The pre-participation physical examination

1. The pre-participation physical examination Chapter 6

2. The pre-participation physical examination (PPE) • Over the years, the PPE has gone from a cursory examination to a comprehensive overall assessment of an athlete’s health and ability to perform a sport at a highest level • Should take place at least 6 weeks before the sports season • If musculoskeletal problems are found that will leave time for rehabilitation and strengthening of the area of concern

3. Primary Goals of the PPE • Main goal is to maintain the health and safety of the athlete • Other goals include • Determination of the athlete’s general health • Disclosure of defects that may limit participation • Detection of conditions that may predispose the athlete to injury • Determination of the optimal level of performance • Classification of the athlete according to individual requirements • Fulfillment of legal and insurance requirements • Evaluation of the level of maturation of younger athletes • Evaluation of fitness and performance for possible improvement prior to participation • Provision of opportunities to compete for students with specific health issues that may preclude blanket approval • Provisions of opportunity to counsel youths regarding personal health issues. • Entry of the athlete into the local sports medicine environment, thereby establishing a doctor-patient relationship

4. Two Types of ppeS • Office based • Benefits include • The family physician, the usual evaluator, has access to the complete medical history of the athlete • The setting is quiet and allows for the discussion of multiple health issues. • Immunization history is available and can be easily be updated. • Station based • Benefits include • many athletes examined in the same setting, often for lower costs • Athlete examined by several specialists • Stations include medical history and basic measurements (BP, height, weight, eyesight) • Specialists include family physicians, orthopedic specialists, physical therapists, ATCs, podiatrists, and pediatricians • Difficulties: Finding volunteer medical specialists an a location for the examination

5. Components of the PPE • A complete medical history will identify 75% of all problems affecting athletes • Recommended baseline history • Medical conditions and diseases • Surgeries • Hospitalizations • Medications • Allergies • Immunization status • Menstrual history • Pulmonary status • Neurological status • Musculoskeletal status • Injuries/illnesses since last exam • Recommended components of PPE • Height • Weight • Pulse • Blood pressure • Eyes • Ears/nose/throat • Abdomen • Genitalia • Skin • Musculoskeletal

6. Clearance • The term used for physical permission for athletic participation, is divided into 3 categories • Unrestricted • Clearance after completion of further evaluation or rehabilitation • No clearance for certain types of sports or all sports • Sports are classified based on degree or level of contact and strenuousness, which could result in clearance for some, but not all sports.

7. When abnormalities are found • The physician must consider several questions if or when abnormalities are found • Does the problem place the athlete at risk for injury? • Is another participant placed at risk of injury because of the problem? • Can the athlete safely participate with treatment? • Can limited participation be allowed while the treatment is being completed? • If clearance is denied for only certain sports of sports categories, in what activities can the athlete safely participate?

8. Recordkeeping • Physical forms are completed and signed by a physician • Is not considered valid until this is done • Information from the PPE is confidential and must be treated with the strictest of confidence by storing the forms in the ATCs or ADs office under lock and key • All PPE forms should be kept and stored for a minimum of 7 years after the athlete graduates or leaves the school • Statue of limitations