A VTCT (ITEC) Sports Massage - Level 3 Feb 2020

London School of Massage
“Massage to a Higher level” ©
QCF Level 3
VTCT (ITEC) Diploma in Sports
Massage Therapy
UK Accreditation: QAN 603/4501/9
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London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 1

Our Vision
“To deliver the best training

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through highly passionate,
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practitioners who are
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Copyright Information ©
All content in this manual remain the copyright of the London School of Massage.
No paragraph or photograph in this manual may be copied, photographed, reproduced or

transmitted without the express written permission of the authors Bhavesh T. Joshi or in
accordance with the provisions of the Copyright, Designs & Patents Act 1988.
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.
© Bhavesh Joshi (London School of Massage) 2015.

About Your Lecturers
Bhavesh T. Joshi BSc. Ost Dip. TCM Acup. Ayurveda (Dip), NLP
Director & Principal
Bhavesh qualified as an Osteopath from the British School of Osteopathy and

has been practising and lecturing for over 23 years. He is the Principal of the
London School of Massage which was set up in 1994. He was the Clinical
Director and a Senior lecturer at the College of Osteopaths (2000) as well as
holding the post of Senior Lecturer (Applied Anatomy) and Clinical Supervisor at
the London School of Osteopathy (1995 - 2000). He has also worked for the
British School of Osteopathy as a "Demonstrator in Anatomy", lecturing to
Osteopathic students at the Royal College of Surgeons.
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.

“Massage to a Higher Level” ©
Exam Details
The following section outlines the VTCT (ITEC) Exam components:
Tel: 020 7700 3777

Massage

ITEC Examinations Details
VTCT (ITEC) Sports Massage Therapy Diploma
The following comprises this VTCT (ITEC) Level 3 QCF course:
Page 5 Technical Unit Title Grading Assessment
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
Pass – 60-74% Merit – Practical Examination

Sports Massage 75-89% Distinction –90-
455 100%
Treatments
Evidence of 3 treatments Pass or Refer

Section 1
Additional Anatomy:
Sports Massage Therapy
Tel: 020 7700 3777

Massage

Human Cell
The human body has many different types of cells. It is made up of:
• Organic & inorganic salts

• Carbohydrates
• Lipids (fatty substances)
• Nitrogen containing substances
The structure of a typical cell consists of: Centrosome

Contains CENTRIOLES (rod like
structures which are important in Lysosome
Endoplasmic Reticulum cell replication
Contains enzymes to digest
Forms Channels for unwanted matter – e.g.
transports within cell bacteria
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
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.
NUCLEUS – Is the largest organelle of the cell. Is the control centre

of the cell controlling all the functions from growth, repair to
reproduction. The nucleus contains DNA (deoxyribonucleic acid),
which carries the cells genetic code and chromatin, the material
needed to form chromosomes.
MITOCHONDRIA - these are the “POWER HOUSE” of the cell.

They contain enzymes, which are involved in the production of
energy for cellular activity through the formation of ATP (adenosine
triphosphate).
ENDOPLASMIC RETICULUM (ER) – network of canals and sacs
connected with the nucleus and cell membrane. It forms the
CHANNELS of the cell, allowing movement of different substances.
Smooth Endoplasmic Reticulum is involved in inactivation of
toxic chemicals.
RIBOSOMES - they are responsible for PROTEIN synthesis in the
cell.
Endoplasmic Reticulum + Ribosomes = Rough Endoplasmic
Reticulum
LYSOSOMES - contain enzymes that digest and remove particles

which are useless or may be harmful to the cell.
VACULOES - these are empty spaces within the cytoplasm. They

contain WASTE material and SECRETIONS formed by the
cytoplasm and are used for storage or digestion.
Vacuoles are more relevant to plants.

GOLGI APPARATUS - this consists of closely packed membranous
sacs and is especially prominent in secretary cells. They function in
COMBINING CARBOHYDRATES AND PROTEINS for use to other
parts of the cell.
CENTRIOLES - these are paired rod like structures which play an

important part in cell replication (mitosis). They are contained within
the CENTROSOME

The Skin
Recall that skin has 2 layers:
1. Epidermis – Superficial layer
Has:
• Melanocytes – give pigmentation to skin.
• 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.
2. Dermis – Deeper layer
The Skeletal System

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3
10
The human skeleton is made up of 206 bones.
Where one bone meets another is called a JOINT.
Synovial joints in the body are held together by LIGAMENTS.
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:
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
12
DEFINITIONS
Term Meaning Picture

Agonist This is the contracting muscle and is responsible
(Prime for generating the movment at the joint.
movers)
Antagonist Muscles which act in opposition to the movement

generated by the antagonist. These also relax
when the antagonist contracts through a reflex
mechanism.
Fixator The fixator in a movement is the muscle(s) that

stabilises the origin of the agonist and the joint
that the origin spans (moves over) in order to help
the agonist function most effectively. In the bicep
curl this would be the rotator cuff muscles, which
stabilise the shoulder joint.
Synergist A synergist muscle is a muscle that works

together with another muscle to make movement.
TYPES OF MUSCLE CONTRACTIONS
Term Meaning Picture

13
Isometric Contraction of a muscle
without any change in its
Iso = same length and any movement at
Metric = the joint. E.g. carrying shopping
length
Isotonic Contraction of a muscle

with change in its length and
Iso = same movement occurring at the
Tonic = joint.
Tension
There are two types of
concentric contractions:
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.
Isokinetic Isokinetic contractions are

similar to isotonic in that the
muscle changes length during
the contraction, where they
differ is that Isokinetic
contractions produce
movements of a constant
speed. Examples of using
isokinetic contractions in day-
to-day and sporting activities
are rare. The best is breast
stroke in swimming, where the
water provides a constant, even
resistance to the movement of
adduction.
Structure of Skeletal Muscle

14
The following prefixes will assist in appreciating the structure of a muscle.
Endo = Inside, Epi = Superficial, Peri = Outside
Skeletal muscle is made up of 2 types of proteins, Actin (thin myofilaments) & Myosin (thick
myofilaments). A bundle of thick and thin myofilaments form Myofibrils.
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.
Muscle Contraction – Sliding Filament Theory

15
Muscle fibres contain smaller fibre’s called MYOFIBRILS which are made up of thick and thin
MYOFILAMENTS. The myofilaments are essentially proteins -
Thick = MYOSIN (large protein)

Thin = ACTIN (small protein)
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
STRIATED MUSCLE CONTRACTION - THE SLIDING FILAMENT THEORY
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”.

16
Neuromuscular Junction
17
The end of motor neurone ends terminates as a motor end plate.
Its connection to the muscle fibres is called the NEUROMUSCULAR JUNCTION.
Motor End Plate
Motor End Plate
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.
PHYSIOLOGY OF MUSCLE CONTRACTION

18
ACTIN - a molecule arranged in two single strands which are entwined helically. Each molecule
contains a myosin binding site. As well as this, there are two further molecules on the actin
strand:
1. TROPOMYOSIN - a strand entwined around the actin

2. TROPONIN - located at regular intervals on the surface of tropomyosin.
Troponin is actually three sub-units:

▪ Troponin I - binds to Myosin
▪ Troponin T - binds to Tropomyosin
▪ Troponin C - binds to calcium ions
Detailed structure of myofilaments
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

19
PHYSIOLOGY OF MUSCLE CONTRACTION
1 A nerve impulse causes synaptic vesicles in motor
axon terminal to release acetylcholine (ACh).
ACh diffuses across the synaptic cleft within the

2 Neuromuscular junction and initiates an impulse
that spreads over the surface of the sarcolemma
The impulse enters the transverse tubules and

3 sarcoplasmic reticulum to release calcium ions
from storage into the sarcoplasm.
Calcium ions combine with troponin, causing the

4 Tropomyosin-troponin binding complex to move,
thus exposing the myosin binding sites on actin.
The nerve impulse also causes ATP ➔ADP + P.

5 The released energy activates myosin cross
bridges, which combine with exposed myosin-
binding sites on actin, and causes the myosin
cross bridges to move toward the H zone. This
results in the sliding of actin past the myosin.
The sliding draws the Z lines towards each other,

6 the sarcomere shortens, the muscle fibres
contract, and the muscle contracts.
ACh. Is inactivated by enzymes, thus terminating

7 the nerve impulse conduction within the
neuromuscular junction.
Once the nerve impulse is terminated, calcium

8 ions are actively transported back into the
sarcoplasmic reticulum using energy from ATP
breakdown.
The low concentration in the sarcoplasm permits

9 the Tropomyosin-troponin complex to reattach to
actin. As a result, myosin-binding sites of actin
become covered, myosin cross bridges separate
from the actin, ADP is resynthesized into ATP
(which reattaches to the ATP-binding site of the
myosin cross bridge), and the thin Myofilaments
return to their relaxed position.
Sarcomeres return to their resting lengths, muscle

10 fibres relax, and the muscle relaxes.
DIFFERENT TYPES OF SKELETAL MUSCLE FIBRES

20
All skeletal muscle fibres are not alike in structure or function.
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:
• slow twitch (Type I) muscle fibres

• fast twitch (Type II) muscle fibres
a. Type IIa fibres
b. Type IIb fibres
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.
Slow Twitch (Type I) – Endurance activities

The slow muscles are more efficient at using oxygen to generate more fuel (known as ATP) for
continuous, extended muscle contractions over a long time. They fire more slowly than fast twitch
fibres and can go for a long time before they fatigue. Therefore, slow twitch fibres are great at
helping athletes run marathons and bicycle for hours.
Fast Twitch (Type II) – Quick, fast activities

Because fast twitch fibres use anaerobic metabolism to create fuel, they are much better at
generating short bursts of strength or speed than slow muscles. However, they fatigue more
quickly. Fast twitch fibres generally produce the same amount of force per contraction as slow
muscles, but they get their name because they are able to fire more rapidly. Having faster twitch
fibres can be an asset to sprinters since they need to quickly generate a lot of force.
Type IIa Fibres

These fast twitch muscle fibres are also known as intermediate fast-twitch fibres. They can use
both aerobic and anaerobic metabolism almost equally to create energy. In this way, they are a
combination of Type I and Type II muscle fibres.
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.
Type IIb Fibres

These fast twitch fibres use anaerobic metabolism to create energy and are the "classic" fast
twitch muscle fibres that excel at producing quick, powerful bursts of speed. This muscle fibre has
the highest rate of contraction (rapid firing) of all the muscle fibre types, but it also has a much
faster rate of fatigue and can't last as long before it needs rest.

21
Often known as fast glycolytic fibres they are white in colour due to a low level of myoglobin
and also contain few mitochondria. They produce ATP at a slow rate by anaerobic metabolism
and break it down very quickly. This results in short, fast bursts of power and rapid fatigue. As
mentioned above, this type of fibre can be turned into type IIa fibres by resistance training. This is
a positive change due to the increased fatigue resistance of type IIa fibres. These fibres are found
in large quantities in the muscles of the arms.
TYPES OF MUSCLE FIBRES & PERFORMANCE

Our muscle fibre type may influence what sports we are naturally good at or whether we are fast
or strong. Olympic athletes tend to fall into sports that match their genetic makeup. Olympic
sprinters have been shown to possess about 80% fast twitch fibres, while those who excel in
marathons tend to have 80% slow twitch fibres.
CAN TRAINING CHANGE THE FIBRE TYPE

This is not entirely understood, and research is still looking at that question. There is some
evidence showing that human skeletal muscle may switch fibre types from "fast" to "slow" due to
training.
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.
Myoglobin is the primary oxygen-carrying pigment of muscle tissues. High concentrations of

myoglobin in muscle cells allow organisms to hold their breaths longer. Diving mammals such as
whales and seals have muscles with particularly high myoglobin abundance.
“ALL OR NOTHING PRINCIPLE” (ALL OR NONE LAW)
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.

22
MUSCLES OF THE TRUNK (POSTERIOR VIEW)
Quadratus Lumborum
(Deep muscle)

23
MUSCLES OF THE BACK
Name Origin Insertion Action

Trapezius Cervical spine Scapula Elevates and braces shoulder
Thoracic spine Occipital bone Rotates scapula
Latissimus Dorsi Thoracic spine Anterior humerus Draws arm backwards,

Lumbar spine Adducts and rotates arm
Iliac crest inwards
Levator Cervical spine Scapula Elevates shoulders, rotates

Scapulae scapula
Rhomboid Thoracic spine Scapula Adducts and rotates scapula

Minor & Major downwards
Teres Minor Scapula Posterior Rotates arm outward

humerus (laterally)
Teres Major Scapula Anterior humerus Extends (draws arm
backwards), adducts and
medially rotates the arm
Supraspinatus Scapula Humerus Abducts arm
Infraspinatus Scapula Posterior Rotates arm outwards

humerus (laterally)
Erector Spinae Vertebra Adjacent One side only – flexes trunk
vertebrae laterally
Both sides – extends trunk
Quadratus Iliac Crest 12th Rib One side only – flexes

Lumborum laterally and rotates trunk
Both sides – extends trunk
External Oblique Next page Next page Please note position

24
USCLES OF THE TRUNK (ANTERIOR VIEW)

MUSCLES OF THE TRUNK (ANTERIOR VIEW)

Sternocleidomastoid Sternum Mastoid process ▪ One side only- flexes neck laterally and rotates it
Clavicle (on temporal bone) ▪ Both sides – flexion
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
Deltoid Scapula Humerus ▪ Anterior Fibres – flexes humerus at shoulder joint

Clavicle ▪ Middle Fibres – abducts humerus at shoulder joint
▪ Posterior Fibres – extends humerus at shoulder joint
Rectus Abdominus Pubis Ribs ▪ Flexes the trunk

Sternum
External Oblique Lower ribs Iliac crest ▪ Lumbar flexion

Linea alba ▪ Side bending
▪ Rotation
Internal Oblique Iliac crest Lower ribs ▪ Lumbar flexion

Inguinal ligament Linea alba ▪ Side bending
Lumbar fascia ▪ Rotation
Transversus Iliac crest Linea alba ▪ Supports the viscera

Abdominus Inguinal ligament ▪ Compresses the abdomen
Lumbar fascia
lower ribs

MUSCLES OF THE RIGHT UPPER EXTREMITY (ANTERIOR VIEW)

MUSCLES OF THE RIGHT UPPER EXTREMITY (ANTERIOR VIEW)

Subscapularis Anterior Scapula Anterior humerus Medial rotation of arm at shoulder joint
Serratus Anterior Upper 9 ribs Anterior scapula Draws shoulder forwards and rotates scapula
Biceps Brachii Scapula Radius Flexion of arm at shoulder joint.

Ulna Supinates & flexes forearm at elbow joint
Coracobrachialis Scapula Humerus Flexion of humerus at shoulder joint
Brachialis Humerus Ulna Flexes forearm at elbow
Brachioradialis Humerus Radius Flexes forearm at elbow
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
Supinator Radii Lateral humerus Radius Supinates forearm at elbow joint

Brevis
Pronator Teres Medial humerus Radius Pronates forearm at elbow joint

MUSCLES OF THE RIGHT UPPER EXTREMITY (POSTERIOR VIEW)

MUSCLES OF THE UPPER EXTREMITY (POSTERIOR VIEW)

Supraspinatus Scapula Humerus Abducts humerus at shoulder joint
Infraspinatus Scapula Humerus Rotates arm outwards (laterally) at shoulder joint
Teres Minor Scapula Posterior humerus Rotates arm outwards (laterally)
Teres Major Scapula Anterior humerus Extends humerus at shoulder joint

Adducts humerus at shoulder joint
Medially rotates humerus at shoulder joint
Triceps Brachii Scapula Ulna Extends humerus at shoulder joint

Extends forearm at elbow joint
Extensor Carpi Lateral humerus Metacarpal Extends hand at wrist joint

Radialis Abducts hand at wrist joint
Extensor Carpi Lateral humerus Metacarpal Extends hand at wrist joint

Ulnaris Adducts hand at wrist joint
Extensor Carpi Lateral humerus Phalanges Extends hand at wrist joint

Digitorum Extends fingers
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
MUSCLES OF THE RIGHT LOWER EXTREMITY (ANTERIOR VIEW)

31
MUSCLES OF THE LOWER EXTREMITY (ANTERIOR VIEW)

Iliacus Collectively Iliac bones Femur
known as Flexes femur at hip joint
Psoas “Iliopsoas” Lumbar spine Femur Laterally rotates femur at hip
Sartorius Iliac bone Tibia Flexes femur at hip joint

Abducts femur at hip joint
Laterally rotates femur at hip joint
Flexes leg at knee
Rectus Femoris Iliac bone Tibia via patella Flexes femur at hip joint,
“Quadriceps Muscle” Extends leg at knee joint
Vastus Lateralis Femur Tibia via patella Extends leg at knee joint
Vastus Intermedius
Vastus Medialis
“Quadriceps Muscles”
Gracilis Pubic bone Medial tibia Adducts femur at hip joint

Medially rotates femur at hip joint
Flexes leg at knee joint
Adductor Brevis Pubic bone Medial femur Adducts femur at hip joint
Adductor Longus
Adductor Magnus
Tibialis Anterior Tibia Tarsal bones (planter Dorsiflexes foot at ankle joint
surface) Inverts foot at ankle joint
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
MUSCLES OF THE RIGHT LOWER EXTREMITY (POSTERIOR VIEW)

33
MUSCLES OF THE LOWER EXTREMITY (POSTERIOR VIEW)

Gluteus Maximus Innominate Femur Extends femur at hip joint
Sacrum Abducts femur at hip joint
Coccyx Laterally rotates femur at hip joint
Gluteus Medius Innominate bone Femur Abducts femur at hip joint.

Gluteus Minimus Medially rotates femur at hip joint
Biceps Femoris Ischium (innominate bone) Fibula

“Hamstring Muscle”
Semitendinosus Ischium (innominate bone) Tibia

“Hamstring Muscle” Extends femur at hip joint
Flexes leg at knee joint
Semimembranosus Ischium (innominate bone) Tibia

“Hamstring Muscle”
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

MUSCLES OF THE FACE (LATERAL VIEW)
Frontalis
Corrugator
Temporalis
Orbicularis Oculi
Procerus
Occipitalis
Nasalis
Levator Labii Superioris

Zygomaticus Masseter
Buccinator
Risorius Pterygoid
Orbicularis Oris (Deep to Masseter)
Mentalis Sternocleidomastoid
Triangularis Trapezius
Depressor Labii Inferioris
Platysma

Cardiovascular System
THE PAPILLARY MUSCLES OF THE HEART
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 CONDUCTION SYSTEM OF THE HEART
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.
This pathway is made up of 5 elements:
1. The sino-atrial (SA) node

2. The atrio-ventricular (AV) node
3. The bundle of His
4. The left and right bundle branches
5. The Purkinje fibres
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.

Respiratory System
MUSCLES OF RESPIRATION
The muscles of respiration can be divided into two groups:
Primary Muscles of Respiration
Inspiration Expiration
Diaphragm Internal Intercostals
External Intercostals Rectus Abdominis
External Oblique
Internal Oblique
Transversus Abdominis
Accessory Muscles of Respiration
Inspiration Expiration
Sternocleidomastoid -
Scalenes
Pectoralis minor

Nervous System
Appreciate that there are 31 pairs of spinal nerves.
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).
Sensory Tracts Motor Tracts
Diagram showing Ascending & Descending Spinal Tracts

Diagram of the cross section of the spinal cord
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.

Endocrine System
ADDITIONAL HORMONES
Hormone Location Action
Somatostatin Islets of Somatostatin from the hypothalamus inhibits the pituitary
Langerhans gland's secretion of growth hormone and thyroid
(Pancreas) stimulating hormone. In addition, somatostatin is
produced in the pancreas and inhibits the secretion of
other pancreatic hormones such as insulin and glucagon.
Cortisol Adrenals Cortisol is a steroid hormone which regulates a wide range
of processes throughout the body including metabolism
and the immune response.
It is a life sustaining adrenal hormone essential to the

maintenance of homeostasis. Called “the stress hormone,”
cortisol influences, regulates or modulates many of the
changes that occur in the body in response to stress
including, but not limited to:
• Blood sugar (glucose) levels
• Fat, protein and carbohydrate metabolism to
maintain blood glucose (gluconeogenesis)
• Immune responses
• Anti-inflammatory actions
• Blood pressure
• Heart and blood vessel tone and contraction
• Central nervous system activation
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.
In a woman's body, one of the main purposes of

androgens is to be converted into the female hormones
called oestrogens.
Epinephrine Adrenals Epinephrine, more commonly known as adrenaline, is a

hormone secreted by the medulla of the adrenal glands.
Strong emotions such as fear or anger cause epinephrine
to be released into the bloodstream, which causes an
increase in heart rate, muscle strength, blood pressure,
and sugar metabolism.
Norepinepherine Adrenals Norepinephrine is a chemical released from the
sympathetic nervous system in response to stress. It is
classified as a neurotransmitter, a chemical that is
released from neurons. Because the release of
norepinephrine affects other organs of the body, it is also
referred to as a stress hormone.
Inhibin Ovaries & Suppresses follicle-stimulating hormone (FSH) secretion
Testes from the pituitary.
Section 2
Sports Massage Physiology
Tel: 020 7700 3777

Massage

Pain Cycle
Injury / Disease
• Trauma
• Infection
• Postural
What can the What can the

massage therapist massage therapist
recommend / do for recommend / do for
ischaemia? pain?
Ischaemia
(Lack of Blood Pain
supply)
Muscle
Contraction
What can the massage therapist recommend /

do for muscle contraction?

Classification of Injuries to Tissues
The following classification is applicable to:
1. Muscles
2. Tendons
3. Ligaments
1st Degree (soreness/stiffness)
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)
The following classification is applicable to:
1. Bursa – a fluid filled “sac”
Frictional – occurs when e.g. tendon repeatedly moves over bursa

(Achilles tendon)
INJURY Chemical – Spread from adjacent inflamed tissues
Septic – caused by bacterial infection either from blood or from the external
environment
Traumatic – caused by a direct trauma to a bursa such as a blow

Sports Injuries: Causes, Signs & Symptoms
MUSCLE TENDON LIGAMENT BURSA BONE
CAUSE Overloading Overloading Overloading Friction • Stress
Overstretching Overstretching Overstretching Trauma Fracture
Direct Trauma Direct Trauma Direct Trauma Septic • Trauma
Chemical –
Adjacent spread
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)
ACTIVE Worse on Tendon is not Ligament is Pain is the result of Force of

MOVEMENT contraction of contractile. not contractile. friction of tendon contraction of
muscle Made worse as Pain is felt against bursa - muscle may
force of when ligament usually due to cause traction
contraction of is stretched. repetitive on bone and
muscle is movements at the cause pain
transmitted to given joint.
tendon
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.

Inflammation & Tissue Repair
INFLAMMATION
Definition: Inflammation is a cellular and vascular response to a harmful stimulus.
The overall process can be broken down into 5 stages:
STAGE 1: VASODILATION AND INCREASED PERMEABILITY OF BLOOD VESSELS
Injury to tissue ➔ immediate vasodilation and increased vascular permeability in

injured area.
Vasodilation = increase in diameter of blood vessels.
Vasodilation ➔ more blood to damaged area ➔removes toxic products and dead cells
Increased permeability➔ permits defensive substances in blood to enter injured

tissue, e.g. white blood 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:
• HISTAMINE: contained in many tissues of the body esp. Mast cells.

• KININS: these also increase permeability and cause vasodilation.
• PROSTOGLANDINS: a product of inflammation and are potent vasodilators by
themselves as well as intensifying the effects of histamine and kinins.
STAGE 2: PHAGOCYTE MIGRATION

Within a few hours of injury, phagocytes migrate from within the blood vessels to the
injured site outside. They move through the dilated blood vessels like amoebae.
Different types of white cells appear at different stages during the inflammatory process.
STAGE 3: RELEASE OF NUTRIENTS

Nutrients are released to support the defensive mechanism.
STAGE 4: FIBRIN FORMATION

The blood contains a soluble protein called fibrinogen. The increased permeability of
capillaries causes leakage of fibrinogen into the tissues. Fibrinogen is then converted to
an insoluble, thick network called Fibrin, which localises and traps the invading
organisms, preventing their spread. The network eventually forms a fibrin clot that
prevents further bleeding and isolates the infected area. Blood Platelets (Thrombocytes)
are also involved in the process.
STAGE 5: PUS FORMATION

In all but very mild inflammation pus is formed. It is a thick fluid that contains living as
well as non-living, white blood cells and debris from other dead tissue.

CHARACTERISTICS OF INFLAMMATION
Inflammation is characterised by:
1. HEAT: due to large amounts of blood in the area.
2. REDNESS: also due to large amounts of blood in the area
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 3 Stages of Healing
The three stages of inflammation:
1. Acute -swelling stage and reaction to injury

2. Subacute - repairing stage
3. Chronic - scar tissue maturation and remodelling stage
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.

Treatment in acute stages includes intervention for the inflammation: ice, compression,
elevation, relaxation and drainage. Sports massage techniques use only gentle applications
with no direct application of compression to the site of swelling. Lymphatic drainage and
relaxation of the muscle spasm are the acute treatment focus. Avoid massaging the site of
acute inflammation for the first 24 hours (unless you have been trained in this). Activities should
be limited to avoid unnecessary work of an injured part. Too much use can re-injure the
tissue. However, a normal level of function and movement needs to be maintained to
encourage proper tissue modelling and repair.
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.

Healing Process
TISSUE REPAIR
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.
COLLAGEN - a protein substance that is a main constituent of connective tissue.

If the rate of collagen breakdown in a scar exceeds production, the scar becomes softer and
less bulky.
If the rate of collagen production exceeds breakdown, it becomes raised and irregular
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.
CONDITIONS AFFECTING REPAIR
Three factors affect tissue repair.
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.

R.I.C.E.(E)
The primary objective for treatment of soft tissue injuries is to minimise or remove the stimulus
producing pain and to prevent or correct the tissue changes leading to impairment.
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
When advising rest, remember to bear the above in mind!

The answer to “How much rest?” can only come from assessing the extent of the injury and the
practitioner and patient must work together for a rehabilitation plan.
24 - 48 hours rest for acute injuries is usually stated in text books.
ICE (CRYOTHERAPY) (I)
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:
1. Adaptation of the sensory receptors (Adaptation = decline in response of receptors to

continuous, even stimulation).
2. Act as a counterirritant effect
The local effects of ice as a treatment modality for an acutely traumatised area are:
1. Being a vasoconstrictor, it decreases or inhibits bleeding.
2. It decreases local tissue metabolism (damaged tissue produces pain producing substances).
3. It neutralises local histamine (a vasodilator and increases vascular permeability) liberated by

trauma.
4. It decreases local muscle spasm by decreasing the sensitivity of the muscle stretch receptor
system.
5. It elevates the threshold of pain transmitting nerves.

ICE ADMINISTRATION
• 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
Use elastic bandages which have a certain degree of give in them.
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
The use of cushions is helpful.
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.

Thermotherapy
Thermotherapy is the use of heat in the treatment of injuries.
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:
1. Always shield the skin with a thin cloth
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.
EFFECTS OF HEAT ON TISSUES
• Helps ease pain

• Increases elasticity of collagen fibres, thereby making area relaxed and supple
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.
The same precautions apply to the use of cold and heat.

The Importance of Diet & Fluids
Diet
An athlete's diet (meaning what they eat rather than the control of food intake for weight loss)
is extremely important to their performance. Without a balanced diet tailored to their
particular physical requirements, their body will not be able to perform at optimum
efficiency. NB This section is a brief introduction, not a comprehensive overview of the
dietary considerations for an athlete.
The Role of Carbohydrates

Carbohydrates are the body's energy providers and therefore the most important food group
for exercise. They are preferable to fat and sugar as they release energy slowly (because they
take longer to digest) and therefore they can provide energy over a longer period.
Carbohydrates are important because they:
-
• are the most important energy source for working muscles
• help keep the brain and nervous system working properly
• enable the body to use fat more efficiently.
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.
What is carbohydrate loading?

Carbohydrate loading is the gradual increase of the amount of carbohydrate consumed in order to
increase endurance and therefore performance in certain endurance sports. Over a period of seven
days, athletes start eating more and more carbohydrates. This process can boost glycogen stores in
muscles by up to 40%- the more glycogen there is in the muscles before exercise, the better the
endurance level. Before a competition, usually in the week before an event athletes will start
tapering - decreasing their training programmes but increasing their carbohydrate intake.
Which carbohydrates are the best for exercise?
• Before exercise: foods which enter the bloodstream slowly and thus provide sustained energy
e.g. bananas, pasta, rice (low to moderate glycaemic foods; glycaemic is the rate at which blood
glucose rises when a particular carbohydrate food is eaten).
• During exercise: energy gels can be eaten because they contain large amounts of sugar which
gives instant energy.
• 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.

The Role of Protein
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.
The Role of Fats
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.
• Saturated fatty acids

These are solid and can be found in butter, lard, cheese and meat fat. It is recommended that
only 10% of your calorie intake should consist of saturated fatty acids.
• Mono-unsaturated fatty acids

These are liquid at room temperature and can solidify in cold temperatures. Examples of these
types of fats are found in olive, rapeseed, groundnut, hazelnut and almond oil, avocados, nuts and
seeds. These are good fats and can reduce low-density lipoprotein (LDL) cholesterol without
affecting the high density lipoprotein (H DL) cholesterol. It is recommended that an intake of 12%
of calorie intake should be monounsaturated fats.
• Poly-unsaturated fatty acids

These are liquid at both room and cold temperatures and are found in most vegetable oils and oily
fish. These fats can reduce LDL cholesterol levels but they can also slightly reduce HDL cholesterol
levels, so the recommended calorie intake is 10%.
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.

FLUID CONSUMPTION
The Importance of Water
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.
How much water should an athlete drink?

Water should be drunk before, during and after exercise. This prevents dehydration which may
cause cramp. An athlete should drink 8 fl ozs /220 ml of water every 15-20 minutes. After
exercise, it is important to drink plenty of water to replace the fluid lost through sweating, even if
the athlete does not feel thirsty.
What are the symptoms of dehydration?

If you think of how much water the body contains and uses, it is easy to see why a lack of fluid can
cause immediate problems. Dehydration can cause chronic fatigue, lethargy and headaches. The
cardiovascular system is overworked because the heart has to pump harder in order to transport
blood around the body. The volume of blood drops, because there is less fluid available, which
means less oxygen can be carried and exercise becomes harder. Finally, because there is less blood
the body must choose between sending the blood to the working muscles or sending blood to the
skin to dissipate heat. The transport of blood to the muscles predominates so heat is kept in the
body and body temperature increases. It is very important to maintain fluid consumption even
without thirst.
Sports drinks
There are two types of sports drinks:
1. fluid replacement drinks
2. carbohydrate (energy) drinks.
1. Fluid replacement drinks

These drinks aim to replace lost fluid faster than water. Also, by maintaining blood sugar levels, the
extra sugar content helps prevent glycogen stores from being used up. These are dilute solutions of
electrolytes (mineral salts dissolved in body fluids, such as chloride and magnesium), particularly
sodium and sugars (carbohydrates).
2. Carbohydrate (energy) drinks

These drinks contain more carbohydrates per 100m1 than fluid replacement drinks. The
carbohydrate is in the form of maltodextrin (glucose compounds).

What is a hypotonic drink?
A hypotonic drink is a weak solution of sugar and electrolytes and contains fewer particles of sugar
and electrolytes than the body’s own fluids. It is therefore absorbed faster than water. The amount of
sugar in a hypotonic drink is normally less than 4g per 100m1 of water. A hypotonic drink helps
restore fluids to the body.
What is a hypertonic drink?

A hypertonic drink is the opposite of a hypotonic drink. It is highly concentrated and contains
more particles of sugar and electrolytes than the body’s own fluids. It is therefore absorbed more
slowly than water. The amount of sugar in a hypertonic drink is normally more than 8g per 100m1
of water. A hypertonic drink helps restore energy to the body.
What is an isotonic drink?

An isotonic drink has approximately the same number of particles in water as body fluids. The
body therefore absorbs it as quickly as, if not quicker than, water. The amount of sugar in an
isotonic drink is between 4-8g per 100m1 of water which means that it helps to restore both fluid
and energy to the body.
Why do some athletes use salt tablets?

Taking salt tablets makes the contents of the stomach extremely hypertonic i.e. concentrated. The
stomach will thus absorb any excess fluid in the body in order to dilute the concentration of sodium.
This prevents the stomach from emptying and stops the body from rehydrating. Some athletes think
that because they are sweating so much they need to replace the salt but in fact taking these tablets
does not have this effect and stops the body getting the fluids it needs.
One way to replace fluids

One way to replace fluids and electrolyte loss is by drinking a dilute sodium/ carbohydrate drink
(either hypotonic or isotonic) with a sodium concentration of 40-110 mg/100 ml.

Section 3
Sports Massage
Practice & Techniques
Tel: 020 7700 3777

Massage

Clinical Practice
The whole clinical practice can be broken down into 3 steps:
Step Description
1 Consultation Process of getting to know the client and taking written details about the area of
injury, past medical history, etc.
2 Assessment Step-by-step process of assessing structures in a methodical manner and is

broken down into:
• Observation
• Palpation
• Active Movements
• Passive Movements
• Special Tests
3 Treatment Methodical process of using treatment techniques to correct/improve faults in the

soft tissues, joints and body awareness.
Treatment can be broken down into:
• Soft tissue Techniques

• Stretching Techniques
• Passive Articulation of Joints

Consultations
The consultation process offers your first meeting with the client. It is important that the practitioner
uses:
• Good communication skills (asking open and/or closed questions where appropriate)
• Professionalism, confidence and enthusiasm
• Confidentiality and trust
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.
Treatment of Children & Vulnerable Adults

Due to the very nature of the law and the sensitivity required in dealing with children and vulnerable
adults it is particularly important to have a chaperone during a treatment.
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.
Importance of Informed Consent Prior to Assessments & Treatment

Prior to an Assessment and Treatment, you must obtain an informed consent from your client then you
can continue with the session. There are a number of times / reasons for doing this:
• 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.

Clinical Records
The clinical records form legal document so you must ensure that they are fully completed at all times.
Keep any additional material together such as GP letters etc.
Maintaining the Dignity & Comfort

It is important that a client’s dignity and comfort are maintained through every visit. This can be
achieved by:
• Taking a good consultation and looking out for contraindications

• Explaining the treatment procedure to the client
• Helping the client onto the couch/seat protecting the client’s modesty at all times
• Ensuring that all parts of the client are covered except the area being massaged
• Cleansing the feet with antibacterial wipes before and after treatment
• Washing your own hands to maintain hygiene
• Ensuring that the client is comfortable throughout the session
• Using appropriate supports during the treatment
• Using correct towel management procedures
• Removing the massage medium at the end of the treatment if appropriate
• Helping the client off the couch/seat protecting their modesty at all times

Assessment
Once the consultation has finished (case history taking), this will then be followed up with a physical
examination of the patient.
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:
6. Massage strategy – treatment and overall plan for future treatments
7. Advice and guidance

Assessment (Area or Joint)
Before touching the Client, you must take a good case history. The history should guide you into
incriminating/ eliminating possible associated structures.
1. OBSERVE - before even touching an area observe the area for:
i) Overall Body Posture – provides information about factors which may be predisposing to an injury.
Look for:
Curvatures of the spine (side view)

ii) Observe the area specifically – both standing and lying down.
• swelling
• bruising
• redness
• atrophy (muscle wasting), hypertonia (increased tone), hypertrophy (increased mass) etc.
• inflammation
• symmetry
• a look at the client to see level of discomfort they are in
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.
• Muscle length test

• Ligament instability tests
• Functional tests
• Testing for fitness – done in the sporting arena (swimming, running, football etc.)

OBSERVATION & PALPATION CHART
Key
xxx = tight muscle
* = painful knot
// = band of muscle

Evaluation of Injured Structures
The assessment of an injury requires a methodical approach. Providing you follow this, and knowing
your anatomy well, you will be close to identifying any injured tissue.
As always, the case history should guide you in your approach.
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
MUSCLE TENDON TENDON LIGAMENT BURSA BONE

SHEATH
Over muscle Over tendon Over tendon Over ligament Over bursa Over fracture
SITE OF belly (made worse sheath site (made worse (made worse or injury
PAIN (made worse on pressure) (made worse on pressure) on pressure) (made worse
on pressure) on pressure) on pressure)
ACTIVE Worse on Tendon is Repetitive Ligament is Pain is the Force of

MOVEMENT contraction of not movements not contractile. result of contraction
muscle contractile. cause pain Pain is felt friction of of muscle
Made worse due to friction when ligament tendon against may cause
as force of is stretched. bursa - usually traction on
contraction due to bone and
of muscle is repetitive cause pain
transmitted movements at
to tendon the given joint.
PASSIVE Pain is caused Pain is Repetitive Ligament is Pain is the Force of

MOVEMENT when muscle is caused when movements not contractile. result of stretch of
stretched force of cause pain Pain is felt friction of muscle may
muscle due to friction when ligament tendon against cause
stretch is is stretched. bursa - usually traction on
transmitted due to bone and
to tendon repetitive cause pain
movements at
the given joint.

Specific Injury Treatment Sequence
Effleurage • Introduces client to touch

On and around the area • Warms area
• Improves circulation and drainage
• Relaxes tissues
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
• Creates a “Wash Out” effect

Neuromuscular Technique (NMT) • Relaxes tissues through reflex
pathways
• Releases endorphins
(feel good hormones)
Stretch
1. Passive Stretching • Lengthens muscles
• Relaxes muscle
• Reduces scar tissue
• Breaks down adhesions
• Realigns scar tissue (collagen) fibres

Holistic Principles in Treatment
Simple considerations
1. Agonist – Antagonist relationship
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
3. Calf pump mechanism – improve circulation to calf so as to aid venous return

Role of Sports Massage
It is recommended that massage should not be used until at least 48 hours after an injury, when the risk
of bleeding and swelling has deceased.
Sports massage is the use of massage for the treatment and prevention of sports injuries.
It can be used as a part of a training programme to:
▪ help prevent injury

▪ help in the rehabilitation process
▪ as a warm up and wind down for an event
It can help by:
✓ Improving suppleness and flexibility of muscles and joints

✓ Maintain body functioning at optimum level
✓ Speeds up the recovery and healing time for injures tissues
✓ Increase fitness capabilities and improve performance potential
✓ Act as a preventative by working of problem areas of the body
✓ Breaks down adhesions (sticking) of tissues which can cause tightness and stiffness in areas
Effect Possible Reason

Speeds up the healing of damaged tissues and By increasing circulation increases nutrients to
muscles area as well as helping drain away waste
products.
Increases fitness capabilities By keeping tissues are in a better state of health,
therefore individual may be able to push
themselves further.
Increases fitness potential Massage helps both the mind and the body. By
helping a keep a good mind state, there may be a
increased feeling of determination in looking after
one’s self.
Prevents future injury By keeping tissues in a good state, especially
helping minimise adhesions and keeping muscles
supple.
Breaks up adhesions By breaking cross linkages of adjacent tissues
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
Improves flexibility By helping reduce tension in tight muscles and

thereby helping flexibility.
Enables peak performance to be achieved more By helping improve mind – body connection and
rapidly self esteem
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.

Effects of Sports Massage on Body Systems
Physical effects of Sports • Stretches and releases muscular tissue
Massage • Increases muscle flexibility and range of movement
• Breaks down scar tissue
• Reduces swelling
Physiological and neurological • Increases blood and lymph flow

effects of sports massage • Increases supply of oxygen and nutrients and removes
waste
• Stimulate nervous activity
• Relieves pain
• Stretches the stretch receptors of a muscle (Golgi tendon
organs)
Psychological effects of sports • Relieves tension and anxiety

massage • Suppresses sensation of pain
• Stimulates physical activity

Types of Sports Massage
Type of Massage Which Techniques are used? Benefits / Why use it?
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
Stimulates the circulation and helps the body work at a more

optimum level.
Helps loosen muscles and joints and improve flexibility.

In-between Event Aim: Speed up recovery from the preceding event due Speed up recovery in between events
to micro trauma allowing the body to prepare itself
more for the next one. Helps treat any damage or fatigue in-between events.
Medium paced rhythm

Specific techniques to suit the condition and client
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.
Prevents stagnation of blood and prevents fluid from accumulating

in the tissues.

Type of Massage Which Techniques are used? Benefits/ Why use it?
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)

Massage Strokes Effects – Practical Session
You will find the following useful in describing the effects of the various massage strokes whilst
carrying out a massage during the practical examination.
Always start with:
“…… it improves the circulation to the area bringing with it nutrients like oxygen and glucose
and helps drainage by roving toxins like lactic acid and urea”.
Then for the specific strokes:
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
Petrissage (Thumb Circles, Wringing, Kneading)

 Relaxing stroke
 Deeper stroke
 Reduces tension in tissues (esp. good for tight muscles)
 Reduces muscle ADHESIONS
 NOT good for LYMPHATIC DRAINAGE as it collapses the lymph vessels
Percussion (Hacking, Cupping & Pounding)

 Very stimulating strokes
 “Wake Up” stroke
 Used for a stimulating massage or towards the end of a session.
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

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Applicators
The following applicators are good for the application of Deep Tissue technique:
Applicator Application
 Fist
 Heel of Hand
 Elbow
 Ulnar Border of forearm
Whenever you can, reinforce your applicator with the non-working hand.

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Muscle Stretches
Hamstring Stretch – Distal Fibres Hamstring Stretch – Proximal Fibres
(Near Insertion - Knee) (Near Origin on Ischial Tuberosity)
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
Maintain the hip flexion (not fully) and

begin to straighten the knee gradually Maintain the knee extension (not fully) and
begin to flex the hip gradually
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
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Quadricep Stretches – Distal Fibres Quadricep Stretches – Proximal Fibres
(Near Insertion - Knee End) (Near Origin - Hip End)
Take up “slack” in quadricep muscles at Take up “slack” in quadricep muscles at

origin by extending the hip the insertion by flexing the knee
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
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Gluteal Stretch
Make sure you place the client’s hands on

their stomach and stabilise torso with counter
pressure.
Take the knee across stretching the iliotibial

tract and the gluteal muscles
Make sure that you adjust the angle of thigh

to get the best stretch
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Neuro-Muscular Technique (NMT)
Ischaemic Compression
This is manual compression of a trigger point in order to deactivate it. The technique consists of pressure
applied by digits, knuckle or elbow when the relaxed muscle, in which the trigger point lies, has been
stretched to the point of discomfort. Moderate pressure is applied at first and, as the discomfort of the initial
pressure subsides, the compression is increased. The total time of compression should be for 1 minute with
between 9 and 13 kg of pressure (recent trend is to hold for only 7 seconds – preventing too much
ischaemia).
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.

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Contraindications to Massage
Contraindication: A reason, symptom or situation that prevents a treatment being carried out.
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.
a. Total Contraindication b. Localised Contraindication C. Contraindications requiring

(specific to a given site on body) medical approval before
treatment can be given.
1. Fever – body temperature 1. Skin Diseases 1. Epilepsy
is high, possible infection
2. Contagious / Infectious 2. Undiagnosed lumps or bumps 2. Cardio-vascular conditions

disease – e.g. flu. Chicken thrombosis, high / low BP
pox, measles heart conditions
3. Under influence of drug / 3. Varicose veins 3. Any condition being treated by

alcohol another medical practitioner /
Osteopath/
Chiropractor /
Physiotherapist
4. If you feel threatened 4. Cuts / Bruising / Abrasions 4. Diabetes – makes skin less
sensitive
5. Diarrhoea or Vomiting 5. Sunburn 5. Osteoporosis
6. Area of undiagnosed pain 6. Asthma / Bronchitis
7. Inflammation 7. Nervous / Psychotic
conditions
8. Scar Tissue 8. Undiagnosed injury
(2 years after a major operation
and 6 months for a small scar)
9. Abdomen (first few days of 9. Acute Arthritis
menstruation depending on how
client feels)
10. Hernia 10. Recent Operation
11. Recent fracture (min 3 months) 11. On prescribed medication
12. Hormonal implants 12. Bell’s Palsy
13. Cervical spondylitis 13. Trapped / Pinched Nerve
14. Gastric ulcers 14. Postural deformities
15. After a heavy meal 15. Gynaecological infections
16. Haematoma 16. Pregnancy
17. Localised swelling 17. Kidney infection
18. Cancer

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Localised Contraindications to a Given Area
Your examiner will expect you to recall at least five, TOTAL, MEDICAL or LOCALISED
contraindications. Below is a list of specific contraindications to given areas. Please know these
well.
Head & Face:
• Herpes Simplex (Cold Sore)

• Acne Vulgaris – spots
• Conjunctivitis – eye infection
• Impetigo – viral infection Stomach Area:
• Broken nose
• Bruising around eye – “black eye” • Hernia
• Sunburn • After a heavy meal
• Shingles (Herpes Zoster)
• Sunburn
• Recent piercing
Leg & Foot: • Recent Tattoo
• Tinea Pedis - Athletes Foot
• Verruca
• Varicose Veins
• Toe nail infection
- Onychomycosis/ Tinea Unguium
• Recent fracture
• Sunburn
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

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Contra-Actions
During or following a treatment the client may experience a contra-action or a ‘healing crisis’. A
contra-action an unwanted or unexpected reaction that occurs either during or after treatment. This
can range from simple reddening of skin from the applied treatment to a full allergic reaction to the
oil, wax or other medium used. A contra-action could also cause the client to physically exhausted
or express a sudden release of pent-up emotions.
Obviously if a contra-action occurs during treatment, treatment should be stopped immediately. If it
happens after and is an adverse reaction it should be recorded for future reference, so the cause is
not repeated. On an individual basis this can also include feeling hot or shivery as the blood
pressure is affected by relaxation and stimulation, and also as the process of self-healing and
detoxing occurs.
Many contra-action symptoms are completely normal and should subside within 24 hours, if not then
medical assistance should be sought.
Typical contra-actions may include:
1. Thirst or dryness of the mouth
2. Erythema slight reddening of the skin as a result of surface stimulation
3. Tiredness / Sleepiness due to release of toxins encouraged by the treatment
4. Light-headedness due to the blood pressure being affected by relaxation and stimulation
5. Muscular Aches / Cramps / Soreness / Pain which are the nerve fibres responding to the
deep work that has been undertaken
6. Light bruising / Inflammation due to heavier pressure during some deeper tissue
treatments
7. Frequent Urination due to stimulation of the lymphatic system
8. Flatulence due to stimulation of the digestive system
9. Increased Defaecation due to stimulation of the digestive system
10. Spots may occur released toxins and hormones may surface through the skin, especially if
you previously suppressed your skin condition
11. Heightened Emotions due to the positive release of deep-held feelings and emotions
12. Sleep Pattern Changes an increased state of relaxation could help improve or promote
better sleep
13. Cold-like Symptoms, Runny Nose or Nausea due to stimulation of the lymphatic or
digestive system
More positive reactions would be
1. Improved mood
2. Increased flexibility / joint movement
3. Sleep improvements
4. Pain relief

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Red & Yellow Flag Clinical Conditions
1. Red flags are clinical indicators of possible serious underlying conditions requiring further
medical intervention. Red flags were designed for use in
acute low back pain, but the underlying concept can be applied more broadly in the search for
serious underlying pathology in any pain presentation.
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.
Flag Nature Examples

• Cauda equina syndrome
• Saddle anaesthesia
• Fracture
• Tumour
Red Signs of serious pathology
• Unremitting night pain,
• Sudden weight loss of 10 pounds over 3 months
• Bladder & bowel incontinence
• Previous history of cancer
• Unhelpful beliefs about pain: indication of injury as
uncontrollable or likely to worsen.
Beliefs, appraisals and
judgements • Expectations of poor treatment outcome, delayed
return to work.
• Distress not meeting criteria for diagnosis of

Yellow mental disorder.
Emotional Responses
• Worry, fears, anxiety
• Avoidance of activities due to expectations of pain

Pain behaviour (including pain and possible re-injury.
and coping strategies)
• Over-reliance on passive treatments.

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Sports Massage Routine - Example
Note: There are NO PETRISSAGE MOVEMENTS in both Pre & Post Event Massage
PRE-EVENT SPORTS MASSAGE POST-EVENT SPORTS MASSAGE

Muscles are warmed up for the event and intensive Massage is used to relax the muscles and
workout. Warm-up massage techniques include help reduce any build-up of waste materials
fast effleurage and percussive strokes
MASSAGE TO LEG
MASSAGE TO LEG
Effleurage
Brisk Effleurage


Criss Cross Light Caterpillar
 
Alternating Palm Alternating Palm - Slow



Percussive Movements Gentle Compression - Gentle
Hacking, Pounding, Cupping
 
Calf Stretch - Brisk Calf Stretch - Gentle
 
Calf Shake – Brisk Calf Shake – Gentle
MASSAGE TO BACK MASSAGE TO BACK
Brisk Effleurage Slow Effleurage
 
Criss Cross Criss Cross
 
Alternating Palm Alternating Palm
 
Vibration Vibration

Hacking

Cupping

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Section 4
Sports Massage Professionalism,
Ethics & Legislation
Tel: 020 7700 3777

Massage

84
Government Laws & Regulations
Act Implications
Health & Safety at Work Act 1974 The Act sets out the general duties which employers have towards
employees and members of the public, and employees have to themselves
and to each other.
The Personal Protective Employers have basic duties concerning the provision and use of personal
Equipment at Work Regulations protective equipment (PPE) at work.
1992 (PPE) It includes all equipment (including clothing affording protection against the
weather) which is intended to be worn or held by a person at work and
which protects him against one or more risks to his health or safety’, e.g.
safety helmets, gloves, eye protection, high visibility clothing, safety
footwear and safety harnesses.
The Control of Substances This law protects the individual from the exposure of hazardous
Hazardous to Health Regulations substances in the workplace. Both employer and employee must be aware
(COSHH) 2002 of the potential hazard of some substances and the necessary safety
precautions that must be taken
Reporting of Injuries, Diseases These regulations protect employees and members of the public who may
and Dangerous Occurrences suffer workplace injury and deal with the correct reporting of the incident in
Regulations (RIDDOR) 1995 an Accident Book and if necessary to the Enforcing Authority. Details
should be kept for a minimum of 3 years.
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

85
• legislates to protect children who may be suffering or are likely to
suffer significant harm.
The Environmental Protection The Environmental Protection Act 1990:Part 1 introduced important new
Act 1990 controls aimed at limiting and preventing pollution from a wide range of
industries in Great Britain - from power stations, oil refineries, municipal
and clinical waste incinerators to re-spraying of road vehicles, maggot
breeding and crematoria.
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:
• Impurities in the raw materials.

• Materials used in the preparation of, but not present in, the final product.
• Materials used as solvents or carriers for perfumes and aromatic
compositions.
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

86
Ethics
Ethics are a set of moral principles/rules of conduct that must be followed at all times. They are
usually set by the governing body and are known as “code of ethics”.
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:
1. The practitioner must never discuss clients with other clients.

2. The practitioner must never discuss other massage establishments.
3. Only carry out treatments that are within the professional qualification.
4. Medical diagnosis or treatment must not be made or recommended.
5. Only make honest recommendations about treatments.
6. Respect the work of other members of the profession and the medical profession
7. Honour client’s confidentiality (Data Protection Act)
8. Do not treat clients that are already receiving treatment from another practitioner.
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.
Possible examples of topics to avoid:

1. Religion
2. Politics
3. Money
4. Marriage problems
5. Controversial topics e.g. blood sports, birth control, and abortion.
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:
1. The client must always come first

2. Always listen to the client
3. Ensure that the client is warm and comfortable throughout the treatment
4. Respect the modesty of a client, providing changing areas, screens, robes or towels as appropriate.
5. Respect client’s confidentiality.
6. Happy, relaxed clients are satisfied customers!

87
Professionalism
When carrying out a body massage treatment it is important that professionalism is adhered to at all times. It
is vital for the practitioner; the profession and the success of body massage treatments. It is not possible to
teach anybody how to be professional. It is a skill that is acquired during training and continues throughout
the career. Professionalism comes with experience. However there are guidelines that assist the process.
Standards of Appearance, Professionalism, Dress & Hygiene

Apply professional standards of personal hygiene, dress and appearance
• 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.
Practical Aspects of Hygiene

In Sports Clinic At Sports Event
Wear correct protective clinical uniform Wear correct protective clinical uniform
Use disinfectant to clean the couch after every Use disinfectant to clean the couch after every
treatment. treatment.
Clean own hands and feet of client with Clean own hands (and feet of client if trainers have
antibacterial wash/wipes, both before and after been removed) with antibacterial wash/wipes, both
treatment. before and after treatment.
Use clean, washed laundry – towels and couch Use clean, washed laundry – towels and couch
covers covers
Cover massage table with disposable couch paper Cover massage table with disposable couch paper
(if using a massage table)
Never let the client step on the floor directly – use Never let the client step on the floor directly – use
their slippers or couch paper. their trainers or couch paper.
Cover any cuts with plasters Cover any cuts with plasters
Do not work over any open wounds Do not work over any open wounds
If treating a bleeding injury, wear gloves if applying first aid principles.
Practical Aspects of Waste Removal

In Sports Clinic At Sports Event
Dispose of any couch paper / wipes in a clinical Dispose of any couch paper / wipes in a clinical
waste bin. This is usually marked as such and waste bin/ bag. This is usually marked as such
disposed of separately to household waste. and disposed of separately to household waste.
Possible use of any “sharps” must be disposed of Possible use of any “sharps” must be disposed of
in a “cin bin” (sharps bin). This is destroyed by in a “cin bin” (sharps bin). This is destroyed by
incineration (burning) at waste sites. incineration (burning) at waste sites.

88
Hygiene & Infection
Infections are spread by touch, food and water, droplets in the air, and through cuts, grazes and any other
incisions in the skin, such as an injection by a needle. Although it is almost impossible to create an
environment that is completely sterile, you can reduce the risk of infection by avoiding treatment of people
who have obvious infections.
Infections are primarily caused by:
Type of infection Characteristics How it spreads Examples

Viral Caused by viruses, Virus reproduces inside Common cold
micro-organisms the human cell
Size: very small smaller than bacteria Cold sore (Herpes simplex)
Chicken pox (Herpes zoster)
Wart (verrucae)
Hepatitis A and B
HIV
Bacterial Caused by bacteria, Bacteria reproduce at Skin infections like impetigo

single-celled micro- the site of infection (Staphylococcus aureus)
Size: medium organisms
Throat infections
(Staphylococcus pyogens)
Food poisoning (Salmonella)
Fungal Caused by parasitic Fungus is reproduced Ringworm

growth; includes by spores (Tineapedis, capitis or corporus)
Size: large moulds, rusts, yeasts
and mushrooms Thrush (Candida albicans)
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.

89
Insurance
There are 3 main types of insurance cover relating to a practitioner and the clinic.
Public Liability Insurance

Insurance that covers financial loss caused by an injury to a non-employee that results from the business's
negligence and that occurs on its premises.
Who it covers Employer / Owner

What it covers Financial loss sustained by the injured person (non-employee)
Amount of cover £ 2-5 million
Professional Indemnity Insurance:

Professional indemnity insurance provides cover for claims brought against the policyholder due to their
professional negligence.
Who it covers The practitioner
What it covers Claims made against the practitioner resulting from injury due to treatment
Amount of cover £ 2-5 million
Clinic Insurance
Clinic insurance allows you to cover your premises, contents, stock and equipment.

90
Equipment Checks
It is important to carry out regular equipment checks to ensure cleanliness and hygiene and that current
health and safety requirements are met.
This should include:
• Regular servicing and checking of servicing records

• Check that wires are fully insulated within the plugs
• Check that there are no trailing wires
• Check there is no water in the vicinity of the electrical equipment
• Check the equipment on yourself first, before applying to the client
• PAT testing is carried out on all electrical equipment (usually annually).
Risk Assessments of Equipment & Treatment Areas

Risk Assessment is the process of identifying and documenting actual and perceived risks to human health or
the environment, to allow further evaluation and appropriate responses.
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
When carrying out the assessment, consider:

• whether a risk is high, medium or low
• how to reduce risks by taking precautions
Regular reviews of risk assessment are necessary and are usually done if problems have been identified or
on a monthly – yearly basis.

91
Section 5
Sports Massage Case History Forms
Tel: 020 7700 3777

Massage

92
Guidelines for Case Studies
The Case Studies form an important part of the overall assessment and award given by VTCT (ITEC). On
the day of the practical exam, your case studies will be handed to the examiner who will take them and mark
them.
The case studies will reflect how good a therapist you are by the considerations you give for each
treatment.
The case studies (and assignments) are marked as “PASS” or “FAIL”. If you complete the case studies as
required.
You can find the templates for the Case Studies and Assignments on the following link;
www.londonschoolofmassage.co.uk/intro_sp3.php
1. [Your Name] - Self Profile.pdf

A brief overview of you, your life and what inspires you.
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
5. [Your Name] - VTCT (ITEC) SP L3 Treatment Evidence.pdf
This will consist of 3 x Full treatments + 2 Follow-up treatments
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
6. [Your Name] - VTCT (ITEC) SP L3 Additional Treatment Log.pdf
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
info@londonschoolofmassage.co.uk 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

93
What is Plagiarism?
Before you begin writing your Case Studies and other Assignments, please ensure you read this
section on originality and plagiarism and ensure that the work you submit is your own, or correctly
referenced.
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.
However, according to various dictionary definitions to "plagiarise" means;
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.
The following is considered as plagiarism
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.

94
Exam Enrolment and Submissions
Please find the following rules & conditions of your exam enrolment for your VTCT (ITEC) Exam.
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.
Training Days Dead Exam Week

Line
Learning,
Day Day Day Day Day Day Day VTCT
Home Assignments
7 6 5 4 3 2 1 (ITEC)
and Case Studies
Exam
Late Fees Exam
No Penalties Day
up to £50 Postponed
If you miss, reschedule or are postponed from the Exam
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.

95
Patient Declaration Form
I _______________________________ (patient name) agree to being a case study for
________________________________ (your name) for a minimum of 2 sessions and
understand/agree to the following:
▪ That ____________________________ (your name) is currently a student who is
undergoing training in Sports Massage.
▪ My personal details will be kept on file
▪ All general and medical information provided by me for this case study is true to the best of
my knowledge.
Signed: ___________________________ Print Name: ______________________________
Date: ____________________
You only need to show one BLANK FORM at the front

of the file you are going to submit as a sample to
demonstrate what you would do.
Please keep completed forms at home as this will

comply with the Data Protection Act.

96
GP Confirmation for Contraindications
I _______________________________ (patient name) confirm that I have seen my GP / Specialist
who has given me their verbal / written permission that massage therapy does not form a
contraindications for medical conditions below:
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Signed: ___________________________ Print Name: ______________________________
Date: ____________________
You only need to show one BLANK FORM at the front

of file you are going to submit as a sample to
demonstrate what you would do.
Please keep originals at home as this will comply with

the Data Protection Act.

97
Self Profile
Anything and everything about you … Your Picture
• What you have done Insert a photo; it can be a

• Where you work portrait, family picture –
• What are your Hobbies anything as long as it
contains you.
• What interests you
• Your creative side This will be the Examiners
• How you feel about yourself first impression of you.
• Your family
• Your partner/children
• Pets
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
1. Use Font Size 12

2. Use the supplied template to help understand what to include.
3. You don’t have to use our template, you can create your own. Just
keep it simple, effective and ensure you have included some of the
content we’ve asked for.
4. Try to keep it to 1-page only
5. Your picture should reflect the real you, make it a picture you love, in
an environment of your choice, it can include your family, friends, pets
or just a nice selfie.
This will be the Examiners first impression of you.

98
Sports Massage Therapy Level 3
Student Name:
Exam Date:
Please indicate ….
1st Treatment 2nd Treatment
Pre-event
Post-event
Maintenance

99
L3 SPORTS MASSAGE TREATMENT Case Study
Please complete using CAPITAL LETTERS (This section only) Date:
Name: Birthdate:
Address: ******** Stored Privately *******

Tel No: ******** Stored Privately *******
Occupation:
GP Name: ******** Stored Privately ******* Tel No: ******* Stored Privately ******
Address: ******** Stored Privately *******
Do you suffer from/or have any of the following?

Question No Yes Action Taken (Practitioner Use Only)
Chest Pain?
CARDIOVASCULA
Shortness of Breath?
R
Persistent Coughing?
Palpitations?
Constipation?
DIGESTIVE
Diarrhoea?
Nausea?
Problems passing water (urination)?
URINARY
Burning sensation on urination?

Changes in frequency of urination?
REPRODUCTION
Changes in menstrual cycle?

Pregnant?
Menopausal?
Are you on any prescribed medication?
GENERAL HEALTH
Any major illnesses?

Any major accidents?
Any major operations?
Anything else not mentioned?
EATING HABITS:
FLUID INTAKE:
EXERCISE:
WELL-BEING:
CONTRAINDICATIONS: ___ None Localised to: ____________ _____ Medical Approval Obtained
CLIENTS INITIALS (Not Signature)

To confirm details are true.

100
CLIENT PROFILE
PHYSICAL EXAMINATION
OBSERVATION + PALPATION + BODY ALIGNMENT + POSTURE
OBSERVATION + PALPATION KEY
Symbol/Colour Used Definition/Explanation Symbol/Colour Used Definition/Explanation
e.g. xxxx e.g Tight muscle e.g. **** e.g. Painful knot
101
General Comments (if any)
REASON FOR SPORTS MASSAGE
Indicate reason for the treatment: pre-event, post-event, maintenance, etc.
CLIENT FEEDBACK
Verbal & Tissue Feedback:
HOMECARE ADVICE
✔ Advice / Suggestions Comments
Short-term / immediate effects of the

treatment
Immediate aftercare information provided
Rest and relaxation
Stretching methods and techniques
Healthy eating and info

on balanced diets
Maintaining good levels of hydration and

the importance of re-hydration
SELF-REFLECTIVE PRACTICE & SELF-ANALYSIS
Indicate aspects of treatment which you felt you did well and/or which you felt you could improve
on

102
2nd TREATMENT (if required)
How the Client felt AFTER the last treatment,

Any changes to history?
Did you follow home advice?
ON EXAMINATION / ASSESSMENT
Observation + Palpation (Quick Specific Exam)
TREATMENT GIVEN
HOMECARE ADVICE – Follow up from previous treatment
SELF-REFLECTIVE PRACTICE & ANALYSIS

103
104
Section 6
Sports Massage Exam Information
Tel: 020 7700 3777
londonschoolofmassage Google+ LSM_Massage London School of

Massage

105
Exam Day – Practical Exam
The below is a proposed breakdown of how you should plan your exam time.
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)
5 Mins Homecare Advice

(Relate to presenting problem)

106
Things to Remember – Exam Day
It is our wish that you gain the highest marks possible during the exam, and we hope that’s your
wish too. Please read the following guidelines to help you prepare for your exam day.
 Model for exam
o You cannot use a student who is taking their exam on the same day as you.
o LSM cannot provide a model
 Clip Board (for the Consultation Form)
 Consultation Form with client medical history completed and signed
 Uniform (strictly no branding/markings or logos)
This uniform is compulsory and cannot be changed
o Black Polo T Shirt (not low-cut)
o Black trousers (not skin-tight, not flared, NOT DENIM)
o Black plimsolls (no bare skin, if laced, they must be well tucked in)
o Black socks or tights (to hide any bare skin on the feet)
o Black Head Band or Sweat Band (if you perspire easily)
 Personal Presentation
o Hair
▪ off the shoulders, in a bun, no hair should touch the collar/shoulders
▪ no wispy bits, it should be all slicked back and tucked in
▪ dreadlocks, weaves or extra-long hair must be kept in a hair net/bag
o Minimal make-up
o Short, well-manicured nails, strictly no varnish or false nails
o No jewellery (un-removable jewellery must be taped over)
 Antibacterial wipes (with a closable lid)
 Slippers/Flip-flops for your client/model
 Couch cover / Bed Sheet with Face Hole (Navy blue or Black) (Remove all labels)
 2 x Towels to cover client/model (100 x 150cm, Navy blue or Black) (Remove labels)
 1 x Towel to cover the face cradle (approx. 75 x 40cm, Navy blue or Black (Remove labels)
 Be effective and show you care
o Make sure you demonstrate effectiveness and intent in all techniques
o Look like you care, don’t look blank or bored and don’t look at what the others are
doing … they may be doing it incorrectly.
o Remember to ask your clients if the pressure is ok at least 3 times during the
massage, or at the places your Tutor has instructed you to. Or, if the Examiner is
within earshot of your massage table.

107
Things to Remember – Exam Day
London School of Massage © 2018 All Rights Reserved: VTCT (ITEC) Sports Massage Level 3 108
Example Theory Exam Questions
Marking Criteria
iUSP178 – Sports massage treatments
Practical examination sequence

Once all aspects of the mandatory units have been completed, learners will complete a final internal
practical assessment. This will be observed by the lecturer using the internal assessment forms. The
results will be reviewed by the external examiner on the day of the final external practical examination.
Practical examination – this will be undertaken in the learner’s college environment in the presence of an
external examiner.
Practical examination sequence – approximately 1 hour:
• Main details of the consultation to be carried out prior to the exam
• Sports specific massage
• Pre‐event massage on an area chosen by the external examiner
• Post‐event massage on an area chosen by the external examiner
• Aftercare/home care advice
• Complete consultation form and hand to the external examiner at the end of the treatment
• Oral questions may be asked at any time during the examination
• A consultation form must be filled in for the unit by each learner and made available for the external
examiner to check. These should be reviewed and completed at the end of the treatment and will be
taken away by the external examiner
• Learners will be expected to demonstrate excellent hygiene and client care throughout as well as
competence in their relevant skills
• The external examiner may reduce the treatment timings, as the examination is a demonstration of
the learner’s professionalism and their accomplished technique
• Approximate time allocated for changeover of practical examination groups – 15 minutes
Learners must be able to demonstrate the following:
Appearance – 5 marks (1 mark each)

1. Clean, ironed professional wear, flat shoes/trainers, no visible underwear
2. Clean hair, neat and tied back/up if long and off the collar and face
3. Short, clean, well‐manicured nails with no varnish and clean hands
4. No jewellery – with the exception of a wedding band and 1 pair of small stud earrings (religious
jewellery must be taped)
5. No chewing gum, sucking sweets, body or breath odour
Client care – 5 marks (1 mark each)

1. Greeted and introduced self to client
2. Assisted the client on and off the couch
3. Explained the treatment procedure to the client
4. Ensured the client’s comfort/modesty throughout
5. Maintained a positive and professional approach to client/colleague throughout
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
Sports specific massage – 35 marks (5 marks each)

1. Demonstrated suitable movements to warm the area initially
2. Demonstrated correct posture throughout
3. Demonstrated correctly a variety of sports specific movements
4. Performed the massage in a logical/flowing manner
5. Ensured that client comfort was referred to throughout the treatment
6. Adapted the massage movements and used suitable pressure for the area being treated 7.
Completed the treatment in a commercially acceptable time
Pre‐event massage ‐ 20 marks (4 marks each)

1. Demonstrated appropriate speed of movements to warm the area
2. Demonstrated correct posture
3. Demonstrated a variety of movements/techniques to prepare the area for a sporting activity
4. Adapted the massage movements and pressure to suit the area being worked on 5. Demonstrated a
logical and flowing sequence
Post‐event massage – 20 marks (4 marks each)

1. Demonstrated appropriate speed of movements to cool down the area
2. Demonstrated correct posture
3. Demonstrated a variety of movements/techniques in response to the sporting activity
4. Adapted the massage movements and pressure to suit the area being worked on 5. Demonstrated a
logical and flowing sequence
After/home care – 5 marks (1 mark each)

1. Advised the client of the importance of rest and relaxation
2. Informed the client of short term effects of the treatment
3. Recommended and provided immediate aftercare
4. Advised appropriate stretching techniques
5. Advised healthy eating and re‐hydration recommendations
Sample oral questions – 5 marks

1. What are the contra‐indications to sports massage?
2. Explain the physiological effect of the movement you are performing
3. What are the benefits of sports massage?
4. Which muscles are you working over?
5. What is the origin and insertion of that muscle?
6. Describe the difference between pre and post sports massage.
7. Why is it important to carry out a full consultation prior to sports massage?
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.?

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London School of Massage

“Massage to a Higher level” ©

londonschoolofmassage Google+ London School of LSM_Massage london_school_of_massage

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 1

“To deliver the best training

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 2

No paragraph or photograph in this manual may be copied, photographed, reproduced or

© Bhavesh Joshi (London School of Massage) 2015.

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 3

Bhavesh qualified as an Osteopath from the British School of Osteopathy and

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 4

“Massage to a Higher Level” ©

The following section outlines the VTCT (ITEC) Exam components:

londonschoolofmassage Google+ London School of LSM_Massage london_school_of_massage

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 5

Page 5 Technical Unit Title Grading Assessment

Pass – 60-74% Merit – Practical Examination

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 6

londonschoolofmassage Google+ London School of LSM_Massage london_school_of_massage

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 7

• Organic & inorganic salts

The structure of a typical cell consists of: Centrosome

NUCLEUS – Is the largest organelle of the cell. Is the control centre

MITOCHONDRIA - these are the “POWER HOUSE” of the cell.

LYSOSOMES - contain enzymes that digest and remove particles

VACULOES - these are empty spaces within the cytoplasm. They

Vacuoles are more relevant to plants.

CENTRIOLES - these are paired rod like structures which play an

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3 9

1. Epidermis – Superficial layer

• Melanocytes – give pigmentation to skin.

2. Dermis – Deeper layer

The Skeletal System

Where one bone meets another is called a JOINT.

Synovial joints in the body are held together by LIGAMENTS.

Term Meaning Picture

Antagonist Muscles which act in opposition to the movement

Fixator The fixator in a movement is the muscle(s) that

Synergist A synergist muscle is a muscle that works

TYPES OF MUSCLE CONTRACTIONS

Term Meaning Picture

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3

Isotonic Contraction of a muscle

Isokinetic Isokinetic contractions are

Structure of Skeletal Muscle

Muscle Contraction – Sliding Filament Theory

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3

Thick = MYOSIN (large protein)

STRIATED MUSCLE CONTRACTION - THE SLIDING FILAMENT THEORY

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3

Its connection to the muscle fibres is called the NEUROMUSCULAR JUNCTION.

Motor End Plate

Motor End Plate

PHYSIOLOGY OF MUSCLE CONTRACTION

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3

1. TROPOMYOSIN - a strand entwined around the actin

Troponin is actually three sub-units:

Detailed structure of myofilaments

London School of Massage © 2018 – VTCT (ITEC) Sports Massage Level 3

ACh diffuses across the synaptic cleft within the

The impulse enters the transverse tubules and

Calcium ions combine with troponin, causing the

The nerve impulse also causes ATP ➔ADP + P.

The sliding draws the Z lines towards each other,

Pass – 60-74% Merit – Practical Examination