Lesson 20 · Classifying and assessing
Sports injuries: classification and TOTAPS assessment
Three players go down in one match: a tackle, a knee that gives way with nobody near, and a shin that has hurt for three weeks. Naming the difference between them is not bookkeeping. The name is a hypothesis about the cause, and the cause is the only part you can change.
Three players go down in the same match. One is tackled and holds their shoulder. One turns sharply with nobody near them and their knee gives way. One has had a sore shin for three weeks and can no longer run on it.
Write down what you would do first for each — not the treatment, the very first action. Then answer the question this lesson exists to make precise: what is the difference between the three injuries, and does that difference change what you do first, or only what you do afterwards?
- Classify an injury as direct or indirect, soft tissue or hard tissue, and acute or overuse.
- Explain why classification is useful rather than merely tidy: it points to the mechanism, and the mechanism points to the prevention.
- Apply the TOTAPS assessment in order, and explain what each step is testing.
- State clearly when TOTAPS must be stopped, and why stopping is the correct outcome rather than a failure.
- Explain how injury classification informs prevention, which is half of what this dot point asks.
- Direct injury — one caused by an external force applied to the body, such as a collision or an impact.
- Indirect injury — one caused by forces generated within the body, or occurring away from the point of impact.
- Soft tissue — muscle, tendon, ligament, cartilage, skin and blood vessels.
- Hard tissue — bone, and injuries to joints involving bone.
- Sprain — a ligament injury, occurring where a joint is forced beyond its normal range.
- Strain — a muscle or tendon injury, from an excessive or poorly controlled contraction or stretch.
- Dislocation — the complete displacement of a bone from its joint.
- Overuse injury — one developing gradually from repeated loading without adequate recovery, rather than from a single event.
- Acute injury — one occurring at an identifiable moment.
- TOTAPS — Talk, Observe, Touch, Active movement, Passive movement, Skill: an on-field assessment sequence.
- Contraindication — a reason not to proceed with an action.
The syllabus classifies sports injuries three ways, and the three are not alternatives — the same injury is classified on all three axes at once. What makes classification worth doing is that each axis tells you something different about what to do next.
| Axis | The two categories | What the answer tells you |
|---|---|---|
| Cause | Direct: an external force is applied, as in a collision, a blow or being struck by equipment. Indirect: forces generated within the body, as in a hamstring tear while sprinting, or an injury occurring away from the point of impact | What might prevent it. Direct injuries are addressed through protective equipment, rules and technique in contact; indirect ones through conditioning, technique, warm-up and load management |
| Tissue | Soft tissue: muscle, tendon, ligament, cartilage, skin. Hard tissue: bone, and joint injuries involving bone, including fractures and dislocations | How urgent it is and how it is managed. A suspected fracture or dislocation needs immobilisation and medical care, not on-field assessment of movement |
| Onset | Acute: occurs at an identifiable moment. Overuse: develops gradually from repeated loading without adequate recovery | Where the cause actually lies. An overuse injury is a training-load problem, so treating the tissue without changing the load returns the athlete to the same injury |
Now the three players from card 01, classified on all three axes.
| Injury | Cause | Tissue | Onset | What that combination suggests |
|---|---|---|---|---|
| Shoulder pain after a tackle | Direct | Possibly hard tissue, given the mechanism | Acute | Possible dislocation or fracture, so this is a stop-and-refer case rather than an assess-and-return one |
| Knee gives way turning with nobody near | Indirect | Soft tissue, likely ligament | Acute | A non-contact mechanism, which points prevention towards landing and change-of-direction technique and neuromuscular training |
| Three weeks of shin pain, now unable to run | Indirect | Could be either; persistent bone pain needs assessment | Overuse | A training-load problem, so the meaningful intervention is in the program, not only in the tissue |
Read the last column and the value of classification becomes obvious. The classification is a hypothesis about the cause, and the cause is what you can change. That is why the syllabus pairs management with prevention in a single dot point.
Classify on all three axes, not one. Cause tells you what would have prevented it, tissue tells you how urgent it is, and onset tells you whether the real problem is in the tissue or in the training program.
Quick check: A sprinter tears a hamstring at top speed with no contact. This injury is best classified as:
Precision with the names matters, because two pairs are confused every year and both confusions change the answer.
| Injury | Tissue | Typical mechanism | What distinguishes it |
|---|---|---|---|
| Sprain | Ligament, soft tissue | A joint forced beyond its normal range, as in rolling an ankle | Sprain is ligament. Pain and swelling around a joint, with instability in more severe cases |
| Strain | Muscle or tendon, soft tissue | An excessive or poorly controlled contraction or stretch, often at speed or under fatigue | Strain is muscle or tendon. Pain on contracting or stretching the muscle, often with a sudden onset the athlete can identify |
| Contusion, or bruise | Soft tissue | Direct impact crushing tissue against bone | Direct cause, with bleeding into the tissue and pain on contraction |
| Fracture | Hard tissue | Direct force, indirect force transmitted through a limb, or repeated loading in a stress fracture | May be obvious, or may not be; persistent localised bone pain requires assessment rather than reassurance |
| Dislocation | Hard tissue, at a joint | Force driving a bone out of its joint, commonly at the shoulder or fingers | Visible deformity, severe pain, loss of function. Never attempt to relocate it |
| Overuse injury | Either, including tendon and bone | Repeated loading exceeding the tissue's capacity to adapt between sessions | Gradual onset, no single event, and typically a history of a load increase two to six weeks earlier |
The two confusions worth eliminating now
Sprain is ligament; strain is muscle or tendon. The two words differ by one letter and describe different tissues, and marks are lost for it every year. And direct and indirect describe the cause, not the severity. An indirect injury such as a ruptured cruciate ligament can be far more serious than a direct one such as a bruise, so an answer that treats direct as meaning worse has misunderstood the axis.
One more thing worth knowing about overuse injuries. They almost always have a history: a sudden increase in training volume or intensity, a change of surface or footwear, or a return from a break without a graded build. That is progressive overload from Lesson 6 breached at its upper failure mode — which is why the injury record and the training log are read together.
True or false: An indirect injury is by definition less serious than a direct one, because no external force was involved.
TOTAPS is an ordered on-field assessment for deciding whether an injured player can return to the field. The order is the whole point: each step is less invasive and less demanding than the next, so the assessment stops at the first sign of a problem rather than discovering it by asking an injured athlete to run.
| Step | What you do | What it is testing | Stop if |
|---|---|---|---|
| Talk | Ask what happened, where it hurts, what they felt or heard, and whether it has happened before | The mechanism, which is your first hypothesis about the injury, and the athlete's conscious state | The athlete is unresponsive, confused, or reports a head or neck injury — call for medical help immediately |
| Observe | Look at the area and compare it with the other side | Swelling, deformity, discolouration, and how the athlete is holding the limb | There is obvious deformity, suggesting fracture or dislocation |
| Touch | Palpate gently, starting away from the painful area and working towards it | The location of tenderness, heat, and any abnormality under the skin | There is severe pain on light touch, or point tenderness over bone |
| Active movement | Ask the athlete to move the joint themselves, without help | Whether they can move it at all, through what range, and with how much pain | They cannot move it, or movement produces severe pain |
| Passive movement | Gently move the joint through its range for them | The range available without the athlete's own muscle work, which distinguishes some muscle problems from joint ones | The range is markedly restricted, or the movement causes severe pain |
| Skill | Ask for progressively demanding sport-specific movement: stand, walk, jog, run, change direction, then perform the skill | Whether the athlete can actually perform under the demands of the game | Any stage cannot be completed normally and without pain — in which case they do not return |
Three points make the difference between reciting TOTAPS and understanding it. First, the order is deliberately escalating, so a serious injury is identified before it is made worse. Second, the skill test is progressive within itself — stand, then walk, then jog, then run, then change direction, then perform the skill — and each stage is a chance to stop. Third, and most importantly, stopping early is the correct outcome, not a failed assessment. TOTAPS exists to decide safely, and a decision not to return is a successful use of it.
Two things TOTAPS is not. It is not a diagnosis: it does not tell you which structure is damaged, and only qualified assessment can. And it is not for suspected head, neck or spinal injury, or for an unconscious athlete, where the response is immediate medical help and not moving the athlete.
Fill the gaps. A ligament injury is called a , while a muscle or tendon injury is called a . In TOTAPS, the step in which the assessor gently moves the joint for the athlete is called .
A protocol is a structure for a decision, not a replacement for one. Three situations arise regularly where TOTAPS is completed correctly and the answer is still a judgement.
| Situation | Why it is difficult | The defensible position |
|---|---|---|
| The athlete completes every step but with mild pain throughout | They have passed nothing cleanly and failed nothing outright, and they want to keep playing | Mild pain that persists through the skill test is a reason not to return in a school or community setting, where there is no medical staff and no ability to reassess during play |
| The athlete insists they are fine and the match is important | Pressure to play is real and comes from the athlete, teammates and sometimes the coach | The assessor's duty of care from Lesson 9 does not yield to the athlete's preference, and a young athlete cannot consent their way out of it |
| Any suspicion of concussion | Signs can be subtle or delayed, and the athlete may not report them | No return to play on the day of a suspected concussion, and medical clearance before returning at all. This is not a judgement call and TOTAPS is not the tool for it |
That last row is unlike the rest of this lesson. Concussion is managed by a separate protocol precisely because on-field assessment of movement cannot detect it, and because the consequences of returning too early are severe. The rule to hold is short: if in doubt, sit them out, and no same-day return.
Notice the shape of all three rows: the difficulty is never technical. It is that the correct answer costs something — a player, a match, an argument — and the protocol's value is that it makes the decision defensible in advance rather than negotiable in the moment. That is exactly the argument Lesson 13 made for deciding a tactical trigger before the contest.
Odd one out. Three of these are reasons to stop a TOTAPS assessment and refer for medical help. Which one is not, by itself?
This dot point asks about the management and prevention of sporting injuries, and prevention is where classification pays off. Each classification points at a different family of preventive measure, and most of them have already appeared in this module.
| Classification | Preventive measures | Where it appeared |
|---|---|---|
| Direct | Protective equipment, rules and their enforcement, safe technique in contact, matching by size and experience, and a safe playing surface and environment | Lesson 9 hazard control; Lesson 19 protective equipment as force absorption |
| Indirect, acute | Warm-up and specific preparation, strength and neuromuscular training, landing and change-of-direction technique, and adequate recovery so technique does not degrade late in a match | Lesson 9 warm-up; Lesson 17 force absorption; Lesson 15 fatigue and technique |
| Overuse | Graded progression of load, variety, monitoring, adequate recovery, and attention to surface, footwear and technique | Lessons 6 and 7 progressive overload and variety; Lesson 15 monitoring; Lesson 18 recovery |
Look at the right-hand column. Almost the entire prevention answer is content from earlier in this module. That is not a coincidence: injury prevention is mostly good training practice, and the reason the syllabus places it at the end of the focus area is that by this point you have already learned it under other names.
And it answers card 01's harder question. The classification does not change what you do first — every one of the three players gets an appropriate assessment, and the shoulder and the shin both get referred rather than assessed for return. What the classification changes is everything afterwards: what the athlete is treated for, how they are rehabilitated, and above all what has to change so that it does not happen again.
Prevention is not a separate topic. It is the classification read backwards: identify the mechanism, and you have identified what would have stopped it.
Two truths and a lie. One of these statements is false. Find it.
Activities · classify, assess, decide
For each injury, classify it on all three axes, then name the one preventive measure the classification most directly points to.
A netballer lands from a rebound, her knee collapses inwards and she feels a pop. No other player is within two metres.
A cricketer is struck on the thigh by the ball and develops a painful, swollen area that hurts when the quadriceps contracts.
A runner who doubled their weekly distance a month ago now has localised pain over the front of the shin that hurts on every run.
A footballer collides with an opponent, lands awkwardly on an outstretched arm, and there is visible deformity at the shoulder.
Match each term to its meaning.
- Sprain
- Strain
- Direct injury
- Overuse injury
- A ligament injury, where a joint is forced beyond its normal range
- A muscle or tendon injury, from an excessive or poorly controlled contraction or stretch
- One caused by an external force applied to the body
- One developing gradually from repeated loading without adequate recovery
You are the responsible adult at an under-16 match with no medical staff present. A player rolls their ankle landing awkwardly and goes down. There are twelve minutes remaining and the score is level.
| Step | What you find |
|---|---|
| Talk | Alert and clear. Says she rolled it landing, felt a sharp pain on the outside, heard nothing. Has done the same ankle twice before. |
| Observe | Mild swelling on the outside of the ankle, no deformity, she is not putting weight on it. |
| Touch | Tender over the outside of the ankle, no point tenderness over bone, no unusual heat. |
| Active movement | Can move it herself through most of the range, with pain at the end of one direction. |
| Passive movement | Range is close to normal, some pain at the end of range. |
| Skill | Stands, walks with a limp, and says she can jog but is clearly favouring it. Asks to go back on. |
Answer five things. What is your decision, and what is the single most important piece of evidence for it? Which step, if it had produced a different finding, would have stopped the assessment earlier, and what would that finding have been? What is the significance of "the same ankle twice before"? How does the fact that there is no medical staff present change your threshold? And finally: write, in one sentence, what you would say to the player and to the coach, given that both want her back on.
Lock it in. In one sentence, explain why the TOTAPS steps are ordered as they are, rather than starting with the skill test.
Explain how classifying an injury and assessing it using TOTAPS determines its immediate management.
Explain asks how classification and assessment produce a management decision. Listing the TOTAPS steps is description; the marks are for what each step rules in or out.
Plan: name the principle, explain what classification determines, work through the assessment, then answer directly.
Immediate management depends on two things: the type of structure damaged and the severity of that damage. Classification identifies the first and assessment estimates the second, so together they determine whether the athlete can continue, requires on-field management, or must be removed for medical assessment.
Injuries are classified as direct or indirect by mechanism, and as soft tissue, hard tissue or overuse by structure. This determines management because the structures respond differently: soft tissue injury such as a sprain or strain is managed acutely by controlling bleeding and swelling, hard tissue injury such as a fracture or dislocation requires immobilisation and referral without any attempt at movement, and overuse injury requires load modification over time rather than acute treatment at all.
TOTAPS then estimates severity in an order designed to stop before causing harm. Talk establishes the mechanism, the location and the sensation, so an audible crack or immediate severe pain raises the possibility of fracture before anything is touched. Observe compares the injured side with the uninjured one for deformity, swelling and colour, since obvious deformity indicates fracture or dislocation and assessment stops there. Touch identifies the precise site and severity of pain and any temperature or sensation change, and severe point tenderness over bone again stops the assessment.
If none of those has stopped the process, Active movement asks the athlete to move the joint themselves, which tests whether voluntary control and range are intact; Passive movement has the assessor move it through range to test the structures without muscular effort; and Skill test requires the athlete to perform the movement the sport demands. Failure at any stage stops the assessment and the athlete does not return to play.
The assessment therefore produces a decision rather than a diagnosis: passing all six stages supports return to play, failure at any stage indicates removal and further assessment, and the earlier the failure occurs the more serious the injury is likely to be — which is why the order cannot be varied.
Immediate management depends on the type of structure damaged and the severity of that damage: classification identifies the first and assessment estimates the second, so together they determine whether an athlete continues, receives on-field management, or is removed for medical assessment. Injuries are classified as direct or indirect by mechanism and as soft tissue, hard tissue or overuse by structure, which determines management because those structures respond differently — soft tissue injury such as a sprain or strain is managed acutely by controlling bleeding and swelling, hard tissue injury such as a fracture or dislocation requires immobilisation and referral with no attempt at movement, and overuse injury requires load modification over time rather than acute treatment. TOTAPS then estimates severity in an order designed to stop before causing harm. Talk establishes mechanism, location and sensation, so an audible crack or immediate severe pain raises the possibility of fracture before anything is touched; Observe compares injured and uninjured sides for deformity, swelling and colour, and obvious deformity stops the assessment; Touch identifies the precise site and severity of pain and any change in temperature or sensation, and severe point tenderness over bone again stops it. If none of these has halted the process, Active movement tests whether the athlete has voluntary control and range, Passive movement tests the structures without muscular effort, and Skill test requires the movement the sport demands. Failure at any stage stops the assessment and the athlete does not return to play. TOTAPS therefore produces a decision rather than a diagnosis, and because the earlier a failure occurs the more serious the injury is likely to be, the order of the steps cannot be varied.
Explain how sporting injuries can be prevented through preparation, equipment and rule modification.
Explain asks for the mechanism of prevention. The stem names three routes, so all three need a mechanism rather than a mention.
Plan: name the principle, take each route as a linked pair, then answer the question directly.
An injury occurs when the load applied to a structure exceeds what that structure can tolerate at that moment. Prevention therefore works in only two ways: reducing the load applied, or raising the tolerance of the tissue — and every preventive measure is an instance of one or the other.
Physical preparation raises tolerance. Progressive conditioning strengthens muscle, tendon and bone so they withstand greater load; balance and proprioceptive training improves the speed of protective reflexes so a joint is stabilised before it is forced beyond range; and warm-up raises tissue temperature and extensibility, so the same rapid load is absorbed rather than resisted by a stiff structure. Adequate recovery preserves the neuromuscular control that all of these depend on.
Equipment reduces or redistributes the load reaching the tissue. Helmets and mouthguards absorb and spread impact force over a larger area and a longer time, so peak force at any point is reduced; appropriate footwear and surfaces manage the ground reaction force and the friction that produces rotational knee injury; and correctly fitted protective padding prevents direct contact injury to exposed structures.
Rule modification reduces exposure to the highest-risk events. Prohibiting dangerous techniques such as high or spear tackles removes the mechanism itself; age and weight grading limits the force mismatch between opponents; and mandatory concussion protocols and return-to-play rules prevent an athlete competing while impaired, which reduces the risk of a second and more damaging injury.
An injury occurs when the load applied to a structure exceeds what that structure can tolerate at that moment, so prevention works in only two ways — reducing the load applied or raising the tissue's tolerance — and every preventive measure is an instance of one or the other. Physical preparation raises tolerance: progressive conditioning strengthens muscle, tendon and bone to withstand greater load; balance and proprioceptive training speeds protective reflexes so a joint is stabilised before it is forced beyond range; warm-up raises tissue temperature and extensibility so rapid load is absorbed rather than resisted by a stiff structure; and adequate recovery preserves the neuromuscular control all of these depend on. Equipment reduces or redistributes the load reaching the tissue, since helmets and mouthguards absorb and spread impact force over a larger area and a longer time so peak force at any point falls, footwear and surfaces manage ground reaction force and the friction producing rotational knee injury, and correctly fitted padding prevents direct contact injury to exposed structures. Rule modification reduces exposure to the highest-risk events, as prohibiting high or spear tackles removes the mechanism itself, age and weight grading limits the force mismatch between opponents, and mandatory concussion protocols prevent an athlete competing while impaired and so reduce the risk of a second and more damaging injury. Prevention is therefore most effective when all three operate together, because each acts on a different term in the same relationship between applied load and tissue tolerance.
Go back to card 01. The classification does not change what you do first — each of the three gets an appropriate assessment, and both the deformed shoulder and the three-week shin pain are referred rather than assessed for a return to play. What the classification changes is everything afterwards: the shoulder is a direct, likely hard-tissue, acute injury requiring immediate medical care; the knee is an indirect, soft-tissue, acute injury whose non-contact mechanism points prevention at landing technique and neuromuscular training; and the shin is an overuse injury, which means the real intervention is in the training program rather than in the tissue. Write down which of the three you would have handled differently before this lesson, and why.
Multiple choice · 5 questions
MC 1. A sprinter tears a hamstring at top speed with no contact. This injury is classified as:
- A. direct, hard tissue, acute
- B. direct, soft tissue, overuse
- C. indirect, hard tissue, overuse
- D. indirect, soft tissue, acute
MC 2. Which statement about sprains and strains is correct?
- A. a sprain is a muscle injury and a strain is a ligament injury
- B. both terms refer to bone injuries of different severity
- C. a sprain is a ligament injury and a strain is a muscle or tendon injury
- D. the two words are interchangeable
MC 3. In TOTAPS, which step involves the assessor moving the injured joint for the athlete?
- A. Touch
- B. Passive movement
- C. Active movement
- D. Skill
MC 4. The TOTAPS steps are ordered from least to most demanding because:
- A. a serious injury is identified before the athlete is asked to do anything that could worsen it
- B. the athlete is more cooperative early in the assessment
- C. the order determines the diagnosis
- D. the skill test is the least reliable of the six steps
MC 5. A runner who doubled their weekly distance a month ago now has localised shin pain on every run. The most important element of management is:
- A. a longer warm-up before each run
- B. strapping the lower leg before running
- C. assessment plus a change to the training load, since an overuse injury is a load problem and treating the tissue alone returns the athlete to the same injury
- D. a change of running surface only
Short answer · exam style
SA 1. Understand Band 4 Explain how sports injuries are classified, using one example for each of the three axes. (4 marks)
SA 2. Apply Band 5 Describe the TOTAPS assessment, explaining what each step tests and why the order matters. (6 marks)
SA 3. Evaluate Band 6 Explain how the classification of a sporting injury informs both its immediate management and its prevention. Use two contrasting injuries. (7 marks)
📖 Comprehensive answers (click to reveal)
Multiple choice: 1 → D. 2 → C. 3 → B. 4 → A. 5 → C.
Activity 1, indicative answers: 1 → Indirect, since the forces were generated within her own body with no contact; soft tissue, most likely ligament given the mechanism and the reported pop; acute, since it happened at an identifiable moment. Prevention: neuromuscular and landing technique training, teaching control of knee position on landing and on change of direction, supported by adequate recovery so that technique does not degrade late in a match. 2 → Direct, since an external force struck the thigh; soft tissue, a contusion with bleeding into the muscle, indicated by pain on contraction; acute. Prevention: protective equipment, which spreads impact force over a larger area and a longer time, plus rules and technique in the situations where the ball is likely to strike a player. 3 → Indirect; could be soft or hard tissue and persistent localised bone pain requires assessment, since a stress fracture is possible; overuse, given the gradual onset and the load history. Prevention: graded progression of load — doubling weekly distance is progressive overload breached at its upper failure mode — supported by monitoring, variety, adequate recovery and attention to surface and footwear. 4 → Direct; hard tissue, at a joint, since visible deformity suggests dislocation or fracture; acute. Prevention: safe technique in contact, rules and their enforcement, and matching by size and experience. What must NOT be done: do not attempt to relocate the joint and do not proceed with the remaining TOTAPS steps; immobilise, support, and arrange immediate medical care.
Activity 2, indicative answers: The decision is that she does not return to play. The single most important piece of evidence is the skill step: she walks with a limp and is clearly favouring the ankle, and a player who cannot complete progressive sport-specific movement normally and without pain has not passed the assessment, whatever she says about being able to jog. The step that would have stopped the assessment earlier is Touch, if there had been point tenderness over bone, which would suggest a possible fracture and require referral rather than further movement testing; obvious deformity at Observe would have done the same. The history of two previous sprains to the same ankle matters in two ways: previous injury is among the strongest predictors of re-injury, and it suggests the underlying problem — strength, proprioception, or an incomplete rehabilitation from the earlier episodes — was never addressed, which is a prevention finding rather than a match-day one. The absence of medical staff lowers your threshold for stopping considerably: there is nobody who can assess more precisely, nobody to monitor her during play, and nobody to intervene if it worsens, so a borderline case is decided against returning. What to say: something factual and non-negotiable rather than an invitation to argue, such as "she can't jog without favouring it, so she's done for today; we'll get it looked at this week and sort out why this keeps happening to that ankle."
SA 1 (4 marks): Direct and indirect [1]: a direct injury is caused by an external force applied to the body, such as a contusion from being struck by a ball, while an indirect injury is caused by forces generated within the body or occurs away from the point of impact, such as a hamstring tear while sprinting. Soft and hard tissue [1]: soft tissue includes muscle, tendon, ligament and cartilage, as in an ankle sprain, while hard tissue means bone and joint injuries involving bone, as in a fracture or dislocation. Acute and overuse [1]: an acute injury occurs at an identifiable moment, while an overuse injury develops gradually from repeated loading without adequate recovery, such as a stress fracture or tendinopathy following a rapid increase in training load. Why it matters [1]: the three axes are applied simultaneously and each informs a different decision — cause points to what would prevent it, tissue indicates urgency and management, and onset reveals whether the problem lies in the tissue or in the training program. Credit also for noting that direct and indirect describe cause rather than severity.
SA 2 (6 marks): One mark per step, correctly described with what it tests, up to five, plus a mark for the order. Talk [1]: ask what happened, where it hurts and what they felt or heard, which establishes the mechanism and confirms the athlete is alert. Observe [1]: look at the area and compare with the other side for swelling, deformity or discolouration. Touch [1]: palpate gently, beginning away from the painful area, to locate tenderness, heat or abnormality, and to check for point tenderness over bone. Active movement [1]: the athlete moves the joint themselves, showing whether they can move it, through what range and with how much pain. Passive movement [1]: the assessor gently moves the joint for them, showing the range available without the athlete's own muscle work. Skill [1]: progressive sport-specific movement — stand, walk, jog, run, change direction, then perform the skill — testing whether they can meet the demands of the game. Why the order matters [1]: each step is less demanding than the next, so a serious injury is identified before the athlete is asked to do anything that could worsen it; the assessment stops at the first sign of a problem, and stopping early is a correct outcome rather than a failed assessment. A strong answer also notes that TOTAPS is not a diagnosis and is not used for a suspected head, neck or spinal injury.
SA 3 (7 marks): Two contrasting injuries, each fully classified, with management and prevention traced from the classification. Injury one, for example a non-contact anterior cruciate ligament injury on landing [3]: classified as indirect, soft tissue and acute [1]; immediate management is to stop play, support and immobilise the joint, apply the acute management principles and refer for medical assessment, since a ligament injury with instability cannot be assessed for return on the field [1]; prevention follows from the mechanism, which was the athlete's own landing and change of direction, so it points to neuromuscular and landing technique training, strength work, and adequate recovery so that technique does not degrade late in matches [1]. Injury two, for example a stress-related shin injury after a rapid increase in running volume [3]: classified as indirect and overuse, and potentially hard tissue, so persistent localised bone pain requires assessment [1]; management is a reduction or modification of load with medical assessment, since continuing to run on it risks progression [1]; prevention lies in the training program rather than the tissue — graded progression of load, monitoring, variety, adequate recovery and attention to surface and footwear [1]. The synthesising mark [1]: the classification is a hypothesis about the cause, and the cause is the thing that can be changed, which is why the syllabus pairs management with prevention; it also explains why treating an overuse injury without changing the load returns the athlete to the same injury.
Two artefacts are worth keeping from this lesson. The three-axis classification grid, because every injury question starts by placing the injury on it. And the TOTAPS sequence with its stopping points, because it is one of the few genuinely procedural things in this course and is therefore highly examinable.
Fix the two confusions permanently: sprain is ligament and strain is muscle or tendon, and direct and indirect describe cause rather than severity. Lesson 21 continues the same dot point with management, rehabilitation and return to play.
Mark lesson as complete
Tick when you've finished the practice and review.