The MBLEx is the Massage & Body Work Licensing Examination. The exam plays a key role in ensuring that anyone practicing massage or bodywork has not only received the proper training but also demonstrated the mastery required to work with patients in a safe, healthy and respectful manner.

The MBLEx, which can be taken throughout the year in locations across the United States, is two hours long (bear in mind that 10 minutes of this time is allotted to the completion of a security and confidentiality agreement and a brief survey). The exam itself consists of 100 multiple choice questions, which are completed on a computer.

The Federation of State Massage Therapy Boards has outlined eight main content areas for the MBLEx. Each content area is weighted differently and aims to test key areas of knowledge in the massage and bodywork fields:

• Anatomy and Physiology (12%)
• Kinesiology (11%)
• Pathology, Contraindications, Areas of Caution, Special Populations (13%)
• Benefits and Physiological Effects of Techniques that Manipulate Soft Tissue (14%)
• Client Assessment, Reassessment & Treatment Planning (17%)
• Overview of Massage & Bodywork Modalities/Culture/History (5%)
• Ethics, Boundaries, Laws, Regulations (15%)
• Guidelines for Professional Practice (3%)

Whether you are just beginning to prepare for the MBLEx or are already scheduled to take the exam, the following overview will help you learn what to study for the FSMTB MBLEx examination. You’ll find tips on what you’ll need to know to pass the MBLEx, what content areas to prioritize while studying, and how to test your knowledge on the exam’s key areas of content.

1. Anatomy & Physiology

The first section of the MBLEx consists of questions related to anatomy (the parts of the body) and physiology (how the body functions). These two larger topics are further broken down into four sub-topics, which include:

• System structures
• System functions
• Tissue injury and repair
• Concepts of energetic anatomy (e.g., more central to Eastern than Western medicine and knowledge, this final area is often associated with concepts such as chakras).

How to prepare? Your first step to acing the MBLEx is to ensure you have a comprehensive knowledge of all parts of the body, what they do, and how they interact. Notably, for the MBLEx, you’ll need to have a basic understanding of how various body parts function from both a Western and Eastern medical perspective. Among other key areas of information you should be able to identify, define and describe the function of the following:

A. System Structures

Understand the parts that comprise each of the following structures along with the functions of each:

• Circulation
• Digestive
• Endocrine
• Integumentary
• Lymphatic
• Muscular
• Nervous
• Reproduction
• Respiratory
• Skeletal
• Special Senses
• Urinary

B. Tissue Injury and Repair

You should have some knowledge of the length and phases connected to healing:

• Bleeding: 2-3 days to 2-3 weeks
• Tissue regeneration: 2-3 days to 6 weeks
• Remodeling of tissue: 6 weeks to 1 year (may take longer)

Also, familiarize yourself with key terminology (e.g., fibroblasts, scar tissue, and macrophages).

In addition, understand the role of specific supplements in the healing process (e.g., Vitamin C is essential to tissue repair and blood clotting).

C. Concepts of Energetic Anatomy

In recent years, Western massage and bodywork have become increasingly informed by Eastern techniques and approaches. While you will not need to become an expert on all these approaches (like Western massage and bodywork, these are large bodies of knowledge that often require years of training to master), you will need to understand something about the Five Elements used in Japanese massage methods, the meridians that inform approaches to acupuncture, acupressure and shiatsu, and the chakras that inform Indian and Hindu methods.

The Five Elements—Japanese Methods

• Metal: Lung and large intestine
• Earth: The spleen and the stomach
• Fire: The heart, small intestine, pericardium and triple heater
• Water: The kidney and bladder
• Wood: The liver and gallbladder

Meridians—Used in Acupuncture, Acupressure, and Shiatsu

There are over 400 meridians and while you may want to memorize all of them, this will likely not be required. You should, however, understand that the meridians are “life channels” through which vital energy (chi or qi) flows. The principle underpinning acupuncture, acupressure and shiatsu is that chi gets blocked due to injuries, stress and in some cases, bad lifestyle habits (e.g., a poor diet) and that trained professionals can help to open up these blocked channels.

Chakras—Indian and Hindu Methods

• Chakras: The centers of the Prana
• Laryngeal: Throat
• Frontal: Between eyebrows
• Root: Base of spine
• Coronal: Top of head

2. Kinesiology

A. Components and Characteristics of Muscles

Understand the fundamental differences between phasic and postural muscles and be able to identify them (e.g., phasic or fast-twitch muscles, which include the deltoids and biceps, generally tire quickly; postural or slow-twitch muscles, which include soleus and erector spinae tire less quickly). Also, ensure you are familiar with general muscle firing patterns (e.g., prime movers, stabilizers, and synergists).

B. Concepts of muscle contractions

There are four types of muscle contractions:
• Issometric: Length of muscle does not change
• Isotonic: Length of muscle changes
• Eccentric: Muscle lengthens
• Concentric: Muscle shortens


C. Proprioceptors

Proprioceptors are sensors that communicate information (e.g., about joint angles and muscle tension). There are three types of proprioceptors:

• Golgi tendon organs: Respond to tension and protect muscles from contracting with too much force; also relax muscles as needed
• Muscle spindles: Respond to sudden lengthening
• Joint kinesthetic receptors: Respond to pressure as well as movement in joints

D. Locations, Attachments (Origins, Insertions), Actions and Fiber Directions of Muscles

Although this is only one small subsection of the exam, it should be a critical part of your study plan! To ace this section of the MBLEx, you should be able to locate all the muscles in the body, know where and how they are attached, and what they do. You will also need to know how to identify their fiber directions. Among other questions, be prepared to identify the muscles on a diagram of the human body and to answer specific questions about these muscles and muscle groups (e.g., What muscles make up the quadriceps? Is the abductor group medial and lateral?)

E. Joint structure and function

Joints occur at any point where two or more bones meet. They are integral to movement and stability. They are classified in two ways: structure and function. On a structural level, joints are divided into three main categories: fibrous, cartilaginous, and synovial. On the basis of function, they are also divided into three main categories: synarthroses, amphiarthroses, and diarthrosis. For the purposes of the MBLEx, you should familiarize yourself with both sets of classification:

Structural Classifications

• Fibrous: Held together by connective tissue; highly stable (e.g., skull)
• Cartilaginous: Held together by cartilage; slight movement (e.g., vertebrae)
• Synovial: Held together in a cavity filled with synovial fluid; permit for maximum level of movement (e.g., tibia)

Functional Classifications

• Synarthroses: Immovable joint (e.g., tibia)
• Amphiarthroses: Slightly movable joint (e.g., vertebrae)
• Diarthroses: Freely movable joint (e.g., skull)

F. Range of motion

“Range of motion” literally refers to the distance of a specific joint movement that is possible. In massage and body work, this is usually discussed in relation to active, passive and resistant ranges.

• Active: The joint movement that requires a patient’s own energy.
• Passive: The joint movement that can be accomplished with the therapist’s support.
• Resistant: Any joint movement that cannot be accomplished with the patient’s energy or therapist’s support.

3. Pathology, Contraindications, Areas of Caution, Special Populations

A. Overview of Pathologies

Pathology is the study of the nature and causes of disease. You’re not expected to memorize every disease in the world for the MBLEx but you should have an understanding of common diseases and their presenting signs and be able to:

• Define disease terminology (e.g., acute versus chronic diseases).
• Identify and define theories of inflammation and injury repair
• Identify and define skeletal conditions (e.g., osteoporosis)
• Identify common fracture and conditions (e.g., arthritis and whiplash)
• Identify and define connective tissue conditions (e.g., tendinitis).
• Identify and define gastrointestinal related conditions (e.g., gallstones)
• Identify and define skin conditions (e.g., skin lesions and burns)
• Understand something about the different types of cancer and how massage can alleviate symptoms
• Define and identify Cardiovascular conditions (e.g. degenerative heart disease or hypertension

A key part of the MBLEx is being able to identify and respond to pathologies for which massage is often prescribed. For this reason, while preparing for the exam, you are advised to give special consideration to the following diseases and conditions:

• Arthritis
• Depression
• Anxiety
• Fibromyalgia
• Headaches
• Back and neck pain
• Herniated discs
• Scoliosis
• Sciatica
• Carpal Tunnel Syndrome

B. Contraindications

Understanding contraindications in massage and bodywork is critical since contraindications are situations in which a drug, procedure or surgery should not be used because they may bring about more harm than good to the patient. There are two types of contraindications: relative and absolute. Relative contraindications may cause some harm but absolute contraindications may cause a life-threatening situation. Anyone engaged in massage or bodywork must be attentive to contraindications for two reasons. First, there are conditions under which massage may be harmful in a relative or absolute way. Second, often massage or bodywork can be an alternative when drugs or surgery are identified as contraindications.

C. Areas of Caution

Understand all areas of caution; this includes muscles and muscle groups that can be easily over-extended.

D. Special Populations

Understand who falls into special populations (e.g., children, the elderly, veterans with PTSD, etc.) and how massage can be used to support healing with these specific populations.

E. Classes of Medications

While not a key part of the MBLEx, it is important to understand how some medications impact mobility and/or the effectiveness of massage and bodywork.

4. Benefits and Physiological Effects of Techniques that Manipulate Soft Tissue

This content area aims to test your knowledge of massage’s therapeutic benefits; key areas of knowledge include:

• The ability to identify the physiological effects of soft tissue manipulation
• An understanding of the psychological aspects and benefits of touch
• An understanding of the benefits of soft tissue manipulation for specific client populations
• A broad knowledge of different soft tissue techniques (e.g. types of strokes)

5. Client Assessment, Reassessment, and Treatment Planning

For this content area, you’re expected to understand what happens when a client arrives in the clinic (e.g., how to carry out an initial intake and assessment and how to set treatment goals). Key areas of knowledge include:

• Structure of a massage/bodywork session
• Client consultation (e.g., verbal intake methods)
• Data collection
• Visual assessment of patient
• Palpation assessment
• Range of motion assessment
• Clinical reasoning (e.g., ability to rule out contraindications and to work with the client to set treatment goals).

6. Overview of Massage & Bodywork Modalities/Culture/History

This content area is the second smallest section of the exam (accounting for only 5% of the questions on the MBLEx); nevertheless, for anyone hoping to pursue a career in massage and bodywork, it is essential to understand something about the fields’ history and culture. Among other key points, ensure you are familiar with:

• The history of massage & bodywork in both a Western and Eastern context
• The different skill sets used in contemporary massage/bodywork environments (e.g., social skills, diagnostic skills, techniques from Western and Eastern massage, cross-cultural understandings about the body and pathology)
• Massage/bodywork modalities (e.g., shiatsu, amma, Jin Shin Do, Thai massage, and tui na among others).

7. Ethics, Boundaries, Laws, Regulations

This is an important area of massage and bodywork practice; at the very least, you will be expected to understand key concepts and issues related to:

• Ethical behavior
• Professional boundaries
• Code of ethics violations
• The therapeutic relationship
• Dual relationships
• Sexual misconduct
• Massage/bodywork-related laws and regulations
• Scope of practice
• Professional communication
• Confidentiality
• Principles

8. Guidelines for Professional Practice

A. Proper and Safe Use of Equipment and Supplies

Understand how to properly use common equipment (e.g., how to sanitize and prepare a massage table between clients).

B. Therapist Hygiene

Know something about proper hand washing techniques and other basic hygiene issues.

C. Sanitation and Cleanliness

Know how to maintain a clear office in compliance with federal regulations and how to dispose of materials used during practice.

D. Safety Practices

Understand how to run a safe clinic where both you and your patients are protected at all times.

E. Therapist Care

Understand how to take care of your own body as a therapist; this includes self-care and injury prevention. You should also know something about protective gear (e.g., masks, gowns, gloves, etc).

F. Draping

Know how to safely and appropriately drape a patient while engaging in massage and body work and how to communicate throughout the process.

G. Business Practices

Understand something about business and strategic planning, office management and marketing. You should also understand how to maintain patient records and keep them confidential.

H. Healthcare and Business Terminology

Understand basic healthcare and business terminology (e.g., What does HIPAA stand for?)

Due to the complexity of the exam and in-depth anatomy and physiology topics, you should plan to study for the MBLEx for at least four months. Try out Pocket Prep’s MBLEx exam prep app and study in conjunction with the referenced textbook!

Mosby’s Massage Therapy Review, 4th Edition