MBLEx cheat sheet

Anatomical position: standing erect, face forward, arms at the sides with palms facing anteriorly, feet parallel and flat.

Directional terms: proximal = nearer the trunk; distal = farther from it; medial = toward midline; lateral = away from midline; superficial = nearer the surface.

Body planes: sagittal divides body into left and right; frontal (coronal) divides anterior from posterior; transverse divides superior from inferior.

Adult skeleton has 206 bones; the axial skeleton (80) includes skull, vertebral column, ribs, and sternum, and the appendicular skeleton (126) includes limbs and girdles.

Three muscle tissue types: skeletal (voluntary, striated), cardiac (involuntary, striated, intercalated discs), and smooth (involuntary, non-striated, in organ walls and blood vessels).

Blood flow sequence: right atrium to right ventricle to pulmonary circulation to left atrium to left ventricle to aorta to systemic circulation.

Nervous system: CNS (brain and spinal cord); PNS splits into somatic (voluntary) and autonomic, and autonomic splits into sympathetic (fight-or-flight) and parasympathetic (rest-and-digest).

Normal arterial blood pH is 7.35 to 7.45; values below 7.35 indicate acidosis and above 7.45 indicate alkalosis.

Skin layers from superficial to deep: epidermis (avascular), dermis (vessels, nerves, glands), and subcutaneous/hypodermis (adipose and fascia).

Origin is the attachment that is relatively fixed or closer to the trunk; insertion is the attachment that moves more during contraction.

Roles in movement: agonist (prime mover), antagonist (opposes or controls the motion), synergist (assists the agonist), and fixator (stabilizes the origin).

Isotonic contraction changes muscle length and moves a joint (concentric shortens, eccentric lengthens); isometric contraction develops tension without joint motion.

Lever classes: first class has the fulcrum between load and effort; second class has the load between; third class has the effort between and describes most human limbs.

Joint motions: flexion decreases the joint angle, extension increases it, abduction moves a limb away from midline, adduction moves it toward midline.

Circumduction is a cone-shaped combination of flexion, extension, abduction, and adduction; rotation is turning around the bone's long axis (medial/internal vs lateral/external).

Movement planes: sagittal = flexion/extension; frontal = abduction/adduction and lateral flexion; transverse = rotation and horizontal adduction/abduction.

Sliding filament mechanism: myosin heads pull actin filaments toward the sarcomere center; calcium and ATP are both required, and ATP is needed for relaxation as well.

Fiber types: Type I (slow oxidative) is fatigue-resistant and posture-oriented; Type II (fast glycolytic) produces rapid, powerful contractions and fatigues quickly.

Cardinal signs of inflammation: redness, heat, swelling, pain, and loss of function; acute inflammation is a local contraindication until it subsides.

Sprain = ligament injury; strain = muscle or tendon injury; both are graded I (mild) to III (complete tear).

Contusion is a bruise from blunt trauma with intact skin; hematoma is a localized collection of blood outside vessels.

Osteoarthritis is degenerative cartilage loss with joint pain worsened by use and morning stiffness typically lasting under 30 minutes.

Rheumatoid arthritis is an autoimmune, symmetric polyarthritis of small joints with morning stiffness often exceeding one hour and systemic fatigue.

Fibromyalgia presents as widespread musculoskeletal pain, multiple tender points, sleep disturbance, and fatigue, without joint deformity or inflammation.

Diabetes mellitus can cause peripheral neuropathy with reduced sensation in the feet, increasing risk of burns, pressure injury, and unnoticed skin damage.

Malignant tumors may metastasize, most often to bone, lung, liver, and brain; bone metastasis raises pathologic fracture risk under pressure.

Contagious skin conditions (tinea, impetigo, herpes, scabies) and infected wounds are locally and often systemically contraindicated until treated.

Absolute (systemic) contraindications include fever, acute infectious disease, acute fracture or dislocation, deep vein thrombosis, and uncontrolled hypertension.

Local contraindications include open wounds, burns, undiagnosed lumps, tumors, contagious rashes, acute inflammation, and recent unhealed scar tissue.

Anticoagulant or antiplatelet therapy increases bruising and bleeding risk; use lighter pressure and avoid deep work over vulnerable areas.

Pregnancy: avoid deep abdominal pressure and prolonged supine positioning after the first trimester; DVT and varicosity risk is elevated.

Diabetes: avoid pressure over insulin injection sites, inspect skin for wounds, and use reduced pressure where neuropathy reduces sensation.

Deep vein thrombosis, phlebitis, and severe varicosities: no massage over or distal to the site, because clot dislodgment can cause pulmonary embolism.

Cardiovascular disease: avoid deep pressure over varicosities and the carotid, femoral, and popliteal areas; modify for heart failure and uncontrolled hypertension.

Acute injury in the first 24 to 72 hours: massage is locally contraindicated while swelling and heat are present; use rest, ice, compression, elevation.

Contraindication screening is repeated at every session, because client health status and medications change between visits.

Swedish massage foundations: effleurage (gliding), petrissage (kneading), friction, tapotement (percussion), and vibration.

Effleurage is generally directed toward the heart to support venous and lymphatic return, using broad palm contact and light-to-moderate pressure.

Petrissage includes kneading, picking up, wringing, rolling, and skin rolling; it compresses and releases tissue to mobilize deeper layers.

Tapotement uses brisk rhythmic percussion such as hacking, cupping, tapping, and pincement; it is stimulating and generally avoided over bony prominences and the kidneys.

Cross-fiber friction is applied perpendicular to muscle or tendon fibers to address adhesions and scar tissue; it can cause temporary soreness.

Trigger points are hyperirritable spots within a taut band that refer pain; they are treated with ischemic compression, positional release, or sustained pressure.

Myofascial release uses slow, sustained, low-load pressure with fascial rebound rather than oil-based gliding over the skin.

Lymphatic drainage uses light, precise strokes directed toward regional lymph nodes to move interstitial fluid without overloading the system.

Joint mobilization is passive movement of a joint within or at the end of its available range, applied without exceeding the client's tolerance.

SOAP format: Subjective (client report), Objective (observation, palpation, ROM measures), Assessment (therapist interpretation), Plan (treatment and follow-up).

Intake data includes chief complaint, health history, medications, surgeries, injuries, occupation, stress level, and client goals.

Range of motion types: active (client performs), passive (therapist moves the relaxed joint), and resistive (client moves against therapist resistance).

Palpation assesses temperature, texture, tone, tenderness, swelling, and tissue mobility; findings are compared bilaterally.

Postural assessment uses a plumb line viewed anteriorly, posteriorly, and laterally to detect deviations such as forward head or pelvic tilt.

Normal adult vital signs: blood pressure below 120/80 mmHg, resting heart rate 60 to 100 bpm, respiratory rate 12 to 20 per minute.

Endangerment sites include the anterior triangle of the neck (carotid), axilla (brachial plexus), femoral triangle, popliteal fossa, and floating ribs.

Reassessment compares current findings to the documented baseline to show progress or regression and to justify plan changes.

Special orthopedic tests suggest but do not diagnose a condition; positive findings warrant referral rather than a treatment conclusion.

Scope of practice: massage therapists assess and treat soft tissue; they do not diagnose disease, prescribe medication, or perform spinal manipulation.

Standard precautions apply to all clients: hand hygiene before and after contact, gloves when body fluids or non-intact skin may be contacted.

Confidentiality: client records and disclosures are protected; release requires written authorization except where law mandates reporting.

Documentation must be legible, dated, signed, objective, and completed at the time of service; errors are corrected with a single line and initials, not erased.

Informed consent is obtained before the first session and whenever techniques or scope change; consent may be withdrawn at any time.

Professional boundaries define a therapeutic relationship; dual or romantic relationships with clients are avoided.

Continuing education and license renewal requirements vary by jurisdiction and must be tracked and completed by the stated deadline.

Referral is required when assessment findings or client conditions exceed the therapist's scope, training, or legal authority.

Autonomy: the client holds the right to decide about their care, including refusing or stopping a session at any point.

Beneficence is acting for the client's benefit; nonmaleficence is avoiding harm and is the reason contraindications are enforced.

Justice requires fair, nondiscriminatory treatment regardless of age, sex, race, disability, sexual orientation, or payment method.

Fidelity means keeping promises and honoring the therapeutic contract; veracity means being truthful with clients and in advertising.

Sexual contact or romantic involvement with a current client is prohibited as a boundary violation, regardless of who initiates it.

Transference is the client's projection of feelings onto the therapist; countertransference is the therapist's own unresolved feelings toward the client.

Dual relationships that risk impairing professional judgment are avoided or disclosed and managed with safeguards.

When a client discloses abuse, neglect, or a reportable condition, the therapist follows the jurisdiction's mandatory reporting law.

Common business structures: sole proprietorship (unlimited personal liability), partnership, limited liability company, and corporation.

Worker classification tests examine control over schedule, tools, supervision, and method of work; misclassifying an employee as a contractor creates tax liability.

Self-employed therapists pay self-employment tax and generally make quarterly estimated income tax payments.

Credential types differ: licensure is a legal permission granted by the state, certification is a voluntary credential from a board, and registration is listing on a roster.

Professional liability (malpractice) insurance covers claims of negligence or injury and typically also funds legal defense.

Written service agreements should state fees, payment terms, cancellation policy, and scope of services provided.

Records are typically retained 5 to 7 years after the last visit, and longer (often until age of majority plus several years) for minors.

Advertising must be truthful and avoid unsubstantiated medical claims or testimonials implying cure of disease.

Employment laws on wages, hours, discrimination, and safety apply to massage practices as to other businesses.

Standard session sequence: intake and screening, assessment, treatment, reassessment, home care instructions, documentation.

Draping covers the client and exposes only the area being treated; it preserves warmth, privacy, and professional boundaries.

Common positions are supine, prone, side-lying, and seated; bolsters support the cervical spine, knees, abdomen, and ankles to reduce strain.

Table height should let the therapist's arms work with elbows slightly bent, and stance should keep feet apart with knees soft to avoid lower-back torsion.

Pressure is verified with the client using a comfort or pain scale, and is adjusted immediately when the client reports pain or numbness.

Hand hygiene, clean linens for each client, and sanitized equipment and containers are baseline hygiene requirements.

A session is terminated if the client withdraws consent, if an adverse reaction occurs, or if a contraindication is discovered.

Client education and home care instructions are documented and consistent with the therapist's scope of practice.

Coordination with other healthcare providers requires written client authorization to release information.