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!