The "Sports Physical" --
Pre-participation Physical Examinations
Daniel S. Fick, MD, Department of Family Practice,
University of Iowa.
During the summer and into fall, pediatricians
and family practice physicians can expect the yearly rush of prospective student
athletes making appointments for their annual preparticipation sports physicals.
In Iowa, such a physical evaluation is required before a student is allowed
to participate in school-sponsored athletic events.
In the past, it has not always been clear what should be included in
such an exam, and physicians have used many different examination formats
for these physicals. To remedy this, the American Academy of Pediatrics
joined the American Academy of Family Physicians, the American Orthopaedic
Society for Sports Medicine, the American Medical Society for Sports Medicine,
and the American Osteopathic Academy of Sports Medicine to jointly publish
a clinical monograph, Pre-participation Physical Evaluation,
that sets uniform guidelines for these examinations.
This useful publication focuses on young patients who participate in
both individual and team sports. It is shaped by two key philosophies:
GOALS OF THE PRE-PARTICIPATION
- Assess development, overall health, level of fitness.
- Identify conditions that might affect, or be affected by, participation.
- Provide anticipatory guidance.
- Meet legal and insurance requirements.
- First, that the physician's primary role is to maintain the health and safety
of the athlete; and
- Second, that the monograph is to present the state of the art in preparticipation
Now in its first revision, this publication is comprehensive and well-organized. The introduction outlines the objectives and goals of the preparticipation physical. Guidelines are offered for the timing and frequency of evaluations. Office-based versus station screening exams are compared. The sections on the medical history and physical examination are thorough and detailed. The usefulness of laboratory testing is discussed. Tables and drawings clearly illustrate key topics, among them Tanner stages and the musculoskeletal exam.
Who may, and may not, participate
One of the most important considerations that arises during these exams is whether a patient with a particular condition or a history of specific injury should be given clearance to participate in a given sport. A section on "Determining Clearance" discusses hypertension, past concussions and other injuries, and other concerns. It offers recommendations specific to contact and non-contact sports, and provides "return to play" guidelines (see also "Time Out! -- Sports Participation Guidelines").
In the appendices, you will find reproducible forms on which to record patient
history and physical examination data, as well as a form to document clearance
for participation. Pre-participation Physical Evaluation, Revised Edition
(1992; order no. C$ - 227, $20) can be ordered from the American Academy of Family Physicians by calling 1-800-944-0000.