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11 Sports massage

11 Sports massage

Sports massage is increasingly becoming a feature of the regimes of people involved in sports and exercise activities. Sports massage is used to treat injuries but it can also be used as a part of the pre-exercise warm-up and as a recovery strategy. These are referred to as pre- and post-exercise massage and are carried out by sports massage practitioners who work to the set of industry standards in delivering high quality sessions in a variety of locations.

Sports massage practitioners will often have a clinic or room where they are based but they also travel to people’s homes and are required to work at venues where sports events are taking place. As a result it offers a varied and interesting career.

This unit explores the sports massage profession and looks at what activities are involved in delivering high quality sports massage sessions.

Learning aims The aims of this unit are:

A Understand the sports massage profession B Undertake client consultation and assessment C Carry out sports massage on a sports performer D Examine the importance of sports massage to

the sport and exercise performer.

How will I be assessed?This unit will be assessed by assignments that have been designed internally by your tutors. It is likely that there will be four assignments for you to complete where you will be able to apply the skills and knowledge you have learnt about sports massage.

Learning aim A achievementA vocationally relevant scenario for a sports massage practitioner may be used to set an appropriate context to allow full coverage of the unit content. As an alternative, learners can independently research the relevant working environments, including clinical, non-clinical, events and sports clubs. Learners will produce an extended essay that demonstrates an understanding of the sports massage profession, including industry standards of practice,

professional associations and the role of the sports massage practitioner.

For distinction standard, learners will consider the sports massage standards of practice, including industry and professional association standards, in a variety of sporting environments such as clinical, non-clinical, events and sports clubs. Learners will examine the strengths, weaknesses and significance of the standards, making judgements about their effectiveness. Learners will consider the role of the sports massage practitioner as part of a multi-disciplinary team, exploring the relationship with other professionals who may work as part of the team to support the performer. Learners will draw conclusions about the benefits to the sports massage therapist of working in a multi-disciplinary team. Learners will support their conclusions with well-considered examples. The information presented will be factually correct and use concise written language. Correct terminology and language should be evident.

Learning aim B achievementFor distinction standard, learners will produce written evidence that supports their approach to the consultation and assessment procedures adopted. Learners will need to provide full justification for the treatment plans produced for each sports performer and will use appropriate evidence to support their opinions.

Learning aim C and D achievement For distinction standard, learners will carefully consider the physiological, mechanical and psychological responses to the two sports massages performed. They could explore the advantages and disadvantages of each response and the significance of these. Learners should make judgements and draw conclusions about the relationships between the massage performed and the response(s) received. Learners will use evidence to prove the effectiveness of the treatment and to make future recommendations and considerations for further sports massage treatment. The information presented will be factually correct and use concise written language. The use of correct terminology and language will be evident.

About this unit

Table 11.1 below shows the assessment criteria for this unit. To achieve a pass grade you must meet all the P criteria; to achieve a merit grade you must achieve all the P and all the M criteria; to achieve a distinction grade you must achieve all the P, M and D criteria.

How will I be graded?

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Level 3 Sport and Exercise Science

How will I be graded?

Pass Merit Distinction

Learning aim A: Understand the sports massage profession

P1A Explain the role of a sports massage practitioner, and the relevant standards of practice and professional associations.

M1A Discuss sports massage standards of practice and professional associations using specific examples.

D1A Evaluate the sports massage standards of practice in a variety of sporting environments, and the benefit of working within a multi-disciplinary team.

Learning aim B: Undertake client consultation and assessment

P2B Conduct client consultations and assessments on two contrasting sports performers and formulate safe treatment plans for each performer.

M2B Conduct client consultations and assessments on two contrasting sports performers in a confident and effective manner and produce a safe and effective treatment plan for each.

D2B Justify the consultation and assessment procedure adopted, and both treatment plans produced for the two contrasting sports performers.

Learning aim C: Carry out sports massage on a sports performer

P3C Conduct sports massage treatments appropriately to two contrasting sports performers, ensuring sports massage standards are upheld.

M3C Conduct sports massage treatments in a confident and effective manner to two contrasting sports performers, providing justification for treatments administered.

D3C D Evaluate the physiological, mechanical and psychological responses to the two sports massages performed, justifying the effectiveness, future recommendations and considerations.

Learning aim D: Examine the importance of sports massage to the sport and exercise performer

P4D Explain the physiological and mechanical responses to sports massage.

M4D Discuss the physiological, mechanical and psychological responses to each sports massage, with regards to the requirements of the sports performers, using specific examples.

P5D Explain the psychological responses to sports massage.

Table 11.1 Assessment criteria

A Understand the sports massage profession ( P1A , M1A , D1A )

A1 Industry standards of practice The sports massage industry is required to meet strict standards of practice so that treatments are carried out in safe and hygienic environments. Sports massage involves physical contact between two people meaning that bacteria and germs can be passed on unless measures are taken to prevent them from doing so.

Health and safety

Health and safety is about making sure that people are protected against being injured, harmed or becoming ill in the working environment. It involves following correct, safe procedures and taking precautions to protect everyone within a workplace. Health and safety is defined by a set of laws that apply to employers, employees, managers, all full-time, part-time, paid and unpaid workers and visitors to the workplace.

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11 Sports massage

The aim of health and safety is to identify any hazards and risks in the workplace and do everything possible to eliminate them. To help implement health and safety there is legislation that needs to be implemented.

Health and Safety at Work Act 1974 (HSWA)This is the main legislation that covers health and safety in the workplace and other legislation will come under this act. The Health and Safety at Work Act 1974 (HSWA) says that all employers and employees have a legal duty, as far as is reasonably practical, to ensure the health, safety and welfare of all persons at work. That would include all employees, customers and anyone else who is on the premises. There is particular responsibility on the employer as by law they must provide a safe working environment for all members of the workforce, including those with disabilities and other people using their premises.

Requirements for employersThe employer is required to:

� Provide a safe working environment and recognise hazards or problems and take the appropriate actions to minimise or eliminate them.

� Have a written health and safety policy that sets out how hazards and risks are minimised.

� Assess risks that may arise from work activities.

� Record the �ndings of the risk assessment.

� Consult with employees regarding health and safety issues.

� Provide health and safety information, training and supervision for all employees.

� Keep a record of any problems that have been identi�ed and recti�ed.

All employees are required to:

� Take reasonable care to avoid harm to yourself or to others by your behaviour or working practices.

� Cooperate with and help your employer to meet statutory requirements.

� Refrain from misusing or interfering with anything provided to protect the health, safety and welfare of all persons as required by the act.

To comply with the requirements an employee must:

� Not put yourself or others at risk by your actions.

� Abide by the rules and regulations of the workplace.

� Know who is responsible for what in the workplace and who problems should be reported to.

� Adopt good working practices and follow correct procedures.

� Be alert to any hazard that may pose a risk to yourself and to others and promptly take appropriate action to minimise or eliminate the risk.

� Be competent in selecting appropriate treatments and administering them correctly and safely.

� Follow correct technique for all treatments, understand their effects and be aware of contraindications and contra-actions.

� Adopt high professional standards of dress and appearance.

� Maintain the highest standards of personal and workplace hygiene.

� Report faulty equipment to the person responsible for dealing with the issue.

Employers’ Liability (Compulsory Insurance) Act 1969By law employers are responsible for the health and safety of their employees while they are at work. Employees, or a former employee, may be injured at work or become ill as a result of their work while and they might try to claim compensation from their employer if they believe they are responsible. The Employers’ Liability (Compulsory Insurance) Act 1969 ensures that an employer has at least a minimum level of insurance cover against any claims by an employee or former employee.

Employers’ liability insurance will enable an employer to meet the cost of compensation for an employee’s injuries or illness whether they are caused in the workplace or carrying out their duties outside the workplace.

There is another type of insurance called public liability insurance which covers claims made by members of the public or other businesses, but not for claims by employees.

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more employees need to record the significant findings of the risk assessment. When carrying out a risk assessment you should consider the following:

� safe maintenance, care and use of equipment

� the safe use, handling and storage of hazardous substances

� safe and hygienic working practices

� personal hygiene and hygiene in the workplace

� adequate procedures for dealing with emergencies such as �res and electric shocks

� appropriate temperature, ventilation and noise level.

Manual Handling Operations Regulations 1992 (MHOR)The MHOR requires an employer to assess the risk to employees when lifting or handling heavy goods and to provide training in safe lifting techniques. Before lifting or moving anything the risk can be assessed by answering the following questions:

� How heavy is the load?

� Can the load be reduced?

� Do you have to lift it off the �oor?

� Can you get assistance from another person?

� How far do you have to move it?

An employer must ensure that their employees are trained in correct lifting techniques.

A sports massage practitioner is often required to move heavy equipment, such as massage couches, so knowledge of lifting techniques is essential.

Data Protection Act 1998The Data Protection Act sets out eight protection principles which form the legislative framework with which a data controller must comply. A sports massage practitioner will gain private and personal information about their clients and it is important they are aware of this Act so that they handle the data appropriately.

� Personal data shall be processed fairly and lawfully.

� Personal data shall be obtained only for one or more speci�ed and lawful purposes.

It is compulsory for an employer to have employers’ liability insurance but public liability insurance is voluntary. An employer can be fined if they do not hold current employers’ liability insurance policy.

The Health and Safety (First Aid) Regulations 1981This regulation requires an employer to provide adequate and appropriate first aid provision for employees if they become ill or injured at work. The minimum level of first aid provision in the workplace would include:

� a suitably stocked �rst aid box positioned in an accessible and clearly labelled site

� an appointed person who is able to provide �rst aid.

All employees must be informed of the arrangements for first aid and this is usually part of the induction process. There should also be clear notices in the workplace stating the location of the first aid kit and the identity of the first aider.

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)RIDDOR places a legal duty on employers, and the self-employed to report work-related incidents. Incidents must be reported to the Health and Safety Executive (HSE) or the local authority. By law the following incidents must be reported:

� deaths

� major injuries or poisonings

� any accident where the injured person misses three or more days of work

� injuries where members of the public are taken to hospital

� diseases contracted at work

� dangerous incidents that may have resulted in reportable injuries.

Management of Health and Safety at Work Regulations 1999The Management Regulations generally make it clear what employers are required to do to manage health and safety under the Health and Safety at Work Act. These regulations apply to every work activity.

The main requirement on employers is to carry out a risk assessment. Employers with five or

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and the legal costs of the person making the claim if you are found to be at fault.

MalpracticeMalpractice refers to negligence or incompetence on the part of any professional and in our case a sports massage practitioner. Negligence would include misdiagnosis or selecting inappropriate treatments for a condition.

A sports massage practitioner will need to have both public liability and professional indemnity insurance as cover for the unlikely event that someone will make a claim against you or in the event of an accident in your treatment area. An annual premium of around £120 will provide insurance cover up to £1 million and covers you in case any harm or damage is caused to your client.

Child protection and vulnerable adults

Child protection legislationThere is specific legislation to protect the safety and well-being of children, however, it does differ slightly across the four nations of the UK. In England there is no legal requirement to report suspected child abuse but there are specific guidelines and procedures in place for people who work with children. If this is the case you need to be familiar with these guidelines and procedures and these can be found through the NSPCC website.

SafeguardingThe Police are responsible for protecting children and investigating crimes against them, such as child sexual exploitation and child trafficking. The Police hold information about children who have experienced harm or are at risk of harm. They share information with partners, such as local authorities, who also hold meeting to discuss how they can safeguard vulnerable adults from physical and financial harm.

ChaperoneWhen treating children or people you may consider to be vulnerable adults you could invite a chaperone who acts a witness to any procedures that are taking place. This is an advisable measure in professions, such as sports massage, that are reliant on physical contact.

� Personal data shall be adequate, relevant and not excessive in relation to the purpose or purposes for which they are processed.

� Personal data shall be accurate and, where necessary, kept up to date.

� Personal data processed for any purpose shall not be kept for longer than is necessary for that purpose.

� Personal data shall be processed in accordance with the rights of data subjects under the Act.

� Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of or damage to personal data.

� Personal data shall not be transferred to a country or territory outside the European Economic Area.

Insurance

A sports massage practitioner will need to ensure that they have insurance. This is particularly the case if they are self-employed as if they were employed they would be covered by their employer’s insurance. There are different types of insurance.

Professional indemnityProfessional indemnity insurance is also called professional liability insurance and is needed to cover any costs if you have provided inadequate services or advice that have caused your clients to lose money. It can be used to cover legal costs and expenses and costs of any damages incurred.

Public liabilityPublic liability insurance covers claims made by members of the public who have suffered injury or damage to property in connection with your business. If a member of the public is injured on your property you may be held responsible. For example, a customer might slip on a wet floor. Public liability insurance will pay compensation for loss of earnings, future loss of earnings and damages awarded to the person making the claim as well as your legal costs in defending the claim

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carried around in a case. Selecting an appropriate couch is very important as it should be the correct height for you and an appropriate size to accommodate clients of different shapes and sizes. You will also need to have a couch cover that you can wash. Most couch covers are made of towelling material and have elasticated edges to hold the cover in place.

Towels are needed for use on the couch. You will need at least two towels; one of which will be rolled up and placed underneath the client’s knees for support and the other towel will cover your client for comfort and warmth. Alternately, a bolster cushion can be used under the knees of the client. A third towel can be used to be placed under the client’s head for support when they are lying on their back. Couch roll which is made of tissue is also useful if your clients are likely to be muddy or sweaty as it can quickly be changed between clients.

In order to perform the massage you will need a massage medium such as oil, cream or talcum powder to overcome the friction that is created through the contact of skin on skin. Oils are more commonly used and are usually based on vegetable oils. Essential oils such as lavender can be added to oils as they act as muscle relaxants but you will need to be qualified in aromatherapy to use these types of oils. Creams are used in the same way as oils and both oils and creams are absorbed by the skin, although any excess can be removed used a sports cologne at the end of the massage. Talc is sometimes used as well as some clients prefer it but also it tends not to leave the skin with an oily finish. Some competitions, such as aerobics, do not allow competitors to have any oil on their skin.

Materials are needed to clean the skin of a client prior to the massage and to clean the oil off afterwards. Flannels or paper towels are used in conjunction with sports cologne for this purpose. It is incredibly important to keep your hands clean as well and to wash them between massages. Any dirt on your hands can be transferred to the client and absorbed into their skin as you apply force to the skin. This can lead to rashes and infections. If you cannot wash your hands between massages then use cologne to clean them.

Environment

The environment where sports massage takes place is important to present a professional service and to ensure the privacy of the client. The environment should be comfortable for the client to enable them to relax. This would include the environment being heated to room temperature of around 21 ºC and to have soft lighting to enable the client to relax. The environment should be private as the client may remove clothing and have parts of their body exposed. It should also be secure and free from any interruptions. There needs to be adequate space so that the couch can be positioned in the middle of the room with plenty of space to move around the couch as well as an area for massage oils and any other equipment that is needed. There should be adequate ventilation provided ideally by natural ventilation but air conditioning is also acceptable. Above all the environment needs to be clean and kept clean by regularly wiping surfaces and changing towels and the couch covers.

Sometimes these ideals are not always met as the sports massage practitioner may be working outside of their clinic in a sports venue. They may be positioned in a tent or in a room that has been modified for the purpose. It is still important to maintain hygiene and cleanliness and do what you can to protect privacy and make the client as comfortable as possible.

To ensure safety the sports massage practitioner and the client should know where the first aid kit is located, who is the nominated first aider and the location of the nearest telephone.

The environment should be comfortable, safe, secure, spacious, clean, private, have adequate ventilation, a first aid kit and access to a phone.

Key term

Equipment

The sports therapist does need quite a lot of equipment to be able to deliver a professional service. Firstly, a couch which should be portable as you will need to transport it to sports events. The couch should be able to be folded in half and

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clients and other people you work with about your level of competency and they also act as a professional seal of approval. In order to join a professional association you will have to have a qualification that is approved by the organisation as well as the appropriate types of insurance. You usually have to show that you are regularly engaged in continuous professional development (CPD) to show that your skills and knowledge are continually being updated. You will also be required to adhere to a code of conduct as laid down by that association.

There are several professional associations that cover the sports massage profession.

Associations

Sports Massage Association (SMA)The SMA was founded in 2002 as a response to the confusion in the industry about who was appropriately qualified to deliver soft tissue therapy. The aims of the SMA and the different types of membership can be found at: www.thesma.org/about

Society of Sports Therapists (SST)The SST was founded in 1990 as demand for sports therapists increased and their aim is to continually improve standards in the profession. One of their major roles is accrediting training programmes so that there is parity in the level of service that sports therapists offer. Their aims can be found at: www.society-of-sports-therapists.org/index.php/about_us/background-aims

The British Association of Sport Rehabilitators and Trainers (BASRaT) BASRaT is the UK regulator for graduates in sport rehabilitation and it was founded to ensure that all degree courses were of an equivalent, high standard. It offers a strict code of professional practice and conduct. More information about BASRaT can be found at: http://basrat.org/home/about

Complementary and Natural Healthcare Council (CNHC)The CNHC is a body that provides a voluntary register for complementary therapists who are engaged in delivering therapies such as

Protocol in emergency situations

The sports massage practitioner must be aware of the protocols for emergency situations, such as evacuation procedures and response to fire alarms. The client may not be fully clothed when a building needs to be evacuated and thus the sports massage practitioner needs to consider the quickest way to cover them up before evacuating the building. This can involve using towels or a dressing gown.

In order to present a professional approach the sports massage practitioner needs to ensure that they follow all health and safety procedures. These procedures will ensure that the sports massage practitioner and their clients are operating within a safe and hygienic environment.

Therapists’ conduct

Physical contact is the basis of a sports massage practitioner’s work so appearance and personal hygiene are of the upmost importance. Most sports massage practitioners wear sports-type clothing, such as a polo shirt and tracksuit trousers rather than tunic styled clothing. The most important thing is that you appear well dressed and comfortable enough to perform the physical work you will be undertaking. It is important that your hair is clean and tied back to avoid any contact with the client. While it is important to keep the hands clean at all times, your nails will need special attention as they can harbour bacteria and micro-organisms. Nails should be kept short and clean at all times.

The attitude of the sports massage practitioner will go a long way to determining their success with clients. As far as is possible you should maintain a positive attitude and be professional in every dealing with your client. Professional associations have developed codes of conduct that should be used to guide your behaviour with clients and, in particular, in understanding boundaries and where the boundaries between massage professional and clients lie.

A2 Professional associations Within all professions there are professional associations that will recognise your skills and scope of your competencies. These will tell your

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position it will compress blood vessels and reduce the supply of oxygen and nutrients to the muscle thus affecting their function. Massage and stretching can relax the muscles and allow blood flow to return with the effect of reducing the risk of injury.

Sports massage plays a role in enhancing athletic performance partly because it helps prevent injury but also because it promotes the recovery of muscles. Massage can help to remove waste products of metabolism after exercise and increase the supply of oxygen and nutrients that are required to promote the healing and recovery of muscles.

Sports massage can help to improve flexibility and mobility that are needed in most sports for optimum performance. Flexibility and mobility are often compromised by muscle tension and short, tight muscles. Massage will help to relax muscles and make them more responsive to flexibility training. A sports massage practitioner will also be proficient in assisted stretching techniques which will improve flexibility, range of motion at joints with a beneficial effect on athletic performance.

Referral to other practitioners

The sports massage practitioner must always be aware of the scope and limit of their skills. They need to be totally clear about what they can actually offer to a client and when they find a condition or injury that is beyond the limit of their skills, then they will need to refer that client on to another practitioner who will be able to offer the client the appropriate treatment. This is why the sports massage practitioner needs to work within a network of medical professionals.

Give a detailed account of the role of the sports massage practitioner, the relevant standards of practice that they need to adhere to, and professional associations they may wish to belong to. Then use specific examples to discuss how standards of practice will influence the role of the sports massage practitioner and specific examples of how professional associations benefit their practice.

Activity: Understand the sports massage profession

Alexander Technique, Reiki, Bowen Technique and Aromatherapy. It also acts as a register for sport therapists and more information can be found at: www.cnhc.org.uk/

Federation of Holistic Therapists (FHT)The FHT claims to be the largest and leading professional association for therapists in the UK. It offers therapists professional status and supports their work by offering insurance and seminars/workshops for professional updating. More about the FHT can be found at: www.fht.org.uk/

A3 Sports massage practitioner role The aim of the sports massage practitioner is to provide safe and effective massage treatments that will meet the needs of the clients they are working with.

Role

The sports massage practitioner will understand anatomy and physiology and particularly the musculoskeletal system. They will also be knowledgeable about the physical, physiological and psychological effects of massage. In particular, they will be able to apply massage techniques to all parts of the body to treat injury and dysfunction.

The sports massage practitioner will deliver pre-event massage to provide a passive warm-up. The main aims of pre-event massage are:

� to boost circulation rapidly

� to increase blood �ow to muscles

� to warm an area

� to stimulate circulation and increase the supply of nutrients and oxygen to muscles.

(Paine, 2015, p. 151)

Post-event massage is done as soon after a competition as possible with the aim of removing excess fluid from muscles to aid the speed of recovery (Paine, 2015) and to prevent blood pooling in muscles.

Sports massage also plays a role in injury prevention. This is because it helps to maintain healthy, functional muscles. Massage can work to relax muscles that have become shortened and tight. When a muscle remains in a tight, contracted

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assessment and different techniques to adjust vertebrae. Both treat similar conditions.

PhysiotherapistPhysiotherapists help to restore movement and function to people who have been injured or ill. They use techniques such as heat and cold and ultrasound as well as manual therapy or aquatic techniques to relieve pain and promote recovery. They are involved in treating patients during the early or acute stage of injury and then during their recovery. They may use movement and prescribe exercises for their patient. They often work with sports massage practitioners in the recovery phase as the sports massage practitioner may be more proficient in the use of massage.

General practitioner (GP)GPs are needed if you find that a client has a contraindication to massage that would need GP clearance before you can treat them. Also, you may suspect that a client has a medical condition that may be contributing to their injury and that they would benefit from consulting with their GP.

RadiographerA radiographer will take X-rays of the body and will be needed if you suspect that there is a fracture to a bone or need confirmation of the severity of damage to soft tissue.

Sports psychologistA sports psychologist can help with the rehabilitation of a sports performer as they may experience anxiety during their period of injury. This may arise from worry about losing their place on a team or performing at the same level after recovery as they were before they were injured. There can also be anxiety about putting themselves back into the situation where they were injured. For example, a rugby player may worry about fully committing to a tackle after they had been injured tackling.

Sports scientistYour client may be working with a sports scientist to improve their performance and you may need to gain information from them about the type and intensity of training they have been involved in prior to the injury. You would also be able to advise

The role of the sports massage practitioner as part of a multidisciplinary team (Distinction content)

As mentioned before, the sports massage practitioner needs to be aware of the limitations of their skills and be aware of who they can refer their client to if they need treatment beyond what they are able to offer. A sports massage practitioner is able to apply massage which involves the manipulation of soft tissue (muscle, fascia, tendons and ligaments) to the benefit of individuals involved in physical activity. The aim of sports massage is to assist in correcting problems with soft tissue that have been caused by trauma or repetitive strain. In particular, sports massage is used before and after exercise to enhance performance and aid recovery.

Due to the specific role that a sports massage practitioner plays they need to work in a network with other professionals who can deal with other types of conditions. This network is referred to as a multidisciplinary team because it takes professionals from a range of other disciplines to work together to cover all treatments that a sports person may require. The multidisciplinary team will include the following professionals with specific skills.

OsteopathAn osteopath is involved in manipulating tissue and bones with a particular focus on the neck, back and lower back. They believe that injury and pain are caused when vertebrae move out of correct alignment causing imbalances. They will use manipulation techniques to treat the cause of pain rather than focus on the symptoms. They work to achieve correct alignment in the vertebrae and will treat conditions such as sciatica, whiplash and headaches caused by neck pain.

ChiropractorChiropractors are very similar to osteopaths in that they are involved with musculoskeletal problems and focus on the neck and back and the correct alignment of the vertebrae. Chiropractors use adjustments to the spine which involve gentle manipulation of vertebrae. They are very similar to osteopaths but they use different methods of

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1 Identify four requirements of an employer under the Health and Safety at Work Act 1974.

2 Explain two types of insurance a sports massage practitioner must hold.

3 Describe an appropriate environment for sports massage treatments.

4 Identify four pieces of equipment a sports massage practitioner requires.

5 Describe the role of the sports massage practitioner in treating injuries.

6 Explain why it is important for the sports massage practitioner to work as part of a multidisciplinary team.

7 Describe how a sports massage practitioner would work with a physiotherapist.

8 Describe why it would be important to have a sports psychologist as part of the multidisciplinary team.

A Check your understanding

Evaluate the sports massage standards of practice by examining the strengths and weaknesses of the standards and give your opinion of their effectiveness based on the strengths and weaknesses. Then explain how the sports massage practitioner can be involved as part of a multidisciplinary team and the benefits that this network of professionals could bring to them.

Distinction activity: Understand the sports massage profession ( D1A )

B Undertake client consultation and assessment ( P2B , M2B ,

D2B )

B1 Assessment Assessment refers to what happens before any massage is applied. It will involve developing a client history and the physical assessment. The aim of the assessment is to reach a conclusion about the needs of the client. This initial consultation is as important as the treatment itself, and an accurate record must be kept along with details of the subsequent physical examination.

the sports scientist about how to take the next stages of your client’s recovery and what state the injured area is currently in.

NutritionistNutritionists are very useful in the recovery period as the quality of your client’s recovery will be directly affected by the quality of the nutrients that they are consuming. Sports people tend to follow strict diets and there can be a tendency for injured sports people to move away from these diets and eat in a less healthy manner. However, it is important that they are still eating top quality nutrients as these nutrients are going to be the building blocks that are used to repair the damage that has been caused.

In order to achieve distinction criteria (A.D1) you need to show knowledge of the industry standards of practice. These standards include the legislation that covers sports massage practice, such as the Health and Safety at Work Act 1974, RIDDOR and MHOR. You need to be aware of the different types of insurance and what they cover. In particular, you need to be able to evaluate the environment that the sports massage practitioner is working in and how they conduct themselves when providing treatments. You can evaluate this by providing examples of good and bad practice and suggesting how an ideal sports massage practitioner would operate within their environment.

You will also need to look at the network of professionals who would be involved as part of a multidisciplinary team and the relationships between them. You need to be clear about the scope of the sports massage professional’s activities and the benefits to them of referring their client to other professionals. It is very beneficial to work with other professionals as just as you refer clients to them so they will refer clients to you. If you deem that a client needs to be treated by a physiotherapist or osteopath in the early stages of their recovery, there is a very high chance that they will be referred back to you once the client has left the acute stage of their injury treatment. This is described as a reciprocal relationship where you do something for a fellow professional and they return this by doing something for you.

Meeting distinction criteria

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� What is your presenting problem?

� When did this injury occur?

� How did this injury occur?

� Did the injury occur immediately or gradually?

� Where are you experiencing pain?

� How would you describe the symptoms, e.g. dull ache, sharp pain?

� Has there been any swelling, redness or increased temperature?

� Are there any factors that are making this injury worse?

As part of the initial consultation, you need to ask the client to sign an informed consent form so that they are aware of what to expect from the treatment and any associated risks. Figure 11.1 provides an example of a form you could use to record the details gained from the subjective assessment.

Subjective assessment

The questioning of a client is known as the subjective assessment. It enables the sports massage practitioner to build up a picture of the client’s current issues, their medical history and what they aim to achieve from treatment.

The initial stage is to gain personal details about the client. You would ask questions about the following:

� date of birth

� occupation

� past medical history (previous injuries and illnesses)

� any current medical conditions

� any medication currently being taken

� current activity levels and lifestyle history

� client aims.

Then you need to know specific details about their current injury or condition. You could do this by asking questions such as:

Name: __________________________________ Occupation: ________________________________________________

D.O.B:_____________________________________________________Age: ____________________________________

Address: _______________________________________________________________________________________________________________

Eve: _________________________________

Height: ______________________________

Mob: ___________________________

Weight: _________________________

Frequency/intensity: ___________________

Tel: Day:_______________________

Gender:_______________________

Sport played:___________________

GP name/address:________________________________________________________________________________________________________

Medical history:__________________________________________________________________________________________________________

Present complaint: _______________________________________________________________________________________________________

History of injury: ________________________________________________________________________________________________________

I confirm that the information I have given is accurate to the best of my knowledge and I have not withheld anydetails. I accept that I will receive sports massage therapy at my own risk.

Signed: _______________________ Date: ______________________________________________________

Therapist signature: __________________________________________Print name: ____________________

Notes – physical assessment

Figure 11.1 Assessment form

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can be also be caused by overtraining the pectoral muscles and not balancing training with work on the back muscles.

Kyphosis refers to an exaggerated thoracic curve resulting in rounded shoulders.

Key term

LordoticA Lordotic spine is one where the lumbar curve becomes exaggerated. This is usually caused by additional weight in the abdominal area, such as during pregnancy or the development of a ‘beer belly’. A person with lordosis will have abdominal muscles that are stretched and weak and erector spinae muscles that are tight and this results in lower back pain.

Lordosis refers to an exaggerated curve in the lumbar region.

Key term

ScoliosisScoliosis is a spinal condition characterised by an s-shaped spine and it can be caused by a birth defect. A person with scoliosis will present with shoulders that are at uneven heights and a pelvis that is higher on one side than the other. Scoliosis can also be caused by the development of musculature on one side of the body, for example in one-sided sports like tennis.

Scoliosis occurs when the spine is curved in an s-shape.

Key term

Flat backA flat back is a condition where the lumbar curve is reduced and it looks like the lower back has become flat. It is usually caused by the hamstrings becoming shorter and tighter and producing the effect of pulling the pelvis back. Often people in sedentary jobs will develop a flat back if they sit in a slumped forwards position.

Objective assessment

The objective assessment is the physical part of the assessment and allows you to gather as much information as you can about your client’s physical condition. It will involve observing the client in a standing position and then testing the range of active motion in specific joints.

The first part is to perform a postural assessment which involves the client being dressed in undergarments so that you can observe the shape of their spine and the position of their pelvis. Figure 11.2 shows the normal spine position and common postural problems.

Normal Kyphosis Lorosis Scoliosis

Figure 11.2 Common postural problems

Postural problems will often result in pain because there is additional strain on certain muscles and irregular stresses on intervertebral discs.

AsymmetricalSpinal asymmetry is a condition where there is slight curvature of the spine. It needs to be monitored as it may develop into the s-shaped characteristic of scoliosis.

KyphoticA kyphotic spine is one that is characterised by a rounding of the upper back or an exaggerated thoracic curve. The shoulders will be rounded as the shoulders joints have moved forwards. There are many causes of kyphosis and often people who work sitting down develop this ‘shoulder slump’ due to them leaning forwards when they work. It

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A posterior pelvic tilt occurs when the pelvis rotates backwards causing the front of the pelvis to move behind the bottom of the pelvis.

Key term

Lateral pelvic tiltA lateral tilt is a condition where one side of the pelvis is higher than the other side. It can be the result of scoliosis of the spine or of a leg length discrepancy.

Palpations of area

Palpation refers to using touch to assess the condition of soft tissue, in particular muscle. Spinal conditions and pelvic tilts will be accompanied by changes in the condition of muscles. With practice you will be able to identify muscles that are tight, or holding muscle tension, and muscles that are weak by touch. Firstly, you need to have a good knowledge of surface anatomy to know exactly where muscles are located and secondly, you need to develop skills by using your sense of touch to identify any particular issues.

Range of active movement

Another method of gaining information about the condition of the musculoskeletal system is to use joint range of movement tests. Firstly, you will need to know the appropriate range of movement at joints and then be able to move a client’s joint safely through the range of movement. For example, you would expect to be able to stretch the hamstrings muscles to a position where there is an 80º angle at the hip joint. If the joint could not move to this position we would be able to identify that the hamstring muscles were shortened.

Understanding of consultation and assessment findings should be confirmed in order to develop safe and appropriate treatment plans, applying professional standards at all times.

B2 Treatment plan Once the subjective and objective assessments have been completed the sports massage practitioner can develop the treatment plan.

Pelvis tilt The pelvis is joined to the vertebrae through joints and its position will be influenced by the position of the spine. Therefore, postural issues will affect the pelvis as well as the spine. Figure 11.3 shows the neutral position of the pelvis where the front point (anterior superior iliac spine) and the bottom points of the pelvis (pubis symphysis) are in line. However, the pelvis can rotate forwards to create an anterior tilt or backwards to create a posterior tilt.

Neutral Anterior tilt Posterior tilt

Figure 11.3 Positions of the pelvis

Anterior pelvic tiltAn anterior pelvic tilt occurs when the top of the pelvis moves forwards in relation to the bottom of the pelvis. It is usually caused when the hip flexor muscles become strong or shortened and the hamstring muscles become lengthened and weak. It is also associated with lordosis where there is an increased load at the front of the body.

An anterior pelvic tilt occurs when the pelvis rotates forwards causing the top of the pelvis to move in front of the bottom of the pelvis.

Key term

Posterior pelvic tiltA posterior pelvic tilt occurs when the top of the pelvis moves backwards in relation to the bottom of the pelvis. It is usually caused by the hamstring muscles becomes shortened and tight and the hip flexor muscles becoming lengthened and weak. It is associated with flat back where the lumbar curve is lost.

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The above conditions need a medical opinion and the client should be advised to see their GP. Other contraindications include:

� Pregnancy – Care should be taken if the client is experiencing nausea and vomiting. Massage of the back and abdomen must be avoided during the �rst 16 weeks of pregnancy as friction could promote miscarriage. In the later stages of pregnancy, massage of the lower limbs may reduce swelling and aid relaxation in areas such as the upper back and shoulders.

� Other medical conditions – Clients presenting with a medical history of cancer, diabetes, tuberculosis, multiple sclerosis or other serious medical conditions should be advised to gain medical clearance from their doctor prior to treatment.

AimThere should be a clear aim to the treatment plan and this aim should be agreed with the client as being the best way to approach treatment for the client’s issue. This aim should inform everything that the sports massage practitioner does and the treatments they provide.

Type of treatmentThe sports massage practitioner will decide the type of treatment that they will proceed with to meet the aims of the treatment plan. At this point they may also consider whether their client would benefit from the services of other professionals. The specific treatments that a sports massage practitioner can offer will be covered in Section C.

Benefits and effectsThe aim of sports massage is to restore normal function to the musculoskeletal system. Massage should therefore be an integral part of every athlete’s pre- and post-training and competition routines. The general benefits of massage fall into three specific categories: mechanical, physiological and psychological.

Mechanical benefits to the athlete are:

� stimulation of soft tissues

� stretching of soft tissue to improve �exibility

There are many considerations to take into account when developing the plan.

Clinical reasoning and planning

The first issue for the sports massage practitioner to consider is whether the client has any contraindications to massage. Under certain circumstances, conditions may be present that sports massage may make worse so should not be carried out. These conditions are collectively known as contraindications. Contraindications to sports massage include the following conditions:

� A body temperature over 100 degrees Fahrenheit, or feeling unwell – These symptoms suggest a period of illness, and as massage improves circulation, it may also spread toxins and potentially make the condition worse.

� Skin diseases and disorders – The skin may become in�amed due to allergies or medical conditions such as eczema and psoriasis. Infections can be recognised by swelling, redness, pain and heat. Massage can cause further irritation and may spread the infection through the client, on to the therapist, or even to a subsequent client.

� Vascular diseases – Phlebitis is the in�ammation of veins, and can often accompany a blood clot called a thrombosis. The clot may be disturbed by massage causing a blockage elsewhere in the blood vessels of the heart, lungs or brains, all with serious consequences. Caution should be taken if there is swelling, increased temperature and pain in the calf muscles. If a clot is suspected, urgent medical attention should be sought. Attempts to massage an area where varicose veins are present could also cause further damage and pain.

� Recently injured areas – The site of an injury may be acutely in�amed with swelling, heat, redness, pain and probable dysfunction. Massage may act to disturb the healing process, thus making the condition worse by increasing circulation and therefore causing further swelling.

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Explanation to performerIt is most important that all points of the treatment plan are communicated and discussed with the client to ensure that they know what to expect and that they are happy with the planned outcomes.

Criteria for proceeding with treatment

Once the sports massage practitioner has completed their assessment they can make the decision whether they will start treatment or whether they need to refer their client to a GP for medical clearance. They will use a set of criteria to base this decision on. Criteria will include:

� Client shows pain-free movement patterns.

� Client is free from disease.

� Client does not have aches and pains that are not injury-related.

� Client has areas of scar tissue or areas of tension or tightness.

� Client needs sport performance enhancement.

� Client’s tissue is non-pathological.

� Client shows no modifying contraindications.

Need for referral

However, in the interests of health and safety of the client, it is necessary to refer the client if the client shows contraindications, such as the following:

� red �ag symptoms such as dizziness, drowsiness, headaches and nausea

� pathological tissue, such as cancer or arthritis

� client is a child or vulnerable adult wanting treatment without a chaperone

� global contraindications (conditions where no massage should ever be applied) including cancer, thrombosis and circulatory disorders

� local contraindications (conditions where massage could be applied but clearance from the client’s GP is needed prior to treatment)

� breaking down scar tissue

� correction of posture and limb alignment to improve body awareness

� reducing tension and associated pain

� reducing soreness and pain after an activity.

Physiological benefits to the athlete are:

� improved circulation via stimulation of the sympathetic nervous system to increase the supply of oxygen and nutrients to the injured tissue, thereby promoting healing

� improved circulation to remove waste products from the soft tissues via the lymphatic system

� improved circulation to reduce swelling post-injury

� sedative effect on the parasympathetic nervous system to reduce tension, induce relaxation and relieve pain

� stimulation of the nervous system to prepare the muscles for activity.

Psychological benefits to the athlete are:

� promoting relaxation

� creating a sense of well-being

� increasing con�dence pre-competition.

Treatment durationThe duration for each treatment needs to be factored into the treatment plan. A sports massage treatment will usually last one hour. This provides time for the sports massage practitioner to consult with the client, prepare the client, apply the massage and then provide any appropriate stretching that is needed.

Massage techniques and considerationsThe treatment plan should show which massage techniques are going to be used during the period of treatment. This will depend on the type of condition being dealt with and the stage of the condition.

MediumThe treatment plan will show which medium is going to be used for the massage treatment. The choice is between oil, cream or talc.

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Select two clients who should be sports performers from two contrasting sports. Then complete subjective and objective assessments on each sports performer and produce a treatment plan for each. The treatment plan should show the following information:

• full personal details on each sports performer

• findings from objective assessments

• any contraindications to massage

• the aim/s of the treatment plan

• schedule of treatments and the content of each treatment.

Activity: Undertake client consultation and assessment

Once the activity to achieve B.P2 and B.M2 has been completed, justify the consultation and assessment process by explaining why you conducted them in the manner that you did and what you were trying to achieve. Then explain why you have planned the treatment plans in the way that you have and how it will meet the aims of the sports performers.

Distinction activity: Undertake client consultation and assessment ( D2B )

C Carry out sports massage on a sports performer ( P3C , M3C ,

D3C D )

Once the treatment plan has been established, it is time to start applying massage techniques. There are several different massage techniques that are applied depending on what conditions the sports massage practitioner is presented with.

C1 Massage application Different massage techniques will be applied depending on the aim of the massage and the timing of the massage in relation to activity.

� where the level of expertise needed exceeds boundaries of the sport massage practitioner

� when the area to be treated has in�ammation present

� client shows co-existing pathology, where there is more than one condition present.

In order to achieve distinction criteria B.D2, you will need to have produced two treatment plans that take into account all the criteria that will influence how they are developed. This will include the clients’ medical histories and the information gained from both the subjective and objective assessments. You should fully consider the results of the postural assessments and the observations you made about the pelvic tilts of either client. If you find any contraindications you need to fully explain why it is a contraindication and what further steps you will take before considering treating the client.

Once you have considered all these factors you can then establish aims for the treatment plans and then justify the treatments that you have selected in light of the needs of the clients and any conditions they are presenting with.


1 Identify four pieces of information that you would gain from a subjective assessment.

2 Explain what kyphotic, lordotic and scoliotic postures would look like.

3 Identify the difference between anterior and posterior pelvic tilts.

4 Explain which muscles would be short and tight and which muscles stretched and weak in a client with an anterior pelvic tilt.

5 Identify three contraindications to massage.

6 Explain four benefits of massage.

B Check your understanding

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will help to move fluid and waste products away from muscles and introduce fresh blood that contains oxygen and nutrients needed for repair and recovery. The final part of the post-event massage should be stretching to return muscles to their original length and reduce any tension being held in the muscles.

Maintenance massageA maintenance massage is designed to keep the soft tissue of a sports person in condition so that they can reach peak performance. Massage will ensure that the blood flow to muscles is maintained and that any areas of tightness, or trigger points, are eliminated. The aim is to keep the muscles in the best possible condition and less prone to injury.

Injury prevention massageMassage for injury prevention has the aim of keeping soft tissue in good condition and promote recovery from exercise so that the risk of overuse injuries, caused by repetitive trauma, is significantly reduced. Massage and stretching techniques will also help to avoid imbalances in muscle strength between antagonistic muscle groups and between limbs. This will decrease the risk of muscular strains and tears.

General maintenance massageA general maintenance massage would have the same aims as a maintenance massage but would be applied to the whole body rather than focus on specific areas that are at risk of injury.

Massage techniques massageThere are a range of sports massage techniques that can be used in different types of massage and to achieve different outcomes.

Effleurage massageEffleurage involves applying a variety of stroking movements and is usually used at the beginning and end of a massage. It can be applied with varying degrees of pressure and is broken into light and deep stroking. Light stroking is performed with the whole hand, keeping the fingers together and with the hand relaxed. The speed and pressure will vary as the massage proceeds. The initial light stroking enables the

Types of massage

Pre-event massageA pre-event massage will act as a passive warm-up and so will mimic the effect of a warm-up. The aim of the pre-event massage is to increase the flow of blood to muscles, to improve the mobility of joints and ensure muscles are ready to move through the range of movement required in the activity to follow.

The pre-event warm-up will be done between 30 minutes to 1 hour before the event and form a part of the warm-up rather than replace it. The massage should be performed in a fairly vigorous, upbeat way as the sports massage practitioner is helping to energise the sports person rather than relax them. Relaxing muscles can inhibit the stretch reflex and lead to potential injury.

Techniques that can be used in the pre-event massage include effleurage, petrissage, vibration and tapotement as well as some stretching and mobility work.

Post-event massagePost-event massage can be performed after competition or even after individual training sessions. The timing of the massage will be between 30 minutes and 24 hours after the activity. The aim of the post-event massage is to help the sports person in their recovery after exercise and to help repair any damage that has occurred to soft tissue during the activity.

The aims of a post-event massage are as follows:

� aid venous return and prevent blood pooling in muscles

� remove excess �uids and waste products that have accumulated in muscles

� reduce muscle tension in muscles that remain contracted after exercise

� mentally relax the sports person after competition.

The most effective techniques to use post-event are effleurage and petrissage. It is very important to avoid deep tissue or applying too much pressure as it may increase damage that has been done to muscles during activity. Effleurage and petrissage

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squeezing with the forefinger and thumb prior to release. Once the tissue is released, blood returns to it, bringing with it the essential oxygen and nutrients for healing. This technique also aims to mobilise tissues and reduce tension, promote lymph drainage and encourage relaxation.

Petrissage involves the compression and relaxation of muscle tissue.

Key term

Figure 11.5 Petrissage

Frictions massage – linear, cross fibreFrictions are small movements over a localised area using the pads of the fingers or thumbs. Unlike other techniques they are often used where there is little soft tissue, such as the elbows, knees and ankles. Considerably more pressure is applied than during petrissage.

The action is initiated by bracing with the heels of the hands, then holding the thumbs steady and moving the fingers in a circular motion. The fingers do not move across the skin but they do move the skin across the deeper tissue. By increasing the pressure you can stimulate the deep muscle tissue and the breakdown of recently formed scar tissue by separating adhesions between repaired muscle fibres. There can be a degree of discomfort but only for a short time. The aims are to stimulate blood flow, separate adhesions, minimise the effects of scar tissue, promote flexibility and promote healing.

therapist to spread the oil and identify tension in the muscle, even starting to relax the muscle. Gradually more pressure is applied, with the aim of assisting fluid flow through the tissue spaces, vessels and veins. The movement should occur up the limb towards the superficial lymph glands which can be found in the groin, back of the knee and the armpit.

Pressure should be consistent throughout a stroke, but can be increased by placing one hand on top of another or using the heel of the hand, finger pads or thumbs. The aim is to relax and sedate initially, then to stretch tissues, increase flow and drainage, reduce swelling, reduce pain by nerve stimulation, and remove waste products.

Effleurage involves applying stroking movements.

Key term

Figure 11.4 Effleurage

Petrissage massagePetrissage, which is also known as kneading, involves the basic movement of compressing and then releasing tissue. Direct pressure is performed in a circular motion using the palm of the hand to compress muscle tissue on to underlying structures. More localised pressure can be applied using the fingertips, thumbs and even the elbows. The next stage is similar to kneading but is known as ‘picking up’ as it involves lifting the tissues up perpendicular to the underlying tissues then

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Figure 11.7 Tapotement

Tapotement involves striking the skin to promote circulation.

Key term

Compressions massageCompressions involve the direct application of pressure into a muscle. The muscle is compressed against bone that is underlying the muscle. Compressions are applied when a muscle is in spasm or a trigger point has developed. A trigger point is an area of high tension in a muscle where fibres have contracted and then failed to relax.

Compressions involve applying direct pressure into muscle tissue.

Key term

Vibrations massageVibrations massage is often used to finish off a massage. It involves the therapist supporting a muscle with one hand and vibrating the other hand from side to side as they move up and down the muscle. This aims to stimulate the muscle, and to promote blood flow and increase flexibility.

Most frictions are applied in a cross fibre manner, meaning that the fingers move across the muscle fibres. However, they can be applied in a linear way meaning that the fingers move along the length of muscles fibres.

Figure 11.6 Frictions

Frictions involve applying high amounts of pressure across soft tissue.

Key term

Tapotement massageTapotement is also known as percussion and can be divided into cupping and hacking.

Cupping involves the sports massage practitioner making a cup shape with their hands and, with the palms down, they strike the muscle making a dull thud, which should sound different from the slap of a flat palm. Moving the hands rapidly up and down the muscle has the effect of improving superficial circulation and stimulating the muscle.

Hacking has a similar effect and involves the sports massage practitioner using the outside of their hands with the palms facing each other to strike the muscle, usually targeting the larger muscles such as the quadriceps.

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the type of technique being applied. The prone position (face down) is used to massage the back and the backs of the legs. It also gives the sports massage practitioner access to the muscles of the arm. The client will lie in a supine (face up) position when massage is being applied to the fronts of the legs (quadriceps) and the chest and abdominal areas. Side lying is used to apply compression techniques to the gluteal muscles and when massaging the iliotibial band (outside of the upper leg). A seated positon is used at times to massage the neck and shoulders but also during pre-event massage when the sports massage therapist wants to avoid the relaxation effect of the client.

Body positioning

The sports massage practitioner needs to consider their own body position during the massage. In particular, they need to maintain good posture during every massage. This will ensure that they are comfortable but will also help to delay tiredness and conserve energy. Good posture will mean that the sports massage practitioner will be able to effectively apply the forces needed during the massage in the most energy efficient manner and this is important if they need to perform several massages over the course of a day.

Good posture for massage would involve the sports massage practitioner keeping their back straight and then slightly flexing the hips and knees. The feet should be reasonably far apart. This position will also help them to transfer their weight when applying long massage strokes. A final point is that the arms and hands should be relaxed and should mould to the contours of the client’s body as they move across their skin.

Legalities

The sports massage practitioner should ensure that they keep records on every massage that they conduct and store any information that they have about a client in a safe, locked place. They must also ensure that the client has given their informed consent for their treatments and that they have the appropriate public liability and professional indemnity insurance in place at all times.

Vibrations massage involves applying vibrations across muscle tissue.

Key term

C2 Considerations for treatment When applying sports massage techniques you should always ensure that your techniques are safe and effective and that the client is comfortable throughout the treatment. This section examines factors that need to be considered when sports massage techniques are applied.

Techniques

There is a suggested sequence of massage techniques that start with the more superficial techniques and then progress to the deeper techniques. The suggested order of applying techniques is as follows:

1 ef�eurage

2 petrissage

3 frictions

4 tapotement

5 compressions

6 vibrations.

The massage session is often completed with some stretching techniques. When applying techniques the sports massage practitioner must pay special attention to applying them in the appropriate direction with the correct depth of pressure and speed of movement. Different muscle groups may require different sports massage techniques depending on their condition, with muscles showing tension requiring deeper application and greater pressure. The medium, oil, cream or talc, should be decided by the sports massage practitioner and client. The choice will depend upon the type of massage being performed, with oil being the medium most commonly used but it is not always appropriate for pre-event massage due to the oily residue it leaves on the skin.

Client position

The position that the client assumes is dependent on the area of the body being massaged and

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communicative so feedback could be delayed until before the next massage treatment.

Contraindications

Contraindications to sports massage were covered in Section B2 but it is also not advisable to apply sports massage when soft tissues are in their acute stage of healing. This means when an injury, such as a muscle tear or ligament strain, has just occurred as massage could cause more damage to the area. Also, massage should not be applied when there is an open wound, recent bruising or burns.

The treatment plan should be modified if the client states that they have developed a condition that is classified as a contraindication or if any massage treatment results in a deterioration in the condition of the client.

1 Explain how a pre-event massage would differ from a post-event massage.

2 Identify the aims of a post-event massage.

3 Explain how sports massage can help prevent injury.

4 Explain why you would use effleurage at the start of a massage.

5 Explain why you would use vibrations at the end of a massage.

6 Identify three conditions when it becomes inadvisable to apply sports massage.

C Check your understanding

Using the two selected contrasting sports performers that you prepared treatment plans for, conduct sports massages on each one. The massages must comply with standards for sports massage and you must provide justification for the massage treatments that you administered.

Distinction activity: Undertake client consultation and assessment ( P3C , M3C , D3C D )

Adverse reactions

The sports massage practitioner should check for any adverse reactions to their massage treatments. In particular, they should check for any rashes which may be due to an allergic reaction to the medium used for the massage or the result of the client’s pores being infected with dirt or bacteria. They should also check for erythema, which is a redness of the skin, and occurs when there is any injury to the skin, or it has become infected or inflamed.

Aftercare advice

The client will only gain the best outcomes from their massage if they adhere to aftercare advice. In particular, it is important that the client rests to allow the body to repair the damage that has been caused by exercise as massage will have promoted the recovery effect. Keeping hydrated by drinking additional fluids is also important as massage can be dehydrating to the body and the body will need water during its recovery.

If erythema continues then it may be necessary to treat it using anti-inflammatory medication but it is best to consult your GP if this is the case. The treatment may have other effects on the client in that they may feel excessively tired or even light headed after the massage and this makes it even more important to rest and relax immediately after the treatment. It may be appropriate after the massage treatment to suggest additional stretches that the client could conduct on their own as this will maintain the suppleness of joints and muscles. The damage done to muscles during exercise can result in small areas of scar tissue and tightening of muscles so stretching is advisable to maintain the range of movement of joints.

After a massage treatment the sports massage practitioner may wish to gain feedback from the client about the effectiveness of the massage and which techniques they felt provided the most benefits to them. However, immediately after a massage the client may feel very relaxed and not

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deep in the muscle, the depth and pressure of the massage needs to increase. Using heavier pressure in the effleurage technique and petrissage will stimulate blood flow in muscles.

Sports massage will also help to increase the flow of lymph away from the area being massaged and move it towards the heart. This will decrease the amount of fluid in the area. Again, effleurage and petrissage will produce this effect.

Improving local area metabolismMetabolism refers to the rate of energy production taking place and massage will increase the metabolism within a muscle. Energy is needed to fuel recovery processes within soft tissue so recovery will be accelerated. Increased metabolism is due to the increase in the amount of oxygen and nutrients that are delivered to soft tissue with each massage stroke.

Tissue permeabilityDeep massage strokes, such as those used during effleurage and petrissage, causes the pores in tissue membranes to open up and become more permeable. This means that fluids and nutrients can pass through more easily. Increased permeability means that waste products, such as lactic acid, can be removed more quickly and the muscles can take in oxygen and nutrients more efficiently.

Removal of waste products and promoting recoveryDue to the increased permeability of tissues and the removal of lymph from the area, waste products will be removed more quickly when massage is applied. As a result the rate of recovery is increased.

Autonomic, sympathetic and parasympathetic nervous system

The autonomic nervous system controls internal organs, such as the heart, digestive system and respiratory system, and how they function. The sympathetic and parasympathetic nervous systems are the two parts of the autonomic nervous system with the sympathetic nervous system being activated when the body becomes stressed and is ready for action. A pre-event warm-up will

Meet Paul HoeyPaul is a self-employed sports massage therapist. He has qualified with a Diploma in Sports Massage (L4) and works at a clinic alongside other professionals, including a sports physiotherapist, an osteopath and an acupuncturist.

Paul’s work involves him working closely alongside the physiotherapist who refers clients to him to apply sports massage techniques to a variety of clients. He also has his own clients who are mainly active sports people who need to have massage treatments on a maintenance basis or when they develop injuries.

Paul also works as the massage practitioner for a part-time football team. He attends their training sessions on Tuesday and Thursday evenings and matches on Saturday. He offers pre- and post- exercise massages at training and on match days for those players who want it. As he is also qualified at first aid he acts as the first aider and is available to deal with any on-field injuries that occur. While this work does not pay very well it provides Paul with excellent opportunities to develop his experience of sports massage and he finds that some of the injured players will come to the clinic for further treatment.

1 What challenges do you think a sports massage therapist faces in their work?

2 Do you like the idea of working in different locations and environments?

Case study

D Examine the importance of sports massage to the sport and exercise performer ( P4D , P5D ,

M4D , D3C D )

D1 Physical effects The physical and mechanical benefits should be discussed in relation to massage techniques and sports performers from a contrasting range of sports, using specific examples.

Benefits

Stimulating blood and lymphatic flowThe circulation of blood into muscle tissues may be improved as a response to sports massage. In order to stimulate the blood vessels that are located

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are relieved of their tension, they increase their flexibility, allowing joints to move through a greater range of motion.

Range of motion can be improved by using stroking techniques such as effleurage and petrissage.

Breakdown of adhesionsAdhesions are small painful bumps that appear in muscles as a result of repetitive strain and long-term muscle tension. Repetitive strain on a muscle shortens muscle fibres that become adhesions and affect how muscle fibres contract, causing limited flexibility. These affect the function of a muscle and increase its chances of becoming injured.

Adhesions need massage techniques that apply heavy pressure to a muscle, such as the use of frictions and compressions.

Mobilise muscle fibresMuscle fibres lose mobility due to spasms (high level of tension) adhesions and scar tissue. Muscle spasms are the body’s response to pain and provide a protective mechanism resulting in increased muscle tension. Effectively the muscle takes up a contracted position so it can no longer contract. Massage can help to relax the muscle fibres and thus increase its mobility.

Muscle spasms need massage techniques that apply heavy pressure in specific points, such as frictions and compressions. These techniques can release the muscle contraction and return function to the muscle.

Reducing and remodelling scar tissueScar tissue forms in a muscle as a result of a muscle tear. In the early stages of muscle repair scar tissue is laid down to re-join the two ends of the torn muscle. These areas of scar tissue can remain in muscle and act as weak spots in the muscle where injury may reoccur.

Cross fibre frictions can be used to break down scar tissue and separate muscle fibres that have adhered together.

Improve kinaesthetic awarenessKinaesthetic awareness refers to how the brain controls the movement of limbs and knowing

activate the sympathetic nervous system and help to redistribute blood flow to the muscles. It will also produce dilation of blood vessels within the muscles to improve blood supply within muscles.

The parasympathetic nervous system will become activated to relax the body and produce muscle relaxation. Taking tension out of muscles is one of the aims of a post-event massage.

Muscle stimulationWhen a muscle becomes short and tight the nervous supply to the muscle can become disrupted causing it to not be stimulated effectively. As massage returns the muscle to their relaxed state the stimulation to the muscle can return.

Lymphatic drainageStroking movements, such as effleurage and petrissage done with gentle pressure will promote the natural drainage of lymph from soft tissue. As lymph drains away it takes with it waste products and reduces the amount of fluid in an area.

Reduction in delayed onset of muscle sorenessMuscle soreness after exercise is caused by an accumulation of fluid in areas of muscle where micro tears have occurred. The micro tears are caused when overload is applied to muscles during training and fluid will build up in the area of damage over the next 48 hours. This fluid increases the pressure within muscle tissue and there is an increased pressure on the nerves within muscles which causes pain to be sensed in muscles. It is called delayed onset of muscle soreness (DOMS) because fluid will build up slowly and pain will not be felt immediately after exercise but gets worse and worse over the following 48 hours. Post-event massage, using effleurage and petrissage will have the effect of reducing the amount of fluid within muscles and delaying DOMS.

D2 Mechanical effects Benefits

Improve mobility and range of movementSports massage that produces muscle relaxation can also result in an increased range of motion in joints. This is because, as the muscles relax and

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� more calmness

� increased self-con�dence.

To promote relaxation and the reduction of anxiety, it is preferable to use the more gentle massage techniques. In particular, effleurage can have a relaxing effect on the mind and the muscles. Techniques using higher amounts of pressure may cause the client to become tense and for the muscles to go into spasm to protect against pain.

Techniques

Explanations of massage techniques are given in section C1.

Application to sport – the physical, mechanical and psychological effects of sport massage (Distinction content)

It is fair to say that all sports people would be able to benefit from sports massage; however, some sports people may be able to benefit more. For example, athletes who compete and train at high intensities, such as weight lifters, rugby players or sprinters, will produce very intense muscle contractions and produce muscle damage in every session that they complete. As a result of the muscle damage (micro tears), they will accumulate fluids in the muscle and need to have long periods of rest before training again. Sports massage techniques, such as effleurage and petrissage, can help to flush away the accumulated fluid and waste products, as well as delivering fresh blood and nutrients to enhance the healing process. Due to the high intensity of training the muscles will be contracting almost completely to provide the force needed and this can result in muscle tension, spasms and reduced flexibility so techniques, such as frictions and compressions, can help to smooth out the muscles and relieve areas of muscle tension to return normal function.

Endurance athletes, such as runners, cyclists and rowers, will produce muscle contractions over a long period of time and can become susceptible to overuse, repetitive strain injuries. These types of activity can result in a shortening of muscles with resulting pain and loss of function. Effleurage, petrissage and stretching can improve the flexibility of muscles and ensure that the range

exactly where your limbs are located. Massage removes ‘blocks’ from muscles, such as scar tissue, adhesions and spasms, meaning that nervous impulses travel more efficiently towards and through muscles. This will improve sensory awareness of the location of limbs.

All massage techniques, particularly effleurage and petrissage, will help to improve kinaesthetic awareness.

Techniques

Explanations of massage techniques are given in section C1.

D3 Psychological effects Despite the potential of being painful sports massage should be pleasurable and lead to a relaxed mental state. Due to the close relationship between the muscular and nervous systems it is difficult to achieve muscular relaxation without accompanying it with mental relaxation. Mental relaxation results in fewer nervous impulses being transmitted to muscles and thus a reduction in muscle activity. Anxiety causes increased muscle tension and an increase in energy expenditure. While the control of anxiety in relation to sports performance is an issue for sport psychologists, the sports massage practitioner has a role to play, particularly in helping a sports person relax after an event.

The main psychological benefits of sports massage are summarised as follows:

� enhanced cognition, emotion and performance behaviour

� decreased feelings of exhaustion

� reduced stress

� enhanced emotional well-being

� improved body awareness

� pain reduction

� relaxation

� reduced anxiety

� promote recovery

� psychological preparation

� reduction in pain

� improved mood

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11 Sports massage

to train harder and more often thus potentially improving performance.

All sports people will benefit from the psychological effects of massage and the benefits that relaxing after exercise can have on the recovery process.

of motion in joints in retained. Repetitive strain on muscles can lead to adhesions being formed in muscles affecting how they contract and relax and frictions and compressions can be used to eliminate adhesions and restore normal function to the muscles. Sports massage will also accelerate the recovery process and allow endurance athletes

In order to achieve distinction criteria in this unit, you initially have to work hard to learn and practise sports massage techniques and then be able to apply these to two sports performers. You will also have to be competent in delivering the sports massage in terms of how you position your client and how you make them comfortable during the massage. Your posture and position during the massage are also important and you will need to practise these.

Once you have completed the two sports massages you will need to assess whether the sports performers have gained physiological, mechanical and psychological benefits from the massages. This can be done by performing tests such as mobility/range of movement tests and by asking each sports performer for feedback. Once you have gained as much feedback as possible, you should evaluate the responses by looking at their advantages to the sport performer and if there are any disadvantages in their response to sports massage. Once you have weighed up the advantages and disadvantages of the sports performers’ responses to sports massage, you can come to a conclusion about its effectiveness and then consider how you could improve the massage by providing future recommendations for yourself.


1 Explain why it is beneficial that massage promotes blood flow to muscles.

2 Explain how sports massage promotes recovery from exercise.

3 Explain how adhesions are created in muscles and which sports massage techniques can eliminate them.

4 Explain the relationship between massage and relaxation.

5 Identify four psychological benefits of sports massage.

D Check your understanding

Task 1 Produce a document for the two sports performers that explains the physiological, mechanical and psychological responses of sports massage.

Task 2 Using the two sports performers that you performed sports massage on, use the document you produced in Task 1 to gain feedback from each one about the extent to which they gained the responses that they wanted for their sports performance.

Then produce a report that discusses the responses to sports massage that each sports performer experienced and how they meet the requirements of their sports.

Activity: Examine the importance of sports massage to the sport and exercise performer

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Sports Injury Clinic

www.sportsinjuryclinic.net/treatments-therapies/sports-massage/sports-massage-benefits-effects

Sports Massage Association

www.thesma.org/

Massage Therapy 101

www.massagetherapy101.com/massage-techniques/sports-massage.aspx

Sports Massage

http://sportsmedicine.about.com/od/injuryprevention/a/Sports_Massage.htm

eOrthopod

www.eorthopod.com/

Useful websites

Paine, T. (2015). The Complete Guide to Sports Massage. Bloomsbury, London.

Reference

Assess the extent to which each sports massage has produced the potential responses by completing tests such as range of motion tests and tests to establish the function of muscles. Also, gain feedback from each sports performer about the effectiveness of the sports massage and whether they think they have gained the expected responses to the sports massage.

Once you have gathered as much information as possible, evaluate the responses to sports massage by looking at the advantages and disadvantages of each sports massage to the sports performers and come to a conclusion about the effectiveness of sports massage for each sports performer.

Then write a report that justifies the use of sports massage for each sports performer and also provides recommendations for the future about the type of massage they need and how your sports massage techniques could be improved.

Distinction activity: Examine the importance of sports massage to the sport and exercise performer D3C D

Biel, A. (2014). Trail Guide to the Body. Book of Discovery, Boulder, USA.

Cash, M. (2014). Sports and Remedial Massage. Ebury, London.

Johnson, J. (2012). Postural assessment. Human Kinetics, Champaign.

Norris, C.M. (2007). The Complete Guide to Stretching. Bloomsbury, London.

Paine, T. (2015). The Complete Guide to Sports Massage. Bloomsbury, London.

Further reading

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