back and knees.

Bolster placement (supine)

Place a bolster under the knees when the client is face-up to ease the low back.

Checking lubricant allergies

Ask about nut and other allergies before choosing an oil, lotion, or cream.

Maintaining professional boundaries in practice

Consistent draping, clear communication, and a professional environment uphold boundaries during the session.

Career longevity

Good body mechanics, self-care, and pacing prevent the overuse injuries that end many massage careers.

Safe client transfer

Assist clients on and off the table safely, especially the elderly, injured, or those with limited mobility.

Temperature and comfort

Keep the room and client warm and comfortable; offer extra draping or warmth as needed.

Equipment safety check

Ensure the table is stable and rated for the client's weight and that the face cradle is secure before the session.

Storing supplies sanitarily

Keep oils, lotions, and linens in clean, covered storage to prevent contamination.

Universal precautions rationale

You cannot always know who carries an infection, so treat all blood/body fluids as potentially infectious for everyone.

Professional boundaries vs friendliness

Be warm and welcoming while keeping the relationship clearly professional and centered on the client's care.