While there are no national regulations, the American Academy of Family Physicians along with the American College of Sports Medicine, American Academy of Pediatrics and the American Medical Society for Sports Medicine recommend a complete Pre-Participation Physical Exam (better known as a PPE or sports physical) be performed at each new level of participation. When warranted during interim years, a review of the medical history and subsequent evaluation should be conducted as well. PPEs are required annually by the Ohio High School Athletic Association (OHSAA) for participation in school sports for grades 7-12.
The main objective of sports physicals is to screen for conditions that may be life threatening (certain heart conditions for example) or that predispose athletes to injury or illness.
Secondary objectives are to:
- Determine general health
- Serve as an entry point to the health care system for adolescents
- Provide an opportunity to initiate discussion on health-related topics
The sports physical starts with completion of a history form consisting of questions about the athlete’s medical and family history. This form is reviewed by the medical provider and then a physical exam is performed.
Based on the findings from the history and exam, the athlete may be:
- Cleared for participation without restriction (most likely)
- Cleared for participation with recommendation for further evaluation or treatment
- Not cleared for participation in some or all sports, possibly pending further evaluation (rare)
Sports physicals should ideally be performed at least 6 weeks prior to the start of practice to allow adequate time for further evaluation, treatment and rehabilitation of any identified conditions and should be performed by the athlete’s primary care physician in the medical home. This allows for evaluation by a provider who knows the athlete personally and who has access to the athlete’s complete medical record, making unnecessary restriction from sport less likely.
The office setting provides a quiet environment which makes it easier to perform an accurate physical exam and provides more privacy for the athlete. Sports physicals provided by the athlete’s own physician allows for more time to discuss confidential health issues and makes it easier to coordinate care with consultants as needed for any follow-up evaluation.
Alternatively, sports physicals may be performed as mass evaluations, usually in the school setting. While this may be cheaper and more convenient for athletes and their families, there are many disadvantages to mass sports physicals. Wait times are often long. Physical exams and discussions of medical history usually take place in noisy environments and offer little privacy to the athlete.
Athletes frequently show up to such events by themselves with incomplete or inaccurately completed history forms and parents may be unavailable, which increases the likelihood that life-threatening conditions may be missed. Finally, these evaluations are performed by providers without a personal knowledge of the athlete or access to his/her medical record, which can lead to unnecessary referrals and/or follow-up with the primary care physician to clarify pre-existing medical issues.
For the reasons listed above, the PPE 4th Edition (an advisory document published by the American Academy of Pediatrics with input from various medical organizations to advise providers on the best practices regarding pre-participation evaluations) recommends sports physicals be performed in the office setting. If athletes do take part in mass sports physicals, it should not be considered a comprehensive medical examination and should never take the place of the recommended annual check-up with the athlete’s primary care physician.
By planning ahead, providing accurate and detailed medical information, and following the above advice, parents can help to ensure a proper evaluation and allow their kids the best opportunity to keep playing the sports they love.Save Save Save