Massage and Bodywork Licensing Examination MBLEx Client Assessment and Treatment 1 — Questions and Answers
Question 1: During passive range of motion assessment of the shoulder, the therapist notes a firm, leathery resistance at end range of external rotation. This type of end-feel most likely suggests which condition?
- Significant joint effusion causing a boggy end-feel
- Capsular fibrosis consistent with adhesive capsulitis (Correct answer)
- Bone-on-bone contact from degenerative joint changes
- An acute bursitis with protective muscle guarding
Correct answer: Capsular fibrosis consistent with adhesive capsulitis
A firm, leathery end-feel during passive ROM is characteristic of capsular fibrosis. In adhesive capsulitis, the joint capsule thickens and contracts, producing this specific quality of resistance at end range rather than the soft or bony end-feels seen in other conditions.
Question 2: A massage therapist observes during postural assessment that a client has a pronounced anterior pelvic tilt. Which muscle pattern is most consistent with this postural deviation?
- Shortened hamstrings and weak erector spinae
- Weak hip flexors and hypertonic hip abductors
- Shortened hip flexors and inhibited gluteal muscles (Correct answer)
- Hypertonic adductors and lengthened iliotibial band
Correct answer: Shortened hip flexors and inhibited gluteal muscles
Anterior pelvic tilt results from a predictable imbalance: shortened hip flexors (iliopsoas, rectus femoris) pull the front of the pelvis down, while inhibited or weak gluteals fail to posteriorly rotate the pelvis, perpetuating the forward tilt.
Question 3: A client describes deep, diffuse, achy pain in the upper trapezius that is difficult to localize and sometimes radiates toward the temporal region. To confirm the presence of myofascial trigger points, which assessment technique is most appropriate?
- Passive cervical lateral flexion to assess capsular end-feel
- Resisted shoulder elevation to isolate muscle weakness
- Palpation of taut bands to elicit a local twitch response (Correct answer)
- Dermatome mapping along the C3–C4 nerve distribution
Correct answer: Palpation of taut bands to elicit a local twitch response
Myofascial trigger points are identified by palpating a taut band within the muscle belly and applying compression to elicit a local twitch response and referred pain pattern. This hands-on palpation finding distinguishes active trigger points from other sources of pain.
Question 4: During a client intake, a therapist reviews the health history and notes the client is taking warfarin. Which assessment finding is most critical to evaluate before beginning treatment?
- Active cervical range of motion and end-feel quality
- Bilateral grip strength for neurological comparison
- Presence of unexplained bruising or skin discoloration (Correct answer)
- Resting heart rate and blood pressure values
Correct answer: Presence of unexplained bruising or skin discoloration
Warfarin is an anticoagulant that significantly increases bleeding risk. Before treatment, the therapist must assess for unexplained bruising or discoloration, which can indicate fragile capillaries or an underlying bleed that would contraindicate deeper pressure techniques.
Question 5: A therapist performs a postural and gait assessment and observes the client's left foot externally rotates during the swing phase of walking. Which muscle should be prioritized in the palpatory assessment for hypertonicity?
- Left tensor fasciae latae
- Left piriformis and external hip rotators (Correct answer)
- Left tibialis anterior
- Left medial gastrocnemius
Correct answer: Left piriformis and external hip rotators
Persistent external rotation of the foot during gait often indicates hypertonicity of the piriformis and the other deep external hip rotators, which excessively rotate the entire lower extremity outward throughout the gait cycle.
Question 6: A massage therapist palpates increased tissue temperature, a palpable nodule at the left levator scapulae insertion, and restricted cervical right lateral flexion. In a SOAP note, where should these specific findings be recorded?
- Subjective section, as they reflect the client's reported symptoms
- Assessment section, as they represent the therapist's clinical diagnosis
- Objective section, as they are measurable observations made by the therapist (Correct answer)
- Plan section, as they inform the treatment strategy selected
Correct answer: Objective section, as they are measurable observations made by the therapist
Palpation findings such as tissue temperature, palpable nodules, and measured range of motion restrictions are objective, clinician-observed data. They belong in the Objective section of the SOAP note, which captures what the therapist directly observes and measures rather than what the client reports.
