(Updated for 2022) 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, 43 states (plus DC, Puerto Rico and the US Virgin islands) utilize the MBLEx 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
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 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?
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 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. 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 exam contains a specified number of questions from each content area. However, it does not separate and label what category each question falls under. So 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 some things 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 content areas in 2022
(11%) Anatomy and Physiology
(14%) Pathology, Contraindications, Areas of Caution, and Special Populations
(15%) Benefits and Physiological Effects of Techniques that Manipulate Soft Tissue
(17%) Client Assessment, Reassessment & Treatment Planning
(16%) Ethics, Boundaries, Laws, Regulations
(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 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.
All questions on the MBLEx are multiple-choice, with four 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 lesions, and names of 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.
Check out our complete MBLEx Prep Course!
MBLExGuide’s complete massage exam course provides massage students and therapists with an organized and comprehensive review of all 7 content areas of the MBLEx. This course along with our practice tests and quizzes provides a convenient and structured test prep solution for the massage licensing exam.
Recent changes to the MBLEx
In July of 2018, there were a couple of small changes to the content areas represented on the MBLEx. 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.
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:
- Special Senses
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.
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 (as of 2022), 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.
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.
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.
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.
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.
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.”
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 July 2022).
- Apply to take the MBLEx through the FSMTB website. Applications are accepted online or by mail. When applying, you also get to select one state licensing board that you want your test results to be sent to.
- Pay the examination fee. $265.00. Processing time is about 5 days
- 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.
- 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 exam, the candidate must re-apply and pay the $265.00 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.