Advanced anatomy, physiology and assessment for … · Advanced anatomy, physiology and assessment for sports ... physiology and assessment for sports massage 3 ... document the criteria

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UV50388

Advanced anatomy, physiology and assessment for sports massage

By signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements have been achieved under specified conditions and that the evidence gathered is authentic.

This statement of unit achievement table must be completed prior to claiming certification.

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Assessor tracking table

Statement of unit achievement

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VTCT is the specialist awarding body for the Hairdressing, Beauty Therapy, Complementary Therapy, Hospitality and Catering and Sport and Active Leisure sectors, with over 45 years of experience.

VTCT is an awarding body regulated by national organisations including Ofqual, SQA, DfES and CCEA.

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UV50388Advanced anatomy, physiology and assessment for sports massageThe aim of this unit is to develop an advanced understanding of the biological basis for complex massage/soft tissue methods. The effectiveness of complex massage/soft tissue methods will also be evaluated, as will research undertaken in this field.

You will develop the understanding and skills required to carry out and analyse comprehensive subjective and objective assessments of clients, and will develop complex treatment strategies based on sound clinical reasoning and evidence-based research.

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GLH

Credit value

Level

Observation(s)

External paper(s)

80

14

5

2

0

UV50388

Advanced anatomy, physiology and assessment for sports massage

3

On completion of this unit you will:

Learning outcomes

1. Be able to undertake biomechanical assessments in sport and active leisure

2. Be able to palpate structures of the musculoskeletal system

3. Be able to assess the integrity of the musculoskeletal system

4. Be able to recognise neurological conditions that warrant urgent referral

5. Understand the advanced anatomy and physiology relevant to complex sports massage/soft tissue methods

6. Understand the components of a subjective assessment

7. Understand sports specific postures and gaits

8. Understand the effects of complex massage/soft tissue methods on the body and mind

9. Be able to evaluate the research undertaken on complex massage/soft tissue methods in sport and active leisure

evidence. Professional discussion may be used as supplementary evidence for those criteria that do not naturally occur. Assessed observations should not be carried out on the same day for the same learning outcome. There should be sufficient time between assessments for reflection and personal development. You need to meet the same standard on a regular and consistent basis. Separating the assessments by a period of at least two weeks is recommended as competence must be demonstrated on a consistent and regular basis.

4. Range All ranges must be practically demonstrated or other forms of evidence produced to show they have been covered.

5. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used.

6. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes and cover ranges in this unit. All outcomes and ranges must be achieved.

7. Sports massage practice Three hundred hours of sports massage must be documented in your portfolio of evidence. Evidence must demonstrate application of all massage methods that make up this qualification and must be undertaken on a range of clients in different environments.

8. External paper There is no external paper requirement for this unit.

Evidence requirements

1. Environment Evidence for this unit may be gathered within the workplace or realistic working environment (RWE).

2. Simulation Simulation is not permitted in this unit.

3. Observation outcomes Competent performance of Observation outcomes must be demonstrated on at least two occasions. Assessor observations, witness testimonies and products of work are likely to be the most appropriate sources of performance

Achieving observations and range

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Achieving observation outcomes Achieving range

Your assessor will observe your performance of practical tasks. The minimum number of competent observations required is indicated in the Evidence requirements section of this unit.

Criteria may not always naturally occur during a practical observation. In such instances you will be asked questions to demonstrate your competence in this area. Your assessor will document the criteria that have been achieved through professional discussion and/or oral questioning. This evidence will be recorded by your assessor in written form or by other appropriate means.

Your assessor will sign off a learning outcome when all criteria have been competently achieved.

The Range section indicates what must be covered. Ranges should be practically demonstrated as part of an observation. Where this is not possible other forms of evidence may be produced. All ranges must be covered.

Your assessor will document the portfolio reference once a range has been competently achieved.

Evidence of sports massage practice

Three hundred hours of sports massage practice must be carried out to achieve this unit.

Your assessor will complete the table below when 300 hours of sports massage practice have been completed and are documented in your portfolio of evidence.

Date achieved Assessor initials

Outcome 1

Observations

You can:

Observation 1 2 OptionalDate achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

*May be assessed through oral questioning.

Be able to undertake biomechanical assessments in sport and active leisure

a. Use tests to measure leg lengths

b. Carry out plumb-line assessments of postures in standing

c. Analyse movement

d. Carry out observational analyses of gait

e. Communicate biomechanical findings, identifying strengths, areas for improvement and indications for massage/soft tissue methods (as appropriate)

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Outcome 2

You can:

Be able to palpate structures of the musculoskeletal system


a. Palpate key bony landmarks relevant to complex sports massage/soft tissue methods

b. Palpate joint lines commonly used in sport and active leisure activities

c. Palpate the origins, insertions, bellies and tendons of the muscles commonly used in sport and active leisure activities

d. Palpate ligaments and bursae important to sport and active leisure activities

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Portfolio reference

Assessor initials

Learner signature

Outcome 3

You can:


Be able to assess the integrity of the musculoskeletal system

a. Measure active and passive joint range of movement

b. Use tests to measure isometric muscle strength through range

c. Use tests to assess the integrity of joints commonly used in sport and active leisure

d. Use tests to assess muscle lengths

e. Communicate musculoskeletal findings, identifying strengths, areas for improvement and indications for complex massage/soft tissue methods (as appropriate)

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Portfolio reference

Assessor initials

Learner signature

Outcome 4

You can:

Be able to recognise neurological conditions that warrant urgent referral


a. Carry out assessments of sensation for the upper and lower limbs

b. Assess muscle strength for neurological weakness

c. Test deep tendon reflexes using a reflex hammer

d. Communicate neurological findings, identifying indications for complex massage/soft tissue methods (as appropriate)

UV503888



Portfolio reference

Assessor initials

Learner signature

Range

*You must practically demonstrate that you have:

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Palpated a minimum of 12 bony landmarks Portfolio reference

Adductor tubercle

Bicipital groove

Capitate

Cuboid

Cuneiforms

Deltoid tuberosity

Gluteal tuberosity

Hamate

Head of fibula

Infraglenoid tubercle

Lister’s tubercle

Lunate

Manubrium

Navicular

Occipital protuberance

Peroneal trochlea

Pisiform

Sustentaculum tali

Radial styloid process

Scaphoid

Spinous process T12 and 12th rib

Trapezium

Trapezoid

Triquetrum

Ulnar styloid process

Xiphoid process

It is strongly recommended that all range items are practically demonstrated. Where this is not possible, other forms of evidence may be produced to demonstrate competence.


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Palpated a minimum of 8 joint lines Portfolio reference

Ankle

Acromioclavicular

Elbow

Hip

Knee

Radioulnar

Sacroiliac

Shoulder

Sternoclavicular

Wrist



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Palpated a minimum of 12 muscles Portfolio reference

Brachialis

Brachioradialis

Coracobrachialis

Diaphragm

Extensor carpi radialis longus

Extensor carpi radialis brevis

Extensor digitorum longus and hallucis longus

Flexor carpi radialis

Flexor carpi ulnaris

Flexor digitorum longus

Iliacus

Pectoralis minor

Peroneals

Plantaris

Psoas major

Rhomboids

Sartorius

Scalene anterior and middle

Scalene posterior

Serratus anterior

Splenius capitis/cervicis

Subscapularis

Sternocleidomastoid



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Palpated a minimum of 10 ligaments Portfolio reference

Anterior talofibular

Anterior tibiofibular

Calcaneofibular

Deltoid

Long plantar

Posterior talofibular

Posterior tibiofibular

Short plantar

Annular

Radial collateral

Ulnar collateral

Medial collateral

Lateral collateral

Patellar

Coronary

Inguinal

Sacroiliac

Acromioclavicular

Sternoclavicular

Capsular ligament of the shoulder



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Palpated a minimum of 4 bursa Portfolio reference

Calcaneal

Deep infrapatellar

Pes anserine

Prepatella

Subcutaneous infrapatellar

Olecranon

Subacromial

Trochanteric

Measured range of movement at a minimum of 3 joints Portfolio reference

Ankle

Elbow

Hip

Knee

Shoulder

Wrist

Measured the isometric muscle strength of a minimum of 4 muscle groups (record muscle groups measured below) Portfolio reference



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Used a minimum of 10 tests to assess the integrity of joints (record tests used below) Portfolio reference

Used a minimum of 5 tests to assess the length of muscles (record tests used below) Portfolio reference



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Assessed sensation of the upper and lower limbs using a minimum of 3 methods (record methods used below) Portfolio reference

Assessed all myotomes Portfolio reference

C1 – T1

L1 – S2

Tested all deep tendon reflexes Portfolio reference

Biceps brachii

Triceps

Patellar

Tendo calcaneus


Achieving knowledge outcomes

Developing knowledge

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You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*:

• Projects• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion

Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning.

When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved.

Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic.

*This is not an exhaustive list.

Knowledge

Outcome 1

Be able to undertake biomechanical assessments in sport and active leisure

You can: Portfolio reference /Assessor initials*

f. Describe the biomechanical findings that warrant urgent medical and/or health care, or require collaborative working with other sports professionals

*Assessor initials to be inserted if orally questioned. Requirements highlighted in white are assessed in the external paper.

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Outcome 3

Be able to assess the integrity of the musculoskeletal system


f. Explain the different types of joint ‘end-feel’

g. Describe the musculoskeletal findings that warrant urgent medical and/or healthcare professional referral, or require collaborative working with other sports professionals


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Outcome 4

Be able to recognise neurological conditions that warrant urgent referral


e. Outline the importance of a neurological examination

f. Describe the pathways of nerves through the upper and lower limbs

g. Explain dermatomes, myotomes and reflexes and their assessment processes

h. Describe the neurological findings that warrant urgent medical and/or healthcare professional referral


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Outcome 5

Understand the advanced anatomy and physiology relevant to complex sports massage/soft tissue methods


a. Outline the importance of sports massage practitioners having an advanced knowledge of anatomy, physiology and pathology

b. Explain the biological basis for complex massage/soft tissue methods

c. Explain the pathologies that may influence the complex massage/soft tissue methods used to prevent and manage sports injuries

d. Explain the impact of nutrition and hydration on sport and active leisure performance

e. Explain the importance of referral as a sports massage practitioner to medical and healthcare professionals

f. Explain the importance of collaborative working with other sports professionals


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Outcome 6

Understand the components of a subjective assessment


a. Explain the importance and process of a thorough subjective examination

b. Explain yellow flags and their potential impact on prognosis

c. Explain red flags and the importance of urgent medical referral

d. Analyse responses from subjective examinations

e. Explain the process of clinical reasoning and stages of problem solving

f. Complete clinical reasoning forms for sport and active leisure clients


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Outcome 7

Understand sports specific postures and gaits


a. Explain the phases of the gait cycle

b. Outline the different methods used to analyse gait

c. Describe common foot deformities and their effects on gait

d. Describe common gait abnormalities

e. Explain postural alignments in sport and leisure activities

f. Explain postural deviations, conditions and types in the context of sport and active leisure


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Outcome 8

Understand the effects of complex massage/soft tissue methods on the body and mind


a. Critically evaluate the physiological effects of massage/soft tissue methods

b. Explain the psychology of injury as it applies to massage/soft tissue methods

c. Critically evaluate the psychological effects of massage/soft tissue methods


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Outcome 9

Be able to evaluate the research undertaken on complex massage/soft tissue methods in sport and active leisure


a. Explain the concept of evidence-based practice

b. Critically evaluate research undertaken on the use of complex massage/soft tissue methods

c. Draw conclusions on the support for complex massage/soft tissue methods


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Outcome 1: Be able to undertake biomechanical assessments in sport and active leisure

Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

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Leg length testing: True leg length vs. apparent leg length, bent knee assessment, Trendelenburg gait, use of tape measures, bony landmarks (anterior superior iliac spine to medial malleolus – bone length discrepancy; umbilicus to medial malleolus – soft tissue).

Posture analysis in standing: Use of plumb line and other equipment, appropriate clothing, foot position, anterior/lateral/posterior observations, ideal alignment, segmental alignment and position (head, arms and shoulders, chest, abdomen, spine and pelvis (side view), hips, pelvis and spine (posterior view), knees and legs, toes and feet), symmetry, interpretation of observations, soft tissue involvement/causes (muscle weakness and shortness).

Movement analysis: Observational analysis of movement, analysis in specific sport and leisure activities, gait, posture, movement mechanics and techniques.

Observational gait analysis: Forwards and backwards walking, on even/uneven ground, slopes, stairs and running, defining ‘normal gait’, joint action throughout the phases of the gait cycle (pelvis, hip, knee, ankle and toes), deviations from the norm and possible causes, stride characteristics including cadence (stride frequency, velocity and stride length), stability and balance, muscle actions, possible causes (e.g. muscle imbalances).

Biomechanical findings: Interpretation of leg lengths/posture/gait, deviations from ‘normal’, possible causes of deviations, strengths and areas for improvement, indications for complex massage/soft tissue methods, involving other sports professionals including technical coaches and strength and condition specialists plus others, to inform clinical reasoning and treatment justification.

Urgent medical referral: Subjective history (red flags, signs and symptoms), gait/postural abnormalities, co-ordination problems, health care vs. medical referral.

Outcome 2: Be able to palpate structures of the musculoskeletal system

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Bony landmarks: Key landmarks, usefulness of landmarks, actions/functions, bony landmarks to be palpated (see range).

Joint lines: Importance of joint line palpation, structures to palpate, joints to be palpated (see range).

Muscular palpation: Origins, insertions and muscle bellies, tendons and fascial tissue, muscles to be palpated (see range).

Ligament palpation: Ligaments to be palpated.

Foot and ankle – anterior talofibular, anterior tibiofibular, calcaneofibular, deltoid, long plantar, posterior talofibular, posterior tibiofibular and short plantar.

Forearm and hand – annular, radial collateral and ulnar collateral.

Knee – medial and lateral collateral, patellar and coronary.

Pelvis and thigh – inguinal, sacroiliac.

Shoulder and arm – acromioclavicular, sternoclavicular, capsular ligament of the shoulder.

Awareness of ligaments that cannot be palpated – e.g. anterior cruciate, posterior cruciate.

Bursae palpation: Bursa to be palpated.

Foot and ankle – calcaneal.

Knee – deep infrapatellar, pes anserine, prepatella and subcutaneous infrapatellar.

Shoulder and arm – olecranon and subacromial.

Hip – trochanteric.

Outcome 3: Be able to assess the integrity of the musculoskeletal system

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Joint end feel: Normal (hard, soft and elastic), abnormal (hard, springy, spasm and empty).

Range of joint movement: Normal movement ranges, use of bony landmarks, active and passive movements, joints to be measured, use of overpressures, reporting of end feel, instruments to measure (e.g. tape measure, goniometers, other instruments).

Isometric muscle strength: Muscles to be assessed (see range), through range of movement, technique, resistance applied, grading of strength.

Joint integrity tests:

Shoulder impingement – e.g. Hawkin’s-Kennedy test, Neers, painful arc and empty can test.

Acromioclavicular joint – e.g. scarf test, O’Brein’s (ACJ and superior labrum).

Rotator cuff integrity – e.g. resisted abduction with straight arms by side, resisted external rotation, hand behind back and lift-off test.

Biceps tendon integrity tests, deltoid – e.g. resisted abduction at 90 degrees.

Winged scapula test, shoulder instability – e.g. drawer test, apprehension and relocation tests.

Knee – e.g. anterior and posterior drawer tests, varus and valgus stress tests, patella-femoral glide and tap brush test.

Elbow – e.g. medial and lateral collateral ligament stress tests.

Pelvis – e.g. gapping and compression tests.

Hip – e.g. quadrant test, Trendenlenburg.

Ankle – e.g. anterior/posterior drawer sign and talar tilt, anterior drawer test.

Other tests – relevant to specific sport and leisure activity.

Muscle length tests: Muscle lengths to be assessed (levator scapulae, upper trapezius, sternocleidamastoid, pectoralis major (sternocostal and clavicular fibres), pectoralis minor, scalenes, erector spinae, quadratus lumborum, latissimus dorsi, piriformis, iliopsoas, rectus femoris, tensor fasciae latae, hamstrings, tibialis posterior, gastrocnemius, soleus, iliotibial band), tests that must be covered (Ober’s test, Faber’s test, Thomas’ test).

Musculoskeletal findings: Interpretation of musculoskeletal findings, false positives, false negatives, reliability, specificity and validity of tests, potential causes, strengths and areas for improvement, indications for complex massage/soft tissue methods, referral to medical/healthcare professionals.

Urgent medical referral: Subjective history (red flags, signs and symptoms), gait/postural abnormalities, tonal changes, co-ordination problems, health care vs. medical referral, outside scope of practice.

Outcome 4: Be able to recognise neurological conditions that warrant urgent referral

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Note for tutors and assessors: The purpose of Outcome 4 is to equip practitioners with the skills to carry out basic neurological tests. It must be made clear to practitioners that these tests must only be used for screening the neurological system so that urgent referrals can be made to medical and/or healthcare professionals if abnormal neurology is detected. It is not the purpose of this outcome to provide practitioners with the skills to diagnose neurological conditions. If abnormal neurology is detected immediate referral must be made.

Treatment required by the massage practitioner will be advised by medical/healthcare professionals once they have conducted their own diagnostic neurological assessment.

Importance of neurological examination: To identify neurological abnormalities, use as a screening vs. investigative tool, differentiate between central and peripheral lesions, urgent referral of neurological abnormalities.

Pathways of nerves/nerve palpation: Brachial plexus, median nerve, radial nerve, sciatic nerve, common peroneal nerve, tibial nerve, superficial peroneal nerve, deep peroneal nerve, sural nerve.

Dermatomes, myotomes and reflexes: Definitions, purpose and value, procedures for systematic assessment, interpretation of information gathered, situations whereby urgent medical referral is required.

Assessment of sensation: Systematic procedure, dermatomes to be assessed including C3-T1 and L1-S2, methods to be assessed (light touch, deep pressure, two-

point discrimination, hot/cold sensation and proprioception), symmetry, positioning of client, interpretation.

Assessment of neurological weakness: Systematic procedure, myotomes to be assessed (C1-T1 and L1-S2), technique (positioning and application of resistance), use of grading scales, interpretation.

Reflex testing: Deep tendon reflexes (biceps brachii, triceps, patellar, tendo calcaneus), grading of the tendon response (absent, diminished, average, exaggerated and clonus), technique (application of force), interpretation.

Neurodynamic testing: Systematic approach, neurological red flag, technique, tests to be conducted including passive neck flexion, straight leg raise, prone knee bend, slump, upper limb tension tests (radial, ulnar and median nerve), normal responses, sensitising tests, interpretation.

Neurological findings: Interpretation of neurological findings, potential causes, areas for concern, indications for complex massage/soft tissue methods, referral to medical/healthcare professionals.

Urgent medical referral: Findings including altered dermatomes, myotomes, reflexes, subjective history (red flags, signs and symptoms), gait/postural abnormalities, co-ordination problems.

Outcome 5: Understand the advanced anatomy and physiology relevant to complex sports massage/soft tissue methods

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Importance of practitioner knowledge base: Application, selection and justification of massage methods/treatment plan, ability to link knowledge to practice, identification of pathology and early intervention, understand mechanism of injury, biomechanical understanding of sport/injury/area of stress, potential problem areas, high maintenance areas.

Biological basis: Biological level (systems working together – interrelated), cellular aspect (skin, subcutaneous tissue, innervations of the skin, connective tissue), fluid system dynamics (hydrostatic pressure and interstitial osmotic pressure related to oedema), immune response (increase in lymphocytes, effect on inflammation), endocrine response (hormonal response to massage (e.g. cortisol, vasopressin, oxytocin, adrenal cortical, endorphins)), neuroendocrine response.

Complex massage/soft tissue methods: Connective tissue massage, proprioceptive neuromuscular facilitation, myofascial techniques, soft tissue release, positional release/strain-counterstrain techniques.

Pathologies: Causes, mechanisms, signs/symptoms, testing for, complications if left unattended, treatment, rehabilitation and prevention, prognosis, acute, chronic, overuse, inflammatory process and role in injury (cells involved, cell roles), healing process (physiological level), collagen formation.

Skin – cuts, abrasions, chafing, sunburn, frostbite, allergies, athlete’s foot (tinea pedis), blisters, corns/calluses, plantar warts (verrucae), etc.

Head and neck – concussion, contusion, haemorrhage, fracture, neck strain, cervical nerve stretch syndrome, whiplash (neck sprain), wry neck (acute torticollis), herniated disc, cervical radiculitis, cervical spondylosis, teeth, eye, ear, nose, etc.

Hands and fingers – metacarpal fractures, ulnar collateral ligament sprain (gamekeeper’s/skier’s thumb), mallet finger, finger (sprain, dislocation), hand/finger (tendinopathy), etc.

Wrists and forearms – sprain, fracture, dislocation, carpal tunnel syndrome, ulnar tunnel syndrome, ganglion cyst, tendinopathy, etc.

Elbow – fracture, sprain, dislocation, triceps brachii tendon rupture, tennis elbow, golfer’s elbow, thrower’s elbow, elbow bursitis, etc.

Shoulders and upper arms – fracture (collar bone, humerus), dislocation of shoulder, shoulder subluxation, acromioclavicular/sternoclavicular separation, biceps brachii tendon rupture, muscle strain (biceps, chest), impingement syndrome, rotator cuff tendinitis/tendinopathy, shoulder bursitis, bicipital tendinitis, pectoral muscle insertion inflammation, adhesive capsulitis, etc.

Back and spine – strain, sprain, thoracic contusion, herniated/ruptured/bulging disc, stress fracture of vertebra, etc.

Chest and abdomen – fractured/broken ribs, flail chest, abdominal muscle strain, etc.

Hip, pelvis and groin – hip flexor strain, hip pointer, Gilmore’s groin, avulsion fracture, groin strain, osteitis pubis, stress fracture, piriformis syndrome, iliopsoas

Outcome 5: Understand the advanced anatomy and physiology relevant to complex massage/soft tissue methods (continued)

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tendinopathy, tendinopathy of the adductor muscles, snapping hip syndrome, trochanteric bursitis, Perthe’s disease, etc.

Upper thigh – femur fracture, quadriceps/hamstring strain, contusion of thigh, iliotibial band syndrome, quadriceps tendinopathy, myositis ossificans, etc.

Knee – medial/lateral collateral ligament sprain, O’Donoghue’s triad, anterior cruciate ligament sprain, meniscus tear, bursitis, synovial plica, Osgood-Schlatter syndrome, osteochondritis dissecans, patellofemoral pain syndrome, patellar tendinopathy, chondromalacia patellae, subluxing knee cap, etc.

Lower leg – fractures (tibia, fibula), calf strain, Achilles tendon strain, Achilles tendonitis, medial tibial pain syndrome, stress fracture, anterior compartment syndrome, etc.

Ankle – sprain, fracture, posterior tibial tendonitis, peroneal tendon subluxation, peroneal tendinopathy, osteochondritis dissecans, supination, pronation, etc.

Foot – fracture, retrocalcaneal bursitis, stress fracture, extensor and flexor tendinitis, Morton’s neuroma, sesamoiditis, impingement (footballer’s/ballet dancer’s ankle), bunions, hammer toe, turf toe, claw foot, plantar fasciitis, heel spur, black nail, ingrown toenail.

Impact of nutrition and hydration: Comparisons between a ‘normal’ and sport-performance diet, the case for supplementation, nutritional strategies to enhance performance in sport and leisure, importance of water intake and fluid dynamics, dehydration and performance degradation in sport and leisure, sports drinks, nutritional ergogenic aids.

Medical and healthcare professionals: For example GP, physiotherapists, dietician, strength and conditioning specialists, podiatrist.

Importance of referral: Professionalism, recognition of boundaries, work within scope of practice, build professional relationships, insurance boundaries, duty of care to client, best interest of client.

Importance of collaborative working: Multi-disciplinary approach, best interest of client, ensure inter-professional and client boundaries are respected, professionalism, enhance/maintain the reputation of sport massage therapists.

Outcome 6: Understand the components of a subjective assessment

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Importance of thorough subjective examination: Exclude red flags, identification of yellow flags, to provide fundamental basis of objective assessment, limited clear-cut diagnostic tests for range of conditions, signs and symptoms are of great value, the importance of managing the clinical presentation rather than a diagnosis, development of a working hypothesis, informing on/planning objective assessment.

Subjective examination process: Body mapping/chart (type and area of symptoms, depth, quality, intensity, abnormal sensation, relationship of symptoms), behaviour of symptoms (aggravating and easing factors, severity, irritability and nature (mechanical, neural or chemical), 24-hour behaviour, daily activities, stage of the condition, special questions (general health, drugs, steroids, anticoagulants, recent unexplained weight loss, rheumatoid arthritis, spinal cord or cauda equina symptoms, dizziness, recent x-rays, history of presenting condition (history of each symptomatic area, mechanism of injury, how and when it started, how it has changed, past/relevant medical history, previous history of same condition, effect of previous treatment), social and hereditary conditions (age and gender, home and work situation, dependants and leisure activities), pain scales.

Yellow flags: Psychosocial risk factors including sickness and pain behaviours, belief that pain and activity are harmful, low or negative moods, social withdrawal, compensation issues, treatment that does not fit best practice, problems at work, poor job satisfaction, overprotective family or lack of support, those at risk, preventative measures, assessing yellow flags,

management of yellow flags, consequences of missing/over-identifying psychosocial issues.

Red flags: Potentially serious conditions requiring urgent medical assessment including features of cauda equina syndrome (urinary retention, faecal incontinence, neurological signs and symptoms in the lower limb including gait abnormality, saddle para/anaesthesia and anal sphincter laxity), severe worsening pain, significant trauma, weight loss, history of cancer or fever, use of intravenous drugs or steroids, patients over 50 years old, severe unremitting night-time pain, pain that worsens when lying down, sleeper presentations (e.g. continual lower back pain, constipation).

Importance of urgent medical referral: Possibility of disability/damage/death.

Analysing subjective responses: Analyse individual responses to questions, interpret and explain responses, conditions and causes associated with individual responses, subjective information as a whole.

Process of clinical reasoning: The process by which clinical decisions are made, source of symptoms, mechanism of each symptom, working hypothesis, contributing factors, precautions and contra-indications, research of condition, management, prognosis.

Types of clinical reasoning: Procedural/interactive/conditional/narrative/pragmatic reasoning processes, developmental, strengthen reasoning skills with practice/time.

Stages of problem solving: Problem recognition, problem definition, analysing

Outcome 7: Understand sports specific postures and gaits

Phases of gait cycle: Loading response, mid-stance, terminal stance, pre-swing, initial swing, mid-swing, terminal swing, push-off.

Gait analysis methods: Observational and video analysis, motion capture systems, electromyography, force plates, electrogoniometry, in-shoe pressure sensors, kinematics vs. kinetics, strengths and weaknesses, effectiveness.

Foot deformities and their effects: Criteria for normalcy, pes planus (flat foot), pes cavus, rear foot valgus, rear foot varus, forefoot valgus, forefoot varus, hallux valgus, splay foot, claw toes, hammertoes, effects of deformities on gait.

Common gait abnormalities: Antalgic, ataxic, steppage, hemiplegic, jump, toe-toe, compensated, scissor, festinating, shuffling, spastic, drop foot, Trendelenburg, arthrogenic, causes of gait abnormalities.

Postural alignments: Ideal postural alignments of the head and neck, shoulder, thoracic region, lumbar region, pelvis and hip, knee and ankle and foot, segmental alignment, sport specific postures and adaptations, links with pathologies, biomechanical stresses.

Postural deviations, conditions and types: Forward head, excessive cervical lordosis, rounded (forward) shoulders, medial/lateral rotation of the shoulder, adducted and abducted scapulae, winged scapula(e), kyphosis and depressed chest, scoliosis, lordosis, swayback, flat-back, pelvic tilt and rotation, femoral anteversion and retroversion, genu varus and valgus, genu recurvatum (hyper-extended knees).

Outcome 6: Understand the components of a subjective assessment (continued)

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the problem, formulating goals, managing data, developing a solution, implementing the solution, evaluating the outcome, reflective practice and improvement.

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Outcome 8: Understand the effects of complex massage/soft tissue methods on the body and mind

Critically evaluate physiological effects: Events in the tissues, on the tissue layers, circulatory effects, effects on muscle, effects on connective tissue, neurological effects including effects on pain and sensation, reflexes and autonomic reflexes, autonomic nervous system, the facilitated segment, stress/strain curve, supporting evidence for specific complex massage/soft tissue methods.

Massage/soft tissue methods – connective tissue massage, proprioceptive neuromuscular facilitation, myofascial techniques, soft tissue release, positional release/strain-counterstrain techniques.

Psychology of injury: Principles and theories of psychology of injury, evidence, application in the context of sports massage, psychological considerations when treating injured clients, recovery

time, mood, affective response to complex massage/soft tissue methods.

Critically evaluate psychological effects: Relaxation, placebo, improved state of wellbeing, improved body awareness, supporting evidence for specific complex massage/soft tissue methods.

Outcome 9: Be able to evaluate the research undertaken on complex massage/soft tissue methods in sport and active leisure

Evidence-based practice: Defining, value, examples in sports massage/soft tissue methods.

Massage/soft tissue methods – connective tissue massage, proprioceptive neuromuscular facilitation, myofascial techniques, soft tissue release, positional release/strain-counterstrain techniques.

Evaluation of research: Review of research methodologies (problem/aims, patient or population, intervention, outcome measures, sample size, statistics used, power calculations, etc.), research

design (systematic review, meta-analysis, randomised controlled trial), sources (Cochrane reviews, periodicals, journals and online databases), appraisal tools, type (qualitative vs. quantitative), strengths and weaknesses of research, implications for future research.

Conclusions: Support for and against range of complex massage/soft tissue techniques, supported indications for use.

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