(Updated for 2024) The Massage & Bodywork Licensing Examination (MBLEx) is the most often required test of entry-level massage therapist competency in the US. This article provides an outline and content breakdown of the MBLEx content areas that you can expect to see on the massage exam. You will also learn about the MBLEx application requirements and find links to helpful resources to help you prepare for the massage licensing exam. Currently 46 states regulate the massage profession at the state level. Of these, 44 states (plus DC and Puerto Rico) utilize the MBLEx exam in their massage license application process.

The Federation of State Massage Therapy Boards (FSMTB) created and administers the test. The FSMTB is a non-profit organization that was established in 2005. Its mission is to support member state boards by simplifying and standardizing the licensing process, and ensuring the competency of massage license applicants.

Overview of the MBLEx Exam

The MBLEx was developed by a collaboration of content experts, testing experts, and thousands of practicing professionals. The FSMTB continues to improve the MBLEx to reflect changes in the massage and bodywork industry as well as changes in job and state licensing requirements. This massage exam is a 100-question multiple-choice test. It is often the most difficult component of the licensing process for many applicants. Massage license applicants usually have additional requirements to fulfill before receiving their license. We’ve provided answers to questions about state license requirements as well as answers to frequently asked question about the MBLEx.

Purpose of a massage licensing exam

States already require successful completion of an approved massage program. So what’s the point of another exam? The main purpose comes down to ensuring public safety. Professions in which a practitioner’s lack of competency could cause harm to the public will usually involve some sort of standardized licensing exam. This includes virtually every career in health care, as well as professions like architecture, engineering, accounting, teaching and law.

All health and public service regulatory agencies have a primary function of protecting the public from harm that can occur from a practitioner who is not adequately trained. By protecting the public from practitioners who are inadequately trained, the FSMTB is also protecting the industry and image of the massage therapy profession. The MBLEx exam serves as a standardized assessment tool, that ensures a minimum competency level regardless of which school the applicant attended or which state a therapist is in.

About the FSMTB

The FSMTB is the organization that created the MBLEx. Their function is to work with state licensing boards to maintain a test that most accurately demonstrates a massage license applicant’s understanding of the practice of therapeutic massage. There is a team of people working with the FSMTB organization that are involved with developing and continuously improving the exam.

It is continually improved to reflect industry changes and new developments in testing methods and the knowledge base needed for massage therapists. The work of the FSMTB not only takes some of the burden off the individual state boards, but helps massage school curriculum developers and teachers know what information to focus on in their training programs.

What’s on the MBLEx Exam?

The MBLEx is much more than just an anatomy and physiology test. Content on the exam is based on what an entry-level massage therapist needs to know to provide safe and effective treatments for their massage and bodywork clients. The MBLEx massage exam consists of 100 multiple-choice questions with four possible answers for each question. According to the FSMTB, each of the possible answers is plausible. However there should be only 1 correct answer for each question.

The MBLEx is a computer adaptive test (CAT). This means that the difficulty of the exam and the questions that are presented to the test-taker will vary based on which questions are answered correctly or incorrectly. For example, as you start answering questions correctly, the testing program will present you with more difficult questions. In order to pass the exam, the test-taker must pass a set number of questions at a certain difficulty level. So if you start seeing more difficult questions, that’s a good sign because it means that you are answering questions correctly. *It is the difficulty of the questions that you answer correctly, in addition to the overall number of correct answers, that determines whether you pass or fail.

Another thing about computer adaptive tests is that taking a CAT exam doesn’t really feel any different from taking any other type of multiple choice exam. The reason is that, like all tests, some questions will seem easy and some questions will seem harder. It’s all subjective based on your own understanding and knowledge gaps. A question that seems harder to a test writer may be easy for you, and vice versa.

*There’s no evidence that using computer adaptive tests to study is any better than using other types practice tests to study. In fact, non-adaptive tests (like those on MBLExGuide) can be a more effective study tool because you can repeat a specific exam later to see if your scores improve. You cannot re-take the same computer adaptive exam because the exam changes based on the answers you choose.

One question that we often hear at MBLExGuide is “how hard is the MBLEx?” According to the FSMTB, the average pass rate for first time test takers is 73.4%. The pass rate for those who have to re-take the exam drops to about 40%. Note: Test takers no longer receive a score report. Before leaving the Pearson VUE testing center you will receive a results summary printout from the test proctor that indicates “Pass” or “Fail”.

Massage exam content areas and breakdown

The content on the MBLEx is based on “what an entry-level massage therapist needs to know to provide safe and effective treatments”. The massage test contains a specified number of questions from each content area. However, it does not separate and label what category each question falls under. Therefore many questions will require knowledge of the material from several content areas. 

For example, a question like, “A new client with osteoarthritis demonstrates decreased active range of motion during right shoulder flexion while standing. Which specific joint is most effected?” [Answer: glenohumeral]. This question is primarily a kinesiology question, but it includes elements of the pathology section (because you have to know something about osteoarthritis) and clinical reasoning (client assessment) section. 

From this example you can see that although a specific section may only be 11% – 14% of the exam, you must still have a thorough understanding of each content area in order to pass.

The MBLEx covers the following seven content areas in 2024

1. (11%) Anatomy and Physiology
2. (12%) Kinesiology
3. (14%) Pathology, Contraindications, Areas of Caution, and Special Populations
4. (15%) Benefits and Physiological Effects of Techniques that Manipulate Soft Tissue
5. (17%) Client Assessment, Reassessment & Treatment Planning
6. (16%) Ethics, Boundaries, Laws, Regulations
7. (15%) Guidelines for Professional Practice

The FSMTB has created a detailed content outline that you can print out and use to guide your studies. This MBLEx breakdown & content outline was used as the guide when creating our MBLEx practice tests as well as our new MBLEx Course (see below). We also offer a few free practice quizzes for each category on the MBLEx massage exam too. Our practice tests allow you to get a feel for the type of questions and level of difficulty that you can expect to see on the actual massage licensing exam.

Since the MBLEx is a 100-question exam, these percentages equal the number of questions on the test in that specific category. The questions on the actual massage exam will be randomized (shuffled), just like they are on the full-length and mini exams you will find here on MBLExGuide. You will have 2 hours to complete the MBLEx.

Questions on the MBLEx are multiple-choice, with four possible answers (some have three possible answers). The incorrect answer options (also called distractors) are plausible, but are incorrect for a specific reason. All questions are based on information that can easily be found in common massage therapy educational books. You can expect a few questions to involve an image, such as a picture of a muscle or joint for example, but most questions will not include any images.

From the MBLEx content outline, you can see that passing the exam requires much more than just memorizing muscle insertion points, skin pathologies, and names of massage techniques. The FSMTB strives to make sure that new massage therapists have the necessary foundation of knowledge to make informed decisions that affect a client’s treatment plan, and the ability to correctly apply massage techniques.

1) Anatomy and Physiology

The anatomy and physiology section on the MBLEx exam currently accounts for 11% of the test questions. Even though this is the shortest section of the massage exam, many other questions will rely on your understanding of anatomy and physiology in order to answer them correctly! The anatomy & physiology section of the exam includes content from 12 main systems of the body:

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

2) Kinesiology on the MBLEx

The kinesiology content area is currently 12% of the MBLEx. Kinesiology is the study of body movement. It considers the anatomical and physiological structures involved, the process of movement, as well as the biomechanical forces. Content covered in this exam section includes details about the tissues that cause movement (muscles). This includes concepts of muscle contraction, tendons and attachment points, fiber direction, and components of muscle tissue. 

Joint structure and function is also covered in the kinesiology section. This includes concepts such as direction of movement, degree of movement, and planes of motion. Range of motion (ROM) is another concept that is covered in the kinesiology section.

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

It is important for every massage practitioner to have a thorough understanding of pathologies that could affect the safety and effectiveness of massage treatments. Massage and bodywork practitioners should also be aware of the contraindications for massage. Currently, the pathology section of the MBLEx is 14% of the test. This content area is slightly larger than the A&P and the kinesiology sections. This is most likely because this section is strongly correlated with client safety. Knowing when to withhold treatment, modify the treatment plan, or refer a client to a physician or other health provider is important for client safety. Again, protecting the public is one of the primary functions of a licensing examination. 

The pathology section of the massage exam will include questions on pathologies that a massage practitioner is most likely to encounter when working. It will also include massage contraindications and precautions related to certain pathologies or special populations. The MBLEx questions are meant to ensure massage therapists can identify potential contraindications, NOT diagnose pathologies. The pathology section of the MBLEx also covers classes of medications. Since client medications can affect the treatment, it is important to have a good understanding of how different classes of medications affect the body and may call for adjustments to the treatment plan. 

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

Massage therapists must have a solid understanding of the effects that their manual therapy and other techniques have on a client. This includes the physiological and psychological effects for typical clients as well as for clients in special populations. The benefits and effects section is currently 15% of the massage exam. This section of the exam covers practical aspects of the application of massage techniques including types of massage strokes and the typical sequence of application. Only common, entry-level bodywork techniques and modalities are covered in this content area. Different methods of hydrotherapy and heat and cold modalities are in this section. The massage therapist should have a good understanding of when to use heat and when cold is a better option. Therapists should also understand the body’s immediate response and delayed response to each modality. 

5) Client Assessment, Reassessment and Treatment Planning

The client assessment and treatment planning section is 17% of the massage exam. This section focuses on how a massage therapist gathers client information in order to create an effective treatment plan. Client data can come in written form, such as with the health history form, and verbal format as with the verbal intake. Client data can also come in the form of a visual, palpation and movement assessment. Massage therapists need to know how to document their assessment and treatments using common methods such as a SOAP note.

An evaluation is the process of examining the information that you collect during the examination or assessment, to determine an effective treatment plan. Clinical reasoning is an important part of this process in which the therapist considers any contraindications, or precautions, as well as the client’s goals. Treatment planning may involve the organization of just a single treatment session into a logical flow. Or it may involve organizing several treatment sessions to gradually move a client towards his or her larger therapy goals that cannot be accomplished in just one session. Reassessment is an ongoing process of examining the progress that a client is making towards established goals, and adjusting treatment plan if needed. MBLEx candidates are expected to understand concepts like these for this section of the massage exam.

6) Ethics, Boundaries, Laws and Regulations

The massage ethics, boundaries, laws and regulations content area currently represents 16% of the MBLEx. This section can be challenging for test takers. Most massage therapists did not go to massage school because they wanted to learn about regulations and philosophical principles of ethics. It can be a boring subject to study too. Students often approach these lessons with the mindset, “Yeah, I get it, do the right thing and be professional”. Although this mindset will prevent most problems in practice, you need to know some specific details about these topics in order to pass the MBLEx exam.

The Ethics, Boundaries, Laws and Regulations section of the massage licensing exam is loaded with specific terminology and concepts that must be learned to the point where you can apply these concepts in different scenarios. Many of these questions on the test will not require the test taker to merely recognize a definition, but to identify which concept that is being demonstrated in a scenario-based question.

7) Guidelines for Professional Practice

Questions from the professional practice content area are focused primarily on client and practitioner safety, the business of massage therapy, and terminology. This MBLEx content area currently represents 15% of the massage exam. It is a good idea to master this content area, not only for the MBLEx, but for your own professional development. Having a solid foundation on topics like safety practices, hygiene, sanitation, proper equipment use, therapist care, body mechanics, and draping will benefit both you and your clients throughout your massage therapy career. This knowledge is relevant whether you decide to work at an established practice or start your own massage business. 

There will be several questions about massage business practices on the MBLEx. Remember that as with all questions on this test, they are based on what an entry-level massage therapist needs to know. You may see questions about documentation, interviewing, types and structures of massage businesses, taxes, marketing and business planning. Also, you will need to be familiar with healthcare and business terminology. Mastering the relevant massage terminology and vocabulary will help you tremendously in your preparation for the MBLEx, and also when you start your massage career. 

“Vocabulary is a strong indicator of success in school and career.”

Recent changes to the MBLEx exam

In July of 2018, there were a couple of small changes to the content areas represented on the MBLEx exam. The content area ‘Overview of Massage and Bodywork Modalities, Culture & History’ was removed or redistributed to other content areas. There were also slight changes in the percentage of questions in other exam content areas. Overall, this was an improvement in the MBLEx. It now emphasizes what a new massage therapist actually needs to know to provide safe and effective treatment, rather than presenting relatively trivial questions about massage history.

MBLEx Application Requirements

MBLEx applicants are required to verify that they have received training in all subject content areas covered in the MBLEx, from an approved massage therapy education program. See the FSMTB Massage Education Policy for current details on this. Further details of application requirements can be found directly on the FSMTB website in the Candidate Handbook (from April 2024).

Application Process

1. The MBLEx application process is completed online through the FSMTB website. Applications are also accepted by mail. When applying, you also get to select one state licensing board that you want your test results to be sent to.
2. Pay the examination fee which is currently $265. Processing time is about 5 days
3. Receive an Authorization to Test (ATT) by email. This shows the dates of your 90-day window to take the exam. There will be a Candidate ID number on this form that you will need for the next step. Be sure to print this ATT form since you will need to show it at the testing center.
4. Schedule your exam. Go to Pearson VUE website and create an account. Call your local testing center to schedule a test or schedule online.

On Test Day

The MBLEx is administered through the Pearson VUE testing center. You can find information about exam security and their check-in process directly on the Pearson Vue website. Here are a few other specifics about the actual MBLEx exam:

• You cannot go back to check an answer on a previous question.
• You cannot skip a question and come back to it later.
• The question and answer choices on the MBLEx are not meant to trick you.
• There is only one correct answer for each question.
• You will have 2 hours to complete the 100-question exam.
• Test-takers will receive a small whiteboard or paper and pen to write down notes if needed.
• You will also receive a some ear plugs to use if you get distracted easily. There will most likely be other test takers in the room working on their own test.

You will receive your results from the proctor immediately after you finish the test. It will simply indicate “Pass” or “Fail”. Result reports that indicate “Fail” will show general the performance for each content area as good, borderline or poor. This will help the candidate know which areas to focus their studies on before retaking the exam if they do not pass. See the FSMTB website for more information on MBLEx result reporting. Your results will be automatically sent to the state board that you selected when you scheduled your exam.

Retaking and rescheduling the massage exam

According to resources on the FSMTB website, the MBLEx averages an approximate 70% pass rate. In order to retake the MBLEx, the candidate must re-apply and pay the $265 again. There is a 30-day waiting period before you can re-apply to take the MBLEx.

Having a good MBLEx test prep resource is a valuable investment because of the high cost of taking the exam. And because of the high cost of retaking it along with the required waiting period associated with retaking the exam. It is worth putting in the time and effort up front to prepare for the MBLEx. Most states will not permit a new massage therapist to work until they receive their license. Learn more about the individual state massage license requirements here.

FAQ About the MBLEx

What is the MBLEx?

The MBLEx, or Massage & Bodywork Licensing Examination, serves as a standardized test that 46 states require massage practitioners to pass as part of the licensing process. It is designed to evaluate their knowledge and skills in related to the practice of massage therapy, and ensure that candidates are competent in the key concepts required for providing safe, effective and ethical massage and bodywork services.

Who should take the MBLEx?

Individuals interested in seeking state licensure to work as a massage therapist will most likely be required to take the MBLEx. There are a few exceptions including people who will work in an unregulated state or state that requires their own licensing exam (New York and Hawaii). However, recent graduates who live in these states may still want to consider going ahead and taking the exam now because it will be more challenging to take it in the future (because of the forgetting curve) if you decide to move to a regulated state.

What are the eligibility criteria to take the MBLEx?

To be eligible to take the MBLEx, you must have graduated or received education and training in all subject areas of the MBLEx Outline from a state-recognized massage therapy education program, which typically includes both coursework and practical training in various massage techniques. It is advised to confirm specific educational requirements with the state licensing board, as your massage education program representative will need to verify your education directly with the FSMTB. Additionally, all applicants must acknowledge and agree to follow all FSMTB examination policies, which includes signing a security and confidentiality agreement.

How often can I take the MBLEx if I fail?

If you fail the MBLEx, you can retake the exam, but you must wait 30 days before retesting. The FSMTB does not limit the number of attempts for taking the exam. Additionally, you will need to submit a new application and pay the examination fee each time you retake the exam.

What is the passing score for the MBLEx?

The FSMTB does not publicly disclose the specific passing score for the MBLEx, as the exam is a computer-adaptive test (CAT), meaning the difficulty of the questions is adjusted based on the test taker’s responses, and results are calculated differently than traditional exams. As a result, candidates receive a simple Pass or Fail result without a numerical score.

Can I take the MBLEx online, or do I need to go to a physical testing location?

The MBLEx cannot be taken online; it is administered at Pearson VUE testing centers located across the country. Therefore, you will need to go to a physical testing location to take the exam.

Can I skip questions and return to them later in the MBLEx?

No, you cannot skip questions and return to them later on the MBLEx. The exam is a computer adaptive test (CAT), which means once you answer a question and move on to the next one, you cannot go back to previous questions.

Is there a penalty for guessing or answering questions incorrectly on the MBLEx?

There is no specific penalty for guessing or answering questions incorrectly on the MBLEx. However, since the exam is a computer adaptive test (CAT), answering a question incorrectly may lead to receiving subsequent questions of lower difficulty, which could potentially impact your overall performance and ability to pass the exam.

What languages is the MBLEx offered in?

The MBLEx is offered in English and Spanish. Candidates can select their preferred language when applying for the exam.

What are some recommended study materials for the MBLEx?

Recommended study materials for the MBLEx include study guides, flashcards, prep course, and MBLEx practice exams from reputable providers such as those found on MBLExGuide.

What kind of study plan should I follow for the MBLEx?

A study plan for the MBLEx should include a comprehensive review of all topics covered in the MBLEx content outline, dedicating a specific amount of time each day or week to each topic area, and including regular practice exams to assess your progress and identify areas that need further study. It is also important to include time for active review, such as creating flashcards, summarizing information in your own words, and practicing hands-on techniques if applicable, as well as scheduling regular breaks and self-care activities to avoid burnout.

How long should I prepare for the MBLEx?

The amount of time needed to prepare for the MBLEx will vary for each individual based on their prior knowledge, experience, and study habits, but a common recommendation is to start studying at least 2-3 months in advance of the exam date. It’s important to create a detailed study plan, dedicating a specific amount of time each day or week to each topic area, and adjust the plan as needed based on your progress and areas that need further study.

How soon after taking the MBLEx will I know my results?

You’ll find out whether you passed or failed the MBLEx immediately after you finish the exam, before you leave the Pearson VUE testing center. The proctor will give you an unofficial score report on the showing your pass or fail status.

How do I send my MBLEx score to the state licensing board?

When you apply for the MBLEx, you can select the state licensing board that you wish to send your scores to, and the FSMTB will send your scores directly to that board once you have taken the exam. If you need to send your scores to additional state boards after you have taken the exam, you can request this through your FSMTB online account, and there may be a fee associated with additional score reports.