Learner name:

Learner number:

H/506/9010

VRQ

USP49

Conduct complex assessment for sports massage

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Statement of unit achievement

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USP49Conduct complex assessment for sports massage

The aim of this unit is to develop the knowledge, understanding and skills to be able to undertake complex assessments on clients for sports massage. This will include identification of neural conditions, postural and gait analysis, range of movement testing, isometric tests and special tests (specifically to identify ligamentous and neural problems). Yellow flags and their potential impact on prognosis and the importance of urgent medical referral for red flags will also be addressed.

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GLH

Credit value

Level

Observation(s)

External paper(s)

42

7

5

5

0

On completion of this unit you will:

Learning outcomes

Conduct complex assessment for sports massage

1. Be able to undertake assessment of sports specific postures and gait

2. Be able to conduct complex assessment methods for sports massage

3. Be able to devise a sports massage treatment plan from information gathered

4. Understand neurological presentations

5. Understand sports specific posture and gait

6. Understand the principles and practice of complex assessment methods for sports massage

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

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

6. Tutor/Assessor guidance Your tutor/assessor must adhere to the ‘Assessment Guidance and Evidence Requirements’ for this unit. This can be found under documents on the relevant qualification page at www.vtct.org.uk. You will be guided by your tutor/assessor on how to achieve learning outcomes and cover ranges in this unit. All outcomes and ranges must be achieved.

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

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Evidence requirements

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

2. Simulation Simulation is not allowed in this unit.

3. Observation outcomes For Learning Outcome 1 competent performance of Observation outcomes must be demonstrated on at least one occasion. For Learning Outcomes 2 and 3 competent performance of Observation outcomes must be demonstrated on at least five occasions on a minimum of 5 clients. Assessor observations, witness testimonies and products of work are likely to be the most appropriate sources of performance evidence. Professional discussion may be used as supplementary evidence for those criteria that do not naturally occur.

Achieving observation outcomes Achieving range

Achieving observations and range

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

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

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

The range section indicates what must be covered. Ranges should be practically demonstrated as part of an observation.

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

4

Tutor/assessor guidance

Your tutor/assessor must adhere to the ‘Assessment Guidance and Evidence Requirements’ for this unit. This document will give guidance for the tutor/assessor on breadth and depth of content that must covered in this unit. This can be found under the documents tab on the relevant qualification page at www.vtct.org.uk.

Learning outcome 1

Observations

You can:

Observation 1 Optional OptionalDate achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

*May be assessed by supplementary evidence.

Be able to undertake assessment of sports specific postures and gait

a. Carry out gait analysis

b. Interpret findings identifying strengths and areas for improvement

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Learning outcome 2

You can:

Be able to conduct complex assessment methods for sports massage

a. Carry out subjective assessments of clients

b. Obtain consent for objective assessment

c. Carry out objective assessments of clients

d. Analyse subjective and objective findings

e. Complete clinical reasoning forms

f. Record clients’ information in accordance with professional practice requirements

g. Store clients’ information as legally required

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Observation 4 5 OptionalDate achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

Observation 1 2 3Date achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

*May be assessed by supplementary evidence.

Observation 4 5 OptionalDate achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

Observation 1 2 3Date achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

*May be assessed by supplementary evidence.

Learning outcome 3

You can:

Be able to devise sports massage treatment plans from information gathered

a. Devise treatment plan

b. Explain rationale for chosen massage strategies

c. Present massage strategies and rationale to clients

d. Obtain consent to treatment

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Range

*You must practically demonstrate that you have:

Carried out complex assessment on all joints of the body Portfolio reference

Ankle

Knee

Hip

Shoulder

Elbow/wrist/hand

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Achieving knowledge outcomes

Developing knowledge

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

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

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

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

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

*This is not an exhaustive list.

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Knowledge

Learning outcome 4

Understand neurological presentations

You can: Portfolio reference

a. Describe the pathways of peripheral nerves

b. Define the characteristics of: • dermatomes • myotomes

c. Explain the organisation of dermatomes

d. Describe common causes of neurological damage

e. Describe common peripheral neuropathy patterns

f. Describe presentations that warrant neurological testing

g. Describe the pathophysiology of common neurological injuries/soft tissue dysfunction

h. Explain the importance of referral for neurological testing

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Learning outcome 5

Understand sports specific posture and gait

You can: Portfolio reference

a. Explain the phases of the gait cycle

b. Outline the different methods used to analyse gait

c. Describe foot deformities and their effects on gait

d. Describe gait abnormalities

e. Explain how postural deviations can effect sporting performance

f. Understand the principles of sports specific posture analysis

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Learning outcome 6

Understand the principles and practice of complex assessment methods for sports massage

You can: Portfolio reference

a. Critically evaluate the range of complex assessment methods used to gather information: • subjective • range of movement (active, passive) • resisted (isometric) • postural analysis • special tests (ligamentous, neural)

b. Explain yellow flags and their potential impact on prognosis

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

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

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Learning outcome 1: Be able to undertake assessment of sports specific postures and gait

Unit content

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

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Gait analysis: Walking (front, rear, side view), base width, swing width, step length, stride length, abnormalities, pelvic tilts, pelvic hitch, movement in the lumbar spine, hip, knee and ankle, pronation, supination, strike.

Interpret findings: Identify abnormalities, propose cause, analyse outcomes of objective testing, understand aetiology, strengths, areas for improvement, plan intervention, referral if necessary.

Learning outcome 2: Be able to conduct complex assessment methods for sports massage

Carry out subjective assessments: General information (name, address, age, sport, hobbies, GP, occupation), body mapping chart (type and area of symptoms, depth, quality, intensity, abnormal sensation, relationship to symptoms), history of presenting condition (mechanism of injury, behaviour of symptoms, aggravating and easing factors, severity, irritability) and nature (mechanical, neural or chemical), 24 hr behaviour patterns, pain scales, daily activities, stage of condition, previous medical history (contra-indications, red flags, pre-existing conditions, genetic conditions), medication.

Obtain consent: Prior to and during assessment, verbal, written, practitioner explains nature, purpose, risks and alternatives of test/s, opportunity to refuse, boundaries of consent.

Carry out objective assessment: Informed consent, subjective information informs tests to be carried out, range of movement (active, passive), resisted

(isometric), postural analysis, special tests (ligamentous, neural, labral, cartilage).

Analyse findings: Analyse response to questions, interpret and explain responses, analyse findings from objective tests, combine results to form working hypothesis, inform treatment planning.

Complete clinical reasoning forms: Carry out clinic reasoning to form working hypothesis, review conclusion, consult with others as required.

Record information: As required by professional organisations, insurers, legislation, record consent, record chaperone details (if appropriate), subjective information, objective testing results, treatment plan and changes to plan, treatment findings, aftercare.

Learning outcome 3: Be able to devise sports massage treatment plans from information gathered

Devise treatment plan: Select appropriate techniques, meet clinical aims and objectives, meet patient aims and objectives, to be agreed with patient, work towards short, medium and long term goals, may involve other healthcare professionals.

Rationale: Indications for use of techniques, meet clinical aims and objectives, meet patient aims and objectives, meet short, medium and long term goals, agreement with patient.

Present strategy and rationale: Information given to patient to obtain informed consent, justification of treatment plan, remove misconceptions, ensure treatment meets patient’s expectations, ensure understanding and preparation of patient for treatment, introduce equipment, massage medium, positioning, patient instructions.

Obtain consent: Prior to and during treatment, verbal, written, practitioner explains nature, purpose, risks and alternatives of treatment, opportunity for patient to refuse or modify treatment, boundaries of consent, consent of chaperone if appropriate.

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Learning outcome 4: Understand neurological presentations

Pathways of peripheral nerves: Brachial plexus, median nerve, radial nerve, ulnar nerve, lumbosacral plexus, sciatic nerve, common peroneal nerve, superficial and deep peroneal nerve, femoral nerve, saphenous nerve, tibial nerve, sural nerve.

Characteristics of dermatomes: Dermatome map, sensory nerves cells, dorsal root, glove and stocking.

Characteristics of myotomes: Myotome map, motor nerves, ventral root.

Organisation of dermatomes: Dermatome map, pathway from peripheral limb to nerve root to spinal cord.

Common causes of neurological damage: Autoimmune diseases i.e. multiple sclerosis, lupus, Guillain Barré syndrome, cancer, compression, trauma, diabetes, motor neurone disease, nutritional deficiencies, toxic substances, stroke, infection i.e. Hepatitis C, Lymes disease, HIV, ischemia.

Common peripheral neuropathy patterns: Mononeuropathy, carpal tunnel, axillary nerve palsy, sciatica, polyneuropathy, diabetic neuropathy, multiple mononeuropathy, neuritis.

Presentations warranting neurological testing:

Motor nerves – unexplained weakness, muscle atrophy, fasciculation, paralysis, partial paralysis, decreased reflexes, foot drop.

Sensory nerves – decreased sensation of peripheral limbs, paresthesia, numbness, tingling, prickling, pins and needles, dysesthesia, hypersensitivity, burning.

Common neurological injuries/soft tissue dysfunction:

Pathophysiology of ankle/foot – Morton’s neuroma, metatarsal stress fracture, posterior tibial nerve pathology, syndesmosis sprain, retinaculum inflammation, deltoid ligament sprain/rupture, lateral ankle sprain/rupture.

Pathophysiology of knee – sprain/rupture medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, patellofemoral syndrome (chondromalacia patellae), anterior meniscal horns, medial meniscus, lateral meniscus, posterior horns of menisci, osteoarthritis, Bakers cyst, fat pad inflammation.

Pathophysiology of hip – osteoarthritis/joint lesion, stress fracture neck of femur, anterior/posterior sacroiliac ligaments, labrum tear.

Pathophysiology of shoulder – acromioclavicular joint injury, inferior instability, labral tear, anterior/posterior dislocation, glenohumeral laxity/subluxation, adhesive capsulitis.

Pathophysiology of elbow – osteophytes, ulnar (medial) collateral ligament, radial (lateral) collateral ligament, elbow avulsion medial apophysis.

Pathophysiology of wrist and hand – collateral ligament sprains, proximal interphalangeal and distal interphalangeal ligament strains, Volkmann’s contracture, Dupuytren’s contracture.

Pathophysiology of back and neck – whiplash, torticollis, ankylosing spondylitis.

Learning outcome 4: Understand neurological presentations (continued)

Importance of referral for neurological testing: Radiating pain and/or paresthesia upon objective assessment, aggravated by objective testing, does not fit a specific peripheral nerve pattern, always refer

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Learning outcome 5: Understand sports specific posture and gait

Phases of gait cycle: Stance phase, swing phase, heel strike, foot flat, mid-stance, heel-off, toe-off, mid-swing.

Methods to analyse gait: Visual (observation), recording, (motion capture, electromyography, electrogoniometry, apps), pressure mats (in shoe sensors, force plates).

Foot deformities: Pes cavus/planus, hammer toes, claw toes, club foot, rear foot varus/valgus, equinus, plantar-flexed first ray.

Effect on gait: Altered gait patterns, altered biomechanics, altered weight distribution, altered stride length, reduced speed, instability.

Gait abnormalities: Hemiplegic, spastic diplegic, neuropathic, myopathic, Parkinsonian, choreiform, ataxic (cerebellar) and sensory, antalgic shuffling, high stepping, ataxia, scissor.

Postural deviations: Pigeon chest, barrel chest, myofascial body reading e.g. anatomy trains, Schleips slings, Zink patterns.

Effect on sporting performance: Reduced speed, reduced performance, increased risk of injury, biomechanical

inefficiency, increased fatigue, increased muscular tension, reduced stability.

Principles of sports specific posture: Unilateral dominance, movement efficiency, result of sports technique or repetitive performance, correction may impact performance.

if positive straight leg raise, slump or Valsalva test.

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Learning outcome 6: Understand the principles and practice of complex assessment methods for sports massage

Complex assessment methods:

Subjective – recognising radiating pain and parathesia patterns (for dermatomes, common peripheral neuropathies), palpation.

Range of movement – active, passive, resisted, spine (gross movements only, not segmental).

Postural analysis – barrel chest, pigeon chest, myofascial body reading e.g. anatomy trains, Schleips slings, Zink patterns.

Special Tests – ligament testing, labral testing, cartilage testing, impingement (trapped peripheral nerve), dislocations.

Dermatome assessment of sensation – sharp/soft, hot/cold, light touch, C3-T1, L1-S2, myotome assessment of weakness (positioning, application of resistance, C3-T1, L1-S2).

Special tests per joint area (list is not exhaustive):

Ankle – draw test (anterior and posterior ligaments), Morton’s test, Syndesmosis sprain (squeeze test), Talar tilt (inversion, eversion).

Knee – valgus stress, varus stress, anterior drawer test, posterior drawer, patellofemoral grind test, Clarke’s test, forced hyperextension, McMurrays test, Apley’s grind test, Apley’s distraction test.

Hip – passive circumduction, Faber’s test, fulcrum test, anterior distraction test, posterior distraction test (Hibbs test), slump test, straight leg raise, spine section, valsalva.

Shoulder – compression (Scarf) test,

Sulcus sign, O’Brien’s labral test, apprehension test (anterior and posterior dislocation), acromial clavicular (AC) spring test.

Elbow – passive repeated extension, valgus stress test, varus stress test, posterolateral rotatory draw test, ulnar nerve test, median nerve test, radian nerve test.

Wrist and hand – Allen test, Tinel’s sign, metacarpophalangeal and interphalangeal ligament stress tests (passive rotation, distraction, compression), valgus and varus stress tests.

Critical evaluation: Validity, reliability, sensitivity, specificity, accuracy, strengths and weaknesses, value of using tests in tandem.

Yellow flags: Psychosocial indicator of potential long term disability/pain, severe or increased pain at presentation, previous pain episodes, multiple pain sites, belief that pain and activity are harmful, catastrophic thinking, passive coping strategies, high levels of distress, low or negative moods, social withdrawal/dysfunction, problems at work, poor job satisfaction, overprotective family or lack of support, assessment methods for yellow flags.

Potential impact on prognosis: Care to avoid unnecessary or inappropriate referrals, care to avoid increasing patient anxiety, balance between ruling out serious conditions and over assessment.

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Red flags: Potentially serious conditions requiring urgent medical assessment (cauda equina syndrome, saddle anaesthesia, thoracic pain, severe worsening pain, unexplained weight loss, history of cancer, age over 55 or under 16, unremitting night pain, bilateral symptoms, neurological deficit, reduced anal tone, bladder retention, deformation of the spine).

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

Clinical reasoning process: Process by which clinical decisions are made, amalgamation of assessment outcomes, mechanism of symptoms, contributing factors, precautions and contra-indications, research of condition, creation of working hypothesis, treatment plan.

Stages of problem solving: Problem recognition, problem definition, analysis, generation of solution, alternatives, selection of best option, evaluation of results, reflective practice.

Learning outcome 6: Understand the principles and practice of complex assessment methods for sports massage (continued)