PREPARTICIPATION PHYSICAL

By: | Tags: | Comments: 0 | July 31st, 2020

The preparticipation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages. The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the preparticipation physical evaluation prevents morbidity and mortality associated with sports, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries. Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates.

All persons undergoing a preparticipation physical evaluation should be questioned about exertional symptoms, presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death.

The physical examination should focus on the cardiovascular and musculoskeletal systems. U.S. medical and athletic organizations discourage screening electrocardiography and blood and urine testing in asymptomatic patients. Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders.

Approximately 30 million athletes younger than 18 years and another 3 million athletes with special needs receive medical clearance to participate in sports every year. The purpose of the preparticipation physical evaluation (PPE) is to maximize the health of athletes and their safe participation in sports.

Although studies have not found that the PPE prevents morbidity and mortality associated with sports participation, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries.

Ideally, the athlete’s personal physician should provide the PPE in a medical home where patients are comfortable discussing sensitive information and where past medical records are available. Alternate models include mass participation screenings and PPEs conducted by a team physician at a student health, outpatient, or athletic facility.

Mass screenings are not ideal, given the unavailability of parents and previous medical records, and decreased continuity of care.

Supervision of mass screenings by a designated primary care physician can improve this process by ensuring that all results are reviewed and by coordinating follow-up when necessary.

PPEs should occur approximately six weeks before activity to allow for further evaluation, treatment, or rehabilitation as needed.

Consensus guidelines recommend yearly PPEs, however, the optimal interval is uncertain, and local regulatory agencies may require more or less frequent PPEs for athletic participation.

The examining physician should determine clearance for participation in coordination with specialists or team physicians. Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete wishes to participate. Most healthy athletes will receive unrestricted clearance to play any sport. An athlete may be provisionally cleared pending successful completion of a specified treatment, test, or rehabilitation program.

For athletes restricted from certain sports, guidance should be provided based on the general category of the sport. Sports may be classified as collision, contact, or noncontact activities or classified based on physical intensity.

The risk of injury depends on the following variables: speed, force of impact, height, and unpredictability of both the actions of the sport and conditions. Even persons with serious medical illness may be able to participate in nonstrenuous or noncontact activities.

Rarely, athletes may be disqualified completely from participation A 2012 study found that 5.5% of adolescents were deemed ineligible for sports. outline a standardized approach to components of the PPE, including a supplemental history form that can be used for athletes who have special needs.

Contraindication to Participation in Sport are

Active myocarditis or pericarditis
Acute enlargement of spleen or liver
Eating disorder in which athlete is not compliant with therapy and follow-up, or when there is evidence of diminished performance or potential injury because of the eating disorder
History of recent concussion and symptoms of post concussion syndrome (no contact or collision sports)
Hypertrophic cardiomyopathy
Long QT syndrome
Poorly controlled convulsive disorder (no archery, riflery, swimming, weight lifting or powerlifting, strength training, or sports involving heights)
Recurrent episodes of burning upper-extremity pain or weakness, or episodes of transient quadriplegia until stability of cervical spine can be assured (no contact or collision sports)
Severe hypertension until controlled by therapy (static resistance activities, such as weight lifting, are particularly contraindicated)
Sickle cell disease (no high-exertion, contact, or collision sports)
Suspected coronary artery disease until fully evaluated (patients with impaired resting left ventricular systolic function less than 50%, exercise-induced ventricular dysrhythmias, or exercise-induced ischemia on exercise stress testing are at greatest risk of sudden death)

Screening for cardiovascular abnormality has been recommended by the AHA, those include :

  • Elevated blood pressure
  • Excessive Dyspnea
  • Exertional chest pain
  • Prior recognition of heart murmur
  • Unexplained syncope
  • Family history of close relative with disability from the heart less than 50 years
  • Premature death {sudden cardiac death  } before 50 years
  • Specific knowledge of certain cardiac condition in family members , hypertrophic cardiomyopathy, prolong QT,syndrome,  Marfan syndrome
  • Brachial artery pulse pressure,
  • Femoral pulse to exclude coarctation
  • Heart Murmur
  • Physical Stigmata of Marfan syndrome

At minimum , the physical examination  the physical examination should include assessment of vital signs, vision, hearing, and the cardiovascular and musculoskeletal systems. The most common abnormal PPE findings are elevated blood pressure and vision problems. Genital examination is not recommended in females but may be indicated in males with symptoms or a history of genitourinary problems. Although a brief standardized orthopedic screening is adequate in asymptomatic athletes.

Special consideration ‘

  1. Screening asymptomatic athletes for previously undetected heart conditions, such as hypertrophic cardiomyopathy or arrhythmogenic right ventricular dysplasia, is recommended by the ACC/AHA guidelines, but the optimal protocol and overall effectiveness are controversial. Screening electrocardiography (ECG) and echocardiography may increase sensitivity for detection of undiagnosed cardiac disease, but accurate interpretation can be challenging and may result in false-positive findings when performed by clinicians who are less experienced in distinguishing athletic heart adaptations from cardiomyopathy.
  2. Patients with known orthopedic injuries should undergo a thorough joint-specific examination. Strict return-to-play timelines (e.g., two weeks after an ankle sprain) are counterproductive; injuries should be treated and cleared on a functional basis. Generally, if the athlete has no disabling pain, full range of motion, and full strength in the affected area, and is able to pass functional tests in a supervised sports setting, clearance can be provided after a PPE, barring other contraindications.
  3. Patients with a history of asthma should be risk stratified based on their history. Standard classification of asthma as mild intermittent, mild persistent, moderate, or severe can help guide decisions. An understanding of asthma triggers is also essential, especially for exercise-induced bronchospasm. Athletes with well-controlled asthma who are asymptomatic at rest and with exertion can be safely cleared after a PPE. Pulmonary function testing should be considered for patients with a historical diagnosis of exercise-induced bronchospasm to exclude undiagnosed asthma. Athletes who are actively wheezing or recovering from an asthma exacerbation should be restricted from participation until symptoms have stabilized. Physicians may require athletes to have a rescue inhaler immediately available as a condition for athletic participation
  4. Persons with well-controlled seizures can participate in sports. Exceptions include sports in which a seizure could be fatal, such as skydiving, hang gliding, and scuba diving.
  5. In athletes with a history of concussion, physicians should determine the number of concussions they have had; their duration, frequency, and recovery time; and risk factors. A complete neurologic examination should be performed. Athletes with signs and symptoms of concussion or postconcussion syndrome should not be cleared for participation until all symptoms have resolved. Neuroimaging is generally not needed. Formal balance testing, such as the Balance Error Scoring System and neuropsychologic testing, can help inform decisions about when to return to play. Disqualification for athletes with a history of frequent or severe concussions is controversial.
  6. Consensus guidelines from the National Hemophilia Foundation advise that athletes with bleeding disorders such as hemophilia be restricted from contact or collision sports. Athletes with von Willebrand disease also may be restricted, depending on the subtype. Although persons with sickle cell disease are functionally limited to low-intensity activities, those with sickle cell trait may participate in all activities. Athletes with sickle cell trait may experience exertional sickling in conjunction with other risk factors such as elevation, dehydration, or illness. In 2010, the National Collegiate Athletic Association (NCAA) mandated that the sickle cell trait status of all incoming athletes must be established by the time of the PPE; however, athletes are allowed to decline screening. Sickle cell trait is associated with 2% of deaths in NCAA football players.
  7. Athletes in weight-sensitive sports (e.g., boxing, wrestling) and aesthetic sports (e.g., diving, figure skating, dance) are at risk of eating disorders and general disordered eating. In females, disordered eating and excessive exercise may lead to low body mass index, menstrual irregularity, and low bone mineral density (i.e., the female athlete triad). These patients should be engaged in a multidisciplinary treatment program with further risk stratification before return to sport.

As parents it is very imperative to access the quality of the services being render  for your loved one , you should avoid mass screening , because error is inevitable, get engaged also when you take your child out for Pre-participation physical . The information on this blog is wtitten to enlighten you on what to look put for and to ask question even  during routine Pre-participation  physical.

At 1st Class urgent care center we take time to screen your children before  clearing them to participate in sporting activities

Dr Joseph Taiwo

HOW WE KEEP YOU SAFE!


When you visit 1st Class urgent care , your safety is our number one priority .
All our staff wear full PPE (protective personal equipment) masks, gloves and we have routine cleaning according to CDC guidelines
We have also made changes to our waiting room to accommodate more spaces for social distancing to minimize contacts.
Also while you are in the exam room being tested or examined, our providers wear protective clothes mask and face shield when they collect the samples.

Joseph Taiwo MD

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