Client Assessment, Reassessment & Treatment Planning practice questions

Answer: B) Muscle guarding, a protective contraction that splints an injured area

Muscle guarding is protective contraction around an injured or painful area that splints it against movement and pressure. Therapists should recognize it and work gently around it, not force through it.

• AIncorrect. A trigger point is a localized, tender nodule in a taut band, often with a referred pain pattern. It doesn't describe a region of muscle tightening to protect an injury as pressure approaches.
• BCorrect. Guarding is muscle contraction around a painful or injured area that limits movement and pressure to protect it. The therapist should work gently around it and not force through it.
• CIncorrect. A cramp is a sudden, sustained, painful contraction that often comes with fatigue or dehydration. It doesn't come and go with how close pressure is to an injury.
• DIncorrect. Spasticity is a velocity-dependent increase in tone from upper motor neuron damage, as after a stroke or spinal cord injury. It isn't a local protective response to a strain.

Answer: B) The elbow flexor muscles and their tendons

Pain on resisted movement with pain-free passive range of motion suggests a problem in contractile tissue (muscle or tendon), in this case the elbow flexors. Inert structures would be more likely to hurt during passive movement.

• AIncorrect. The capsule and ligaments are inert tissues, which are stressed mainly by passive movement. Pain-free passive range of motion makes them less likely to be the source.
• BCorrect. Resisted movement loads contractile tissue (muscle and tendon). Pain on resisted flexion with pain-free passive motion points to the flexors, such as biceps brachii and brachialis.
• CIncorrect. A bursa is an inert structure. The olecranon bursa sits at the back of the elbow and is usually irritated by direct pressure, not by resisted flexion.
• DIncorrect. Joint surfaces are inert. A problem there would usually cause pain or restriction during passive movement, which is full and pain-free here.

Answer: A) The assessment findings, combined with the treatment goals the client stated

A treatment strategy comes from clinical reasoning: it combines this client's assessment findings with the goals set together, rather than therapist preference or a set routine.

• ACorrect. Clinical reasoning means building the strategy from what the assessment found and from the goals set with the client. That keeps the session specific to this client.
• BIncorrect. The therapist's skills limit what can be offered, but a technique should be chosen because it fits the findings and goals, not because the therapist prefers it.
• CIncorrect. A fixed routine ignores the assessment the therapist just did. The plan should be individualized.
• DIncorrect. A client's past experiences are useful background, but they don't replace the current assessment findings or the goals for this session.

Answer: A) To evaluate how the client responded to treatment so future sessions can be adjusted

Reassessment after treatment shows how the client responded compared with baseline, so the therapist can adjust the treatment plan. It is not diagnosis and it is not pre-session contraindication screening.

• ACorrect. Reassessment compares post-session findings with baseline findings. This shows whether the treatment worked and guides changes to the treatment plan, which is the 'evaluation of response to previous treatment' named in the MBLEx outline.
• BIncorrect. Diagnosing disease or injury is outside the massage therapist's scope of practice. Findings can support a referral, but they do not confirm a diagnosis.
• CIncorrect. Screening for contraindications happens during intake, before treatment starts. Post-session retesting measures the effect of treatment that has already been given.
• DIncorrect. Reassessment does not replace the health history. Intake information should still be reviewed and updated at later visits, and the reassessment results should be documented.

Answer: D) Scalenes

Upper-chest breathing at rest relies on accessory muscles of inspiration such as the scalenes, sternocleidomastoid and pectoralis minor, which lift the upper ribs and sternum. Over time they become overworked and tense while the diaphragm is underused.

• AIncorrect. The diaphragm is the primary muscle of quiet inspiration. Upper-chest breathing usually means the diaphragm is being underused, with accessory muscles taking over its work.
• BIncorrect. The rhomboids retract and stabilize the scapulae. They are not accessory muscles of inspiration and don't lift the upper ribs.
• CIncorrect. The infraspinatus is a rotator cuff muscle that laterally rotates the humerus. It plays no role in raising the rib cage during breathing.
• DCorrect. The scalenes are accessory muscles of inspiration that elevate the 1st and 2nd ribs. Habitual upper-chest breathing overworks them, along with other accessory muscles such as the sternocleidomastoid and pectoralis minor.

Answer: A) About 80 degrees

• ACorrect. Limited rotation may suggest tight muscles.
• BIncorrect. That's very limited.
• CIncorrect. That isn't possible.
• DIncorrect. That isn't possible.

Answer: A) Review the existing history with the client and record any changes since the last visit

Review the health history with the client at every visit and record any changes, because health status, medications and injuries can change between sessions and affect contraindications and the treatment plan.

• ACorrect. Health status, medications, injuries and pregnancy status can change between sessions. Reviewing the history at each visit helps the therapist spot new contraindications or areas of caution and update the plan.
• BIncorrect. An intake form is only accurate for the day it was completed. Relying on it unchanged could miss a new condition, medication or injury that changes the session.
• CIncorrect. Clients often don't realize which changes matter, such as a new medication or a recent procedure. The therapist should ask about changes before the session instead of waiting for the client to raise them.
• DIncorrect. A full form may be redone periodically, but health status can change at any time. The history should still be reviewed with the client at every visit.

Answer: B) Low back pain that wakes the client at night, with weight loss over recent months that the client cannot explain

Night pain together with unexplained weight loss is a red-flag combination that can signal serious disease such as cancer or infection, so the client needs medical referral. Complaints with a clear mechanical cause that improve with rest or movement are usually benign.

• AIncorrect. Pain linked to a clear mechanical cause that eases with rest and position changes fits a typical muscular strain. It has no red-flag features by itself.
• BCorrect. Pain at night and unexplained weight loss are recognized red flags for serious disease such as cancer or infection. They need medical evaluation before massage continues.
• CIncorrect. Stiffness with an obvious positional cause that improves with movement fits a benign musculoskeletal problem and does not suggest serious disease.
• DIncorrect. Soreness on both sides one to two days after unaccustomed exercise matches delayed-onset muscle soreness. It is expected and usually resolves on its own.

Answer: D) The therapist moves the limb

• AIncorrect. The therapist moves the limb.
• BIncorrect. That's active ROM.
• CIncorrect. That's resisted ROM.
• DCorrect. The client stays relaxed.

Answer: A) Genu valgum

Knees that angle toward the midline and touch while the ankles stay apart are genu valgum (knock-knees). Genu varum (bowlegs) is the opposite alignment.

• ACorrect. In genu valgum the knees angle inward toward each other (knock-knees), so they may touch while the feet and ankles stay apart.
• BIncorrect. Genu varum (bowlegs) is the opposite alignment: the knees stay wide apart when the feet and ankles are together.
• CIncorrect. Pes planus is a flattened medial arch of the foot. It describes the foot, not how the knees are aligned.
• DIncorrect. Kyphosis is an increased rounding of the thoracic (upper) spine. It is not a lower-limb alignment finding.