MBLEx Pathology and Contraindications: What the 14% Covers
Pathology, Contraindications, Areas of Caution, Special Populations is 14% of the MBLEx, roughly 14 of your 100 questions. The skill underneath the whole area is one decision: for this client, with this condition, do you massage as planned, adapt, avoid an area, or postpone and refer?
FSMTB labels its percentages approximate, so treat 14 as a planning number. Below: the outline, local vs general contraindications, areas of caution, special populations, medication classes and three original sample questions.
What the outline lists
FSMTB's MBLEx content outline breaks this area into five subtopics (outline wording):
- Overview of pathologies
- Contraindications: site-specific, pathology-related, special populations, tools, special applications
- Areas of caution
- Special populations
- Classes of medications
FSMTB says the MBLEx "identifies those with entry-level knowledge and skills," so study pathology the way a new therapist uses it. For each condition, learn what it is in one sentence, the signs you would notice in a session, and what it means for massage.
The same reasoning reaches past the 14%. Client Assessment, Reassessment & Treatment Planning (17%, the largest area) includes ruling out contraindications under clinical reasoning, and Benefits and Effects of Soft Tissue Manipulation (15%) covers effects for specific client populations.
Local vs general contraindications
Sort every condition into one of three outcomes. Once the sorting is automatic, you have a method for any scenario.
| Category | What you do | Typical examples |
|---|---|---|
| General (systemic) | Postpone the session, or get medical clearance first | Fever; contagious illness such as the flu; signs of a possible blood clot (refer right away) |
| Local (site-specific) | Avoid the area and massage the rest of the body | Bruise; open wound or recent burn; localized skin infection such as athlete's foot; recent injection site; varicose veins (no direct pressure) |
| Caution | Massage, with changes to pressure, position or duration | Client on anticoagulants; older client with fragile skin; late pregnancy |
Three rules to reason with:
- General beats local. If the client has a fever, no local adaptation fixes it.
- Refer what you can't explain. An unexplained lump, swelling or skin change goes to a healthcare provider. Massage therapists don't diagnose; scope of practice is its own Ethics topic.
- Tools and special applications count. Heat, for example, doesn't belong on a fresh injury or on skin where the client has reduced sensation.
Areas of caution and special populations
Areas of caution, often called endangerment sites, are places where blood vessels and nerves sit close to the surface with little protection. Use light pressure there and no sustained deep pressure. Know these five at minimum:
- Anterior triangle of the neck: carotid artery, jugular vein, vagus nerve
- Axilla: brachial plexus, axillary artery and vein, lymph nodes
- Cubital fossa (front of the elbow): brachial artery, median nerve
- Femoral triangle: femoral artery, vein and nerve
- Popliteal fossa (back of the knee): popliteal artery and vein, tibial nerve
Special populations call for adjusted sessions:
- Pregnancy. Later in pregnancy, side-lying with bolsters is the usual position; lying flat on the back for long can press on the inferior vena cava.
- Older adults. Skin can be thinner and bones weaker, so pressure comes down and position changes slow down.
- Clients with diabetes. Reduced sensation in the feet or hands means they may not feel excess pressure or heat.
- Clients in cancer treatment. Work with the client's healthcare team and adapt pressure, positioning and the areas you work.
Classes of medications
Candidates often report meeting medication questions on their exams. The outline says "classes of medications," so study by class: what the class does, and what it changes on your table.
| Class | What it does | What changes in the session |
|---|---|---|
| Anticoagulants | Slow blood clotting | Bruising comes easier: lighter pressure, no aggressive deep work |
| Analgesics and anti-inflammatories | Reduce pain and inflammation | The client's feedback on pressure is less reliable: stay moderate |
| Muscle relaxants | Reduce muscle tone; can cause drowsiness | Feedback is dulled: avoid aggressive stretching, let the client sit up slowly |
| Corticosteroids (long-term use) | Suppress inflammation and immune response | Skin, bone and connective tissue can weaken: lighter pressure |
| Antihypertensives | Lower blood pressure | Dizziness on sitting or standing up: have the client rise slowly |
| Insulin and other diabetes medications | Lower blood sugar | Avoid a recent injection site; watch for signs of low blood sugar |
Three original sample questions
We wrote these to the outline; none comes from the MBLEx. Each has one best answer.
1. A regular client arrives for a scheduled session with a fever and body aches that started this morning. What is the most appropriate action?
Show the answer
Answer: C. Fever signals a systemic response, usually to infection, which makes it a general contraindication: the session is postponed, not adapted.
2. A client has taken an oral corticosteroid every day for several years. Which adjustment is most appropriate?
Show the answer
Answer: B. Long-term corticosteroid use can thin the skin and weaken bone and connective tissue, so pressure comes down; the medication itself is not a reason to refuse massage.
3. Which of these is an area of caution where sustained deep pressure should be avoided?
Show the answer
Answer: D. Behind the knee, the popliteal artery, popliteal vein and tibial nerve lie close to the surface with little padding; the other options are thick, well-padded muscle.
Practice pathology under the clock
Each of our full forms carries 14 pathology questions, matching the outline weight, inside a 100-question, 110-minute run: one question at a time, no going back. In our simulator the clock never pauses. Results come back by content area as Strong, Borderline or Weak, using the cut-points on our scoring method page, and every question has a worked explanation, so a missed medication item tells you which class to review. Practice mode drills pathology on its own, untimed.
The real MBLEx adapts which questions you get; our practice form is a fixed set weighted the same way.
Take the free full-length MBLEx practice test
Pair this page with the kinesiology guide and the four-week MBLEx study guide.
MBLEx pathology FAQ
How many pathology and contraindication questions are on the MBLEx?
The area is 14% of FSMTB's content outline, so expect about 14 of the 100 questions. FSMTB labels the percentages approximate. Contraindication reasoning also appears in Client Assessment, Reassessment & Treatment Planning, the largest area at 17%.
What is the difference between a local and a general contraindication?
A local (site-specific) contraindication means you avoid one area, such as a bruise or a recent injection site, and massage the rest of the body. A general contraindication, such as a fever, means the session is postponed or needs medical clearance first.
Do I need to memorize drug names for the MBLEx?
The outline lists "classes of medications." Learn each class's effect and what it changes in a session first. Drug names help only once you can place them in a class.
Are areas of caution the same as endangerment sites?
Largely, yes. "Areas of caution" is the outline's heading; massage textbooks usually call these places endangerment sites, such as the anterior neck, axilla and popliteal fossa, where vessels and nerves lie close to the surface.
Written by Tom Prescott for LMTPrep. Facts checked against FSMTB's MBLEx Candidate Handbook (effective September 17, 2026) and fsmtb.org on October 8, 2026.