Preparticipation physical exams are required for any public middle and high school student prior to taking part in any school sponsored sport, but what do doctors and nurses evaluate before your young athlete is allowed to take the field, court or mat? Dr. Richard Brookman, a pediatrician with a focus on adolescent medicine, answers these 5 questions about what happens during sports physicals.
Can you explain why sports physicals are so important?
Sports participation is encouraged for all youth and contributes to physical health, emotional well-being and social development. Preparticipation sports physicals help ensure the health and wellness of athletes especially to avoid worsening of a condition that could result in serious injury or even death. These assessments are an opportunity to offer guidance about both healthy living and safe sports. They also provide a health check-in for students who otherwise might not have a yearly preventive health visit.
What do providers look for during a preparticipation sports physical?
Providers will ask about the following:
- Are there any symptoms that have not been evaluated but might suggest an undiagnosed condition (such as dizziness, fainting spells, shortness of breath with activity)?
- Are there any current or past significant medical conditions? If current, are they being treated or managed adequately?
- Any past surgical procedures? If so, how recent and what is the state of recovery?
- Any prior injuries? If the answer is yes, what has been the treatment and recovery process, what is the current state of the injury and is there risk of repeat injury?
- What medications are currently being taken? Are any required to participate safely? (Examples include seizure medications, insulin for diabetes or albuterol for asthma).
- Are any supplements being taken or unusual diets being tried?
- Are there any allergies that might be worsened by the environment where the sport takes place?
- Is there a need for protective equipment like a helmet, kidney pads or genital cup?
- For girls, are they having menstrual periods and are they regular? Intensive physical activity can affect menstrual patterns.
- Is there any family history of heart disease that might predict a problem and require further evaluation by a cardiologist?
- Is there a need for any immunizations? Is their tetanus shot up to date?
Providers will also:
- Check height, weight – are there any concerns about being too heavy or too light/thin for a particular sport?
- Measure blood pressure, pulse
- Test vision – is there a need for corrective lenses or eye protection?
- Perform a general exam with extra attention to lungs and heart
- Perform a musculoskeletal exam – strength, mobility of all extremities and joints
- Check skin for conditions that might impact participation, at least until treated
What types of findings would disqualify a student athlete from participating in a school sport?
Some disqualifications could be temporary, for example:
- A current acute illness like upper respiratory or infectious mononucleosis
- Poorly controlled asthma or seizures until adequately controlled
- Skin conditions such as ringworm until treated or appropriately covered
- Minor injuries such as a sprain until sufficiently healed
Other disqualifications may be permanent for certain sports, although other sports may be permitted and even encouraged. For example, athletes with repeated concussions should avoid sports like football or soccer. Your provider will be able to give you that information during this preparticipation sports physical. If the student has a chronic condition, the involved specialist(s) should be consulted about which sports are safe and recommended.
Can you recall a time where a preparticipation has revealed a health condition not previously known about?
Years ago during a sports physical, we found high blood pressure and a subsequent urinalysis found evidence of chronic kidney disease. The patient had no symptoms, so the preparticipation physical helped diagnose a very serious medical condition.
What advice do you have for parents as they navigate this process?
The best advice I have is to anticipate the need for a sports physical and schedule early so it can be done prior to try-outs or early training. You should also make sure it can be done with the student’s primary care provider. Physicals done at school or urgent care facilities are often less comprehensive, do not allow adequate time or privacy for a thorough health history, and involve providers who don’t have access to the student’s medical history.