Sports Physicals

The sports physical, also known as the pre-participation examination (PPE), is an annual rite for millions of students who participate in school athletics.    Even though the necessity of these exams in the young, healthy population in which they are performed has been questioned, most states in the U.S. require some form of physical evaluation before participation in sports at the high school level.  As noted in a publication from the American College of Sports Medicine, "the purpose of the PPE is not to disqualify or exclude an athlete from competition, but rather to help maintain the health and safety of the athlete in training and competition.

When performed appropriately, the sports physical can serve a number of useful purposes such as:

• Identifying medical or musculoskeletal conditions that could make sports participation unsafe.
   
• Detecting previously undiagnosed health problems.
   
• Evaluating for previous injuries that may not have been adequately rehabilitated.

There are some very definite limitations, however, with the way that some of these examinations are currently being performed.  Parents should be aware of these limitations, and if necessary, take steps to assure the safe participation of their children:

1. The sports physical should not be viewed to be the same as a general physical exam.  The PPE tends to focus on sport-related issues and does not cover a number of important issues potentially impacting adolescent health such as such as tobacco use, risky sexual behaviors or improper nutrition.  Scheduling an appointment with the athlete's regular doctor for a health maintenance exam along with the completion of the school's required form may be a better approach if a more in depth evaluation is warranted.
   
   
2. Sports physicals are often performed during a mass screening.  This "cattle call" method is usually performed by several health care providers at designated "stations" in a gymnasium or auditorium.  This method can result in the loss of privacy or inhibit the student from bringing up a personal concern with the doctor. Mass screenings tend to also be noisy which limits the ability of the doctor to accurately diagnose problems such as heart murmurs.
   
   
3. Perhaps the most important part of any examination is the medical history.  Relying on information provided solely by adolescents is risky. It is important that parents participate in completing these forms or be present during the exam to provide pertinent medical information.
   
   
4. Typically, the school athletic department will schedule the mass-screening examination shortly before the beginning of the athletic season (often in August prior to the start of football practice).   Unfortunately, this may not allow time for the treatment or rehabilitation of identified problems.  For example, if elevated blood pressure is discovered, repeat readings or treatment may be necessary to assure safe participation. Or, if an ankle sprain has resulted in persistent ankle weakness, several weeks may be required to adequately rehabilitate the injury. Ideally, these exams should be performed 4-6 weeks prior to the start of the season.

Sudden death in athletes, usually due to a congenital or genetic heart defect, is a rare, but devastating occurrence. In 2014, experts from the American College of Cardiology released a 14-point checklist designed to screen for congenital or genetic heart disease in 12- to 25 year olds.  This checklist is history-based and asks about issues such as whether the athlete has had chest discomfort during exertion or whether he/she has a relative who died of heart disease before the age 50.  A positive answer to any of the 14-points warrants further evaluation including an electrocardiogram.  Physicians or other health care providers performing sports pre-participation examinations should be familiar with this checklist.  Parents who want to try to assure the safe participation of their children should make sure that these 14 issues are adequately addressed.