Many schools require the preparticipation exam every year for liability reasons. Guidelines for preparticipation screening of athletes are designed to ensure the health and safety of the 10 million school age and collegiate athletes who train and compete each year.
The goal is to identify risk factors for injury, illness, and even sudden death. The preparticipation exam should be completed at least six weeks before preseason activities. This allows enough time for follow-up if referral or consultation is needed.
To help physicians perform an effective exam, a proposed preparticipation exam has been developed. A consensus approach was used to formulate the evaluation. Consensus means the opinions of many experts were gathered. Items agreed upon by the majority of doctors were included.
The consensus report comes from many well-known medical groups. For example, the American Family of Family Physicians, American College of Sports Medicine, American Academy of Pediatrics, and American Orthopaedic Society for Sports Medicine participated (to name a few). Specific cardiac recommendations have been added by the American Heart Association.
Physicians are encouraged to obtain the most accurate history possible. This means interviewing both the athlete and his or her parent/guardian. Areas to include are: past hospitalizations and surgeries, current medications, allergies, and use of vitamins or other supplements. A social history is equally important with questions about tobacco use and alcohol or other drug use. A past history of medical disqualification raises a red flag requiring further investigation.
The physician follows a typical comprehensive physical exam including a systems review: head; ears, nose, throat; skin; gastrointestinal; and genitourinary function. Certain body systems require a closer look than others. For example, the cardiovascular, pulmonary, neurologic, and musculoskeletal systems must be reviewed in detail. Nutrition is also very important as well as looking for specific signs and symptoms that might suggest an eating disorder or risk factors for delayed growth.
Each of these areas is described in detail for physicians reviewing the current guidelines. Samples of forms and checklists with multiple questions are included for the reader. Drawings of tests used in the general musculoskeletal screening exam are provided. Tests for range-of-motion, muscle strength, scoliosis screening, balance, and flexibility are included.
Ask your physician what format he or she uses for the physical exam. A full exam may not be needed every time. Current recommendations are for an exam every two years for younger athletes, and every two-to-three years in older athletes. Specific ages have not been standardized as yet. A thorough exam is advised at the start of new phases (e.g., upon entering middle school, at the start of high school, when participating in sports for the first time).
A modified and less thorough update exam can be performed each year in-between major transition periods. Any important health changes can be noted at that time. This might include changes in height and weight, any new personal/family history of injury or illness, and current blood pressure.