Sports Participation Evaluation
The overall goal of the preparticipation physical evaluation (PPE) is to ensure safe participation in an appropriate physical activity and not to restrict participation unnecessarily. Whether athletes receive the PPE in the context of an ongoing primary care relationship or as a focused preseason checkup, the following goals of the evaluation are universal:
• To identify conditions that may interfere with a person’s ability to participate in a sport
• To identify health problems that increase the risk for injury or death during sports participation
• To help select an appropriate sport for a person’s particular abilities and physical status
Sports and disciplined physical effort enhance fitness and coordination, increase self-esteem, and provide positive social experiences for participants, including individuals with physical and intellectual disabilities. Few children and youth have conditions that might limit participation, and most of these conditions are known before the PPE takes place. The PPE should be completed well enough in advance of the planned sports activity so that any needed specialist evaluations, rehabilitation, or therapy can be completed before participation begins. As a general rule, 6 weeks before participation is an appropriate time.
Examination Guidelines
Recommended components of the PPE include a focused medical history and examinations of high-yield areas, like the cardiac and orthopedic systems. Physical examination items are shown in italics in the following box.
Recommended Components of the PPE
• Illnesses or injuries since the last health visit or PPE
• History of having been denied or restricted from participation in sporting activities and reason for restriction
• History of heat illness or muscle cramps
• Current viral illness (patients with mononucleosis may return to play after 3 weeks if no longer symptomatic and no splenomegaly; fever at the time of the examination is an absolute contraindication because of the association with viral myocarditis)
• Sickle cell trait or disease (adequate hydration is necessary, and caution should be taken to avoid extreme conditions because of the risk for rhabdomyolysis)
• Hospitalizations or surgeries
• All medications used by the athlete (including steroids and nutritional supplements or medications taken to enhance performance)
• Use of any special equipment or protective devices during sports participation
• Allergies (including food-, insect bite–, and exercise-provoked allergies), particularly those associated with anaphylaxis or respiratory compromise
• Absence of paired organs (single-organ athletes may participate if the single organ can be protected and the patient/caregivers understand the risks involved)
• Immunization status including hepatitis B, varicella, meningococcal, human papillomavirus, and pertussis
• Height, weight, and body mass index
• Symptoms of exertional chest pain/discomfort
• Unexplained syncope/near-syncope
• Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
• Prior recognition of a heart murmur
• Elevated systemic blood pressure
• Family history of premature death (sudden and unexpected, or otherwise) before age 50 years because of heart disease in one or more relatives
• Family history of disability from heart disease in a close relative younger than 50 years
• Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
• Heart murmur (auscultation should be performed in both supine and standing positions, or with Valsalva maneuver, to identify murmurs of dynamic left ventricular outflow obstruction); heart rate and rhythm to assess for arrhythmias
• Femoral pulses to exclude coarctation of the aorta
• Physical stigmata of Marfan syndrome (e.g., arm span greater than height and hyperextensible joints)
• Brachial artery blood pressure (sitting position with appropriate size cuff, preferably taken in both arms)
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
