Massage Therapist: The Basics of Anatomy and Physiology

Key Topics:

- Anatomy, physiology, and body systems
- Anatomical position and directional terms
- Systems of special note for the massage therapist
- Tips for answering questions on anatomy and physiology
 

Knowledge of the body’s configuration and functioning forms a critical foundation for the massage therapist. Anatomy is the study of the body’s structure. Physiology is the study of the body’s functioning. You should be able to identify the major structures and systems of the human body and understand what they do. You should also recognize how different structures and systems respond to the application of therapeutic modalities.
As part of your studies, you should be sure to utilize the standard medical terminology to describe the human body and its functioning. Not only will you need to know common terms for your exam, but using appropriate language will underscore your professionalism and facilitate communication with other health-care providers.
This guide highlights important information and gives you some practice questions in these areas. If you are having trouble understanding the information or answering the practice questions, take some time to review your textbooks and notes.
The number of questions you will need to answer on anatomy, physiology, and body systems varies by exam.

If you are taking the MBLEx, you will be required to answer a total of 125 questions; of these, about 14 percent, or 18 questions, are on the topics of anatomy, physiology, and body systems. If you are taking the NCETMB, you will be required to answer a total of 160 questions; of these, about 35 percent, or 40 questions, touch on the subjects of anatomy, physiology, and body systems.

Anatomy, Physiology, and Body Systems
Anatomy is the study of the body’s structure. Accumulating and applying a deep knowledge of the way the body works will help you to provide the best treatment for your clients. You will be more likely to recognize when a client is suffering from a particular medical condition or injury. Also, you will understand how to adjust treatment so it is appropriate to a specific situation and how to refer the client to a more appropriate health-care practitioner if that is necessary.
The study of anatomy includes the major body systems as well as cellular structure and cellular chemistry. Cellular chemistry is not addressed on your examination, but it is necessary in order to understand how body systems operate. Other important areas of study include joints and muscles.
The human body is comprised of a variety of important systems. Each system has specific functions, but none of the systems is independent of the others; they work together to allow the body to function.

For your examination, you should be able to identify the location and function of the primary body systems, as follows:
- Cardiovascular/circulatory system: The cardiovascular or circulatory system controls the circulation of blood through the body and includes the heart as well as blood vessels such as capillaries, arteries, and veins.
- Endocrine system: The endocrine system manufactures hormones that affect things such as health, growth, and reproduction. The endocrine system includes endocrine glands such as the pituitary and thyroid glands.
- Gastrointestinal/digestive system: The gastrointestinal or digestive system breaks down food substances so they can be absorbed and used by the body. The gastrointestinal system includes the mouth, stomach, intestines, and salivary and gastric glands. Along with understanding how the digestive system works, you should have an understanding of the basic principles of nutrition.
- Integumentary system: The integumentary system is the skin. Besides its obvious function in protecting other body systems, the skin is also responsible for regulating the body’s temperature and respiration, among other functions. Because you will be in such close contact with the skin of your clients, this is an area requiring careful study.
- Lymphatic system: The lymphatic system is sometimes considered part of the cardiovascular system, because its role is to distribute and circulate lymph throughout the body. The lymphatic system includes lymph, the lymph nodes, and lymph vessels.
- Muscular system: The muscular system controls the movement of all parts of the body. This system is made up of the various types of muscles present in the body. This is another area that you will need to study carefully.
- Nervous system: The nervous system is the hub of awareness. It includes the brain, spinal cord, and the network of nerves threaded through the body. The nervous system is the control center for the body and coordinates all bodily functioning.
- Reproductive system: The reproductive system controls human reproduction and includes the genitals and a variety of internal organs and accessory systems.
- Respiratory system: The respiratory system controls breathing and includes the nose, mouth, lungs, air passages, the pharynx, trachea, and bronchial tubes.
- Skeletal system: The skeletal system is the framework of bones and joints in the body. The skeletal system provides the body’s foundation and supports and protects other body systems.
- Urinary system: The urinary system produces, stores, and eliminates urine. It includes the kidneys, bladder, and urethra as well as the sphincter muscles.

Energy Systems
Traditional Eastern medicine believes that in addition to the visible physiological systems, the body also has its own energy system, which is sometimes referred to as the energetic system or the meridian system. The energetic system is called subtle because it is not visible to the human eye and is difficult to perceive with other senses. The energetic system forms the body’s aura, or energy field. The energetic system communicates inside and outside the physical body along meridian pathways (energy pathways) and through the chakras. The chakras are located at specific parts of the body and are associated with particular organs, body parts, senses, and emotions or areas of consciousness.
The seven chakras begin at the crown and travel down the body. If you are taking the NCETMB examination, you will need to be able to describe the body’s energy systems and name and locate the body’s chakras. You should also understand standard associations for each chakra.
- Seventh chakra: The seventh chakra is also called the crown chakra. It is located at the very top of the head and traditionally associated with the brain. This chakra is associated with thought and consciousness.
- Sixth chakra: The sixth chakra is also called the third eye chakra. It is located between the eyes and is traditionally associated with the eyes, forehead, and temples. This chakra is associated with perception and telepathy.
- Fifth chakra: The fifth chakra is also called the throat chakra. It is located at the base of the throat and traditionally associated with the upper extremities, neck, and throat. This chakra is associated with communication, expression, and creativity.
- Fourth chakra: The fourth chakra is also called the heart chakra. It is located in the center of the chest and traditionally associated with the heart, lungs, and circulatory system. This chakra is associated with intuition, love, and relationships.
- Third chakra: The third chakra is also called the solar plexus chakra. It is located at the solar plexus (midway between the navel and the sternum) and traditionally associated with the digestive system. This chakra is associated with sight and perception (that “gut feeling”).
- Second chakra: The second chakra is also called the sacral or spleen chakra. It is located in the center of the abdomen and traditionally associated with the reproductive system. This chakra is associated with passion and sexuality.
- First chakra: The first chakra is also called the root or base chakra. It is located at the base of the spine and traditionally associated with the skeletal system. This chakra is associated with instincts and survival.

Exercises: Anatomy, Physiology, and Body Systems
Choose the option that best answers the question.

1. The four types of simple epithelial tissues are squamous, cuboidal, columnar, and (A) transitional. (B) keratinized. (C) pseudostratified. (D) connective.
Pseudostratified is a type of simple epithelial tissue that resembles stratified epithelial tissue because the nuclei of cells are located at different heights. Transitional and keratinized are types of stratified epithelial tissue, and connective is an entirely different type of tissue. The correct answer is (C).

2. Which of the following is part of the peripheral nervous system? (A) Spinal cord (B) Cranial nerve (C) Brain (D) Cerebellum
The peripheral nervous system consists of nerves that are found outside of the central nervous system, which is made up of the brain (the cerebellum is part of the brain) and the spinal cord. The cranial nerves exit the brain and are therefore part of the peripheral nervous system. The correct answer is (B).

Anatomical Position and Directional Terms
Any time health-care practitioners refer to the human body, they use a universally accepted standard position called the anatomical position. In the anatomical position, the human body is standing in an upright position, face forward, with arms at the sides and palms facing front. Using this position as a common orientation point makes it easy for health-care providers to conduct clear and concise discussions about their patients.
Directional terms are universal standards that describe the location of body parts and structures in relation to other structures in the body. Directional terms help to further orient descriptions of human anatomy and also to distinguish different movements of the body. You may find it easier to study directional terms with opposite meanings together.

The terms with which you should be familiar include:
- Anterior: Front or situated in front of
- Posterior: Rear or situated behind, toward the rear
- Distal: Away from, or situated farther from the origin
- Proximal: Near or situated closer to the origin
- Dorsal: Near the upper surface, or situated toward the back
- Ventral: Toward the bottom, or situated toward the belly
- Superior: Above or situated over
- Inferior: Below or situated under
- Lateral: Toward the side, or situated away from the mid-line
- Medial: Toward the middle, or situated away from the side
- Rostral: Situated toward the front
- Caudal: Situated toward the back or tail

For purposes of discussion, the body can also be divided into three planes, which is useful for describing specific sections or regions of the body. Planes are created using imaginary lines.
- The sagittal or vertical plane is created by an imaginary line running vertically through the middle of the body, dividing the body into left and right parts.
- The coronal or frontal plane is created by an imaginary vertical line dividing the body into front (anterior) and back (posterior) halves.
- The transverse or horizontal plane is created by an imaginary line running horizontally through the middle of the body; it divides the body into upper and lower halves.

Meridians
Meridians are energy pathways in the body. The concept of the meridians originated with Eastern bodywork modalities and is associated particularly with specialized techniques such as acupuncture. The exact definition and functioning of the meridians varies, depending on the culture you are studying, but in a general sense, they are considered the pathways through which energy and awareness flow through the subtle (non-physical) body.
For the purposes of the NCETMB, you should be able to identify the 6 organ pairs that form the 12 primary meridians in the body. You should also be able to indicate where they are located.

- Bladder ——————> Kidneys
- Gallbladder ——————> Liver
- Heart ——————> Small Intestine
- Lungs ——————> Large Intestine
- Pericardium (circulation) ——————> Triple warmer (function rather than a physical organ)
- Stomach ——————> Spleen

Exercises: Anatomical Position and Directional Terms
Choose the option that best answers the question.

1. In the anatomical position, the body is characterized by all of the following EXCEPT (A) lateral thumb position. (B) anterior facial position. (C) upright body position. (D) posterior palms position.
In the anatomical position, the palms are in the anterior position (facing forward), not the posterior position (facing backward). The correct answer is (D).

2. The hand is located at the __________ end of the forearm. (A) proximal (B) distal (C) anterior (D) posterior
Distal means away from, or situated farther from the origin. Proximal means at or near the origin; anterior and posterior refer to the front and back of the body, respectively. The correct answer is (B).
 
Tips:
As you probably recall from your schoolwork, it would be nearly impossible to memorize the meanings of every medical term you might hear or use over the course of your career. Instead, the most effective way to study medical terminology is to learn the meanings of common prefixes, root words, and suffixes. This allows you to break any unfamiliar medical term down into its parts to understand the meaning.
For example, the word epidermis means outermost layer of the skin. If you know that the prefix epi- means at, by, or on top of and the root word dermis means skin, you can define this word easily.
Using this technique, can you determine what the words endodermis and epidermidis mean without looking them up?

Systems of Special Note for the Massage Therapist
Massage therapists must have a holistic view of the body; that is, you must have a strong understanding of ALL the body systems and the way they interact with one another. For your examination, you should be prepared to answer questions on all of the body’s systems. However, due to the amount of practical knowledge you need on both the integumentary and muscular systems, we will look at these systems in a little more detail.

The Integumentary System
Because you will be working in such close proximity to your clients’ skin, pay special attention to this topic. Integumentary literally means “covering” or “skin.” The skin is considered the largest organ in the body and has several key functions, such as providing protection to the internal organs, regulating heat and body temperature, and providing the basic sense of touch.
The skin is made up of two layers: the epidermis, or outer layer, and the dermis, or the subcutaneous layer. The epidermis is multi-layered and comprised of a solid sheet of cells. This layer encases and encloses the body and protects it from foreign invaders such as bacteria. The dermis is made up of a mixture of fibers such as collagen and elastin as well as water and extrafibrillar matrix. The dermis includes a network of cells such as nerves and sweat glands.
Healthy skin is soft, flexible, and somewhat moist. Its texture should be smooth. Skin color will vary, but healthy skin looks healthy; that is, it is even in tone and does not have a yellow, ashy, or red tint. A variety of pathologies present with skin disorders such as lesions or tumors. Since you will be in such close contact with the client, you should be able to identify these so you can explain to the client why treatment may not be appropriate.
Problems with nutrition are also frequently reflected in the skin.
 
Note:
Fibrous adhesions result when fascia tissue binds together. This can result from a variety of causes, including surgery, infection, or trauma. Adhesions act as trigger points for pain. One effective treatment of adhesions is myofascial release therapy. Myofascial literally means, “Fascia related to the muscles.”

The Muscular System
Because soft tissue work involves the muscular system of the body, you should pay special attention to this topic area. Muscle is composed of tissue and fibers that are attached by a complex system of connective tissue, which is a substance that supports, binds, and connects body structures. The function of muscle is to produce and control force that powers movement of the body. Muscles include tendons, which are tough connective tissue that attaches the muscle to bone and allows the body to exert a pulling force.
Fascia (plural: fasciae) is connective tissue that serves a variety of functions, including the wrapping and encasing of individual muscle fibers as well as individual muscles. The body has three layers of fascia: the superficial fascia layer that lies directly under the skin and serves as connective tissue between the skin and muscles; deep fascia, a strong, densely packed layer that divides and protects the muscles; and subserous fascia that lies between deep fascia and the major organs deep inside the body.

Muscle can be classified as one of three types.

1. Skeletal muscle makes up the fleshy areas of the body. Skeletal muscle is voluntary because you consciously put it into action. Skeletal muscle attaches to the skeletal frame—bones, skin, and other muscles. Skeletal muscle is also referred to as striated muscle.
2. Cardiac muscle is found only in the heart. Cardiac muscle propels blood in and out of the heart and powers the circulatory systems.
3. Smooth muscle is also called involuntary or nonstriated muscle. Smooth muscle is located inside the walls of blood vessels and other structures such as the urinary and digestive tracts. Smooth muscle operates automatically, without conscious will.

Skeletal muscle is composed of muscle fibers arranged into bundles called fascicles, which form the belly of the muscle. Individual muscle fibers are frequently classified as fast twitch or slow twitch. Fast twitch fibers are associated with powerful, short bursts of energy that cause rapid fatigue, such as sprinting. Slow twitch fibers are associated with activities of lower intensity and longer duration, such as marathon running. Most people have a predominance of one or the other, based on genetics and activity level.

Some standard terminology is used to describe the direction of muscle fibers.
- Rectus fibers run parallel to the long axis of the body or limb; for example, the rectus femoris muscle in the quadriceps.
- Transverse fibers run perpendicular to the long axis of the body or limb; for example, the transvere abdominal muscle.
- Oblique fibers align at an angle to the long axis of the body or limb; for example, the abdominal obliques.
 
Tips:
No matter which examination you choose to take, you should be able to identify and locate the major muscle groups of the human body, including the upper and lower extremities as well as the abdominals.

Structure of Joints
Joints are the locations in the body where bone meets bone. The ends of bones that connect in the joint are called articulating surfaces. (Note: Ligaments connect bones to each other, and tendons, which connect muscle to bone, can cross joints.) Joints provide the flexibility that allows the body to move. Joints are classified by the amount and range of motion they permit.
- Fixed (fibrous) joints do not allow for any movement (or allow only micro-movement), such as those that connect the bones of the skull.
- Slightly moveable (cartilaginous) joints allow for a limited range of movement, such as those that connect the bones in the pelvis.
- Synovial (diarthrotic) joints move freely within range, such as those at the elbows and knees.

Movable joints in the body are classified as pivot joints, hinge joints, ball-and-socket joints, gliding joints, saddle joints, and ellipsoidal or condyloid joints.
- Pivot joints allow for a side-to-side motion. For example, the pivot joints in the cervical spine allow you to turn your head from side to side.
- Hinge joints allow movement similar to the opening and closing of a hinged door. Examples include knees and elbows.
- Ball-and-socket joints allow you to swing the limbs in many different directions. Examples include hip and shoulder joints. These are the most flexible type of joint in the body.
- Gliding joints join two flat bones and allow sideways movement. Examples include some of the bones in the wrists and ankles.
- Saddle joints allow the bones to rock back and forth or from side to side. The only saddle joint in the human body is the location where the thumb meets the wrist/rest of the hand.
- Ellipsoidal or condyloid joints, such as the joint at the base of your index finger, allow bending and extending, rocking from side to side, but rotation is limited.

Cartilage is an elastic substance that cushions the bones at the joints and prevents jarring during motion. Cartilage is also the substance that forms body structures such as the nose and ears. Ligaments are fibrous tissue that connect bones to other bones and provide support for the joints. Bursae are fibrous sacks that act as a cushion between bones and muscle, tendons, or skin.

Exercises: Systems of Special Note for the Massage Therapist

Choose the option that best answers the question.

1. In which of the following parts of the body can smooth muscle tissue be found? (A) Back muscles (B) Heart (C) Abdominal muscles (D) Iris
Smooth muscle tissues control body processes outside of our conscious control, including the dilation and constriction of the iris. The heart contains cardiac muscle tissue, and the muscles of the abdomen and back are composed of skeletal muscle tissue. The correct answer is (D).

2. Which of the following muscles is found in the back? (A) Trapezius (B) Iliopsoas (C) Pectineus (D) Sartorius
The trapezius is a large muscle that covers parts of the neck, shoulders, and back. The iliopsoas, pectineus, and sartorius are all found in the hip and thigh regions. The correct answer is (A).

3. Sudoriferous glands are cutaneous glands of the integumentary system that secrete (A) oil. (B) sweat. (C) follicles. (D) sebum.
The two types of cutaneous glands are sweat-secreting sudoriferous glands and oil- or sebum-secreting
sebaceous glands. Follicles are hair-producing structures. The correct answer is (B).

Tips for Answering Questions on Anatomy and Physiology
When answering test questions that deal with anatomy and physiology, you may find it helpful to remember these tips:
- Anatomy and physiology are interrelated subjects. Anatomy looks at the structures of the human body while physiology considers how those structures function. Many creative educational materials are available to help you more easily learn about the interrelationship between these subjects. Look in your school textbook, the library, or online for materials such as diagrams or models.
- Understanding how the body works is essential for selecting and properly executing therapeutic treatment on clients. Try applying diagnostic tools as you review the diagrams of the human body. For example, if the client’s skeletal system shows signs of osteoporosis, what does that mean to you in terms of how you will handle the client?
- Some systems call for special attention. You need to know all of the body systems, of course, but you should pay special attention to those body systems that are of the essence for massage therapists and body workers, such as the integumentary and muscular systems.
- Medical discussions always assume the body is in the anatomical position. Recognizing the anatomical position is especially important when you are using directional terms, because directional terms describe the locations of structures in the body in relation to other structures or locations in the body.
- To learn terminology, try using flashcards and a study partner. You can create flashcards using plain white index cards. Simply write the term on the front of the card and the meaning on the back of the card. Try to find a “study buddy” to work with, perhaps someone who went through your massage program with you. You will maximize your ability to learn if you are quizzing the other person as well as being quizzed yourself.
- For directional terminology, pair each term with its opposite. For all other terms, focus on common prefixes, root words, and suffixes. You may find it easier to also match like or opposite items; for example, you may find it easier to remember the meanings of the prefixes infra, inter, and intra if you study them in relationship to each other.