The School of Natural Therapies
Training School for Massage & Holistic Therapies
ITEC Sports and Remedial Massage
ITEC Level 3
Submitted by: Khaleem Ash
- Understanding legislation required in sports massage.
- Understanding scope of practice in sports massage
- Understanding the standards relevant to the sports massage profession
- Understanding the principles of professional practice in sports massage
- Understand how to produce, maintain, and store client records.
- Explain how current legal obligations relate to the sports message therapist.
One important characteristic of a healthcare profession is the dedication of its members in providing a service to the patients they care for. At a sports message therapy, the law demands Health, Safety, Hygiene and Protection.
As a Massage Therapists in UK, you must abide by the laws and regulations put in place by the government and must accept the obligations and responsibilities to act in accordance with the ideals and standards laid out by other governing laws and regulation.
Each Therapists must adhere to the highest standards of conduct in attending to the needs of their patients/clients and must embraces the belief that the ideals, standards, and principles contained in the Standards of Conduct, Performance and Ethics must be always adhered.
Any Member who violates any of the ideals, standards, or principles, may be subject to disciplinary action led by the local government bodies.
The Standards of Conduct, Performance and Ethics (2012) incorporate and include the generic Standards of Conduct Performance & Ethics of the Health & Care Professions Council (HCPC).
Standards of Conduct, Performance and Ethics (“the Standards”)
Your duties as a massage therapist:
- You must always act in the best interests of your patients/clients.
- You must always respect the confidentiality of your patients/clients.
- You must always maintain high standards of personal conduct.
- You must provide relevant information about your conduct, competence, and health.
- You must always keep your professional knowledge and skills up to date.
- You must act within the limits of your knowledge, skills, and experience and, if necessary, refer the matter to another professional.
- You must maintain proper and effective communications with patients/clients and other professionals.
- You must obtain informed consent to give treatment (except in an emergency).
- You must effectively supervise tasks you have asked other people to carry out.
- You must keep accurate patient records.
- You must limit your work or stop practising if your health affects your performance or judgement.
- You must behave with integrity and honesty and ensure that your behaviour does not damage the public’s confidence in you or your profession.
- You must deal fairly and safely with the risks of infection.
- You must follow published and accepted guidelines for the advertising of your services. 15. You must ensure that your behaviour does not damage the reputation of Sports Therapy
There are a handful of laws which must be followed including:
The Health and Safety at Work Act (1974) provides the comprehensive underlying legal framework to encourage, promote and maintain high standards of health and safety. To ensure businesses are actively achieving this, a therapist must:
-Complete risk assessments
-Provide hygienic facilities
-Report and record injuries as appropriate
-Have appropriate insurance cover
These aspects all promote health and safety which is a main legal requirement of any organisation.
Manual Handling Operations Regulations (1992, amended 2002) draws attention to musculoskeletal disorders caused by manual handling, lifting, repetitive strain disorders and unsuitable postures. The Operations Regulations outline measures which should be taken to reduce these disorders. When working as a Sports Massage Therapist (SMT), it is essential to minimise the risk of handling injuries. A SMT must be able to discuss the law as well as future lifting techniques to reduce future injury.
Health and Safety (First Aid) Regulations (1981) regulates that there must be appropriate first aid treatment, along with a first aider always, in the event of an emergency. The minimum first aid provision includes:
-A fully stocked first aid kit
-An appointed individual to take charge of the first aid kit
-Clear indication as to where the first aid kit is located
This meaning a mobile SMT would need to be a fully qualified first aider, along with carrying their own first aid kit.
Data Protection Act (1998) regulates the processing, usage and storage of personal data recorded electronically or on hard copy. The Information Commissioner’s Office (ICO) ensure that all data is used and stored ethically, as well as being kept confidential. SMT organisations will most likely have to register with the ICO, as they work with many external clients and process personal data in both paper and electronic formats. SMT client records must be:
-Stored for 8 years if the client is an adult
-If the client is a child, it should be kept until their 25th birthday- 26th birthday if the client was 17 when treatment ended
-If on paper, should be secured immediately after use and not left out
-If stored electronically, should be password protected and have back-up systems with the same security strength.
Employers’ Liability (Compulsory Insurance) Act (1969) ensure there is appropriate insurance covering accidents, or ill health.
Control of Substances Hazardous to Health Regulations (2002) ensures employers must take precautions against the risk of hazardous substances. This includes checking both the therapist and client aren’t allergic to any substances which may be found within any lotion used during the massage.
- Explain the importance of having a chaperone present when working with children and vulnerable adults.
To effectively manage professional boundaries, a massage therapists must understand and appreciate the innate power imbalance that exists between a child/Vulnerable person. A therapists have a duty of care to ensure that the interaction between the client and the therapist is based on plans and outcomes that are therapeutic in intent.
Having a chaperone or a guardian in the room not only safeguards the child/vulnerable person, but the Therapist against any allegations of inappropriate behaviour.
A child is anyone under the age of 18 and the definition of a vulnerable is either a minor or someone who, for physical or mental reasons, is unable to look after themselves or their finances.
Given that we know there could be an increase in cases once restrictions are removed and to comply
To acknowledge a patient’s vulnerability and to ensure a patient’s dignity is always preserved. A chaperone may assist with patients as required. Providing emotional comfort and reassurance to a patient.
When working with Children and the vulnerable adults the responsibilities of a therapist are both legally and is a common law ‘duty of care. A therapist must adhere to – acknowledge the patient’s vulnerability and ensure their dignity is always preserved.
Knowledge of and practice within relevant legislation (Children’s Act 1989, Protection of Children Act 1999, Safeguarding Vulnerable Groups Act 2006. Some parents / guardian may request a same gender therapist.
Children’s Act 1998: The purpose of this act is to protect from harm and neglect during any services provided to and for children. Being usually weaker, smaller or in vulnerable situations, children’s physical, mental and emotional well-being is of higher concern.
Safeguarding Vulnerable Adults Groups Act 2006: If the chaperone is not present this must be recorded on the clinic notes. There is a statutory duty to for people working with children to register and undergo a controlling process to ensure the appropriateness of working with children. Criminal sanctions are non-compliance.
- Explain the importance of obtaining and working within boundaries of informed consent.
A therapist must understand a client needs and rights and must be given clear and concise information to determine what is right for them and what they are going through. The Informed consent enables client to decide as to whether they want a therapist to work on them and what they want a therapist to do.
A consent is one off and is a ongoing process and should be sought as part of the process before and during the treatment.
Three important factors are involved here:
Disclosure: All the relevant information needed to make an informed decision.
Capacity: client is capable of understanding the treatment, benefits and consequences.
Voluntariness: The client can make a free decision based on the information.
A clear written consent from someone authorised must be obtained on behalf of the client for their treatment, if the client is unable to provide consent due to their age, illness or mental capacity.
Where GP’s consent is required, this should be sought before treatment. If GP’s consent is given orally, the client should sigh and date a statement confirming they have obtained GP’s consent.
If GP consent has been refused, treatment maybe discontinued or declined, and the consent expressed or internally given reflects the feelings of a recipient.
- Describe what information needs to be given to client to obtain informed consent.
A client must be given all the information about what their treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead.
There are 4 components of informed consent.
Including decision capacity, documentation of consent, disclosure, and competency.
Obtaining consent involves informing a client about their care, the purpose of the treatment, procedures to be undertaken, potential risks and benefits, expected duration / sessions needed for the treatment.
Once obtained the consultation form is signed by the client and this becomes a legally binding document.
- Evaluate the consequences of non-compliance with legislation and professional standards.
Failure to comply with legislation and professional standards of ‘Protecting the public’ have serious consequences for a therapist or an organisation. Sanctions may include fines, loss of Reputation, disqualification and sometimes even imprisonment.
Breaching health and safety regulations is a criminal offence. Organization and its members have a common law duty to ensure the working environment is safe for therapist as well as the clients and failure to adhere to law may result in:
– Loss of professional membership
– Loss of right to practise and work in the sector – loss of career and income
– Loss of reputation
– Invalid insurance
– Possible injury to the client
– Liability claims
2.1 Describe cautions and contraindications to sports massage
Caution – A situation in which a massage Practitioner may proceed with the treatment but will need to modify techniques in the light of the client’s condition e.g., using lighter pressure or refraining from the use of percussive techniques.
A contraindication is a pre-existing medical condition that could make it inadvisable for a massage treatment to be carried out.
Types of Contra-indications:
- Total Contra-Indication
- Local Contra-Indication
- GP referred
This could either be due to conditions that could put a client at risk as well as illnesses that could be contagious and potentially affect a therapist and their place of work.
Total Contraindication – A situation where massage is avoided completely. This is usually for reasons presented by the customer and therapist safety and protection
Local contraindications are complications that will require modification of the massage therapy session. Usually, this includes avoiding affected areas of the body. Common examples are: Open sores or wounds
Anything (including a symptom or medical condition) that is a reason for a person to not receive a particular treatment or procedure because it may be harmful. For example, having a bleeding disorder is a contraindication for taking aspirin because treatment with aspirin may cause excess bleeding
If an individual is currently undergoing a medical treatment for a medical condition, then written consent may be required from their GP or medical practitioner before massage treatment can be commenced. A therapist will be able to advise you at their initial consultation prior to the treatment.
Whilst massage can be beneficial for the treatment of many minor musculoskeletal conditions and certain medical conditions, there are certain instances (medical conditions) where massage may be a contraindication. These include:
- Acute Inflammation
- Open Wounds
- Bone Fractures
- Deep Vein Thrombosis
- Varicose Veins
- Bleeding Disorders
- Infectious Skin Diseases
- Cancer (GP consent Required)
- Post-Surgery (GP consent required)
Some other conditions includes –
Osteoarthritis, Rheumatoid arthritis, Osteoporosis, Acute sprains and strains, Whiplash of treatment, Postural deformities (Kyphosis, Lordosis and Scoliosis), Myositis Ossificans, Bursitis, Recent fractures, Spondylitis, Periostitis.
Hypertension, Hypotension, Heart Conditions, Deep vein thrombosis, Phlebitis, Varicose veins, Bypass and heart surgery, Haemophilia.
Sciatica, Disc prolapse, Piriformis syndrome, Thoracic outlet syndrome, Carpal tunnel syndrome, Parkinson’s disease, Multiple sclerosis, Cerebral palsy, Bell’s palsy, Motor neurone disease, Epilepsy, Spastic conditions, Areas of altered skin sensation.
Irritable bowel conditions, Crohn’s disease, constipation, Diarrhoea, Constipation, Vomiting, Hernia, Gastric ulcers.
Asthma, Bronchitis, Emphysema
Skin Conditions: (Cuts, Bruises, Lacerations, Contusion, Abrasions, Sunburns)
Bacterial: Acne, Vulgaris, Impetigo, Folliculitis,
Viral: Warts, Verrucae, Herpes Simplex/Zoster.
Fungal: Tinea Corporis/pedis, Folliculitis.
2.2 Distinguish the actions to take if presented with cautions or contraindications:
A contraindication is a reason why a massage therapist or practitioner would not give a massage to a client because it may cause harm in some way. The treatment must be tailored to account for the conta-indications/cautions
Local Contraindication – is when message cannot be performed over a certain area. Often time message can be done rest of the body not to the area where it is contraindicated.
- Vigorous massage be avoided.
- Massage should not be done to any part of the body which has open wounds, skin infections, and healing from the recent surgery.
- Although massage is safe with cancer patients It’s generally best for patients to consult their oncologist prior to receiving massage.
- Pregnant woman should also consult their healthcare provider prior to using massage therapy and should seek a specially trained massage therapist during pregnancy.
2.3 Describe referral procedures when working with other professionals
A therapist must often take consent from the client about the fact that you want to refer them to another worker or agency and the reasons why.
Information must be provided about the new therapist and give them time to ask questions and talk through the referral process. Also be very aware of confidentiality issues.
A referral can be a written request or oral from one health professional to another health professional or health service, asking them to diagnose or treat or guide you for a particular condition.
2.4 Describe how to communicate with others in professional manner
One must always be respectful to one another, it’s a duty of both parties to create a receptive atmosphere while communicating. Simplifying your message and try to get to why by being respectful of their time.
Seek informed consent of the client every time when needed and recognise own limitations and seek advice when needed.
3.1 Discuss key principles of professional standards as stipulated by sports massage membership organisations
To comply with the legislation and provide clients with the appropriate respect, it is important to provide a high standard of treatment. And also to optimise treatment benefits, prevent cross-infection, promote confidence in the practitioner, client retention and satisfaction, maintain reputation, maintain credibility of the profession.
The two main regulators for massage therapy are CNHC and GRCCT.
Their aim is to protect the public and maintain standards of the profession and a professional with their skills and knowledge to give confidence to the general public. The Equality Act 2010 asserts the rights of all people to be treated with respect and dignity
Key Principles include:
- Legal and Ethical
- Record keeping
- Business practice and insurance
- Roles and Boundaries
- The care of your client must be your first concern.
- Your professional knowledge must be kept up to date.
3.2 Evaluate the roles of professional organisation relating to sports massage
The role of professional organisations relating to sports massage is to establish and maintain a nationwide set standard with the Professionals Trainings, Code of Conduct and Competence.
Give confidence to the general public in the profession and a therapists is suitably trained to provide a quality care. Some standards include, Professionalism, Legal and Ethical Requirements, Confidentiality, Business Practices, Roles and Boundaries to protect the public.
Some advantages of participating in a professional organization are
1: Continuing education.
4: Networking opportunities.
5: Access to resources.
6: New perspective.
7: Continuing Professional Development (CPD)
3.3 Explain the purpose of regulation
The purpose of regulation is to establish, professionally determined and independent standard of training, conduct and competence for each profession for the protection of the public and guidance of practitioners.
The purpose of regulation is to “Protect the Public.” and retain confidence in the profession and give the public confidence when visiting a reputable therapist, Protection of public from untrained therapists, ensure therapists meet standards, demonstrates standards and professional attitudes of wellbeing are maintained.
3.4 Explain the importance of continuing professional development.
Continuing professional development or usually CPD is important to a Professional to continue to be competent in their profession and practice safely by keeping up to the recent updates, trainings, legal knowledge, and scientific developments.
CPD is a ongoing mandatory career process for practicing professional for most of the healthcare professions.
3.5 Describe the protocol to follow when presented with an emergency situation.
When presented with an emergency situation, remember to Check-Call-Care.
Risk assesses the situation for immediate risk to health, life, property, or the environment and raise the alarm and appropriate first aid if needed and follow emergency protocols.
During the massage if a patient has their Nose bleed, a therapist must sit the person down with their head well forward and loosen any tight clothing around their neck. Advise them to breathe through their mouth and to pinch the soft part of the nose. Forbid speech, swallowing, coughing, spitting or sniffing. Allow them to dribble and mop it up. Release the pressure after 10 minutes.
If the bleeding has not stopped, continue treatment for further periods of 10 minutes as necessary and do not let the person raise their head. While the head is still forward, if possible, get them to gently clean around the nose and mouth using a swab or clean dressing soaked in lukewarm water. Do not plug the nose. When the bleeding stops tell them to avoid exertion and not to blow their nose for at least for hours so as not to disturb the clot. If after 30 minutes the bleeding persists or recurs, seek medical aid.
3.6 Describe insurance requirements for Sports Massage Practice.
Public Liability and Professional Indemnity, Sports Accident, Loss of Earnings, Sports Equipment and Employers Liability are some of the insurance types that a Sports Massage therapist is entitled to.
As a Massage Therapist, while there are no laws relating to insurance an individual must hold, however, a sports therapist is required to maintain insurance as a requirement of their association membership, and to gain an approved provider status.
General liability covers for any accidents that occur before or after treatment, however, Professional indemnity insurance works to protect both businesses and professionals towards compensating for full or part costs arising from a damage.
The main type of insurance they need is public liability insurance. This is also the type of insurance that needs to be tailored to the unique needs of massage therapists because standard public liability insurance could leave a massage therapist uninsured in the event of certain claims.
Public Liability provides protection against legal liability for accidental injury to any person or damage to their property because of the actions of your business. Professional Indemnity will cover you against claims arising from the advice you give to your clients
Professional indemnity insurance for massage therapists protects against allegations of professional negligence, malpractice and breaches of professional codes of practice
4.1 Explain the importance of valuing equality and diversity when working with clients.
Importance of valuing equality and diversity is to ensure that everyone has access to same opportunity and receive fair treatment.
To treat everyone as equals and that the people get their respect and dignity they deserve, and their differences are appreciated and celebrated In line with relevant equality, human rights, and anti-discrimination legislation (Equality Act 2010, Human Rights Act 1998, Sex Discrimination Act 1975)
Promoting equality and respecting diversity are central to life today. To provide care and support that meets the needs of everyone you must understand what these terms mean and take account of them in your work.
You should make sure that everyone is given equality of opportunity. For example, you may need to give information in different formats (for example Braille) or make sure there is access to a building for an individual in a wheelchair. Equality is about treating people alike according to their needs.
Diversity can be described as ‘difference’. All individuals are different; the many different parts of a person’s character and identity make them unique. Examples of the things that make up diversity are:
Age, Appearance, Ability, Disability, Job Role, Health, Background, Gender, Family, Friends, Sexual Orientation, Religion, Belief’s, Values, Culture, Race, National origins, Marital status.
The Equality Act 2010.
Every human being has rights and freedoms which apply regardless of their situation or characteristics. Equality and inclusion are basic human rights. The Equality Act 2010 makes it against the law for people to be treated unfairly because of the things that make them different. The Act sets out how individuals should experience equality of opportunity and lists a number of ‘protected characteristics’ that help to safeguard them from discrimination.
Promoting equality and respecting diversity help to ensure that people are valued and have the same access to all opportunities.
The Act also provides protection for individuals who experience discrimination by association with someone who has a protected characteristic.
Other legislation as a health or care worker is governed by a number of different laws in addition to the Equality Act 2010.
The Human Rights Act 1998 sets out the ways that everyone should be treated by the state and by public authorities.
Care Act 2014 brings care and support legislation together into a single act with a new wellbeing principle at its heart. It aims to make care and support clearer and fairer and to put people’s wellbeing at the centre of decisions and include and develop personalisation.
4.2 Explain the importance of professionalism.
The important qualities and characteristics of a professional is to work within the boundaries of a therapist’s conduct, behaviour and professional attitude towards the client and their best interest.
Professionalism is measured by the best and the highest standards provided by Duty of care, Integrity, excellence, and social responsibility.
4.3 Explain the personal and clinical standards expected of the Sports Massage therapist.
To provide a professional service to clients, the therapist must ensure that appropriate personal and clinical standards are maintained. A therapist must continually see to improve their practice and aim to achieve standards of excellence.
Personal Hygiene (Nails)
Treat client with respect and dignity
Dress code and Smart Appearance
Provide treatment with professional competence.
Attitude and personal Conduct
Hygiene of all equipment and sterilization
Integrity, Respect and Reliability
Health and Safety maintained at all times
Care, Empathy and Positive Regards
Taking consent at all aspects
Client referral when needed
Within scope of practice
High standards of bookkeeping
Respect personal and professional boundaries
Liability or Personal Indemnity insurance
Respecting history and tradition of the sector
Adherence to the guidance provided by the Profession Regulators.
4.4 Explain the importance of good communication skills
Good communication skills are essential and are important to allow individuals to understand information accurately and quickly and provide service relevant to the client needs.
- Listening is one of the most important aspects of communication and non-verbal communication includes eye contact, body language, passive, aggressive, passive-aggressive, and assertive communication.
- A therapist must ensure that the client give sufficient details regarding their health and background of their problem and provide relevant GP’s referral and sign the consultation form.
4.5 Describe advantages/disadvantages of different means of communication.
Consultation Written advantage – Permanent Record Keeping
Consultation Written Disadvantage – Slower Feedback
Oral questioning – Appropriate questions
Oral Disadvantage – No Records of the conversation kept
Loss of client
Appropriate Body Language
Misappropriate or sluggish body language
Privacy and comfortable area
Crowded environment and noisy surroundings.
5.1 Explain the importance of accurate and confidential record keeping
An accurate and confidential record keeping is necessary to provide a quality and care service to a client and is an integral part of a service industry.
A therapist must not discuss the personal details of a client to another therapist.
Good record keeping will not only protect individuals and organisations against legal challenges but also gains the trust of a client and an industry.
A therapist must ensure the client that the information will be released to gain guidance from other trained practitioner or to ascertain permission from a GP.
As an effective process The Data Protection Act 1984, governs towards an effective keeping of medical records. (Commissioner.gov.uk) especially when information is stored electronically, and a client is always eligible to access their health records at any time when they request.
5.2 Explain what information should be recorded.
- Client details on every sheet of record.
- Medical history.
- Treatment used.
- Effectiveness of the treatment.
- Whether the treatment met the needs of a client.
- Effects, outcomes, changes to strategy.
- Cautions and contra-indications, referrals, aftercare/advice given.
5.3 Explain the principles to apply when recording treatments.
- The information recorded must be clear and legible
- Should be entered in timely manner with clear Aim and Objective of a treatment.
- Benefits of the treatment and aftercare provided.
- Other professionals’ reviews, evaluation, reflection, and changes to the future treatment plan if needed.
5.4 Explain the legal requirements for the storage and disposal of records.
Massage therapists have a duty to the client to make and maintain proper records of any professional interaction.
It assists the Massage Therapist in recalling details of the client’s history, condition, and the treatment provided; or to It assists the continuity of care if colleagues are called upon to treat the client.
Any professional record kept must be kept in alliance with Organisation’s protocol, Code of Ethics, Code of Practice and is kept securely in a place, where it can be easily accessed when needed.
Massage therapists are required to:
Make and maintain client records relating to the provision of Massage Therapy services.
Maintain client records for up to ten years from the date of the last entry, or if the client is less than 18 years old, 10 years from the date the client becomes 18 years of age
Ensure that the confidentiality of client information is maintained.
Release information contained in the client’s health record with the client’s consent.
All information relating to the Massage Therapy services provided to a client is to be treated as confidential.
The health information contained in the file belongs to the client and can be released only with his/her consent or as required by law.
The client has a right to access the information contained in his/her health record.
If the client information is stored digitally, the therapist must register with the information commissioner.