A VTCT (ITEC) Sports Massage - Level 3 Feb 2020
A VTCT (ITEC) Sports Massage - Level 3 Feb 2020
A VTCT (ITEC) Sports Massage - Level 3 Feb 2020
QCF Level 3
VTCT (ITEC) Diploma in Sports
Massage Therapy
UK Accreditation: QAN 603/4501/9
This File belongs to: …………………………………………………………….
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
Any person breaching this copyright may be liable to criminal prosecution and a claim for civil
damages.
The writers have asserted their right to be identified as the authors of this work in accordance with
the Copyright Designs & Patents Act 1988.
He is a qualified Assessor and Internal Verifier for the various examination boards as well as attaining his
teacher training qualifications.
Bhavesh is also a qualified NLP Practitioner, Traditional Chinese Acupuncturist and has trained in
Ayurvedic treatments and massage techniques in Central and South India.
He is a gifted teacher who has a knack of making subjects easy and understandable as well as helping
individuals realise their full potential. He has a life aim of setting up an Ashram in India to help feed and
educate poor communities.
He teaches, and is involved with most of the courses including, Anatomy, Physiology & Holistic Massage,
Sports Injuries & Massage, Advanced Therapeutic, Indian Head Massage and Ayurvedic Massage.
Exam Details
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
Anatomy and
Pass 50-74%
Merit 75-
451 Physiology for Sports 25 MCQ – paper
89% Distinction 90-100%
Massage
Principles of Health
452 Pass or Refer Assignment
and Fitness
Professional Practice
453 Pass or Refer Assignment
in Sports Massage
Understand the
454 Principles of Soft Pass or Refer Assignment
Tissue Dysfunction
Section 1
Additional Anatomy:
Sports Massage Therapy
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
Mitochondrhia
Produces Energy Nucleus
for cell activities Control centre of the
cell. Contains the
DNA of the cell
Nucleolus
Controls activities of the
nucleus.
Plasma membrane
Golgi Apparatus
Combines
Carbohydrates &
Proteins
Cytoplasm
Ribosomes Vacuoles
Responsible for
Produce Proteins Secretions & waste products
of the cell.
Diagram of a cell
THE CELL ORGANELLES
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 8
The small-formed structures, which lie within the cell, are called organelles.
Organelle Diagram
CYTOPLASM (CYTOSOL) – medium for all cell reactions.
CYTOSKELETON – a microscopic network of protein filaments and
tubules in the cytoplasm of many living cells, giving them shape and
coherence. Direct movement within cell.
Has:
• Keratinocytes – is predominant cell in epidermis (90%). Lie mainly in the Basal layer. Produce
Keratin.
• Langerhans Cells – are dendritic cells (antigen-presenting immune cells) of the skin. They are
present in all layers of the epidermis, but are most prominent in the stratum spinosum.
• Merkel Cells – is a touch receptor in the skin that is sensitive to light touch and connected to a
sensory nerve.
LIGAMENTS
Functions:
• Attaches bone to bones
• Stabilises joints – passive structures
• Directs joint motion
• Have been found to contain many sensory receptors indicating that they are important in
providing information to the brain about the joint, e.g., joint position sense.
Structure:
• Collagen fibre bundles arranged in multiple directions.
Properties:
• Resist forces in several directions.
TENDONS
Functions:
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3
11
• Attaches muscle to bone
Structure:
• Collagen fibre bundles arranged in parallel formation.
Properties:
• Has a high tensile strength (resistance of a material to breaking under tension).
Muscular System
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3
12
DEFINITIONS
Concentric
Contraction of a muscle
resulting in movement at the
joint with the muscle length
decreasing.
Eccentric
Contraction of a muscle
resulting in movement at the
joint with the muscle length
increasing.
Bundles of myofibrils are called Muscle Fibres and are covered by a connective layer called the
Endomysium.
Fascicle - contains several group of muscle fibres and is covered by the Perimysium, which is an
outward extension of the Endomysium.
Several groups of fascicles are covered by the Epimysium, which is an extension of the
Perimysium.
Beneath the Endomysium and surrounding the muscle fibre is the Sarcolemma which is the fibres
cell membrane and beneath this is the Sarcoplasm, which is the cells cytoplasm, a gelatinous fluid
which fills most cells.
This contains Glycogen and Fats for energy and also Mitochondria which are the cells
powerhouses, inside which the cells energy is produced.
Surrounding the Myofibril there is a network of tubules and channels called the Sarcoplasmic
Reticulum in which Calcium is stored which is important in muscle contraction. Transverse
tubules pass inwards from the Sacrolemma throughout the Myofibril, through which nerve
impulses travel.
The proteins are arranged in such a way that they create striations on muscle fibre’s when looked
under magnification.
MYOFILAMENTS IN DETAIL
The myofilaments of a myofibril do not extend the entire length of a muscle fibre. They are
arranged in compartments called SARCOMERES. This is the functional unit of muscle contraction
and extends from Z Line to Z Line.
ACTIN MYOSIN
Z line Z line
During contraction, when the muscle is stimulated by the motor end plate, actin filaments first
create cross bridges with the myosin before sliding past, resulting in the sarcomere shortening
and the muscle contracting. This is known as the sliding filament theory.
Muscle
Relaxed
Muscle
Contracted
The Cross Bridges move together like oars of a boat causing the muscle to contract. This is
known as the “Power Stroke”.
When a nerve impulse reaches the muscle fibres, it causes the release of CALCIUM IONS (Ca+)
within the muscle, which is required for the muscles to contract.
MYOSIN - Molecule is shaped like a golf club. That is it has a head and a tail. The head contains
an actin binding site and ATP binding
Skeletal muscle fibres contract with different velocities depending on their ability to split ATP.
Faster contracting fibres have a greater ability to split ATP.
On the basis of various structural and functional characteristics, skeletal muscle fibres are
classified into two types:
It is generally accepted that muscle fibre types can be broken down into two main types:
These distinctions seem to influence how muscles respond to training and physical activity, and
each fibre type is unique in its ability to contract in a certain way. Human muscles contain a
genetically determined mixture of both slow and fast fibre types. On average, we have about 50%
slow twitch and 50% fast twitch fibres in most of the muscles used for movement.
Type IIa fibres are also sometimes known as fast oxidative fibres and are a hybrid of type I and II
fibres. These fibres contain a large number of mitochondria and Myoglobin, hence their red colour.
They manufacture and split ATP at a fast rate by utilising both aerobic and anaerobic metabolism
and so produce fast, strong muscle contractions, although they are more prone to fatigue than
type I fibres. Resistance training can turn type IIb fibres into type IIa due to an increase in the
ability to utilise the oxidative cycle.
MYOGLOBIN
Myoglobin is an iron and oxygen-binding protein found in the muscle tissue of vertebrates in
general and in almost all mammals. It is related to haemoglobin, which is the iron- and oxygen-
binding protein in blood, specifically in the red blood cells. The only time myoglobin is found in the
bloodstream is when it is released following muscle injury. It is an abnormal finding, and can be
diagnostically relevant when found in blood.
When a muscle fibre contracts, it contracts completely. There is no such thing as partially
contracted muscle fibre. Muscle fibres are unable to vary the intensity of the contraction relative to
the load against which they are acting.
This means that a muscle fibre will remain relaxed or contract to its fullest. This is known as the
“All or Nothing Principle” (All or None Law)
If this is so, then how does the force of muscle contraction vary in strength from strong to
weak?
What happens is that more muscle fibres are recruited, as they are needed, to perform the job at
hand. The more muscle fibres that are recruited by the central nervous system, the stronger the
force generated by the muscular contraction.
Quadratus Lumborum
(Deep muscle)
Pectoralis Major Sternum Anterior humerus ▪ Flexes rotates arm at shoulder joint
Clavicle ▪ Adduct rotates arm at shoulder joint
Upper ribs ▪ medially rotates arm at shoulder joint
Serratus Anterior Upper 9 ribs Anterior scapula Draws shoulder forwards and rotates scapula
Flexor Carpi Medial humerus Metacarpals Flexes & Abducts hand at wrist
Radialis
Flexor Carpi Ulnaris Medial humerus Metacarpals Flexes & Adducts hand at wrist
Flexor Carpi Medial humerus Phalanges Flexes hand wrist joint and fingers joints
Digitorum
Thenar Eminence Hand muscle (Palm) Fat muscle on thumb side Adduction, Abduction and flexion of thumb
Hypothenar Hand Muscle (Palm) Fat muscle on little finger Adduction and flexion of little finger
Eminence side
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 30
MUSCLES OF THE RIGHT LOWER EXTREMITY (ANTERIOR VIEW)
Vastus Lateralis Femur Tibia via patella Extends leg at knee joint
Vastus Intermedius
Vastus Medialis
“Quadriceps Muscles”
Peroneus Longus Fibula Tarsal bones (planter Plantarflexes foot at ankle joint
surface) Everts foot at ankle joint
Extensor Digitorum Tibia & fibula Phalanges Dorsiflexes foot at ankle joint
Longus Extends the four lateral toes
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 32
MUSCLES OF THE RIGHT LOWER EXTREMITY (POSTERIOR VIEW)
Gastrocnemius Posterior Femur Calcaneus via Achilles Flexes leg at knee joint
tendon Plantarflexes foot at ankle joint
Soleus Posterior Tibia Calcaneus via Achilles Plantarflexes foot at ankle joint
tendon
Frontalis
Corrugator
Temporalis
Orbicularis Oculi
Procerus
Occipitalis
Nasalis
Triangularis Trapezius
Depressor Labii Inferioris
Platysma
The papillary muscles are muscles located in the ventricles of the heart. They attach to the
cusps of the mitral and tricuspid valves via the chordae tendineae and contract to prevent
inversion or prolapse of these valves on ventricular contraction.
There are five total papillary muscles in the heart, three in the right ventricle and two in the left.
The pumping action of the heart (heartbeat) is controlled by the heart’s electrical system or the
cardiac conduction system. This is a group of specialised cells located in the wall of the heart
which send electrical impulses to the cardiac muscle causing it to contract.
Cardiac muscle cells contract spontaneously. These contractions are coordinated by the
sinoatrial (SA) node which is also referred to as the pacemaker of the heart.
The SA node is composed of nodal tissue that has characteristics of both muscle and nervous
tissue and is located in the upper wall of the right atrium.
When the SA node contracts it generates nerve impulses that travel throughout the heart wall
causing both atria to contract.
The impulses are then sent down the atrioventricular bundle. This bundle of fibres branches
off into two bundles and the impulses are carried down the centre of the heart to the left and
right ventricles.
At the base of the heart the atrioventricular bundles start to divide further into Purkinje fibres.
When the impulses reach these fibres they trigger the muscle fibres in the ventricles to contract.
Inspiration Expiration
Diaphragm Internal Intercostals
External Intercostals Rectus Abdominis
External Oblique
Internal Oblique
Transversus Abdominis
Inspiration Expiration
Sternocleidomastoid -
Scalenes
Pectoralis minor
Each spinal nerve comes off the spinal cord at various levels and is made up of motor nerves
(descending from the brain) and sensory nerves (ascending to the brain).
Unlike spinal nerves, the sensory and motor neurones in the spinal cord are kept separate and
ascend or descend respectively to and from the brain as columns of sensory or motor tracts.
Androgens Adrenals Androgens may be called "male hormones," but don't let
the name fool you. Both men's and women's bodies
produce androgens, just in differing amounts. In fact,
androgens have more than 200 actions in women.
The principal androgens are testosterone and
androstenedione. They are, of course, present in much
higher levels in men and play an important role in male
traits and reproductive activity.
Section 2
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
Injury / Disease
• Trauma
• Infection
• Postural
Ischaemia
(Lack of Blood Pain
supply)
Muscle
Contraction
1. Muscles
2. Tendons
3. Ligaments
Rupture/Tear 2nd Degree (pain, possible swelling & bruising varied loss of function)
3rd Degree (severe pain, swelling, bruising, most fibres are torn,
major loss of function)
Septic – caused by bacterial infection either from blood or from the external
environment
SITE OF Over muscle Over tendon Over ligament Over bursa Over fracture or
PAIN belly (made worse (made worse (made worse on injury
(made worse on pressure) on pressure) pressure) (made worse on
on pressure) pressure)
PASSIVE Pain is caused Pain is caused Ligament is Pain is the result of Force of stretch
MOVEMENT when muscle is when force of not contractile. friction of tendon of muscle may
stretched muscle Pain is felt against bursa - cause traction
stretch is when ligament usually due to on bone and
transmitted to is stretched. repetitive cause pain
tendon movements at the
given joint.
Vasodilation ➔ more blood to damaged area ➔removes toxic products and dead cells
Vasodilation and increased permeability are caused by the release of certain chemicals
by the damaged tissue in response to the injury. Examples of some of these are:
3. SWELLING: this is due to large amounts of blood in the area, vasodilation enhancing
its effects.
4. PAIN: may result from injury to the nerve fibres or from irritation caused by the release
of toxic chemicals from micro-organisms.
5. LOSS OF FUNCTION: This may arise due to damage of the tissues and nerves,
and as a result of pain.
Knowing the effects of Cryotherapy, you should be able to work out the effect ice
has at a cellular level on injured tissue. (Look at notes on R.I.C.E.)
The Acute stage is the swelling stage. During this stage there is inflammation, redness and
swelling due to the vascular changes. There is exudation of cells and chemicals that cause the
swelling and the pain. If there is bleeding, haematomas form in this stage. Secondarily, the
chemical irritants are neutralized, the area is sealed off from surrounding tissue and circulation
is impaired. There is early fibroblastic cell activity. Symptoms are pain at rest and aggravated
by activity. The pain is felt over a diffuse area. Secondary muscle spasm and guarding restrict
passive movement. In range of movement (ROM), pain is felt before the tissue resistance is
felt. With injury to very deep structures or poorly vascularised areas, surface swelling and
oedema may not be noticeable.
The Subacute stage is the time of healing and repair. Harmful chemicals are further
neutralized. New capillary beds growing into the damaged areas are supported by connective
tissue growth (collagen fibres) and together form granulation buds. This new tissue is fragile
and must be handled gently as it is easily injured. Visible signs of inflammation subside. ROM
increases with pain felt at the point of tissue resistance.
The Chronic stage is the remodelling stage. Signs of inflammation are absent and scar tissue
is maturing. Pain is felt in the ROM after the tissue resistance at the end feel. Maturation refers
to the growth of the fibroblasts to fibrocytes and remodelling refers to the organization of and
shrinking of collagen fibres along lines of stress.
In order to determine if the condition of the injury is in the acute, subacute or chronic
inflammatory stage an adequate case history is needed along with assessment. The history
should include all incidences leading to the condition, past injuries and activities and a
description of the symptoms being experienced. The assessment should include a visual scan,
active muscle testing, passive range of motion testing and resisted isometric muscle tests and
palpation of the structure involved.
A prolonged chronic stage or persistent disorder is not healing properly. This may be caused by
abnormal modelling of tissue during resolution of an acute disorder or injury. Without resolution,
abnormal amounts of collagen are produced, forming crosslinks that adhere to adjoining
structures. This limits the extensibility of the structure as well as prevents the formation of a
smooth gliding surface between adjoining structures. Proper amounts of mobilization are
required for normal healing and prevention of adhesions.
Immature scar tissue is susceptible to re-tearing during repeated use. Mobilization too early in
the rehabilitation program can interfere with healing if the tissue is re-injured before it is properly
healed. Lack of adequate mobilization can result in adhesions that tear the injured tissue once
movement is introduced. The goals of treatment have not been met, inflammation has not been
resolved and exercise to maintain normal use has not been incorporated.
Definition: This is the process by which new tissues replace dead or damaged cells.
New cells originate by cell duplication from the stroma (supporting connective tissue) or
parenchyma (cells which form the organs functioning part).
The restoration of an injured tissue or organ depends entirely on which type of cell (stromal or
parenchymal) is active.
If only the Parenchymal elements accomplish the repair, a near perfect reconstruction of injured
tissue may occur.
If only the Stromal FIBROBLASTS (Fibroblasts are cells which produce COLLOGEN and
ELASTIC fibres) are active, the tissue will be replaced by a new connective tissue called scar
tissue a process called Fibrosis.
Scar tissue is not specialised to form functions of the parenchymal tissue, so function is
ultimately impaired.
When collagen is laid down, it is generally better if it is “organised” and not in laid in a
haphazard manner. For example if a muscle is torn, it would be better if the fibres were laid
down in the direction of the contraction of the muscle rather than perpendicular to it.
1. Nutrition - required by tissues. Including proteins (cell structure) and vitamins (play various
parts in the healing process).
2. Blood Circulation - brings nutrients and oxygen and removes unwanted materials of
metabolism and toxins from injured area.
3. Age - generally in the young, the above two are better. Cellular replication is also better in
the young.
ADHESIONS
Scar tissue formed by fibrosis can cause abnormal joining of tissues called adhesions. This
would obviously hinder function - Muscle fibres would not be able to contract easily and
filaments would have difficulty in sliding past each other.
By treatment, the aim is to avoid or minimise progression of an injury into a chronic state.
REST (R)
With any ACUTE injury the first thing to do is rest the affected part.
Activity may increase bleeding, inflammation and induce swelling. Activity may also cause
further tearing of soft tissues.
Total inactivity, however, has proven been proven to decrease blood supply to, and removal of,
undesired metabolic waste products from the injured tissues. Weakness and atrophy of
muscular tissue have been shown to occur and to a greater degree than previously believed.
Bone decalcification has been documented to occur rapidly. There is also obvious loss of
muscle strength.
REST ADMINISTRATION
The local application of ice to the injured area has an accepted role in treating acute pain.
There are 3 possible mechanisms for the effectiveness of local cold on acutely injured tissue.
These include:
The local effects of ice as a treatment modality for an acutely traumatised area are:
2. It decreases local tissue metabolism (damaged tissue produces pain producing substances).
4. It decreases local muscle spasm by decreasing the sensitivity of the muscle stretch receptor
system.
• Cold pack of peas is best. Wrap pack in a thin cotton sheet so that you do not get frostbite.
Also you want deeper tissues to get cold and not the superficial skin only.
• Place pack on injured area and let the area cool - advise the patient not to get an “ice burn”
• Once the area has cooled down to bearable levels, remove the ice pack and place in the
freezer to allow it to cool down again. In the meantime, let the injured area warm up naturally
• Once the injured area has warmed up, repeat the procedure with the ice pack.
• Repeat procedure several times.
Remember: If cooling is to be effective, it must penetrate deep into the injured area.
COMPRESSION (C)
Compression has the effect of producing counter pressure to injured area thus preventing
swelling and further bleeding.
COMPRESSION ADMINISTRATION
ELEVATION (E)
Elevating an injured part has the effect of reducing the blood flow to the area and therefore
reduces the amount of swelling formed. It also helps with venous return thereby preventing a
pooling of blood.
Usually, if one of the extremities is injured, it should be raised 45 degrees or more with the
patient supine.
ELEVATION ADMINISTRATION
Text books recommend that acutely injured areas should be elevated for 24 hours.
Subsequently, it should be elevated whenever the opportunity arises.
EXERCISE (E)
In the long run, it is exercise that benefits injured soft tissues. All other modalities, such as ice
etc., benefit the involved soft tissues merely by allowing them to function and tend to minimise
pain.
Heat is usually used on chronic injuries or on tired and fatigued muscle to help ease the pain
and discomfort. It is NOT used on acute injuries (this does not mean that it cannot be used
during an acute injury situation where the heat is applied at a distance from the injured tissue).
Heat can be applied by using a hot pack (wheat pack or gel pack) and then applying it to the
affected area. It is important to remember the following points:
2. Make sure that heat is not constantly applied to the same area to relieve pain as there is
a tendency to get desensitisation of the skin and burn the area.
Contrast Bathing
Contrast bathing is the alternate application of cold and heat.
The general rule is always start with the cold and end with the cold. Let each application take
effect before changing to the other, i.e. let the cold penetrate to the tissues before removing and
let the heat warm up the area comfortably before swapping again.
The alternating cold and heat causes a pumping action in the area and is used to “kick start” the
healing process in a chronic injury.
Carbohydrates are stored in the form of glycogen and this store is the body's most important
fuel when exercising. 55- 65% of the total calorie intake for any athlete or person exercising should
consist of complex carbohydrates such is bread, pasta and cereals which also provide fibre, B
vitamins and some trace minerals.
After exercise, carbohydrates are equally important to replace the glycogen that has been used up.
Post-exercise is a good time to eat carbohydrates and sugar because the reduced amount of
glycogen stimulates the production of glycogen synthase, an enzyme which controls glycogen
storage.
• After exercise: foods which enter the bloodstream quickly and can therefore be used to
replenish energy levels e.g. high glycaemic index foods such as baked potatoes, cornflakes or
honey.
Low glycaemic foods, e.g. pulses, apples, green vegetables, etc. may eliminate the need for
consuming carbohydrates during long-term exercise because they maintain normal blood sugar
levels.
Eating protein is essential to good health. Proteins are the building material for the body and they
are converted into amino acids in order to be used wherever required. Protein is found in dairy
products, meat, fish and beans. There are some athletes and training regimes which believe that
eating more protein than the body needs will improve performance or health because the extra
protein becomes muscle. However, there is no benefit to eating more than is necessary - it has not
been proven, for example, that protein supplements, which often contain powdered milk and egg
or soya protein can increase muscle growth, strength and endurance-and they could even have a
negative effect. Once the body has enough protein, any extra is broken down and eliminated. The
part of the protein which contains nitrogen is turned into urea in the liver and is then excreted via
the urinary system. This may cause dehydration if insufficient fluids are consumed. The rest of the
protein is turned into glucose, a sugar, and used as an energy substitute. This energy may be
needed immediately or it may be stored as glycogen. But if the athlete already has a full glycogen
store, the body will convert any excess glucose into fat.
Fats are made up of glycerol and fatty acids. There are three different groups of fatty acids -
saturated, monounsaturated and poly-unsaturated. Depending on the way each fat is handled by
the body depends on how it affects your health. It is recommended that athletes should eat an
intake of 1530% of fats.
Some poly-unsaturated fat has to be supplied in our food as they cannot be made in the body.
These are called essential fatty acids of which there are two types Omega 3 and Omega 6. Omega
3 fatty acids can be found in vegetable oil e.g. rapeseed, soya bean and linseed oil, oily fish and
their oils. Omega 6 fatty acids can be found in vegetable oils e.g. sunflower, safflower and corn oil.
These poly-unsaturated fatty acids help in many body functions including blood clotting,
inflammation, blood pressure and the immune system. It is recommended that 1-2% of calories in
the diet should be essential fatty acids.
The body is made up of approximately 90% water and is therefore very susceptible to a lack of it.
Water is needed for almost all bodily functions, whether circulation, digestion or excretion.
Water:
• forms 90-92% of blood plasma and is therefore essential for blood function - the transport of
oxygen and nutrients to cells and the removal of waste such as carbon dioxide and lactic acid
• constitutes 96% of urine and is therefore essential for excretion and removing waste; if urine
darkens it means it has a high concentration of waste, which may lead to kidney stones, and
this signals a need to drink more water; normal water balance in the body produces pale
yellow urine
• enables us to sweat. Sweating is an excretory function which helps control body temperature. When
we exercise, muscle heat is absorbed by water, which then dissipates this heat in sweat, thereby
regulating body temperature
• is part of saliva and gastric juices and thus helps us digest food
• lubricates joints and protects organs and tissues.
Sports drinks
There are two types of sports drinks:
1. fluid replacement drinks
2. carbohydrate (energy) drinks.
Section 3
Sports Massage
Practice & Techniques
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
Step Description
1 Consultation Process of getting to know the client and taking written details about the area of
injury, past medical history, etc.
• Observation
• Palpation
• Active Movements
• Passive Movements
• Special Tests
Prior to a treatment it is important to carry out a consultation. There are many reasons for this exercise.
1. It gives a good introduction and impression to the client and develops a practitioner/client relationship.
2. You get to know the type of person/lifestyle your client leads
3. To establish if there are any contraindications to massage treatment.
4. Allows the therapist time to explain what benefits can be derived from the treatment.
5. To find out what is expected by the client from the treatment and if they have any worries.
6. To then formulate the best type of treatment that can be suited to your patient.
Remember that as a practitioner, you have a duty of care towards your client.
It is also important to appreciate that personal or written permission from the parent/guardian is
recommended if treating a client under 16 years of age.
• Personal or written permission from the parent/guardian is recommended if treating a client under 16
years of age
• From a guardian if a client is too ill to consent themselves From a GP if the client is taking medication
or contraindicated in any way
• To make sure there is adequate disclosure of information: e.g. nature and purpose of massage, its
risk and consequences, alternative course of treatment available.
• Shows competency of yourself in carrying out the treatment
• Demonstrates that you are interested in the clients welfare
• Provides a level of capacity for decision making on the clients behalf
• Provides the client with a choice
• Shows, Integrity, Respect, Ethical principles and Professionalism
• Demonstrates that you are maintaining standards of conduct and good practice
• Obtain client signatures to verify all that they have been informed of procedures and information
provided by them is true.
Inform the client that all information will remain private and that this would only be disclosed to ascertain
permission to treat from a GP or other medically trained practitioner.
If the condition being presented is outside the boundaries/scope of the practitioner, they need to refer the
client to either the clients GP or someone more suitably qualified.
There are several methods of assessment which are used during the examination process. These are:
1. Observation:
2. Palpation:
3. Active Movements
4. Passive Movements
5. Specialist tests
• Muscle length test
• Ligament instability tests
• Functional tests
• Testing for fitness
Followed by:
i) Overall Body Posture – provides information about factors which may be predisposing to an injury.
Look for:
2. PALPATE – gently run the back of your hands over the area and feel for:
• warmth
• "sponginess" of effusion (e.g. fluid due to inflammation or blood)
• tenderness
• muscle quality - spasm, hypertonia etc.
3. ACTIVE MOVEMENTS - check what active movements are possible for that:
• joint in all ranges of motion:
• flexion / extension
• side-bending
• rotation
• abduction / adduction
• supination / pronation
• inversion / eversion
4. PASSIVE MOVEMENTS - check what passive movements are possible of the joint to be examined
(movements as above).
Note: These are usually greater than that of active movements
5. SPECIAL TESTS - conduct any special tests which you think will help your evaluation – stretching &
muscle resistance.
Key
* = painful knot
// = band of muscle
We will be assessing:
• Muscle injuries
• Tendon injuries
• (Tendon sheath injuries)
• Ligament injuries
• Bursa injuries
• Bony Injuries (limited)
Pain is usually a very good symptom of indication of injury to an area. Injured structures are usually
painful (to varying degrees) and knowing this forms the basis of evaluation.
Stress of any mechanical kind to an injured area will cause pain. Different types of stresses will
cause pain to different types of injured tissue.
APPLICATION OF STRESS
• Direct application of pressure to injured tissue
• Stretch to injured area - both active or passive
• Contraction (Muscle & Tendon, ligaments are NOT contractile) both isotonic & isometric
• Compaction of bone if fractured should cause pain
Petrissage (on and around the area) • Improves circulation and drainage
1. Longitudinal (lengthens muscle) • Relaxes tissues
2. Cross Fibre (Relaxes muscle) • Reduces muscle tension
3. Friction (breaks down scar tissue) • Reduces adhesions
• Breaks down scar tissue
Stretch
1. Passive Stretching • Lengthens muscles
• Relaxes muscle
• Reduces scar tissue
• Breaks down adhesions
• Realigns scar tissue (collagen) fibres
As can be seen from the diagram below, healthy muscle structure (agonist – antagonist)
maintains the muscle in good shape, keeps healthy blood supply to areas and keeps joints in
their neutral working position without causing any restriction to movement.
2. Relationship of joints above and below area of injury – are they moving freely
Sports massage is the use of massage for the treatment and prevention of sports injuries.
Helps clear out waste and toxins By improving the blood supply to an area and
helping the drainage of waste products.
Also helps stimulate movement of lymph which
will help drainage and the immune system.
Enables faster healing As above
Gentle superficial stroking massage can be applied to strains 2 - 3 days after the injury.
With mild and moderated strains, deep stroking and friction techniques can be used after 7 days as
fibrous tissue has started to form. The treatment should always be applied without causing pain, which
will ensure that no further damage is caused by massage.
With severe strains medical advice and control should be sort before starting the treatment.
The above is not an exhaustive list.
Pre-Event Aim: Stimulate the body and focuses the mind. Stimulates the mind & body
Stimulates the circulation
Brisk and fast rhythm
Effleurage, Percussion movements. Can be used on muscles that are going to be used
Post Event Aim: Relax the body & mind. Aid drainage Used straight after the event
Slow rhythm. Superficial massage techniques. Helps to start the healing process preventing micro trauma from
Compression, Effleurage becoming problematic.
It cleanses the body helping remove waste products and facilitate
relaxation and recovery.
Preventative Aim: Keep the tissues in optimum condition Improves blood and lymph drainage
(Maintenance) Improves delivery of nutrients & removal of toxins
Forms part of the athletes training programme and is Makes tissues more supple
used to pinpoint and protect problem areas. Enhances flexibility and performance
Helps identify problem areas at an early stage
Compression, Effleurage, Petrissage & Friction
Corrective Aim: Focuses on treatment for injured tissues Enables faster healing of and recovery from injuries.
(Treatment)
Is the most focused type of massage out of the above
because it pin points problem areas, both past and
present.
Petrissage
Friction
Compression
Neuro-Muscular Technique
Vibrations
Effleurage (At beginning & End of treatment)
Effleurage (Palms):
Light, superficial stroke
Relaxing stroke
Introductory stroke
Gets the client used to your hands
Linking stroke during a massage
Helps DESQUAMATION – makes skin look “fresh”
Helps LYMPHATIC DRAINAGE – thereby helping reduce areas of swelling
Specifically:
Hacking
Helps tone muscle by stretching muscle stretch receptors – good for loose, flabby muscle
Cupping
Creates a vacuum thereby creating a suction and causing blood towards the skin
Helps free any phlegm in the chest and lungs
Passive Movements
Improves range of movement and flexibility
Helps circulate synovial fluid within joint
Helps to stretch muscles
Friction
Helps warm a small area thereby relieving pain
Helps reduce scar tissue
Breaks down adhesions
Helps improve the production of synovial fluid around joints
Applicator Application
Fist
Heel of Hand
Elbow
Whenever you can, reinforce your applicator with the non-working hand.
1a 2a
Take up “slack” in hamstring muscle at origin Take up “slack” in hamstring muscle at the
1.
by flexing the hip insertion by straightening the knee
1b 2b
1c 2c
Continue straightening the knee until the Continue flexing the hip until the patient
patient feels a stretch in the muscle feels a stretch in the muscle
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3
75
Quadricep Stretches – Distal Fibres Quadricep Stretches – Proximal Fibres
(Near Insertion - Knee End) (Near Origin - Hip End)
Maintain the hip extension (not fully) and Maintain the knee flexion (not fully) and
begin to flex the knee gradually begin to extend the hip gradually
Continue flexing the knee until the Continue extending the hip until the
patient feels a stretch in the muscle patient feels a stretch in the muscle
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3
76
Gluteal Stretch
It has been postulated that ischaemic compression produces its effects by a combination of the following
factors:
(1) Ischaemic Nerve Block - this implies that the pressure causes a temporary ischaemia thus depriving the
area of oxygen. This causes a reduction in action potentials and blocks noxious sensory afferent input to
the higher levels of the nervous system;
(2) Reflex Vasodilation - pressure over the trigger point causes an initial blanching and when it is released
the area undergoes reflex vasodilation and an active hyperaemia ensues. This probably produces a
"washout" effect, removing the metabolic products responsible for the hyperirritability;
(3) Release of Endogenous Substances - the pressure can be regarded as a form of hyper stimulation
analgesia, described by Melzack & Wall (1982). Analgesia is due to activation of descending inhibitory
mechanisms, which results in the release of endogenous pain-relieving substances such as endorphins
and encephalin.
The therapist must be careful to eliminate the possibilities of the existence of contraindications
during ALL sessions of treatment.
The list below is not exhaustive, but it gives you a good starting point on contraindications.
Neck Area:
• Cervical Spondylitis
• Tinea Corporis (“Ringworm”)
Low Back Area:
• Undiagnosed neck pain
• Sunburn
• Area of undiagnosed pain
• Enlarged lymph nodes
• Lumps / bumps
• Recent Tattoo
• Shingles (Herpes Zoster)
• Sunburn
• Tinea Corporis (“Ringworm”)
• Recent piercing
• Recent Tattoo
2. Yellow flags are psychosocial indicators suggesting increased risk of progression to long term
distress, disability and pain. Yellow flags were designed for use in acute low back pain. In
principle they can be applied more broadly to assess likelihood of development of persistent
problems from any acute pain presentation.
Criss Cross Criss Cross
Vibration Vibration
Hacking
Cupping
Section 4
Sports Massage Professionalism,
Ethics & Legislation
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
The Electricity at Work These regulations aim to impose duties to limit the risks involved in using
Regulations 1989 electricity at work
The Consumer Protection Act The Act makes producers liable for loss or damages caused to consumers
1987 by defective products. Producers have an obligation to ensure that their
products are safe and free from defects. The Act places liability on
producers, importers and own-branders. It is not concerned with products
that are not fit for purpose, which are covered by the Sale of Goods Act
1979.
Data Protection Act 1998 Requires everyone who uses computers to keep personal information on
other people to register the use to which he or she will put this information.
It also gives right of access to the people concerned to check the accuracy
of the information held on them.
The Disability Discrimination Act The Act is aimed to end the discrimination many disabled people face,
2005 giving important protection, including the duty of service providers to make
reasonable adjustments for disabled people so that they do not face
difficulties with access to services.
Mental Health Act 2007 The main purpose of the legislation is to ensure that people with serious
mental disorders which threaten their health or safety or the safety of the
public can be treated irrespective of their consent where it is necessary to
prevent them from harming themselves or others
The Care Standards Act 2000 An act which provides for the administration of a variety of care institutions,
including children's homes, independent hospitals, nursing home and
residential care homes.
Children Act 1989 Introduced comprehensive changes to legislation in England and Wales
affecting the welfare of children. The Act:
• reinforces the autonomy of families through definition of parental
responsibility
• provides for support from local authorities, in particular for families
whose children are in need
The Work Place Regulations Cover a wide range of basic health, safety and welfare issues and apply to
(Health, Safety and Welfare) 1992 most workplaces. These Regulations aim to ensure that workplaces meet
the health, safety and welfare needs of all members of a workforce,
including people with disabilities.
The Management of Health & Generally make more explicit what employers are required to do to
Safety at Work Regulations 1999 manage health and safety under the Health and Safety at Work Act. Like
the H&S Act, they apply to every work activity.
The Health and Safety (First Aid) These regulations place a duty on employers to make adequate first aid
Regulations 1981 provision for their employees, in case they become ill or injured at work.
The Provision and Use of Work The Regulations require risks to people’s health and safety, from
Equipment Regulations 1998 equipment that they use at work, to be prevented or controlled.
The Fire Precautions Act 1971 The focus of these regulations is to reduce risk to life once fire has started.
The Manual Handling Operations Relate to how employees lift, lower, pull, carry, etc items / clients whilst at
Regulations 1992 work
Cosmetic Products (Safety) A list of ingredients, headed 'Ingredients' must be supplied, in descending
Regulations 2008 order of weight, determined at the time the ingredient was added to the
product.
You do not need to include any of the following as ingredients:
The Supply of Goods and Requires the trader to use reasonable care and skill and says that any
Services Act 1982 materials or goods must be of satisfactory quality, fit for purpose and as
described. It also says that, unless a specific date is agreed for a service to
be provided, it must be carried out within a reasonable time.
Trades Description Act 1972 This Act makes it an offence if a trader:
a. Applies a false trade description to any goods
b. Supplies or offers to supply any goods to which a false trade description
is applied
c. Makes certain kinds of false statement about the provision of any
services, accommodation or facilities.
Medical Act 1983 The purpose of the Act was to create the body now known as the General
Medical Council. The Act created the position of Registrar of the General
Medical Council whose duty is to keep up-to-date records of those
registered to practice medicine and to make them publicly available
Upon qualification, the therapist’s membership to a given organisation will depend on him/her abiding by the
rules of the given body.
Here are a few examples of a code of ethics for the massage profession:
Clients come for a body massage for many different reasons. It may be they are very lonely and 'need'
someone to talk to, or it may be their life is so hectic that they want to escape. It is part of the professionalism
to be able to assess this and react accordingly.
It is important that the conversation is 'client led'. So if the client wants to chat because they are lonely, then
suitable responses must be made. However if, on the other hand, the client wants to 'escape' and have an
hours peace - then this must be respected. The masseur would only issue instructions and speak when
necessary - checking pressure, comfort etc. With experience it will become clear and conversation will be
freer flowing. However, as a useful guide it is important to avoid certain topics.
Client Care
Client care is not something that can be taught. It comes more with experience. There are however certain
criteria that should be born in mind. These are:
• Reasons for good personal hygiene • Socks/tights and full flat shoes
• Wash own hands • Remove all jewellery (except wedding
• Wipe the client’s feet band) from self and client
• Use clean towels for each client • No nail enamel
• Put couch roll on top of towels • Clean short nails
• Wear clean white professional work wear • Hair tied back off collar and face
Massage Area
A body massage can be carried out in many situations providing that there is ample room for you to move
around the couch and that the area is warm, clean, tidy and relaxing. There should be adequate clean
laundry available and a private area for changing. Gowns or large towels must be to hand for transfer to the
couch. The room should be undisturbed during the duration of the consultation and treatment.
Wart (verrucae)
Hepatitis A and B
HIV
When carrying out a massage treatment it is vital for the safety of the clients that strict hygiene measures are
adhered to. These include personal hygiene, clinic hygiene and client hygiene. All aspects of clean practice
should be demonstrated in front of the client, in order to provide a professional treatment and prevent
CROSS INFECTION.
What it covers Claims made against the practitioner resulting from injury due to treatment
Clinic Insurance
Clinic insurance allows you to cover your premises, contents, stock and equipment.
Examine the work place to identify anything that may be harmful. Include hazards relating to:
• salon/clinic environment
• category of person at risk
• equipment
• cleaning and sterilising/sanitising products
• Products used in treatments
• procedures for treatments
Regular reviews of risk assessment are necessary and are usually done if problems have been identified or
on a monthly – yearly basis.
Section 5
Sports Massage Case History Forms
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
2. [Your Name] - VTCT (ITEC) SP L3 Unit 452.pdf - Unit 452 - Principles of Health and Fitness
3. [Your Name] - VTCT (ITEC) SP L3 Unit 453.pdf - Unit 453 - Professional Practice in Sports
Massage
4. [Your Name] - VTCT (ITEC) SP L3 Unit 454.pdf - Unit 454 - Principles of Soft Tissue Dysfunction
The treatments must include at least 1 x each of the following selection below:
a. Pre-event Massage
b. Post-event Massage
c. Maintenance Massage
This will consist of providing 20 x additional treatments in the form of a log, rather than Case Studies.
When you’ve done your first assignment/case study, please email them to
[email protected] so that we can provide you with feedback
to make sure you’re heading in the right direction
And remember don’t plagiarise! Try to make your work as original as possible
Many people think of plagiarism as copying another's work or borrowing someone else's original
ideas. Terms like "copying" and "borrowing" can sometimes disguise the seriousness of the offense.
i. to steal and pass off (the ideas or words of another) as one's own
ii. to use (another's production) without crediting the source
iii. to commit literary theft
iv. to present as new and original an idea or product derived from an existing source
v. In other words, plagiarism is an act of fraud. It involves both stealing someone else's work
and lying about it afterward.
vi. Cut/copy and pasted material (words, pictures, diagrams etc.) from the Web
vii. Copying the work of another student (past or present)
viii. Copying course material or lecture notes
ix. Copying material out of a textbook or journal
Most cases of plagiarism can be avoided by citing or referencing the sources of the information.
Simply acknowledging that certain material has been borrowed and providing the reader with the
information necessary to find that source is usually enough to prevent plagiarism.
All text on this page is not owned by the London School of Massage, it has been copied and
modified from the following sources:
http://www.plagiarism.org/plagiarism-101/what-is-plagiarism/
https://intranet.birmingham.ac.uk/as/studentservices/conduct/plagiarism/guidance-students.aspx
There is no need for Formal / Harvard referencing, but ensure you include the links or book
references for any section where you have borrowed images, text or tables.
Use “ “ quotes if you are using someone else’s words in your own paragraphs, and provide the
appropriate link or reference.
If evidence of plagiarism is found your work will be rejected. VTCT (ITEC) have strict policies on
plagiarism, which could affect or invalidate your qualification.
1. It is a requirement of VTCT (ITEC) that Students must complete ALL completed Case Studies and Assignments
before they can be enrolled on any VTCT (ITEC) Exam.
2. ALL Case Studies and Assignments must be approved and submitted 1-week before the scheduled exam
3. Students submitting their completed and approved Case Studies and Assignments within 7-days but before 3-
days of the exam will be charged late fees to a maximum of £50.00 (Assignments = £25.00, Case Studies =
£25.00)
4. If we have not received the completed and approved Case Studies and Assignments 3-days before the exam,
your exam date may be postponed and have to reschedule a new exam date. You may still be charged late
fees.
1. The cost to be enrolled on the next available exam is £118.80, which includes VTCT (ITEC) and LSM
Administration Fees. Please note that there are no guarantees you can be enrolled on the next exam, and may
be enrolled on an exam at a later date in the year.
2. If you missed your scheduled exam through illness, then the cost of re-enrolment can be reduced to £45.00
with the submission of a formal Doctor’s or Hospital Discharge Note. This note will be submitted to VTCT
(ITEC) with your new enrolment request.
3. All Case Studies and Assignments must be completed and approved, and any outstanding payments paid,
before you can be enrolled on the next exam.
Refresher Days
1. If you have missed or rescheduled your exam date, you may be required to purchase a Refresher Day to ensure
you are prepared for the exam. This is at the discretion of your Course Tutor and based upon your scores
during the Mock Exam, on the last day of the course.
2. If you missed the Mock Exam then it is mandatory that you arrange a Refresher Day at your own cost.
3. Refresher Days are available as half days at £65.00 or full days at £125.00 and you will be required to bring
your own model to practice on.
Date: ____________________
Date: ____________________
You get the idea – anything that will describe you to the Examiner.
Remember, show your POSITIVE side, but also be honest and reflective
Why I am doing this course & what I hope to gain from it…
• New job / change in career
• Want to help people – do voluntary work for local community
• Course is a stepping stone to further your own education and development etc
Student Name:
Exam Date:
Please indicate ….
Pre-event
Post-event
Maintenance
Name: Birthdate:
Shortness of Breath?
R
Persistent Coughing?
Palpitations?
Constipation?
DIGESTIVE
Diarrhoea?
Nausea?
Problems passing water (urination)?
URINARY
EATING HABITS:
FLUID INTAKE:
EXERCISE:
WELL-BEING:
CONTRAINDICATIONS: ___ None Localised to: ____________ _____ Medical Approval Obtained
PHYSICAL EXAMINATION
OBSERVATION + PALPATION + BODY ALIGNMENT + POSTURE
e.g. xxxx e.g Tight muscle e.g. **** e.g. Painful knot
London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3
101
General Comments (if any)
CLIENT FEEDBACK
HOMECARE ADVICE
Indicate aspects of treatment which you felt you did well and/or which you felt you could improve
on
ON EXAMINATION / ASSESSMENT
TREATMENT GIVEN
Section 6
Sports Massage Exam Information
LondonSchoolofMassage.co.uk
[email protected]
Tel: 020 7700 3777
Join us on our Social and Professional media sites for the
Latest News, Special & Sporting Events, Promotions and Job Opportunities
Please remember that the exam is a DEMONSTRATION of what you know and not a treatment.
This means that when the examiner has seen all criteria, they can on occasions bring the
examination to an end.
10 mins
Observation & Palpation
45 mins
35 mins
Maintenance Massage
(area of your choice – e.g. back, legs etc)
60 min
5 mins
Pre Event Massage
(legs of back – determined by examiner)
10 Mins
5 mins
Post Event Massage
(legs of back – determined by examiner)
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 108
Example Theory Exam Questions
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 109
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 110
Marking Criteria
iUSP178 – Sports massage treatments
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 111
Hygiene and sterilisation – 5 marks (1 mark each)
1. Wiped over equipment with appropriate sanitiser before and after use
2. Sanitised hands before, during and after treatment as appropriate
3. Replaced lids on products and used spatulas to remove cream
4. Disposed of cotton wool, tissues, paper roll and general waste hygienically and appropriately
5. Used salon/clinic sterilising equipment/cabinets appropriately and sanitised, used and stored small
equipment
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 112
8. Why should medical permission be sought prior to treatment?
9. How does massage help to prevent sporting injuries?
10. How often would you recommend your client to have a sports massage treatment?
11. When would you use connective tissue massage (CTM)?
12. How would you decide which massage technique to use?
13. When would you use preventative massage?
14. What is a varicose vein and how would you recognise it?
15. What is R.I.C.E.?
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 113
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 114