Pre-participation Physical Exams

Objectives

Determine the need for PPEs Understand the goals of PPEs Determine the components of a PPE Establish guidelines for PPEs Identify the legal considerations of

PPEs

Introduction

Preceded by signing a waiver granting permission to complete the physical exam

Complex and time consuming, but worthwhile when done right a team process, with many valuable

members a collection of information used to

determine the readiness of athlete for competition

Introduction

Potential to be an expensive process PPEs should be:

valid and reliable ethical purposeful

Not uniformly regulated at any level Substitutes for a detailed

comprehensive physical examination for general health = ???

PPE Goals

Provide an objective, sport-specific musculoskeletal examination.

Obtain negative information that alters participation options.

PPE Goals

Obtain positive information to decrease injury potential and increase performance.

Provide a reproducible record for comparison in the future.

Provide baseline data for sport-specific conditioning.

Organizing PPEs – Why?

Injury & Illness Prevention Must USE data

generated by exam Potential liability if

not Must design PPE

effectively

Organizing PPEs – Why?

Injury & Illness Prevention Determine

readiness for competition

Disqualification Know role of team

physician, athlete, parents, and other physicians/specialists

Organizing PPEs – Why?

Compliance with Association Rules High School

National Federation of State High School Athletic Associations defers to states - CIF

College NCAA, NAIA, etc.

Professional Youth Leagues, Tournaments, etc.

Organizing PPEs – Why?

Educating & Counseling Athletes Some suggest this should be focus of

PPE Potential to be very useful Need the right….

Environment Staff Information

Organizing PPEs – Why? Compliance with Standards of

Practice NATA, BOC, CIF, NCAA, AMA, AHA American Academy of Family Physicians American Academy of Pediatrics American College of Cardiology American Medical Society for Sports

Medicine American Orthopaedic Society for Sports

Medicine American Osteopathic Academy for

Sports Medicine

Organizing PPEs – When?

6-8 weeks before vigorous activity One season before athlete intends to

participate

Organizing PPEs – When?

Occurrence: Upon entering program with yearly

health history updates Some states require one every 3 years in HS

Every other year w/update in between Every year

Organizing PPEs – Where & How?

Debate exits, must decide…. Information to be obtained from PPE Staff

Number, training, volunteer/paid, etc. Facilities & privacy available

Organizing PPEs – Where & How?

Debate exits, must decide…. Time available Expenses & Budget Athletes

Number, characteristics (age, sex, etc.)

Organizing PPEs – Where & How?

Office-Based PPEs Who will perform? Benefits of this method? Concerns with this method?

Organizing PPEs – Where & How?

Group PPEs & the Station Method Who will perform? Benefits of this method? Concerns with this method?

PPE Design Factors

Athlete age and level of competition 14 year old male soccer player vs. 28

year old free agent in MLB Sport

Specifics for different sports/teams Follow-up on information collected Predictability of tests

Common Elements of a PPE

Health History Physician’s Exam

General review of systems, cardiac screening, etc.

Orthopedic Exam Posture, Gait, ROMs, etc.

Common Elements of a PPE

Special Tests Urinalysis, x-rays, ImPact, etc.

Physical Fitness Tests Others?

Health History

Questionnaire asking specific details of athlete’s health

Broken down by system Cardiac Pulmonary Neurological

Physician’s Exam

General medical overview Vitals, vision, etc. Auscultation, blood pressure,

palpation Neurological screening Hernia check for males

Orthopedic Exam

Functional screening of the body’s joints

Specific movements are checked for gross motor function

Special Tests

Concussion screening Urinalysis Blood draw

Physical Fitness Tests

VO2 Max testing Examines the lungs efficiency to

exchange gases General conditioning tests Sport-specific tests

40-yd dash, broad jump, vertical jump, etc.

Others

EKG/ECG Echocardiogram Sickle Cell Anemia Drug Testing

Benefits vs. Risks?

Legal Considerations

Consent Must explain PPE Athlete must understand explanation Opportunity for athlete to ask questions Sign documenting agreeing to undergo

PPE Minors = parent signature also

Legal Considerations

Waiver of Liability – for disqualification Athletes/parents may want to play again Recommendation – options….

Tailor waiver to EACH situation – use legal counsel

Stick to your decision NOT to clear athlete Document each situation!