Swedish Massage

Swedish Massage Strokes Chart Summary

Stroke Purpose/Uses Mechanical effect Reflexive effect Contraindications
Gliding, Fanning, Tree branching, shingling etc.

Spreading oil

Evaluating tissue

 Relaxes muscles (parasympathetic nervous system)

Relieves pain (Gate control theory, endorphins)

Increases arterial and capillary circulation

Increases vasodilation (slowing heart rate and blood pressure)


Marked or pitted edema

Gross swelling

Open wounds

distal to inflammation or infection

 Increases venous and lymphatic flow removing wastes, reducing edema

Improves nutritional status of tissues

Increases arterial and capillary circulation, bringing nutrients

Warms superficial tissue

Desquamation of dead skin

Same as above

Deeper muscle relaxation

Capillary dilation longer lasting

 Same as light effleurage

Very hairy skin

New scar tissue

Venous stasis

Picking up, wringing, kneading, open C/closed C, alternating thumb, squeezing, lifting, skin rolling (lifting tissue away from underlying structures)
Used after effleurage

Relieves congestion

Reduces swelling

Digestive disorders

Muscle shortening

Spastic paralysis


 Stretches muscle fibers and stimulates muscle tone, broadens fibers

Breaks up adhesions

Increased circulation and waste elimination

Moves interstitial fluid

 Slow-relaxes nervous system

Fast-stimulates NS

Increases glandular activity of skin

Increases peristalsis  when done over abdomen

Affects proprioception

 Atrophied muscles

Flaccid paralysis

Acute inflammation

Use after tissues have been warmed up

Hypertonic muscles

Treatment massage

Deep tissue work

 Compresses and spreads tissue

Temporary ischemia

Mobilizes muscle/tendon junction

 Reduces pain and spasm


Increases peristalsis when done over abdomen

For all frictions:

Acute inflammations


Recent injuries

Osteo and rheumatoid arthritis-especially acute stages

Muscles lacking innervation(paralysis)

Debilitating neuromuscular dysfunction such as MS, ALS, MD.

LINEAR OR CIRCULAR FRICTION same as above  Myofascial releasing-separating adhered fascial planes

Broadens and stretches muscle fibers

Increases muscle

 Decreases tension through stimulating Golgi tendon reflex

Increases circulation

Creates hyperemia

Cross fiber friction  Use only after a thorough warming of involved tissue

Apply at right angles to scar/fibrotic tissue

Superficial tissue must      move over underlying structure

Apply frequently enough to have an impact

 Breaks up adhesions

Assists in realigning scar tissue


 Relaxes muscles by stimulating Golgi tendon reflex
Heat rub friction  Heats skin

Warms tissue


Relaxes muscles

Tapping, Pincement, Slapping Hacking, Cupping, Beating, Pounding
 Stimulation of tired muscles

Relaxation of hypertonic muscles

 Loosens mucus in thoracic cavity  Stimulates nervous system, muscles, vessels

Enhances muscle tone via contract-relax response

Increases circulation

Stimulates organs through low back

Increases gaseous exchange

Stimulates skin and glandular activity

 Muscles is spasm or cramping

Spastic paralysis

Atrophied muscles

Flaccid paralysis

Insomnia, neurasthenia or complete exhaustion

Neuritis or painful conditions

Over bony area

No heavy tapotement over the kidneys

No heavy tapotement over low back in pregnancy or menstruation

Static or moving
Relaxation  sedates nervous system

reduces pain(gate theory)

relaxes muscle

same as tapotement
Static or moving
loosens ligaments  Penetrating stimulation
JOSTLING/SHAKING  Increases synovial activity

Increases circulation

 Stimulates organs

Reduces muscle guarding

Rejuvenating  tired muscles

same as tapotement
Active free, active assisted, passive, resistive
Stretches muscles and ligaments

Increases circulation and nutrition

Increases waste elimination

Loosens adhesions

Increases ROM and flexibility

 Stimulates NS

Increases blood pressure and temperature

 Torn ligament, tendon or muscle

Unhealed fracture

Post surgery

Heart conditions

( active and resistive)

Acute injuries


Definition: A succession of light or deep stroking or gliding motions following body contours, applied by passing the flat of the hand or other flat surface such as the forearm, over a portion of the body or body part.

Light effleurage is generally relaxing and has only reflexive effects. Deep effleurage has more mechanical effects.

Effleurage dynamically affects the body mainly via its stimulation of the nervous system.  Deeper strokes can also positively influence circulation.


Effleurage can be applied with full hands or parts of the hand or arm (fingers, fists or forearm) depending on the body part being worked on and the desired effects.

The surface applying the stroke must be able to conform to the body part and remain fully in contact of the body part being worked on. You must be able to maintain the same contact and amount of pressure for the duration of the stroke.


Light Effleurage

Superficial touch, accessing the skin only.  Full hand contact with very little pressure.  No visible rippling of the skin.  No noticeable pressure to an observer’s eye or the client.  On the limbs, the stroke moves distal to proximal to assist venous return and lymphatic flow.  On the back, the stroke can be applied from shoulders to ilium or ilium to shoulders, but the stroke should follow a pattern.

  • a.continuous effleurage – full hand contact the entire length of the stroke – one hand following the other, ulnar side (little finger) leading.
  • b. V-shape both hands to conform to the contour of the legs or body part with one hand following the other

Deep Effleurage

Aaccess a deeper level to the subcutaneous layer of the skin, which is the fascia covering the superficial layer.  This stroke creates a very slight ripple of the skin.  If the muscle tissue moves, you have compressed too deep and have progressed to a friction stroke.


Fast, slow, long or short, depending on the desired physiological effect.  Faster and shorter are stimulating while slower and longer are more relaxing.

Use the palms, fingers, fingertips, full thumb and forearms in any of the following variations: horizontal, vertical gliding or stroking, shingling, thumb effleurage, t- stroke, bi-lateral tree stroking.  It is not the hand variation, but the depth and rhythm of the stroke that determines the effect of the effleurage.

Keep you hands soft and pliable.

Move hands towards the heart with gradually deepening pressure, using massage oil.  Then return the hands lightly keeping contact with the body.

Gliding: applied lightly or deeply using full hand contact working side-by-side as on the large surface of the back.  Vary by having one hand following the other or reinforcing hand (one on top of the other) or some other surface such as the forearm.

Alternate Hand: light or deep applied alternately with one hand contacting the body as the other follows.

Shingling: one hand following the other while working longitudinally in an area such as one side of the back or leg.

Fanning: stroking outward in a three-stroke fan shape from a single point often used for draining after friction massage.

Tree stroking or branching: hands start at the center line and move outward, while creating the shape of a tree.  Alternate hand movements are generally more stimulating that gliding movements


Place both hands on the part of the body that is closest to you.  Glide toward the center of the body toward the heart with gradually deepening pressure.  Apply oil before you assess the tissue or after.  Return hands to start and keep contact with the body. Repeat.

Effects of Effleurage

Effects of Effleurage can be reflexive or mechanical depending on the depth and rhythm of the application of the stroke.  The effect can be relaxing or stimulating. In general, effleurage creates an over all muscle relaxation and assists in blood and lymph circulation.  It aids in the process of removing waste products from normal cellular metabolism.

Light Effleurage Effects – Reflexive:

  • initially a reflexive parasympathetic nervous system response that is relaxing due to being touched.
  • Decreases the sympathetic nervous systems contraction of the muscles in the walls of blood vessels, which results in vasodilatation and an increase in capillary apace in the surface layer of the tissue.  (The area may turn red.)
  • The parasympathetic nervous system slows the heart rate and lowers the blood pressure
  • Slows breathing rate
  • affects the nervous system’s pain sensors which results in lessening of pain (gate theory or counter-irritation theory which is based on the observation that stimulating an area of pain or adjacent to the pain will suppress the sensation of pain and therefore other sensations can over-ride pain.  There are other theories of pain reduction including release of endorphins.)
  • Reduces edema reflexively by the increased exchange of fluids at the capillary level and by the stretching of the lymph vessels
  • may enhance healing process (theories of increased macrophage migration, increased antibody presence and the positive effect on the immune system.

Deep Effleurage – Reflexive Effects:

  • longer lasting capillary dilation
  • creation of deeper muscle relaxation
  • aids in pain reduction
  • surface heat caused by friction on the skin increases metabolism in the skin which results in increased peripheral circulation

Mechanical Effects:

  • Assists in the flow of venous blood and lymphatic fluid when applied in the direction of circulation.
  • assists in the renewed nutrition and removal of waste products
  • compresses and stretches the fascia layer between the superficial muscles and the subcutaneous layer of tissue
  • warms superficial tissue by friction of the hands on the clients body
  • assists in desquamation of dead skin cells

Nervous System Effects:  

The effects of effleurage on the nervous system are what create the reflexive effects in the other systems.  Light effleurage stimulates the receptors of the parasympathic division of the nervous system, which results in a reflexive, generally relaxing response.  This autonomic response causes vasodilatation and an accompanying inhibiting of vasoconstriction.  It is generally accepted (but not scientifically proven) that these nervous system responses occur in a reflex arc, either in the central nervous system or in the local ganglion of the nerve receptors.

Swedish Massage Glossary of Terms

  • Active assisted movement – Movement in a joint in which both the client and therapist produce the motion together.
  • Active free movement –  Movement of a joint freely through its range of motion, unassisted: done by client alone.
  • Acute – signs and symptoms happen quickly, last a short amount of time and then disappear.
  • Adhesion – Abnormal adherence of collagen fibers  within connective tissue to surrounding structures following trauma or stress; as a result of surgery.  restrict the normal elasticity of these structures as well as the transfer of electrolytes and other fluids.
  • Autonomic Nervous System –  The body system that regulates involuntary body functions such as action of glands, smooth muscles and the heart.  It consists of the sympathetic and parasympathetic nervous system.
  • Atrophy – Wasting away or decrease in size of  something, due to disease or other factors such as nutrition or lack of use.
  • Beating – a form of heavy tapotement  usually using the fist.
  • Chronic – disease or condition that develops slowly and lasts for a long time.
  • Compression – Massage petrissage stroke, applied with fist, palm, heel of hand or fingertips; used to spread tissue against underlying structures; can vary in pace and depth.
  • Connective tissue – The most abundant type of tissue in the body, providing support, structure, framework, space, stabilization and scar formation; binds structures together.
  • Contraindications – factors that indicate that the treatment is not advised, unless further evaluation by a physician can recommend a treatment plan.
  • Desquamation – The shedding of epethelial tissue; mainly the skin  as in exfoliation.
    Effleurage- gliding stroke; does not access the muscle layer; following the fiber direction of the underlying muscle
  • Friction – circular or transverse technique that focuses on the underlying tissue.
  • Gate Theory – A hypothetical mechanism that diminishes pain.  There is a gate through which pain impulses travel.  Pain signals travel to the Central nervous system on unmyelinated nerve pathways, which are a slower route to the brain.  Pressure, touch, vibration, and temperature signals travel on the faster myelinated nerve pathways.  These signals will arrive first and block out the sensation of pain.
  • Golgi Tendon Receptors – receptors in the tendons that sense tension; found mostly near the junction of tendons and muscles.  It will trigger a central nervous system response which will inhibit muscular contraction when the tendon is in danger of tearing due to excessive tension.
  • Hyperemia – an excess of blood in an area or body part; usually indicated by red, flushed color or heat in the area.
  • Hyperesthesia – Unusual sensitivity to sensory stimulus, hyper irritalbility, or increased muscular sensitivity to pain.
  • Hypertonicity –  Excess muscle tone
  • Hypertrophy – An increased size in muscle or thickening of muscle tissue in response to increases stress.
  • Inflammation – characterized by pain, heat, redness, swelling; usually as a result of an injury or infection.
  • Ischemia –  Local and temporary decrease in blood flow to an area.
  • Kneading – Petrissage; rhythmical lifting of tissue; rolling or squeezing; pulling away from underlying tissue.
  • Mechanical Effect – based on structural changes in the tissue; primary effects created manually; as a direct result of the application of the technique.
  • Myofascial – affecting the connective tissue of the body
  • Muscle spasm – a non-voluntary contraction of the motor unit of a muscle; usually causing a contraction without shortening the muscle; can be a result of mental, physical, emotional, chemical stress.
  • Peristalsis – Successive muscular contractions along the wall of a hollow muscular structure such as the movement of food through the intestine and colon.
  • Petrissage – kneading; rhythmic rolling, lifting, squeezing, wringing of sort tissue.
  • Proprioceptor – a receptor located in muscles, tendons or joints that provides information about body movement an position.
  • Reflexive effect – secondary effects that occur as a result of the massage technique but we do not cause directly or manually.
  • Scar tissue – tissue that results from healing of wounds; It is composed of collagenous fibers which will restrict normal elasticity of tissue involved.
  • Stroke – a technique of therapeutic massage; applying to the surface or deeper structures of the body.
  • Tapotement – percussive movement that are applied to the body, rhythmically.
  • Vibration – fine, coarse tremulus movement that creates reflexive responses

Contraindications and Endangerment sites by Nervous, Vascular and Organ Systems Swedish Massage

Nerves location Notes
Occipital Foramen Magnum Base of skull superior to 1st cervical vertebra
greater occipital nerve, suboccipital nerve, cranial nerves II (optic) III (oculomotor) IV trochlear
Do not work the occipital area during passive extension.

Static pressure ok in lengthened position

Trigeminal Nerve (V Cranial) TMJ pressure on nerve may cause Trigeminal neuralgia or tic de la ru with nerve inflammation.

Caution when working with jaw open.

Brachial Plexus -above lateral clavicle
-posterior triangle of neck
-insertion of deltoid, pec Major and biceps
-medial upper arm between the biceps and triceps
Impingement can cause pain/tingling down arm/hand
Axillary Nerve -deep inside arm on the humerus
Musculotaneous Nerve

Median Nerve

-lateral to biceps and triceps at the elbow -accessed when elbow is bent. Work with the arm straight
Lumbar Plexus -between the 12th rib and T12 along top edge of quadratus lumborum
-along the transverse processes of T12 and lumbars
Vagus Nerve -deep in abdomen -deep psoas work is risky with people with high blood pressure as it may over stimulate the vagus nerve and cause sweating, nausea
Femoral Nerve -anterior pelvis lateral to psoas
-femoral triangle
-caution when doing iliacus work
follow the contour of the pelvis
Common peroneal Nerve

Common popliteal Nerve

-back of knee
-tendon flattens when knee is straight
-hamstring work done with knee bent
Veins and Arteries
Common Carotid
External Jugular Vein
medial to SCM in anterior triangle pressure may cause dizziness or blackouts
Subclavian Artery/Vein behind clavicle in the hollow under the clavicle between the Pec Major and deltoid
Aorta lateral to navel -move off if you feel pulse
– may cause blackouts
Cephalic Vein anterior to deltoid, medial to triceps, lateral to pectoralis can be impinged to the humerus
Basilic Vein upper arm can be trapped between the biceps and triceps
Heart heavy compression on sternum is contraindicated
Liver below rib cage extending from the right side to the left of center press liver down as you press under ribcage to work diaphragm
Spleen left abdominal region behind stomach feels mushy
Kidneys protected by lower rib cage between T10 and T12 on both sides No compression or vibration over kidneys on back.
No high psoas work through abdomen
Lymphatic Structures many locations: cervical area, axillary, abdomen, femoral triangle, popliteal area avoid
Eyes do not apply pressure on eyeballs:
retinal detachment indicated by flashes of light or color

Contraindications for Swedish Massage

Contraindications are general precautions that are taught in massage school.  More proof is needed to show that these conditions are indeed contraindicated.

Who decides what is indicated or contraindicated? Article by Diane Polseno Massage Therapy Journal

Possible consequences
Acceptable Interaction
Inflammatory Conditions -heat, redness, swelling, pain
-sprains, strains, bursitis, synovitis, tenosynovitis,
could aggravate and worsen condition RICE,
Sub-acute- general massage above area
chronic inflammation- direct massage may be ok.
Varicose Veins -veins that are enlarged and twisted due to damaged valves
-can be painful
-direct pressure can cause further damage
-deep draining stokes below varicosity is not advised as it may put more pressure on the valve
-spider veins ok
-work around vein or move it out of the way
-nutritional supplementation with Vit C and bioflavinoids recommended
blood Clots -inflammation of vein
-warmth, redness,
-found in elderly or after trauma
-may be discolored (reddish cyanotic hue)
-massage could dislodge and move clot possibly causing a heart attack or stroke Wait for medical clearance; blood thinner medications may be necessary
Cardiac conditions -severe high blood pressure that is unstable
-heart/body may not tolerate increase in circulation -work only when medicated or controlled by diet and stress reduction methods
Hemophilia – inability of the blood to coagulate
-abnormal tendency to bleed
-may cause swelling in joints
-usually medicated with cumaden or other blood thinners
-deep pressure may bruise or cause tissue damage
-light pressure until you find out what the client can tolerate
Diabetes -advanced cases: loss of feeling and circulation in extremities
-pitted edema: pressing into tissue leaving indentation that stays
may cause tissue damage -circulatory strokes may still be beneficial: proceed with caution
Pregnancy -reduced circulation in legs
-possible blood clots due to hormonal changes
-miscarriage Use Common Sense
Work with physician or midwife.
Local or systemic infections -fever
-inflamed lymph nodes
-some examples: chicken pox, measles, influenza, scarlet fever, nephritis, hepatitis
-massage may be too stressful on the body and the immune system -energy work
-physicians approval needed
Infectious Skin Diseases -bacterial infections (staph, impetigo, tuberculosis)
-viral infections (herpes simplex and zoster, warts, chicken pox,
-parasites (scabies, fleas, lice, ticks)
-Fungal Infections (athletes foot, ringworm, yeast infections)
-may spread disease to yourself and other clients -physician approval

Swedish Massage – General Areas of Endangerment

Area of concern Anatomy Notes
Temporal and forehead Temporal artery- lateral sides of cranium
Temporal branches of facial nerve
Opthalmic branch of trigeminal nerve
Temporomandibular joint (TMJ)
submandibular areas
-parotid gland on ramus of mandible on top of masseter
-facial nerve anterior and superior to parotid gland
-facial artery inferior to parotid gland
-styloid process of temporal bone posterior to mandible, anterior to mastoid process
-styloid process may break with excessive pressure
-opening the jaw exposes nerves more
-compressing or damaging the nerves can cause trigeminal neuralgia
Anterior triangle of Neck -SCM, mandible, trachea
-carotid artery
-internal jugular vein
-hyoid bone
-submandibular salivary glands
-pressure on carotid can slow heart rate or cut off blood supply to head causing dizziness or black out-vaso-vagul reactions
Posterior Triangle of Neck -SCM, clavicle, trapezius
-external jugular vein
-brachial plexus
-subclavian artery and vein
-pressure on brachial plexus can cause pain down arm and hand
Occipital area -occipital foramina
-greater occipital nerve (C2)
-suboccipital nerve (C1)
Digging too deep in the occipital area with the head in passive extension, can entrap the nerves there. Static pressure with caution is ok.
Delto-pectoral triangle -inferior fibers of anterior deltoid, clavicle, and superior fibers of the clavicular head of the Pec Major
-cephalic vein
-brachial plexus
-axillary artery and vein
Axillary region -anterior border: deltoid, biceps and Pec Major
-posterior border: deltoid, triceps, latissimus
-Axillary nerve, artery, vein, lymph nodes
-cephalic vein
-brachial plexus
-median nerve
-brachial artery
There are many very effective techniques for working the muscles of the pecs, subscapularis, through the armpit.  Know what you are doing before proceeding.
Brachial region -superior border: inferior aspect of the biceps
inferior border: superior aspect of the triceps
-Median nerve
-Brachial Artery
-Basilic, brachial and cephalic veins
-radial nerve
Basilic Vein can be trapped medial to the humerus between the biceps and triceps.

Cephalic Vein can be pinned to the humerus just lateral to the biceps

Antecubital fossa- anterior elbow -distal to biceps brachii
-border: lateral common extensor tendon, medial- common flexor tendon
-median and radial nerve
-basilic vein
-brachial artery
Caution when using Cross fiber friction on the insertions of the biceps and brachialis in the shortened position as it may entrap the median nerve
Cubital notch-posterior elbow -posterior to medial epicondyle, anterior to olecranon
-ulnar nerve
“Funny bone”
cross fiber wok on the triceps insertion requires a lengthened position to protect ulnar nerve
Anterior surface of distal forearm and wrist -radial nerve and artery
-median nerve
-ulnar nerve and artery
Xiphoid process -xiphoid process -heavy direct pressure could break off bone
Abdominal Region -Liver, spleen, stomach, gall bladder, reproductive organs, intestines, colon

-abdominal aorta, vena cava
-vagus nerve

Visceral manipulation is an advanced technique that can be learned.

Deep pressure on the psoas may over stimulate the vagus nerve and cause symptoms such as sweating, nausea

Femoral Triangle -Sartorius, Inguinal ligament, adductor longus
-femoral nerve, artery and vein
-inguinal lymph nodes
-great saphenous vein
-area prone to herniation
-avoid pulse when palpating psoas tendon
Gluteal region -between sacrum and greater trochanter
-Sciatic nerve
When working the piriformis watch for referred pain
Posterior Knee -tibial and peroneal nerve (split off from sciatic nerve)
-Popliteal artery and vein

Massage Theory Test Questions

(These test questions and answers need to be updated and corrected.  I am also looking for more example questions to be posted here.  Contact me if you have some you would like to share or share your experience of the national exam on the bulletin board linked above.  Thanks!)

  • The sequences and directions of Swedish massage strokes are most adapted to which anatomical situation? (a) Muscle Attachments (b) Subcutaneous adipose tissue (c) autonomic nervous system (d) lymph drainage and venous return
  • Reflexive physiological effects (a) are generally a result of nervous system responses are directly produced by the massage therapist (c) include desquamation of dead skin cells and assisting lymphatic and venous circulation (d) are always stimulating and to be avoided
  • The best massage stroke to be used on a chronic sprain is (a) transverse friction (b) effleurage (c) pick up (d) tapotement
  • Lymph drainage massage procedures should begin at the (a) tendons (b) left thoracic lymph duct (c) right thoracic lymph duct (d) immune system
  • Cross fiber friction massage must be applied in which direction to the fibers? (a) horizontal (b) at right angles (c) triangular (d) longitudinally
  • Friction, percussion and vibration are techniques that (a) stimulate (b) relax (c) strengthen (d) weaken
  • The kneading technique in which the practitioner attempts to grasp tissue and gently lift it away from the bone is called (a) effleurage (b) pettrissage (c) tapotement (d) pinching
  • Pressing one superficial layer of tissue against a deeper layer of tissue to improve blood flow is called (a) rolling (b) spreading (c) friction (d) tapotement
  • Nerve trunks and centers are sometimes chosen as sites for the application of (a) rolling (b) rocking (c) triggerpoint (d) vibration
  • A hyper-irritable point that is painful when pressure is applied to it is called a (an) (a trigger point (b) pressure point (c) energy center (d) pain point
  • The general effects of percussion movements are to tone muscles by (a) vibration (b) friction (c) kneading (d) hacking
  • The ability to carry on an activity over a prolonged period of time and resist fatigue is called (a) strength (b) muscle bulk (c) endurance (d) exercise
  • Deep strokes and kneading techniques can cause an increase in (a) vasoconstriction (b) blood flow (c) diastolic arterial pressure (d) spasm
  • The cupping technique is best suited for (a) bronchitis (b) lung cancer (c) asthma (d) pleurisy
  • In addition to massage, which is most helpful in increasing lymph flow? (a) exercise (b) heat (c) immobilization (d) passive movement
  • The therapeutic benefit of friction is (a) local hyperemia (b) lymphatic drainage (c) tonification (d) none of the above
  • The main purpose of deep cross fiber friction is to (a) separate fibers (b) lengthen fibers (c) reduce pain (d) all of the above
  • Which is the best stroke for breaking down adhesions? (a) effleurage (b) petrissage (c) friction (d vibration
  • The purpose of petrissage is to milk the muscle and (a) remove toxins and waste products (b) assist venous return (c) squeeze the arteries and veins (d) apply pressure to the bones
  • Moving a joint without assistance or resistance is called (a) flexion (b) range of motion (c) extension (d) resisted movement
  • Direct physical effects of massage techniques on the tissues they contact are called (a) reflex effects (b) pressure points (c) physiological effects (d) mechanical effects
  • Gentle stroking, light friction and light petrissage are found to be (a) stimulating (b) reactive (c) calming (d) all of the above
  • Variations of effleurage include (a) knuckling and stroking (b) backstroke and friction (c) pressure and brushing (d) angling and stroking
  • Variations of petrissage include (a) one-handed petrissage (b) open and closed C (c) V hand position (d) all of the above
  • Variations of friction massage are (a) wringing and squeezing (b) knuckling and stroking (c) cross fiber manipulation and hooking (d) hacking and squeezing C
  • Kneading includes all of the following except (a) rolling (b) fulling (c) petrissage (d) friction
  • Vibration is best used for (a) breaking up scar tissue (b) relieving chronic edema (c) relaxing tight muscles (d) decreasing circulation
  • Blood Pressure generally decreases during massage because (a) the heart pumps less blood (b) venous flow is impeded (c) vasoconstriction occurs in the aorta (d) vasodilatation occurs in the peripheral arterial beds
  • Ischemia is (a) swelling (b) pain caused by hypertonicity (c) lack of muscle tone (d) lack of blood in an area
  • Which stroke is best used to break up subcutaneous adhesions? (a) cross fiber friction on the borders of the muscles (b) skin rolling (c) light effluerage (d) tapotement
  • The swedish massage stroke most helpful for relieving edema is (a) light tapping proximal to the edema (b) direct pressure friction into the edema (c) effleurage proximal to the edema and going towards the trunk (d) all of the above
  • Cross-fiber friction is most useful for (a) breaking up blood clots (b) releasing endorphins into the brain (c) spreading and broadening the muscle (d) increasing venous return
  • The gate theory is used to explain how massage may assist in (a) lessening a client’s edema (b) decreasing a client’s pain (c) increasing a client’s ability to move a joint through facilitation activation (d) helping client get in and out the door
  • The five basic swedish massage strokes are (a) effleurage, hacking, shaking, vibration and cupping (b) effleurage , Petrissage, squeezing, compression and swedish gymnastics (c) effleurage, petrissage, friction, vibration and tapotement (d) effleurage, petrissage, friction, cupping and hacking
  • The three stages of inflammation are (a) cute, subacute and hypertonic (b) acute, subacute and hyperacute (c) acute, subacute and chronic (d) acute, superacute and subacute
  • An endangerment structure in the posterior triangle is (a) the common carotid artery (b) the sciatic nerve (c) the brachial plexus (d) the median nerve
  • The borders of the femoral triangle are (a) inguinal ligament, rectus femoris, and sartorius (b) inguinal ligament, rectus femoris and adductor longus (c) inguinal ligament, sartorius and adductor longus (d) inguinal ligament, sartorius and popliteus
  • Friction includes (a) light and deep gliding strokes over the skin (b) direct pressure and cross-fiber and linear strokes (c) shaking and tapping (d) rubbing the skin until the client’s skin turns bright red
  • Reciprocal inhibition refers to ( a) a clients shyness (b) the fact that one group of muscles must relax when the client makes them (c) the fact that one group of muscles must relax when the opposite group contracts (d) all of the above
  • Hypoxia is (a) less than the normal amount of blood in an area (b) lack of oxygen (c) a contraindication for massage (c) a condition characterized by cold extremities
  • The antagonist muscle is ( a) the group of muscles contracting (b) the group of muscles opposite the group of contracting (c) the group of muscles assisting the group of muscles contracting (d) all of the above
  • The ability of a muscle to contract in called (a) strength (b) power (c) speed (d) endurance
  • The piriformis may be involved with (a) anterior leg pain (b) sciatic pain (c) anterior abdominal pain (d) lateral knee pain
  • Which of the following is true of the muscle spindle cell? (a) when stretched too far, too quickly, it causes the muscle to relax (b) when stretched too far, too quickly, it causes the muscle to contract (c) when stretched too far, too quickly, it engages the Golgi tendon organ (d) when stretched too far, too quickly, it engages the gate theory
  • The common carotid artery is in what region? (a) posterior triangle (b) bracial region (c) anterior triangle (d) delto-pectoral triangle
  • Which massage stroke has the least effect on blood circulation? (a) effleurage (b) petrissage (c) tapotement (d) wringing
  • Linear friction is most useful for (a) breaking up blood clots (b) releasing endorphins into the muscle belly (c) stretching muscle fibers (d) increasing venous return
  • Which of the following is contraindicated for effleurage? (a) very hairy skin (b) insomnia (c) pain (d) inflammation
  • Cupping, Hacking, slapping and beating are all forms of (a) effleurage (b) friction (c) petrissage (d) tapotement
  • Which of the following are contraindicated for tapotement? (a) insomnia (b) hypertonicity (c) hyperemia (d) hypothyroidism
  • Which of the following strokes, if done for too long a period, can cause loss of sensation due to nervous system overload? (a) light effleurage (b) tapotement (c) petrissage (d) knuckling
  • Nerve strokes are most often used to (a) stimulate (b) tickle (c) assist venous return (d) soothe the nervous system
  • Tapotement can be beneficial (a) if it is applied lightly over the abdomen (b) when used over the thoracic cavity to loosen mucus in the lungs (c) to stimulate circulation (d) all of the above
  • Effluerage has the following effects: (a) eliciting parasympathetic response (b) vasodilation (c) assisting lymph and venous flow (d) all of the above
  • Physiological effects primarily effect which system(s)? (a) nervous (b) circulatory (c) endocrine (d) all of the above
  • If you want to stimulate rather than relax your client, your massage strokes would be (a) vigorous (b) slow and gentle (c) deep (d) light
  • Mechanical effects occur because (a) the endocrine system is activated (b) the parasympathetic nervous system is stimulated (c) of our intent (d) we apply strokes to certain areas of the body
  • Which structures are best massaged using petrissage? (a) joint capsules (b) muscle bellies (c) tendons (d) fingers
  • Petrissage is contraindicated for (a) flaccid paralysis (b) hairy skin (c) pregnancy (d) ischemia
  • The bodies ability to receive information from muscles, tendons and other structures regarding their external and internal conditions is called (a) proprioception (b) parasympathetic nervous system (c) the gate theory (d) hyperemia
  • Reflexive physiological effects (a) are generally a result of nervous system responses (b) are directly produced by the massage therapist (c) include desquamation of dead skin cells and assisting lymphatic and venous circulation (d) are always stimulating and to be avoided

Sample Massage Test Questions
(Answers are in Capitals)

  • The sequences and directions of Swedish massage strokes are most adapted to which anatomical or physiological situation? a) Muscle attachments  b) Subcutaneous adipose tissue c) Autonomic nervous system  D) Lymph drainage and venous return
  • Which Best describes the effect of massage therapy? A) Increased venous and lymph flow b) increased venous, decreased arterial flow c) decreased venous and lymph flow d) decreased venous increased lymph flow
  • In first aid for a choking victim, you want the victim to A) cough  b) swallow  c) vomit d) inhale
  • The massage therapist needs to wear gloves if  a) there is no time to wash hands b) a client is embarrassed C) a client is infected with a contagious, transmittable disease d) his or her nails are too long
  • A form of touch therapy in which the energy of the recipient is rebalanced, promoting health and healing is called  a) Reflexology b) acupressure C) Therapeutic Touch d) Lympathic Drainage
  • Lymph massage procedures begin at the a) tendon  b) left thoracic lymph duct C) right thoracic lymph duct d) immune system
  • Using Neurophysical muscle reflexes to improve the functional mobility of the joints is called  a) kneading b) NMT C) muscle energy technique d) stretching
  • A pregnant client should have pillows under her back when she is lying a) on her side B) supine c) prone d) upside down
  • A pre-event sports massage is basically a swedish massage with the movements performed a) precisely  b) using heat c) slower  D) Faster
  • Cross-fiber friction massage must be applied in which direction to the fibers?  a) horizontal  B) at right angles  c) triangular d) longitudinally
  • MET helps counteract a) soft tissue injury  b) headache  c) sprains D) muscle spasms
  • Cold applied for therapeutic purposes is called a) cryptology B) cryotherapy c) thermo-therapy d) icing cubing
  • The draping method that covers the entire body is called A) top cover b) full-sheet c) diaper d) wrapping
  • The draping method that covers the table and wraps the client is called the a) top cover B) full sheet  C) diaper  d) wrapping
  • At the start of a massage, the client is lying a) face up B) face down c) on their side d) all of the above
  • Most current massage styles are based on A) Swedish Movement  b) swiss movements  c) German Movements d) Greek movements
  • Psychological benefits of massage inclued reduced tension and fatigue, calmer nerves and a) therapeutic  B) renewed energy c) improved circulation d) spasms
  • Friction, percussion and vibration are techniques that A) stimulate b) relax c) strengthen d) weaken
  • The kneading technique in which the practitioner attempts to grasp the tissue and gently lift and spread it is called A) fulling b) pulling c) spreading d) nudging
  • Pressing one superficial layer of tissue against a deeper layer of tissue in order to flatten the deeper layer is called a) rolling b) spreading C) Friction d) ironing
  • Physiological effects  a) include results of the nervous system responses b) are never created directly by the massage therapist c) include desquamation of dead skin cells and sedation of the nervous system d) none of the above E) both a and c
  • Petrissage is best used for a) breaking up scar tissue b) relieving chronic or pitted edema C) relaxing tight muscles d) decreasing circulation e) shortening a muscle that is overstretched
  • Ischemia is a) swelling b) pain caused by hypertonicity c) lack of muscle tone D) lack of blood in an area
  • When using Range of Motion (ROM) testing preceding an injury treatment, you would expect which of the following responses? a) pain on stretch in the acute stage b) pain with any movement in the chronic stage c) a soft end feel, which always indicates inflammation D) little or no pain during ROM in the chronic stage e) you do not use ROM testing prior to an injury treatment
  • Development of scar tissue occurs during which stage of inflammation? a) acute b) sub-acute c) sub-chronic D) chronic
  • Which stroke is best used to break up subcutaneous adhesions? a) cross fiber friction B) skin rolling c) light effleurage d) jostling
  • Blood pressure generally decreases during massage  because a)the heart pumps less blood b) venous flow is impeded c) vasoconstriction occurs in the aorta D) vasodilation occurs in the peripheral arterial beds e) massage does not decrease blood pressure
  • Which of the following strokes has the least effect on blood circulation? a) effleurage b) pettrissage C) tapotement d) wringing
  • The swedish massage stroke most helpful for aligning scar tissue is a) tapping over the forming scar b) direct pressure friction into the scar c) effleurage distal to the scar and going away from the wound D) cross-fiber friction on the site
  • If you want to assess your client’s full range of motion in any joint, you would a) have them look straight ahead and touch their fingertip to their nose B) use a combination of Active and Passive Swedish Gymnastics taking the joint through it’s motions c) use efflerage and petrissage to palpate for hypertonicities and scar tissue d) use friction to gently move the joint through its motions
  • How would you test for a tight piriformis? a) client supine, straight leg lift B) client prone, internal rotation of thigh c) client prone, external rotation of thigh d) client supine, flexion of the knee
  • An effective way to treat tendinitis would be a) direct pressure friction on the muscle belly B) cross fiber friction on the tendon c) petrissage on the tendon d) application of heat followed by vigorous stretching
  • Linear friction is most useful for a) breaking up blood clots b) releasing endorphins into the muscle belly C) stretching muscle fibers d) increasing venous return of blood and lymph
  • Neck ligament injuries may result in which of the following symptoms? a) pain in the arm b) headaches c) dizziness D) all of the above
  • Collagen A) is a form of connective tissue that forms scar tissue b) is one of a host of digestive enzymes c) occurs naturally in the development of larger muscles during weight training d) is out of our scope of practice
  • Which of the following skin conditions in not contagious? a) scabies b) ring worm C) psoriasis d) herpes
  • Whiplash a) is a term that describes injuries sustained in rear-end collisions B) is a term that describes the movement of the head and neck c) is a term used to name the ligament damage to the neck d) occurs only in the neck
  • Which of the following conditions are contraindicated for effleurage? A) very hairy skin b) insomnia c) pain d) inflammation
  • Which of the following is contraindicated for massage of the abdomen? a) pregnancy b) diarrhea c) intestinal flu D) all of the above
  • Massage applications can be defined by a) their depth b) their direction c) the movements of the practitioners hands D) all of the above
  • Nerve trunks and centers are sometimes chosen as sites for the application of a) rolling b) rocking c) pressure D) vibration
  • A bath with a temperature of 85 degrees F to 95 degrees is considered a) cool b) cold C) Tepid d) hot
  • Warm baths should be followed by a (an) A) cool shower b) whirlpool c) salt bath d) ice pack
  • The source of pain can be pinpointed through  A) palpation b) hard end feel c) inert tissues d) knuckling
  • The procedure that uses bounding movements to improve the flow of lymph through the entire system is called lymphatic a) bounce b) sway c) purging D) pump manipulation
  • Realignment of muscular and connective tissue and reshaping the body’s physical posture is called a)adjustment b) centering c) Rolfing d) posture analysis
  • The attempt to bring the structure of the body into alignment around a central axis is called A) structural integration b) trauma c) alignment d) adjustment
  • A hyperirritable spot that is painful when compressed is called a(an) A) trigger poing b) pain point c) ampule d)rolfing
  • Better flexibility is the result of A) sustained stretching b) ballistic stretching c) weight lifting d) exercise
  • Linens should be washed a) when dirty b) monthly C) after each use d)twice monthly
  • According to Dolores Krieger, therapeutic touch is most effective on a) fluid and electrolytes b) ANS C) lymphatic and circulatory problems D)all of the above
  • The general effects of percussion movements are to tone the muscles by a) vibration b) friction c) kneading D) hacking
  • The idea that stimulation of particular body point affect other areas is called a) chiropractic B) reflexology c) Rolfing d) touching
  • The ability to carry on an activity over a prolonged period of time and resist fatigue is called a) strength b) muscle bulk C) endurance d) exercise
  • Joint mobilization is a passive movement that can be integrated into a massage routine,for example a) pulling b) friction C) stretching to ROM d) tapotement
  • Deep strokes and kneading techniques can cause an increase in a) vasoconstriction B) blood flow c) diastolic arterial pressure d) systolic arterial pressure
  • Which best describes the technique of Rolfing? a) reflex therapy b) German Massage C) structural integration d) connective tissue massage
  • Deep friction massage works best if it is applied a) directly over the problem area b) proximal to the problem c)distal to the problem D) around the problem e) where ever you want
  • The cupping technique is best suited for a) acute bronchitis b) cancer of the lungs C) brondhiectasis d) acute tracheitis
  • According to Beard, in superficial stroking the direction is A) feet to head b) lateral c) of no consequence d) head to feet
  • Cupping, slapping, hacking and beating are all forms of a) effleruage b) friction c) petrissage D) tapotement
  • Pain on stretch at the end of Range of Motion indicates a)acute injury to the muscle fibers b) acute injury to the joint capsule c) that an injury is in the subacute stage D that an injury is in the chronic stage e) we are not allowed to know this
  • Which of the following are contraindications for tapotement? A) insomnia b) hypertonicity c) hyperemia d) all of the above
  • When testing for tendinitis, you would a) use only active tests b) expect to get pain only in resisted tests C) get pain upon stretching the tendon d) always take the joint to the full end of it’s range of motion regardless of the client’s ability
  • Friction can generally be used on which of the following conditions? a) when a joint is tight due to arthritis b) newly formed scar tissue C) hypertonic muscles d) when swelling or edema occurs
  • Which of the following would not be effective in relieving a cramp ? A) heat on the muscle b) ice on the muscle c) reciprocal inhibition d) direct pressure
  • You have a client with edema in the left knee.  Where might you begin massage?  a) on the left gastrocnemius b) on the left knee C) on the left hamstring and quad d) you would never perform massage on a client with edema
  • Which of the following strokes, if done for too long a period, can cause loss of sensation due to nervous system overload? a) light effleurage B) tapotement c) petrissage d) kneading
  • Rheumatoid arthritis in the acute phase is a) a condition for doing injury work B) contraindicated for all massage c) is contraindicated for only deep work d) is a condition for doing intense hydrotherapy
  • The Piriformis, when tight, may entrap which structure? a) femoral nerve B) sciatic nerve c) gluteal artery d) gluteal nerve
  • The therapeutic benefit of friction is A) local hyperemia b) lymphatic drainage c) tonification d) none of the above
  • On the basis of current information the psychogenic effects that massage are most likely due to is a) histamine releases B) endorphin releases c) local lactic acid accumulation
  • The main purpose of deep transverse friction is to A) separate muscle fibers b) lengthen muscle fibers c) shorten muscle fibers d) minimize pain
  • Bindegewebs massage is a) connective tissue massage b)reflex zone therapy c) German connective tissue massage D) all of the above
  • Which stroke most often begins and ends a swedish massage? A) effleurage b) petrissage c) friction d) vibration
  • What is the best massage technique to life muscles off the bone? a) effleurage B) Petrissage c) vibration d) tapotement
  • What is the first primary consideration before beginning massage treatment? a) make sure the client is comfortable b) Make sure no jewelry is being work c) wash hands thoroughly D) determine if contraindications are present
  • How should you vary massage treatment with the age of the patient? a) progressively with increased age b) shorter with increased age C) shorter for very old and very young d) the same for any age
  • According to McMillian, what type of tapotement is done with a cupped hand?  a) hacking B) clapping c) tapping d) beating
  • According to Cyriax, the most potent form of massage is a) effleurage b) petrissage C) deep transverse friction d) shiatsu
  • Which massage technique gives the best information about connective tissue structure in ligaments, tendons and joints? a) effleurage B) friction c) vibration d) tapotement
  • Which stroke is best used for breaking down adhesions? a) effleurage b) petrissage C) friction d) vibration
  • Strokes that knead are called a) effleurage B) petrissage c) friction d) vibration
  • Biofeedback is useful in a) relieving pain through autogenic training b) controlling involuntary processes c) a therapeutic program D) all of the above d) what the national certification board need asap
  • Which should not be claimed as a result of massage therapy?  a) prevention of edema b) increased arterial flow c) increased lymph flow D) weight reduction
  • Guided imagery and mediation techniques a) remove blocks and stimulate healing b) are used for preventative treatment c) subliminally reinforce the mind D) all of the above
  • The relaxing action of a muscle is obtained immediately by the application of a) cold B) heat c) tepid d) none of the above
  • Pre-event sports massage includes all of the following strokes except a) compressions b) jostling c) circular friction D) light effleurage
  • Which of the following would you treat for “runners knee”? a) piriformis B) IT band c) patellar aponeurosis d) medial collateral ligament
  • The stretch-reflex mechanism is a term that describes a) how a muscle will stretch in response to a direct blow B) how a muscle contracts in response to being stretched c) shy you want to use as much force as possible to stretch a muscle d) what happens when you do cross-fiber friction on a muscle belly
  • Torticollis involves which muscle? a) splenius capitis b) rectus capitis C)sternocleidomastoid d) rectus longus colli
  • Which of the following structures may contribute to thoracic outlet syndrome? a) scapula b) scalene muscles c) brachial plexus D) all of the above
  • Which of the following conditions could be relieved using manual lymphatic drainage technique? a) acute systemic infections b) thrombosis C) edema accompanying a sprained ankle d) congestive heart failure.
  • Open C/Closed C, skin rolling and fulling are all forms of a) vibration b) effleurage C) petrissage d) friction
  • Which structures are best accessed using tapotement? a) joint capsules B) muscle bellies c) tendons d) you would not use tapotement in massage
  • The gate theory is used to explain how massage may assist in a) lessening a client’s edema B) decreasing a client’s pain c) increasing a clients ability to move a joint d) helping clients get off the table
  • When you have a sprain, sharp pain is generally an indication of a) slight injury B) a more serious, acute injury c) you cannot tell by the severity of the pain d) we are not allowed to work with pain
  • Massage benefits lymph flow best when strokes are a) away from the heart B) toward the heart c) heavy in both directions d) in certain local areas
  • For which condition is abdominal massage most beneficial?  a) pregnancy b) appendicitis C) constipation d) enteritis
  • In which area is massage most often used for spinal cord injury to T12? a) chest b) neck C) legs d) trunk

Test Questions Part 2 (Answers in Capital letters)

  • Pettrissage beginning just distal to the medial condyle and moving proximal to the gluteal fold affects whichmuscles?  a) Anterior adductors B)Medial Hamstrings c) Quadriceps d) Deltoid
  • In tapping a large area of the body, which massage maneuver is used?  A) Percussion b) Friction c) Efflerage d) Petrissage
  • In massaging the anconeus, the massage therapist is working in the area of the A) upper extremity b) lower extremity c) abdominal wall d) none of the above
  • For insomnia, which is BEST? a) heavy effleurage B) Light effleurage c) tapotement d) Pick – up
  • The main purpose of deep transverse fricition is to A) separate muscle fibers b) lengthen muscle fibers c) shorten muscle fibers d) minimize pain
  • Which is characteristic of a pressure stroke?  a) is of no consequence b) follows venous flow c) follows arterial flow D) follows gravity
  • A client complains of and requests massage for severe low back pain.  Which condition produces this pain and is a contraindication for massage?  a) phlebitis b) postural deviation C) herniated disc d) torticollis   ( I got this question off a massage school test and feel that it is inaccurate.  I work on people with disc injuries all the time – so go figure)
  • To massage the elderly, which stroke would you use?  a)tapotement B) gentle effleurage and petrissage c) deep pressure d) friction over pressure area
  • When palpating the midline of the back, what is being touched?  a) transverse process b) vertebral body C) spinous process d) articular joint
  • Mild stimulation of the vagus nerve results in a) irregular heartbeat b) no change c) increased heart beat D)  decreased heartbeat
  • Contraindications for hydrotherapy do NOT include which of the following?  a) kidney infection B) cold c) high or low blood pressure d) skin infection
  • Massage therapy is used in pain management for a) cardiac and terminal cancer patients b) posttrauma patients c) post surgical patients D) all of the above
  • The use of cold to depress the activity of pain receptors in the treatment of myofascial pain  a) treatment skin temperature of 13.6 degree C  b) increases nerve conduction velocity  C) permits passive stretching and exercise d) decreases the general activity of the patient

Massage School Test Questions

  • What condition commonly results in bone spurring? a) tendinitis  b) migraines C) osteoarthritis d) neuritis
  • Curing a rear impact accident, the acceleration rate of the victim’ head:  a) is slower than the vehicle  B) is greater than the vehicle c) is the same as the vehicle d) is equal to the movement of the torso
  • Typical head position for a client  with the right SCM in contracture from Torticollis would be: a)lateral flexion to the left, rotation to the left b)lateral flexion to the right, rotation to the right C) lateral flexion to the right, rotation to the left  d) lateral flexion to the left, rotation to the right
  • Rotator cuff tendinitis does not include which tow tendon areas? A)deltoid and teres major b) infraspinatus and subscapularis c) supraspinatus and teres minor d) supraspinatus and subscapularis
  • The painful arc in active shoulder abduction occurs at approximately: A) 50 to 120 degrees b) 180 degrees c) when the arm comes down d) The first 10 degrees
  • The pain in a painful arc test is the result of: a)bracial plexus impningement b) pressure on the sternum C) pressure on the inflamed rotator cuff tissue as it passes under the acrominon process d) the movement of the scapula over the ribs
  • Which of the following conditions is the result of an inflamed nerve ?  A) neuritis b) tendinitis c) bursitis d) rheumatoid arthritis
  • Upon postural assessment, you find that the client’s right foot is severely pronated.  On which part of the right foot does he stand?  A)medial b) lateral c) on his outside heel d) on his toes
  • Which muscles would you attempt to lengthen in question 8?  a) tibialis posterior and sartorius B)peroneous longus and extensor digitorum longus c) tibialis posterior and gastrocnemius d) all of the above
  • Thoracic outlet syndrome is a type of a)arthritis b) fibromyalgia C) neuralgia d) chronic fatigue
  • The borders for the posterior trangle of the neck are: a) transverse processes of the cervicals, splenius capitus, trapezius  B) SCM, trapezius, clavicle c) SCM spine of the scapula, trapezius d) SCM, trachea, mandible
  • What type of hydrotherapy application includes active movement following numbness?  a) foot bath B) cryokinetics c) hot compress d) vascular flush
  • Why is tendinitis slow in the healing process? a) poor synovial fluid secretion B) poor vascularization c) poor mobility d) poor muscular support
  • Which joint is involved with a shoulder separation? a) sterno-clavicular B) acromio-clavicular c)costo-clavicular d) glenohumeral
  • Which joint is involved with shoulder dislocation?  a) sterno-calvicular b) acromio-clavicular c) scapular thoracic D) glenohumeral
  • Which of the following is defined as nerve pain?  a)neuritis b) tendinitis c) bursitis D) neuralgia
  • A protruding 4th lumbar disc would most likely cause: a) arthritis b)tendinitis c) bursitis D) sciatica
  • Which ROM is indicated when assessing an acute whiplash injury?  a) active b) passive c) resisted d) assisted
  • What would be the most appropriate massage treatment for a muscle spasm?  a) gliding friction b) effleurage C) direct pressure d) tapotement
  • Another name for tennis elbow is:  a) thoracic outlet syndrome b) golfer’s elbow c) mdial epicondylitis D) lateral epicondylitis
  • Which head positions puts transverse processes and facets at minimum risk?  a) a rear end collision with victim turned looking in their rear view mirror B) a rear end collision with the victim looking straight ahead c) a sideswipe collision d) head on collision with the victim turned facing the passenger

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