The Core Components of a Sports Physical

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2 Millions of American athletes - many of them teens - undergo sports physicals each year before they get into their game of choice. Also called a pre-participation examination, the sports physical may seem unnecessary to some, particularly since most people who get them are very healthy. Understanding the purpose, goals, and outcomes of the sports physical is therefore essential to deciding whether to get one, and when and how to go about getting one. Page 2

3 Background of the sports physical In a nutshell, sports physicals are designed to ensure that athletes of all ages are healthy enough to participate in sports and related activities while minimizing the risk of sports-related injuries. Their purpose is to clear athletes to play or compete and assess how they should compete and train safely. They are also intended to identify any conditions that could put an athlete at risk to avoid injuries and plan for smarter rehabilitation should injuries occur. Although sports physicals exist in 50 of the 51 states (counting the District of Columbia), there is no one standard for how they are conducted. Each medical practitioner has his or her own approach to conducting these exams, and each state may have its own requirements, especially for student athletes. Some practitioners see sports physicals primarily as risk-based screening evaluations; others view them as thorough health examinations that take place periodically. While the American Medical Association (AMA) states that there is a right to a thorough preseason evaluation, it doesn't explain any more about what that entails. Page 3

4 Sports physicals and competing interests Sports physicals are conducted with three interest areas in play: athletic/coaching interests, administrative/legal interests, and medical interests. Sometimes these interests all coincide, but often they are competing interests. Athletes and coaches tend to put their respective interests first. Athletes want to compete and need the right information about their health, injuries, and performance to train properly and safely. Coaches need the information too so they can help their athletes achieve maximum performance. Athletic directors, schools, and legal departments tend to focus on administrative and legal interests. They need to be sure that athletes can participate safely so their institutions won't be subject to lawsuits, loss of insurance and/or rising coverage costs, and other problems. Treating physicians are usually proponents of medical interests. Practitioners want to protect their patients, their practices, and their reputations, so they usually proceed with caution when it comes to injuries. Each case is different, and physicians need to be as sure as they can that an athlete can compete and train safely. Page 4

5 Goals and objectives of a sports physical The broader goals of the entire sports physical look like this: Assess the athlete's general health and health history. Assess the athlete's present fitness level. Assess the athlete's size and developmental maturation. Detect any congenital anomalies that could increase the risk of injury for the athlete. Detect any other conditions that could increase the athlete's risk for injuries. Evaluate the athlete's existing injuries. Detect any inadequate, improper, or otherwise poor conditioning the athlete has undertaken that could put him or her at increased risk. Page 5

6 When is the right time to get a sports physical? There is no set rule for when to get a sports physical, but six weeks before the start of physical activity (including training) is ideal. That's because if the timing is too close to when the season starts, there is not adequate time to rehabilitate any physical problems or injuries detected in the exam. There is also not enough time to implement proper conditioning to prevent future injuries based on the specific findings in the sports physical. The result may mean missing part of the season caring for an injury or other problem, or causing an unnecessary injury with poor training. Page 6

7 Who conducts sports physicals? In general, there are two kinds of sports physicals: those conducted by the personal physician of the athlete and those conducted by multiple providers in a multi-station setting - usually set up by a school or other institution. Now there is also a third, hybrid approach: the sports physical conducted by private physicians and medical providers in a private setting other than the office of the athlete's personal doctor. Although they are less common, sports physicals conducted by the athlete's personal physician or another private doctor are far more likely to be complete exams. They are also more likely to be part of an integrated approach to the athlete's healthcare, making the sports physical part of the overall continuity of care for that patient. Because they take place in a healthcare facility, they are also more conducive to privacy. Their primary drawback is that they're conducted by private doctors who may not have as much experience in this area. Multi-station sports physicals are sometimes arranged for multiple athletes by schools and other institutions. Under these circumstances multiple doctors and other healthcare providers will congregate on hand to conduct various different portions of the sports physical for each athlete, often assisted by trainers. This kind of approach sometimes offers the advantage of more attention to more athletes that might otherwise go untreated. It can also provide immediate attention from attending specialists for those whose problems surface. Obvious drawbacks include a lack of privacy, a disconnect from continuity of care, and a possibility that subtler problems remain undetected. The third hybrid approach sees some sort of specialized healthcare facility - such as a sports medicine facility or urgent care facility with sports medicine capabilities - providing sports physicals to a broad spectrum of patient athletes. In this scenario the sports physical is conducted in private with access to the patient's entire history and medical record. However, due to the cost-effectiveness of the model, this kind of arrangement is typically less expensive and more accessible than a traditional private doctor model. It also ensures that the practitioner conducting the sports physical has the right training. Page 7

8 What happens during a sports physical? Each sports physical consists of two main components: the medical history and the physical exam. The medical history is a critical tool for identifying existing conditions that could impact an athlete's ability to perform in sports. The focus of the medical history is on the detection of disease and injuries, both previous and current, and the detection of things like musculoskeletal and cardiovascular abnormalities. Any sign of any of these issues will prompt further inquiry and testing. A practitioner conducting this portion of the sports physical will address at least these issues: Demographic data such as contact information and details concerning authorization to treat specific conditions. Status of immunizations, particularly tetanus; tetanus is related to the risk of abrasion and laceration inherent to most sports. Page 8

9 History of excessive or rapid weight gain or loss which may suggest an eating disorder, purging, or steroid abuse. History of asthma, both in the athlete and the family, whether triggered by exercise or other factors. Family history of serious illnesses. Episodes of dizziness or collapse with exertion to rule out heart disease. Menstrual history abnormality can be linked to significant underlying medical conditions such as drug abuse, eating disorders, nutritional deficits, osteoporosis, pregnancy, and psychiatric conditions. Use of contact lenses or dental appliances, and other devices which could become dislodged during competition. History of concussions; evidence regarding the morbidity associated with repetitive head injuries makes assessment of concussion history essential to risk assessment for contact or collision sports. History of allergies and anaphylactic reactions, especially if an athlete has known anaphylaxis with insect bites. Use of alcohol, drugs, dietary supplements, and/or performance enhancing drugs, such as steroids. Family history of exercise-related death. Loss or dysfunction in one of a pair of organs (such as one kidney, eye, or testicle) since injury to remaining organ will mean a total loss. History of dislocations, fractures, and other injuries which can indicate conditions that require further treatment or an abnormality in playing mechanics or equipment that demand modification. History of heat illness which indicates risk for recurrence. Source of the medical history and assessment of its reliability. The history sets the roadmap for the physical examination. It must be complete and global to detect any risk and abnormality which could hamper an athlete's performance or safety. Generally, the physical portion of the examination includes a medical evaluation, performance testing, and an orthopedic examination. Page 9

10 The physical examination will typically include these elements: Lungs will be examined. Height and weight are assessed in terms of growth and development, general fitness, and pathology (presence of eating disorders, for example). Minimum weights may impact suitability for some contact sports, and other sports may categorize athletes by weight class. Blood pressure is a good first sign of abnormalities and significant elevations are grounds for limited participation and referrals. Vision need not be perfect to participate in sports, but to prevent injuries vision should be corrected adequately. Eye exams will also include assessment of pupil reactivity and anisocoria so that later comparison in case of head injury is more accurate. Heart examination for routine murmurs or irregular rhythms in at least two body positions is an essential part of a sports physical to maximize the chances of detecting the subtler abnormalities. Abdominal examination for organomegaly, especially splenomegaly, is critical to any sports physical due to the risk of rupture inherent to contact sports. Genital examination is often part of a sports physical because it can be used to detect hernias and the presence of a single testicle. Skin examination for infectious dermatoses such as herpes or impetigo is critical for certain sports like wrestling. A musculoskeletal exam includes an evaluation of arm and leg function, gait, knee extension, joint range of motion, posture, and scoliosis. Flexibility testing may be assessed using range of motion comparison, general lowerextremity flexibility measurement, and other tools. Endurance testing may be conducted with timed running, distance running, timed sprinting, maximal weight lifting, vertical leaping, broad jumping, and other measures. Page 10

11 What happens if the doctor finds something wrong? The sports physical is specifically designed to help the doctor detect any conditions, defects, or diseases that could hurt the athlete's performance or cause injury. Once the problem is identified, the practitioner and the athlete (and his or her coach, if applicable) can get to work formulating a plan. There may be additional tests and examinations needed before final conclusions can be drawn. Often, the doctor can recommend a training and/or treatment plan to start right away so the athlete can begin to rehabilitate the illness or injury at once. The medical team can also cooperate with coaches and family to ensure that the process is safe while remaining competitive. Often there's no bad news to report and the findings from the sports physical are all good news. Even when this is the case, every athlete owes it to him- or herself to continue to communicate with his or her doctor and report any changes or injuries immediately. This way, proactive treatment and early diagnosis can ensure the best possible outcome. Page 11

12 Conclusion Today's athletes are in a great position to maximize their performance safely. The sports physical is one of the main tools athletes need to use to make this goal a reality. Sports physicals are effective and efficient when they are performed correctly by an experienced practitioner. Remember, even the best sports physical doctor can't conduct his or her work without the help of the athlete/patient. To better assist your doctor, keep these core goals of a sports physical in mind: To detect any injuries, abnormalities, diseases, or other problems that place the athlete at risk for sport-specific injury To empower the athlete by informing him or her of correctible problems before the season starts To assess the safety of participation To protect athletes as well as their coaches and institutions Every athlete is entitled to participate in sports. Ensuring that athletes participate safely keeps everyone healthier and happier and promotes better lifelong habits of physical activity throughout our culture. Page 12