PREVENTION: PRE-PARTICIPATION

PHYSICAL EXAMS

Annise Nalepa, ATC, LATTarleton State University

What is a PPE and why is it important?

• How thorough are the physicals?• Is your paperwork really screening for

all risk factors or is it just the bare minimum?

• Pre-participation physicals are a crucial part of physical health and determining if an athlete is healthy enough to compete.

• This seminar will discuss what should be included in a PPE and how you can make sure the athlete is safe.

Pre-Participation Physical Exams

Primary Detect Pre-disposing injuries Detect life-threatening/disabling

injuries Meet legal/insurance requirements

Secondary Determine general health Counsel health related issues Assess fitness levels

Personal Physician vs. Station Exam

(+)Access to medical record

(+)Know athlete Personally

(+)Can institute preventive care

(-)Time Consuming (-)Expensive (-)Not all PCP know

sports

(+)Faster (+)Economical (+)Fundraiser (+)Station Exam

(-)Physician unfamiliar with history

(-)Need to have someone review chart at end

Personal Physician

Station Exam

PPE different for each Population

Pre-Adolescent Determine Life Threatening Medications Allergies Congenital Abnormalities

PPE different for each Population High School

Screening by unfamiliar physicians Determine minimum level of health Heath education

PPE different for each Population College

Comprehensive health physical Investment in athlete Obtain PMH Meet and Greet

Components

Vital Signs Height Weight Vision Blood Pressure Heart Rate

Personal History Cardiac Pulmonary Neurological Heart illness Musculoskeletal Allergies

Physical Exam Joint Flexibility/ROMs Shoulder Knee Ankle Hip Trunk Elbow Wrist/Finger

Orthopedic Clearance Full Unlimited Limited Clearance Withheld Until… No Athletic Participation

Cardiac Concerns

Cardiac Stats CVD Sudden Death in Athletes:

(56%) 29% occurred in blacks 54% in high school students 82% with physical exertion during

competition/training 11% occurred in females

12 AHA Questions Personal History Exertional Chest Pain/Discomfort Syncope/Near Syncope Excessive exertional and otherwise unexplained, dyspnea/fatigue associated

with exercise Previous recognition of a precordial murmur Elevated systemic BP Family History Premature death before age of 50 related to heart disease in one or more

relatives Disability from heart disease in a close relative less than 50 years old Specific knowledge of certain cardiac conditions in family members:

hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan’s syndrome, or clinically important arrhythmias

Physical Examination Heart Murmur Femoral pulses to exclude aortic coarctation Physical stigmata of Marfan’s syndrome Brachial artery blood pressure (sitting position)

Concussion History / Testing

BESS Testing Balance Error Scoring System Concussion Baseline Inexpensive yet time consuming

ImPACT Computer-based concussion

baseline testing Expensive yet efficient

Natasha’s Law Required Concussion training for

Coaches and ATs Physician Clearances Education

Education www.cdc/concussion Heads Up: Concussion in HS Sports S/S Management

Form Examples

Other Topics: Determine MD/DO/DC Insurance Require School Issued Form for

consistency