Active IQ Level 4 Certificate in Sports Massage Therapy (sample manual)

Manual 

Level 4 Certificate 

in Sports Massage 

Therapy 

Version AIQ005510

Section 1: Anatomy and physiology of the major joints of the body 

Foot 

There are 26 bones in the foot: 

• 7 tarsals (talus, calcaneus, navicular, cuboid and 3 cuneiforms). 

• 5 metatarsals. 

• 14 phalanges. 

The talus and calcaneus form the connection between the lower leg and the foot. The other five tarsals complete the 

rear foot. The metatarsals form the mid-foot and the phalanges form the toes. 

Phalanges 

1st to 3rd cuneiform 

(medial to lateral) 

1st to 5th metatarsal 

(medial to lateral) 

Navicular 

Cuboid 

Figure 1.2 Dorsal view of the right foot 

There are three arch systems in the foot and these play an important role in shock absorption: 

• Medial longitudinal arch. 

• Lateral longitudinal arch. 

• Transverse arch. 

Medial longitudinal arch 

Lateral longitudinal arch 

Transverse arch 

Figure 1.3 The three arches of the foot 

The arches are formed by the shape of the bones and are supported by soft tissues. The plantar fascia (a flat aponeurosis) 

extends from the calcaneus to the metatarsals and on to the phalanges, maintaining the arch of the mid-foot. The 

tendon of the tibialis anterior maintains the medial arch and controls the rate of footfall into plantarflexion. The peroneus 

longus tendon plays an important role in the positioning of the foot during heel strike, but the tibialis anterior, tibialis 

posterior and peroneus longus all work synergistically to control motion at the STJ and mid-foot. 

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The Q-angle 

In a male, the acetabulum of the pelvis is directly above the knee; this means that weight is distributed evenly across 

the surface of the joint. In a female, the knee is medial to the acetabulum, resulting in an increase of surface pressure 

on the lateral aspect of the knee. This uneven weight distribution often leads to knee pain, particularly from repetitive or 

high-impact activities, e.g. running. The angulation of the articulating surfaces is described as the Q-angle. 

The ‘screw home mechanism’ 

As the knee moves into the last 10-15° of extension, 

the tibia laterally rotates slightly to ‘lock’ the knee 

joint into position. This is called the ‘screw home 

mechanism’. The menisci act in a similar way to 

car gaskets or O-rings as they absorb this rotation to 

provide a clean seal between the femur and the tibia. 

To ‘unscrew’ the knee joint, either the tibia or the 

femur needs to rotate slightly. 

Figure 1.9 Comparative Q-angles in males and 

females 

The menisci 

The rotation created during the screw home 

mechanism increases stability at the knee joint, 

particularly during weight-bearing movements. It is a 

part of sagittal knee extension and does not constitute 

an additional transverse movement capability. 

(Norkin and White, 2009) 

The menisci are C-shaped pieces of fibrocartilage located on the tibial plateau. They are held in position by muscles 

and ligaments and can move inside the joint depending on the forces being applied. Injury to these structures can occur 

when movement of the articulating surfaces is very abrupt, such as in rapid directional changes, which can trap and 

tear the menisci. The menisci play an important role in the ‘screw home mechanism’ as part of the locking action that 

maintains extension and prevents hyperextension of the knee. 

Functions of the menisci include: 

• Assisting in fluid movement of the joint. 

• Providing a smooth, concave surface for articulation with the femur. 

• Protecting the articulating hyaline cartilage of the femur and the tibia. 

• Acting as shock absorbers during weight-bearing activity. 

• Contributing to stability by increasing the contact area between the femur and the tibia. 

• Acting as part of the locking mechanism to prevent hyperextension of the knee. 

• Improving weight distribution. 

• Joint lubrication. 

• Facilitating the screw home mechanism. 

Some of the fibres from the medial collateral ligament help 

maintain the position of the medial meniscus in the joint. 

In the event of the meniscus being pulled rapidly out of 

position, damage can occur to the medial collateral ligament 

and/or the meniscus. 

Menisci 

Figure 1.10 The menisci 

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MUSCLES AFFECTING HIP AND PELVIC MOTION AND POSITIONING 

MUSCLE ORIGIN INSERTION CONCENTRIC HIP 

ACTION(S) 

Adductor brevis Anterior pubis Upper femur Adduction 

Internal rotation 

Flexion 

Adductor magnus 

Base of pubis, ischium and 

ischial tuberosity 

Mid to lower femur 

Pectineus Anterior superior pubis Posterior upper femur, just 

below lesser trochanter 

Adduction 

Internal rotation 

Extension 

Adduction 

Flexion 

Structure and function of the spine 

Table 1.4 Muscles and muscle actions of the hip and pelvis 

The adult spinal column consists of 33 irregular bones which are divided into 5 main regions. When viewed from the 

side, these regions form distinct curves, the flexed (kyphotic) thoracic and sacrococcygeal curves, and the extended 

cervical and lumbar (lordotic) curves. 

7 Cervical 

(secondary 

curve) 

12 Thoracic 

(primary 

curve) 

5 Lumbar 

(secondary 

curve) 

5 Sacral 

(fused) 

4 Coccygeal 

(fused) 

7 

12 

5 

5 

4 

Cervical vertebrae. 

Thoracic vertebrae. 

Lumbar vertebrae. 

Sacral vertebrae (fused). 

Coccygeal vertebrae (fused). 

Figure 1.18 The regions of the spine 

Vertebrae 

Typical vertebrae consist of a vertebral body, a spinous process, two transverse processes and four articular processes 

(two inferior and two superior) (see figure 1.19). When vertebrae are stacked on top of one another, two types of joint 

are formed: 

• Intervertebral joints – cartilaginous joints formed between two vertebral bodies that are separated by an 

intervertebral disc (see figure 1.23). 

• Facet (zygapophyseal/z) joints (see figure 1.20) – small synovial gliding joints where the facet on the inferior 

articular process of one vertebra articulates with the opposing facet on the superior articular process of the 

vertebra below. Each facet joint has its own synovial capsule. 



Shoulder girdle 

The scapula is a flat, triangular bone with a spine running diagonally across its superior aspect. Laterally, the spine of 

the scapula flattens to form the acromion process. The acromion process then articulates with the clavicle forming the 

synovial gliding acromioclavicular (AC) joint. This creates the subacromial arch between the AC joint and the head of 

the humerus. The clavicle and sternum articulate to form the synovial gliding sternoclavicular joint around which the 

movements of the shoulder girdle are anchored. 

The articulations at the shoulder girdle are necessary for the scapula to glide across the thorax and, in turn, the scapula 

provides a secure base for a number of muscular attachments from which the arm derives its leverage. 

In order to perform abduction of the arm, the rhomboids and mid trapezius are eccentrically loaded to stabilise the 

scapula. The thoracic and cervical spine are also important contributors to this stabilisation, which is why dysfunction 

of the shoulder complex will affect the spine – in much the same way as changes in spinal alignment or stability will 

affect the ability of the shoulder girdle to stabilise arm movements. 

Sternoclavicular joint 

Manubrium 

Acromioclavicular 

joint 

Figure 1.25 The shoulder girdle 

Shoulder joint (glenohumeral joint) 

The glenohumeral joint is a synovial ball and socket joint comprised of the humerus and the scapula (glenoid cavity). 

The head of the humerus and the glenoid cavity are covered in hyaline cartilage to reduce friction. 

Due to the high level of mobility that is demanded at this joint, it is predisposed to instability and related injury. Most 

of the stability of the shoulder is supplied by the surrounding soft tissues. The socket is very shallow and much smaller 

than the ball, which allows the wide range of mobility. Greater depth and strength of the joint are provided by a ring of 

fibrocartilage (glenoid labrum) and the articular joint capsule. The capsule extends from the glenoid cavity to the neck of 

the humerus; it is very flexible in order to allow movement, but its tensile strength also assists in preventing dislocations. 

Glenoid labrum 

Head of the humerus 

Glenoid cavity 

Figure 1.26 Shoulder joint 


Structure and function of the elbow, wrist and hand 

Elbow 

The elbow consists of two joints: 


• A synovial hinge joint formed by the humerus articulating with the heads of the radius (humeroradial) and ulna 

(humeroulnar), allowing flexion and extension. 

• A pivot joint formed by the radius articulating with the ulna (radioulnar joint), allowing supination and pronation 

of the forearm. 

These joints share a common capsule that assists the ligaments and musculature in stabilising the elbow. 

Olecranon 

process 

Radial head 

Lateral 

epicondyle 

Ulna styloid process 

Radial styloid 

process 

Medial 

epicondyle 

Figure 1.31 Bony landmarks of the humerus, radius and ulna 

Ligaments 

There are three important ligaments that work together to stabilise unwanted movements: 

• The ulna collateral ligament (medial collateral ligament) attaches the humerus to the ulna. 

• The radial collateral ligament (lateral collateral ligament) attaches the humerus to the radius. 

• The annular ligament attaches the radius to the ulna. 

There is also an interosseous membrane that connects the radius to the ulna. This membrane extends from just below 

the elbow all the way to where the bones meet just above the wrist. 

Interosseous membrane 

Annular ligament 

Ulna collateral ligament 

Figure 1.32 Ligaments of the elbow 


Section 4: Assessment techniques 

ROM assessments for each joint 

Joint ROMs Joint ROMs 

Spine Flexion 

Knee 

Extension 

Lateral flexion 

Rotation 

*active only 

Flexion 

Extension 

Medial rotation 

Lateral rotation 

*active, passive, 

resisted 

Hip 

Flexion 

Extension 

Abduction 

Adduction 




resisted 

Ankle 

Plantarflexion 

Dorsiflexion 

Eversion 

Inversion 


resisted 

Shoulder 

Flexion 

Extension 

Abduction 

Adduction 




resisted 

Elbow 

Flexion 

Extension 

Pronation 

Supination 


resisted 

Wrist and hand 

Flexion 

Extension 

Ulnar deviation 

Radial deviation 

Abduction (fingers) 

Adduction (fingers) 


resisted 

Figure 4.3 ROM assessments for each joint 

Active ROM 

Active ROM assessments involve the client taking control of their limb and moving it through the specific range of 

motion that has been assigned by the SMT. In active ROM testing there is a great reliance on contractile tissue to control 

movement around a specific joint. The SMT can gain important information about the client’s ROM, muscle strength, 

coordination, compensations, pain and willingness to move from this type of test. 

Passive ROM 

Passive ROM tests involve the therapist taking the client’s limb through a specific ROM. The SMT takes full control of 

the limb while the client relaxes; this allows tissues to be stressed in a different way to active testing. Contractile tissues 

will still be stressed, but they won’t be actively working. 


Section 4: Assessment techniques 

Special tests for the upper body 

SPECIAL TEST PROTOCOL FINDINGS 

Arm drop test 

In a seated or standing position, the 

SMT passively abducts the client’s 

arm to 90°. The SMT lets go of the 

client’s arm and instructs them to 

slowly lower their arm to the side of 

the body under control. 

The client will report pain or may be 

unable to continue the movement if 

there are any rotator cuff tears. 

Movement should also be smooth – 

any juddering or sticking indicates a 

positive test. 

This test is used to identify any 

rotator cuff tears, typically in the 

tendon of the supraspinatus. 

Painful arc test 

In a seated or standing position, the 

client is instructed to slowly abduct 

the arm in the scapular plane. 

Movement should be full, with the 

aim of taking the arms above the 

head and all the way down to the 

side of the body. 

If pain is experienced between 60 

and 120°, the test is positive and 

suggests impingement. 

This test is to identify subacromial 

impingement. 

Empty can / Jobe and Full can tests 

Empty can test 

Full can test 

Empty can test 

Whilst standing or sitting, the client 

rotates their arms so their palms face 

forwards and abducts their arms to 

90° in the scapular plane. The client 

is then instructed to internally rotate 

the arms so that their thumbs face 

downwards. The SMT then applies 

pressure on top of the forearms, 

whilst the client attempts to lift their 

arms upwards. 

Full can test 

The same position and protocol is 

repeated, however this time, the 

arms are externally rotated so that 

the thumbs point upwards. 

If pain and/or weakness is identified, 

this results in a positive test. 

These tests are used to identify and 

differentiate impingement or integrity 

of specific rotator cuff muscles.

Active IQ Level 4 Certificate in Sports Massage Therapy (sample manual)

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