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Elements and Performance Criteria

  1. Consult with referred clients presenting with stable musculoskeletal considerations.
  2. Deliver prescribed exercise programs.
  3. Monitor and review clients responses to the prescribed exercise program
  4. Apply extensive knowledge of musculoskeletal anatomy and physiology to the delivery of exercise for moderate risk clients.

Required Skills

Required skills

communication skills to elicit and convey information to clients with musculoskeletal conditions to enable the delivery and modification of appropriate and effective exercise prescription

problemsolving skills to

identify adverse signs and symptoms requiring intervention and

unsafe exercise performance

recommend appropriate changes in consultation with an appropriate medical or allied health professional

team work skills to work collaboratively with medical or allied health professionals according to legal and ethical considerations

analytical skills to interpret information on the health and functional status of clients with musculoskeletal conditions in terms of their medical conditions risk factors medical treatments and exercise history

decision making skills to determine appropriate instructional techniques

literacy skills to accurately document and report on client progress

Required knowledge

anatomy of the musculoskeletal system and its supporting systems

function of the musculoskeletal systems to enable design of appropriate programs

the pathology of musculoskeletal conditions and considerations in relation to the conditions of the client

directional and movement terminology to enable effective communication with medical or allied health professionals

range of motion and stretching techniques to enable the inclusion of exercise variables to suit clients functional capacity

structural and physiological changes consistent with the pathology of disease states or conditions affecting the musculoskeletal system

risk factors and contraindications associated with musculoskeletal conditions to enable the provision monitoring and adjustment of safe and effective exercise

effect of musculoskeletal conditions on the acute response to exercise to enable assessment of the individuals functional capacity when developing exercises

categories of medications used to manage musculoskeletal conditions such as nonsteroidal antiinflammatory drugs NSAIDs and their effects on the condition

medical and anatomical terminology to interpret referrals from medical or allied health professionals

relevant legislation and organisational policies and procedures to maintain the safety of clients and the confidentiality of client information

causes and consequences of specific musculoskeletal considerations in the context of their effect on exercise capacity

principles of biomechanics to enable the application of appropriate exercise techniques for specific fitness activities

the role of physical activity in managing musculoskeletal conditions and enhancing health

use care and maintenance of facility equipment to maintain safety of clients and other facility users

Evidence Required

The evidence guide provides advice on assessment and must be read in conjunction with the performance criteria required skills and knowledge range statement and the Assessment Guidelines for the Training Package

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the following is essential

communicates effectively with accredited exercise physiologist or relevant medical or allied health professional regarding health and functional status of the referred client

effective communication skills to discuss aspects of exercise prescription with clients

when appropriate react to adverse events to deal with exercise program problems and issues

ability to correctly interpret the exercise prescription and make modifications consistent with prescribed parameters and scope of practice

safely and effectively delivers exercise for referred clients with musculoskeletal conditions and recommends appropriate alterations according to clients physical and motivational responses

monitors and maintains the safety of clients exercise equipment and the exercise setting and applies effective contingency management techniques to deal with problems and issues that may arise during the exercise program

applies all relevant legal and ethical requirements when discussing and recording client information

demonstrates appropriate manner empathy and patience when working with clients

Context of and specific resources for assessment

Assessment must ensure demonstration of skills over a period of time within a facility where a variety of exercise modes and equipment are available to support effective musculoskeletal exercise

Assessment must also ensure access to

facility where a variety of exercise modes and equipment are available such as exercise machines weight machines exercise mats and adequate floor space

a range of clients with real or simulated musculoskeletal conditions from a range of ages

a range of real or simulated medical or allied health professionals referrals for a range of clients with musculoskeletal conditions and risk factors

demonstration of skills on sufficient occasions to determine competence in interpreting relevant information and delivering the prescribed exercise program for a range of clients with a range of musculoskeletal conditions

relevant documentation such as client record forms

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge The following examples are appropriate for this unit

observation of consulting with clients and adjusting standard exercise prescriptions in consultation with an appropriate medical or allied health professional to account for a range of musculoskeletal conditions and risk factors to focus on functional capacity and health rather than physical fitness

observation of dealing effectively with a range of contingencies such as real or simulated client injuries or inability to complete the exercise prescription

oral and or written questioning to assess knowledge of the physiology of musculoskeletal conditions medications and associated risk factors

thirdparty reports from a supervisor detailing work performance

Holistic assessment with other units relevant to the industry sector workplace and job role is recommended for example

SISFFITA Deliver prescribed exercise to clients with cardiorespiratory conditions

SISFFIT523A Deliver prescribed exercise to clients with cardiorespiratory conditions

Guidance information for assessment


Range Statement

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Medical or allied health professional may include:

sports physician

sports doctor

general practitioner

physiotherapist

accredited exercise physiologist

occupational therapist

remedial massage therapist

chiropractor

osteopath

accredited practising dietician

psychologist

aboriginal health worker

diabetes educator.

Client may include:

aged

sedentary

overweight

presenting with additional medical or psychological conditions (including trauma)

athletes.

Relevant legislation may include:

Occupational Health and Safety

duty of care

privacy

codes of practice

fair trading.

Organisational policies and procedures may include:

Occupational Health and Safety

emergency procedures

risk management

use of client record systems

collection and use of client information

equipment use and maintenance

client supervision

incident reporting

client screening procedures

client referral procedures.

Risk factors may include:

family history

obesity

joint trauma and injury

menopause in females

repetitive occupational use

physical inactivity

eating disorders

low body weight and calcium intake

smoking.

Fitness assessment may include:

cardiovascular response to exercise

range of movement

strength

girth measurements.

posture.

Muscular conditioning may include:

muscular strength

muscular power

muscular endurance.

Instructional techniques may include:

establishing rapport

instructional position

demonstration and motivational strategies

positive feedback.

Exercise program may include:

exercise selection, sequence and variety

logical progression

warm-up and cool-down

stretching.

Exercise equipment may include:

cardiovascular equipment

resistance training machines:

hydraulic machines

aquatic equipment

resistance bands

free weights.

Monitor client responses may include:

rating of perceived exertion (RPE)

heart rate measures

'talk test'

possible fluctuations in blood glucose levels and dehydration.

Symptoms requiring interjection may include:

shortness of breath at rest or with mild exertion

dizziness or syncope

orthopnea or paroxysmal nocturnal dyspnea

palpitations or tachycardia

intermittent claudication

unusual fatigue or shortness of breath with usual activities

illness or sickness

lack of functional strength

neck soreness or strain

pain on movement of any body part.

Procedures to respond to symptoms requiring interjection include:

cessation and modification of activity

first aid

emergency medical assistance

referral.

Signs of unstable condition may include:

fatigue and weakness

cardiac pain

breathlessness

oedema

palpitations

claudication pain

dizziness.

Posture may include:

static

dynamic

standing

sitting

supine

specific observations of standing posture:

head and neck

thoracic spine

rib cage

shoulder position

scapula position

elbow position

lumbar spine

pelvis

abdominals

femur

knee

patella

foot position.

Postural variances may include:

structural

functional

kyphosis

rounded shoulders

winging of scapula

scoliosis

increased lordosis

decreased lordosis

excessive posterior pelvic tilt

excessive anterior pelvic tilt

genu varum

genu valgum

increased pronation of foot and or ankle complex

increased supination of foot and or ankle complex

hyperextension of knees

lateral tilt of pelvis

lateral tilt of head.

Functional anatomy of the joints may include:

glenohumeral

bones:

humerus

scapula

clavicle

ligaments:

corocohumeral

corococlavicular

glenohumeral

transverse humeral

related structures:

subscapular bursa

subacromial bursa

subdeltoid bursa

subcorocoid bursa

muscles acting on the joint

elbow

bones:

humerus

ulna

radius

ligaments:

ulnar collateral

radial collateral

related structures:

olecranon bursa

muscles acting on the joint

lumbo-sacral:

bones

5th lumbar vertebrae

1st vertebrae of sacrum

ligaments

muscles acting on the joint

intervertebral:

bones

vertebral bodies:

ligaments

muscles acting on the joint

hip (coxal)

bones:

femur

hip:

ligaments:

pubofemoral

iliofemoral

ischiofemoral

transverse ligament of acetabulum

ligament of head of femur

muscles acting on the joint

knee (tibiofemoral and or patellofemoral)

bones:

tibia

femur

patella

ligaments:

patella

oblique popliteal

arcuate popliteal

tibial collateral

fibular collateral

posterior cruciate

related structures:

tendons of the quadriceps femoris and facia latae

medial meniscus

lateral meniscus

prepatellar bursa

intrapatellar bursa

suprapatellar bursa

muscles acting on the joint

ankle (talocrucal):

bones:

talus

tibia

fibula

ligaments:

deltoid

anterior talofibial

posterior talofibial

calcaneofibular

related structures:

achilles tendon

muscles acting on the joint

Major joints may include:

intervertebral

glenohumeral

elbow

radiocarpal

sacroiliac

hip (coxal)

tibiofemoral

patello-femoral

ankle.

Joint movement may include:

flexion

extension

dorsiflexion

plantar flexion

horizontal flexion

horizontal extension

abduction

adduction

circumduction

rotation

supination

pronation

inversion

eversion

protraction

retraction

elevation

depression.

Muscles may include:

erector spinae

trapezius

rectus abdominis

internal obliques

external obliques

multifidus

quadratus lumborum

iliopsoas

latissimus dorsi

rhomboid major

rhomboid minor

pectoralis major

pectoralis minor

serratus anterior

levator scapulae

teres major

teres minor

subscapularis

supraspinatus

infraspinatus

gluteus maximus

gluteus medius

gluteus minimus

pelvic floor

iliotibial tract

tensor fascia latae

piriformis

rectus femoris

vastus lateralis

vastus medialis

vastus intermedius

sartorius

biceps femoris

semitendinosus

semimembranosus

gastrocnemius

soleus

tibialis anterior

adductor magnus

adductor longus

gracilis

sartorius.

Musculoskeletal conditions may include:

ostoepaenia

sub acute soft tissue injury and or sprain and or strain

osteoporosis

epicondylitis

tendonitis

osteoarthritis

repetitive strain injuries

Musculo-skeletal system may include:

functions

types of bones:

long

short

flat

irregular

growth and development of long bones

structure of long bones

classification of joints:

fibrous

cartilagenous

synovial structure of a synovial joint:

bones

articular or hyaline cartilage

joint capsule

joint cavity

ligaments

synovial membrane

synovial fluid

bursae

meniscus

connective tissue:

fascia

tendons

ligaments

muscular system

function of muscle tissue

properties of muscle tissue:

excitability

contractility

extensibility

elasticity

types of muscles:

smooth

cardiac

skeletal

structure of skeletal muscle tissue:

muscle belly

tendon

fascicle

muscle fibre

myofibril

microscopic anatomy:

sarcomere

filaments

actin

myosin

tropomyosin

troponin

sarcolemma

sarcoplasm

sarcoplasmic reticulum

T-tubules

Z lines

A band

I band

muscle contraction:

sliding filament theory

length-tension relationship

attachments:

origin

insertion

role of muscle contraction:

agonist

antagonist

fixator

synergist

skeletal muscle fibre types:

slow twitch oxidative

fast twitch oxidative-glycolytic

fast twitch glycolytic

distribution and recruitment of different fibre types

physiological adaptations due to training:

hypertrophy

increased strength

increased extensibility

muscle actions of major muscles.

Moderate risk client may include:

chronic disease state

medical condition or injury

under prescribed medication

symptoms of cardiorespiratory disease

moderate or high risk as identified by medical or allied health professional

aged and sedentary

musculoskeletal moderate risk includes:

history of injury to back or neck or joints or muscles of arms and legs requiring assessment and or treatment by a medical or allied health professional but is now fully resolved

previous surgery to back or neck or joints or muscles of arms and legs

recurrent injury

injury to musculoskeletal system in the past 8 weeks even if it has resolved

recent low level of physical activity

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