National Certification Board For Therapeutic Massage .
National Certification Boardfor Therapeutic Massage & BodyworkBOARDCERTIFICATIONSTUDY GUIDEOUTLINE1333 Burr Ridge Parkway, Suite 200Burr Ridge, IL 60527(800) 296-0664 or (630) 627-8000www.ncbtmb.orgREVISED 2018
Study Guide Outline for Board CertificationBoard Certified massage therapists have obtained the highest voluntary credential in the massage therapyand bodywork profession. The Board Certification Exam of Massage Therapy & Bodywork wasdeveloped to challenge massage therapists in many different areas to ensure each possesses advancedknowledge and has evolved beyond entry level in the profession.When working in the medical profession, massage therapists must speak and understand medicalterminology, have a deeper anatomical and physiological understanding of the systems of the body aswell as a thorough understanding of pathologies. Knowledge of indications, contraindications, and signsand symptoms of pathologies will ensure massage therapists won’t harm clients and also won’t perpetuatethe spread of infection.This study guide was developed to help massage therapists who wish to separate themselves from entrylevel education by mastering additional concepts. This examination will contain questions that go beyondthat of entry level credentialing. Please visit www.ncbtmb.org for a practice exam written for the BoardCertification Examination for Therapeutic Massage and Bodywork.PathologyThere are numerous pathologies of all systems of the body a massage therapist will encounter. Knowingwhether a pathology is contagious, and how to work within the scope of the pathology is important whenworking in a professional atmosphere – home office, clinic, hospital, spa – to minimize the spread ofdisease and/or ensure the client is comfortContagious Pathologies Candidates will demonstrate knowledge of common contagious diseases. Candidates will demonstrate knowledge of how is each contracted and spread to others. Candidates will demonstrate knowledge of signs and symptoms of each disease. Candidates will demonstrate knowledge of precautions when working with people diagnosed withcontagious diseases. Candidates will demonstrate knowledge of indications and contraindications when working withpeople with contagious diseases. Candidates will demonstrate knowledge of the differences between bacteria, viruses and fungi.o Influenzaso Pneumoniao Hepatitis A, B, Co HIVo Methicillin-resistant staphylococcus aureus (MRSA)o Tuberculosiso Streptococcuso Staphylococcuso Herpeso Herpes Zostero Impetigoo Tinea corpuso Tinea pedis1
ooooRingwormCellulitisClostridium Difficile (C. Diff)MeningitisAllergic Reactions/AllergiesAllergies are an immune system reaction to otherwise harmless substances the body deems harmful andreacts to the substance as if it was a threat. Candidates will demonstrate recognition of allergies and how to proceed if a client presents withan allergic reactions during massage therapy treatment. Candidates will demonstrate recognition of signs and symptoms of allergies.o Dermatitis/Contact Dermatitiso Eczemao Hay fevero Drug interactionso AnaphylaxisMusculoskeletal SystemMassage therapists must have an advanced knowledge of the musculoskeletal systems and pathologiesfrom which the clients may suffer. Pain can arise in different areas caused by structural misalignment ofthe skeletal system or dysfunction of the muscles. A massage therapist must identify the location of eachmuscle and bone, looking at the body in three dimensions to assess the causative factor of pain anddiscomfort.Musculoskeletal pathologies can have multiple causative factors. An advanced massage therapist candigest the information from the intake and assessment and create a treatment plan that will assist the bodyin readjustment and healing. Candidates will demonstrate advanced knowledge of musculoskeletal pathologies. Candidates will identify musculoskeletal pathologies that can utilize manual soft tissuetechniques to assist in the recovery process. Candidates will identify depths of pressure that should be used when working with people whohave musculoskeletal pathologies. Candidate will demonstrate knowledge of indications and contraindications when working withclients who have musculoskeletal pathologies.o Fibromyalgiao Lower Cross Syndromeo Tetanuso Scoliosiso Hyperlordosiso Hyperkyphosiso Osteomyelitiso Osteoporosiso Whiplasho Myositis Ossificanso Chronic/Acute Compartment Syndromeo Plantar Fasciitiso Dupuytren Contractureo Ganglion cystso Bunions2
Nervous SystemNervous system pathologies may lack external signs, so an advanced massage therapist must be able torecognize signs and symptoms of central and peripheral nervous system pathologies and disorders.Knowing how to recognize manic or depressive behavior and when to refer out or seek assistance from aclient’s primary care provider will assist a massage therapist in creating a treatment plan and determiningwhen mental illness may prevent a client from receiving massage.Recognizing nerve entrapment and damage will assist the massage therapist in determining massageprotocol, including appropriate positioning, to work different areas while the client remains comfortableand pain free. Candidates will demonstrate knowledge of different mental illnesses and whether to refer theclient out. Candidates will demonstrate knowledge of indications and contraindications when working withdifferent nervous system pathologies and disorders. Candidates will demonstrate knowledge of peripheral nerve entrapment and pathologies. Candidates will demonstrate knowledge of how to position clients with nervous systempathologies for comfort.Mental Disorderso Bipolar disordero Depressiono Anxietyo Stress Somatization Psychosis Understand the effects of stress on the bodyo PTSDo Addictiono HivesPhysical Disorderso Traumatic brain injurieso Epilepsyo Parkinson’s diseaseo Dementiao Alzheimer diseaseo Cerebral palsyo Bell palsyo Thoracic outlet syndromeo Carpal tunnel syndromeo Neuritiso HivesAutoimmune PathologiesAutoimmune pathologies may mimic symptoms of other pathologies causing the client to believe theyhave the pathology of another system such as the nervous or musculoskeletal systems. A massagetherapist must learn the extent of the pathology and any indications or contraindication prior to workingwith a client suffering from autoimmune pathologies. Candidates will recognize different autoimmune pathologies, their signs and symptoms.3
Candidates will demonstrate knowledge of indications and contraindications of autoimmunepathologies.Candidates will determine when it’s necessary to refer a client to his/her primary care physician ifneeded.o Rheumatoid arthritiso AIDSo Lupuso Guillain-Barre syndromeo Ankylosing Spondylitiso Crohn diseaseo Psoriasiso Multiple SclerosisEndocrine SystemThe endocrine system is composed of glands that secrete hormones to maintain homeostasis within thebody. Endocrine system pathologies can disrupt sleep patterns, cause the body to react poorly totemperature changes, creating disordered eating – weight gain and loss – and cause many other problemsin all body systems. Endocrine system pathologies will affect the functions of other systems due to thehormonal abnormalities that lead to improper functioning of the other systems. Candidates will demonstrate knowledge of endocrine system pathologies. Candidates will demonstrate knowledge of indications and contraindications when working withclients.o Diabetes Mellituso Diabetes Insipiduso Hashimotoo Hyperthyroidismo Hypothyroidismo Graves diseaseo Addison diseaseo Cushing diseaseLymphatic SystemLymphatic system pathologies often lead to swelling and edema that makes movement difficult. Massagetherapists must have a fundamental knowledge of how the lymphatic system works and massagetechniques that will enhance the function of the lymphatic system. Candidates will demonstrate knowledge of the functions of the lymphatic system. Candidates will demonstrate knowledge of indications and contraindications for massage inrelation to the lymphatic system. Candidates will demonstrate fundamental knowledge of manual lymphatic drainage techniques.o Lymphangitiso EdemaDigestive SystemDigestive system pathologies can lead to discomfort, illness and systemic infections if not treated.Massage therapists must understand the digestive system and pathologies associated with digestion andelimination to ensure each is providing a safe massage while working within the client’s comfort level. Candidates will demonstrate knowledge of the digestive system. Candidates will demonstrate knowledge of indications and contraindication of massage when aclient presents with digestive system pathologies.4
erolemiaCeliac diseaseGastroesophageal Reflux disease (GERD)Peptic ulcersDiverticulitisIrritable Bowel syndrome rdiovascular SystemThe cardiovascular system moves blood, nutrients and oxygen throughout the body. Pathologies of thecardiovascular system can cause strokes, heart attacks and tissue death. A massage therapist must have anin-depth knowledge of cardiovascular pathologies and understand when massage is indicated andcontraindicated for anyone suffering from cardiovascular pathologies. Candidates will demonstrate knowledge of indications and contraindication of massage whenworking with clients who have cardiovascular pathologies. Candidates will demonstrate knowledge of major cardio vascular pathologies.o Deep vein thrombosiso Embolismso Strokeo Heart Attacko Hemophiliao Anemiao Phlebitiso Aneurysmso Atherosclerosiso Anginao Hypertensiono Varicose veinsInsects and insect BitesMany insect bites can cause pathologies in the body. Some insects can embed themselves into the skinand cause long lasting effects. A massage therapist must recognize different bites and embeddings andrefer a client out for medical help. Candidates will recognize different bites and know whether massage is indicated, or if acontraindication is a local or general. Candidates will refer clients to a primary care physician if the situation is serious.o Tick Lyme diseaseo Spider biteso Fleaso Mites5
Massage Techniques – When they would be usedMassage therapists must have knowledge of multiple techniques for working on clients with differentneeds. For example: understanding sports massage when working with an athlete can speed recoverytime; knowing lymphatic drainage will help remove edema when working with cancer patients. Candidates will demonstrate knowledge of the following techniques and when it is appropriate touse them.o Stabilization techniques Stabilize joints when stretchingo Sports massageo Reciprocal inhibitiono Muscle approximationo Post isometric relaxationo Pin and stretcho Trigger pointo Neuromuscular therapyo Muscle energy techniqueso Positional release Understand each step of positional releaseo Tensile forceo Torsiono Compressiono Frictiono Kneadingo Vibrationo Shearingo Bendingo Lymphatic drainageo Myofascial releaseo Hydrotherapyo Cryotherapyo Contrast hydrotherapyo Moist heato Active engagement techniquesAssessmentPrior to massage therapy treatment, the therapist must assess a client’s overall wellbeing and ability toreceive massage. The therapist should give a short interview to find out how the client is feeling and alsoassess the client’s gait and posture balance.Clients who present with discomfort due to muscle strain or taut areas may need additional assessment touncover soft tissue issues. The therapist should not stop at assessing the area of discomfort but continueon to other areas of the body. Candidates will demonstrate knowledge of interviewing and evaluating clients prior to treatment. Candidates will demonstrate knowledge of treatment plans and addressing areas in need ofmassage. Candidates will demonstrate knowledge of different orthopedic tests. Candidates will demonstrate knowledge of postural imbalances.o Interviewing and evaluating intake forms Uncover finding6
Determine appropriate treatment Develop treatment planso Range of motion testing Active Passive Resistive Active assistedo Hypertonicityo Hypotonicityo Gait theoryo Aggregate principleo Overload principleo Recruitment principleo Sherrington’s lawo Law of reactiono Law of accelerationo Straight-leg-raiseo Posterior drawer testo Valgus stress testo Varus stress testo Anterior drawer testo Intake procedureso Treatment planso Goalso Pain scales Sensory Pain Scale McGill Pain Scale Wong-Baker FACES Pain Scale Allina Health Pain Scaleo Pelvic alignmento Postural distortionso Functional imbalanceo Pathological imbalanceo Structural imbalanceo Know muscle anatomy and how to position clients for purposes of treatmentMuscle assessment Assess referrals from different muscles and muscle groups into other areas of the body.o Erector spinae groupo Trapeziuso Rhomboidso Teres major and minoro Pectoralis major and minoro Abdominalso Psoaso Iliacuso Quadratus lumborumo Gluteus minimus, medius, maximuso Piriformiso Quadriceps7
MusclesoooHamstringsAbductorsAdductorsA massage therapist must have an advanced knowledge of the muscles of the body, which actions theyperform, their agonists, antagonists and synergists. When a client is having difficulties moving or ishaving pain in an area of the body, the massage therapist must be able to assess all of the structures in thatarea to relieve discomfort or stiffness and know whether the discomfort is caused by nerve entrapment ormuscle dysfunction. Candidates will have an advanced knowledge of each muscle’s location, the action, its agonist,antagonist and synergist. Candidates will demonstrate an advanced knowledge of each muscle associated with thefollowing muscle groups.o Head Muscles of mastication Muscles of swallowing Muscles of facial expression Cervical spineo Neck Muscles that move the head and neck – flexion, lateral flexion, extension androtationo Thoracic and lumbar spine, rib cage and abdomen Muscles that move the spine – flexion,lateral flexion, extension and rotation Muscles that elevate and compress the ribs Muscles of inhalation and exhalation Abdominal muscleso Shoulder and Arm Muscles of the rotator cuff Muscles of the shoulder girdle Rotation, flexion, extension, abduction, adduction of the glenohumeraljoint, Protraction, retraction, elevation, depression, upward rotation anddownward rotation of the scapula and the clavicle Muscles of elbow flexion and extension Muscles of wrist flexion, extension, ulnar deviation, radial deviation, pronationand supinationo Hip Lateral and medial rotators Hip flexors and extensors Hip abductors and adductorso Leg Knee flexors and extensors Muscles of dorsiflexion and plantarflexion Muscles of ankle eversion and inversion Receptorso Muscle spindleso Golgi tendon organs Principals of muscle physiologyo Overload8
oooAggregateRecruitmentAll-or-none responseNerve Assessment Assess nerve entrapment, which structures may be causing dysfunction and how to provide relief Understand which structures may be implicated in the condition.o Innervations – nerve/muscleo Dermatomeso Sciatic nerveo Accessory nerve (CN XI)o Thoracic nerveo Median nerveo Subscapular nerveo Radial nerveo Ulnar nerveo Obturator nerveo Vasovagal nerveo Femoral nerveo Cervical plexuso Brachial plexuso Lumbar plexuso Sacral plexusJointsJoint injuries can become complex and require critical thinking to assess soft tissue involvement. Jointsmay take long periods of time to heal and require an educated massage therapist that understands all ofthe intricate structures that are involved in joints throughout the body. Candidates will demonstrate knowledge of common joint injuries of the shoulder, elbow, wrist,hip, knee, and ankle. Candidates will demonstrate knowledge of joint structures including muscles and ligaments ateach joint, the articulating bones, relevant bony landmarks, bursae and other structures foundwithin each joint such as menisci. Candidates will demonstrate knowledge of indications and contraindication of massage whenassessing and evaluating joint pathologies.o Joint nameso Types of joints Synarthrotic/fibrous Amphiarthrotic/cartilaginous Diarthrotic/synovialo Sprains and strains Grading (1, 2, 3) The difference between strains and sprainso End feels Capsular Empty Bonyo Temporomandibular Joint Disordero Bursitis9
ooooooooooooooooAdhesive capsulitisTennis elbowGolfer’s n’s tenosynovitisBakers ylosisHerniated discGoutArthroplasty Hip KneeLigament and muscle names that cross each jointSpecial populations (indications, contraindications, special needs)Massage therapists must have a fundamental knowledge of indications, contraindication, positioning,pressure and working with special populations. Clients may not understand that massage may not beindicated due to illness, medications or other things happening in their bodies due to pregnancycomplications, surgical sites, tissue integrity, etc. Candidates will demonstrate knowledge of indications and contraindications when working withspecial populations. Candidates will demonstrate knowledge of working with clients who are taking differentmedications that may alter the client in areas such as state of mind, tissue integrity, bloodcomposition and heart function. Candidates will recognize the massage therapy scope of practice and know when to refer out.Pregnancy Eclampsia Preeclampsia Thrombus Embolisms Hypertension Endocrine activityCancer Working with clients with cancer – positioning and treatmentso Radiationo Chemotherapyo Surgical sites Leukemia Non-Hodgkin’s Lymphoma Prostate Breast Liver Colorectal10
LungGeriatric Thermoregulatory needs Tissue changes Help getting on and off the table Depth of pressure and speed of strokesResearchResearch has strengthened trust between the medical profession and massage therapists. Research hasproven massage is an excellent alternative to pain relieving medications and can be integrated intopatients’ treatments to speed recovery. Also proven, massage therapy helps with depression and anxiety.As a community of massage therapists, we must continue our research to strengthen our role within themedical profession. Understanding the basics of research is important to continue forward movement. Candidates will demonstrate knowledge of research literacy, how to read, how to find and how toanalyze research. Candidates will demonstrate knowledge of different stages of research. Candidates will demonstrate knowledge of common research terminology.o Methodso Developmento Reasoningo Measurementso Resultso Criteriao Relevant massage researcho Case reports Hypothesiso Desiredo Alternativeo Researcho Null statisticalo Conclusionso Quantitativeo Assessmento Subjectiveo Scientific methodo Statistic compilationo Database analysiso Inclusionary criteriao Exclusionary criteriao Independent variableo Dependent variableEthics and ProfessionalismMassage therapists must consistently demonstrate professional behavior while remaining ethical whenworking with the public and other professionals in healthcare. 11
Candidates will demonstrate ethical behavior when working with clients and healthcareprofessionals.Candidates will demonstrate advanced knowledge of the massage therapy scope of practice.Candidates will demonstrate professional behavior when in the public eye during time off.o Transference/Countertransferenceo Drapingo Scope of practiceo Client interaction outside of massage treatmentso When and where to refer clients for specific conditionso Therapist’s right to refuse treatmento Reporting another massage therapist’s misconduct Report to manager Report to state Report to NCBTMBo Power differentialBusiness and LawMany massage therapis
Study Guide Outline for Board Certification . Board Certified massage therapists have obtained the highest voluntary credential in the massage therapy and bodywork profession. The Board Certification Exam of Massage Therapy & Bodywork was developed to challenge massage therapists in many different areas to ensure each possesses advanced
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