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Pre-Participation Physical Examinations

Jan 13, 2012

Written by Brent Rich, M.D., ATC

Originally printed as an ACSM Current Comment.

Before sports participation, almost all student athletes are required to undergo a preparticipation physical exam (PPE). It is important to understand that the purpose of the PPE is not to disqualify or exclude student athletes from competition, but to help maintain the health and safety of the athlete in training and competition. There are three primary and three secondary objectives of the PPE.

Primary Objectives:
1. Detect conditions that may predispose the athlete to injury.
2. Detect conditions that may be life-threatening or disabling.
3. Meet legal and insurance requirements.

Secondary Objectives:
1. Determine general health.
2. Counsel on health-related issues.
3. Assess fitness level for specific sports.

Although there is some disagreement among health professionals as to the necessary frequency and timing of the exam, the PPE is generally a formal requirement prior to participation in high school, college and professional sports each year. The qualification of the health care professional who performs the PPE is based on practitioner availability, clinical expertise and individual state laws, but the training of M.D./D.O. physicians usually makes them the best qualified to perform the exam. The exam may be performed in an office-based or a station-based setting, depending on the number of exams to be performed, cost and privacy needs. Either method has advantages and disadvantages, and may be tailored to the individual situation.

The content and extent of the exam should include a medical history and a physical exam. A complete medical history to review past injuries, surgeries or illnesses, medication usage, signs or symptoms (especially during exertion) and drug allergies should be obtained. An interim history should be obtained for follow-up PPEs on a regular basis. Detailed history questionnaires may be used, depending on the situation. The physical exam should always include a measure of height, weight, visual acuity and vital signs (blood pressure, pulses). The extent of the examination of the head, ears, nose and throat, lungs, cardiovascular system, abdomen, genitalia, skin and musculoskeletal system varies and may be customized depending on the sport.

If concerns are identified during the PPE, determining clearance for participation should be undertaken with the following principles in mind:

1. Does the concern place the athlete at increased risk for injury?
2. Is another participant at risk for injury because of the problem?
3. Can the athlete safely participate with treatment (such as medication, rehabilitation, bracing, or padding)?
4. Can limited participation be allowed while treatment is being completed?
5. If clearance is denied only for certain sports or sports categories, in what activities can the athlete safely participate?

Restriction from participation must be made based upon the best objective medical evidence, and should be determined with the cardiac and aerobic demands of the proposed activity in mind. An understanding of the strenuousness of the activity in relation to the physical limitations is crucial. If clearance is denied, recommendations for correction prior to participation should be communicated, and a follow-up evaluation should be scheduled. If acute illnesses or correctable conditions are resolved prior to the sport season, clearance should be given.

Each case should be evaluated individually. Understanding the value of participation should guide the practitioner in determining a suitable approach for clearance.

By working with a physician, the majority of athletes can safely enjoy the benefits of sports.

View the full summer 2009 issue of the ACSM Fit Society® Page online.

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