Why are sports physicals necessary?

If you have children who participate in sports, you know how anxious they are to get in the game. For their safety, however, many schools require a sports physical, also called a pre-participation exam (PPE), before they’re allowed to play. In the United States each year some 30 million student athletes under the age of 18 and another three million special needs athletes receive medical clearance to participate in sports.

The intent of a sports physical is to:

  • Assess your student athlete’s general health and current fitness level.
  • Screen for existing illnesses and injuries, including life-threatening conditions.
  • Help detect conditions or factors that could increase your athlete’s risk of illness or injury.
  • Ensure that any chronic medical conditions are appropriately managed.
  • Provide strategies to prevent injuries and promote safe participation in sports.

Who conducts sports physicals?

In some cases, your child’s school will set aside time for a healthcare professional to conduct sports physicals on site. Sometimes a physician's assistant or athletic trainer will assist with the exams.

If possible, it’s best to have your child’s pediatrician or personal doctor complete the sports physical. Your child’s own healthcare professional is most likely to conduct a complete exam, have access to past medical and laboratory records, review immunization records, be familiar with family medical history, and be able to answer personal questions in a private setting. Your child’s pediatrician or primary caregiver is better able to notice changes over time and respond appropriately.

Keep in mind that exams sometimes offered by schools are limited and not a substitute for an annual exam with your child’s doctor. If your child is seen by someone other than their personal physician, be sure to get a copy of the report and share it with your child’s doctor.

When should a sports physical appointment be made?

Although there is no hard and fast rule about when your student athlete should have a participation physical, the best time may be at least six to eight weeks before the start of the sport season. This time frame allows your child time, if needed, to treat any issues identified, rehabilitate an existing injury, return for a re-evaluation or improve conditioning before starting their sports season. Proper conditioning is important because it can help prevent future injuries.

If the timing of the physical is too close to the start of the season and a problem is found, your son or daughter may not be cleared to play and may have to sit out part of their season.

What happens during a sports physical?

There are two components to the physical: the medical history and the physical exam. The medical history helps identify about 90% of your child’s medical problems and about 70% of muscle and bone (musculoskeletal) problems. Ideally you – the parent(s) or guardian – should be present to provide history details if your student athlete is younger than 18 years old.

Medical history

Your healthcare provider will review your child’s:

  • Immunization history, particularly last tetanus shot.
  • Nutrition/calorie intake. Weight gain and/or weight loss. History of any eating disorder.
  • History of asthma or other breathing problems
  • Family history of serious illnesses.
  • History of dizziness, light-headedness, collapse/passing out during activity.
  • Heat illness history.
  • Menstrual history.
  • Seizure history.
  • History of fractures, concussions and head injuries headaches, memory issues.
  • Allergies.
  • Heart health. Any history of chest pain or discomfort, tightness or pressure during exercise, irregular heartbeats.
  • Family history of heart problems including sudden cardiac death.
  • Surgery history.
  • Bone, joint and muscle injury history.
  • Medication and supplement history. Prescription and over-the-counter medicines, herbal and nutritional supplements.
  • Use of drugs, alcohol, tobacco, dietary supplements, and/or performance enhancing drugs, such as steroids, high energy caffeine drinks, creatine and protein.
  • Mental health. Discussion of any feelings of nervousness, anxiety, worry. Any stress or anxiety due to performance expectations. Feelings of depression.

Physical exam

The focus of the physical exam might include an evaluation of your child’s:

  • Lungs.
  • Height and weight.
  • Blood pressure.
  • Vision.
  • Hearing
  • Heart. (Looking for conditions such as murmurs and irregular heartbeat, Marfan syndrome.)
  • Abdomen.
  • Skin
  • Bones and muscles, examining flexion, extension, rotation, range of motion, alignment, strength and balance
  • Genitals in males if there is a history of genital or urinary problems.

What are the possible outcomes of the preparticipation evaluation?

Based on the results of the exams, your child’s healthcare provider will deem your child (one of the following):

  • Medically eligible to participate in all sports without restriction.
  • Medically eligible for all sports without restriction with recommendations for further evaluation or treatment (such things as follow-up exam, additional tests, specific treatment, completion of a rehabilitation program).
  • Medically eligible for certain [named] sports.
  • Not medically eligible pending further evaluation.
  • Not medically eligible for any sports.

Although up to 10% of student athletes have a finding that needs further investigation or management before being cleared to play, only 1% to 2% of athletes are disqualified from participation.

What happens if your child’s healthcare provider finds a problem?

If a problem is discovered, additional tests and follow up exams may be needed. Your healthcare provider and child will work together to develop a treatment plan or rehabilitation plan (if there is an existing injury) with the goal of getting your child ready to participate before the sport season begins.

Last reviewed by a Cleveland Clinic medical professional on 07/29/2020.

References

  • American Academy of Pediatrics. Sports Physicals: When, Where, Who Should Do It. (https://www.healthychildren.org/English/healthy-living/sports/Pages/Sports-Physical-PPE.aspx) Accessed 11/18/2021.
  • American Academy of Pediatrics. Preparticipation Physical Evaluation. (https://services.aap.org/en/community/aap-councils/council-on-sports-medicine-and-fitness/preparticipation-physical-evaluation/) Accessed 11/18/2021.
  • Mirabelli MH, Devine MJ, Singh J, Mendoza M. The Preparticipation Sports Evaluation. (https://www.aafp.org/afp/2015/0901/p371.html) Am Fam Physician 2015 Sep 1;92(5):371-376. Accessed 11/18/2021.
  • Miller SM, Peterson AR. The Sports Preparticipation Evaluation. Peds Rev 2019;40(3):108-128. Accessed 11/18/2021.
  • American Academy of Pediatrics. Updated monograph offers new guidance on preparticipation physical evaluation. (https://www.aappublications.org/news/2019/05/15/ppe051519) Accessed 11/18/2021.

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