The “sports physical,” otherwise referred to as “preparticipation physical evaluation” is the result of a collaborative effort between organizations such as the American Academy of Orthopaedic Surgeons (AAOS), American Orthopaedic Society for Sports Medicine (AOSSM), American Family Physician (AFP), and American Academy of Pediatrics (AAP) whose goal is to identify conditions that predispose athletes to a higher risk of injury, illness, and even death. Today, children often fail to meet the recommended 60 minutes of daily moderate to vigorous physical activity. Organized sports is a proven strategy that increases the likelihood that a child or young adult will meet a recommenced number of hours each week engaged in beneficial physical exercise.[1] Physical inactivity leads to poorer health in both the short and long term. It contributes to such conditions as obesity, depression, decreased cardiovascular health, and less effective motor coordination, just to name a few examples.
The duties of the team physician, as defined by the American Orthopaedic Academy of Sports Medicine, are as follows: “The team physician should possess special proficiency in the care of musculoskeletal injuries and medical conditions encountered in sports. The team physician also must actively integrate medical expertise with other healthcare providers, including medical specialists, athletic trainers, and allied health professionals. The team physician must ultimately assume responsibility within the team structure for making medical decisions that affect the athlete’s safe participation.[2]
Preparticipation physicals are mandated in nearly every organized athletic program and are performed with the intent of identifying any condition that may preclude an athlete from safely participating in athletic events. It is also noteworthy that a preparticipation sports physical exam may be the only time that a child or adolescent actually sees a medical professional with the presumption that many of America’s youth do not regularly undergo physical exams or checkups. Thus, it is important to utilize this opportunity to screen athletes for physical and or psychological ailments that may warrant further workup and treatment by other healthcare professionals.[3]
An appropriate preparticipation physical examination is composed of the following components:
Much discussion is focused on the diagnosis and detection of cardiomyopathy, as it is a leading cause of cardiac arrest and death in young athletes. Hypertrophic subaortic stenosis and cardiomyopathy can be very difficult to identify on clinical examination, particularly for sports physicians who may not be familiar with cardiac pathology and stethoscope examinations.[14][2]
Thus it is again of paramount importance that a physician knows the warning signs of such and never disregards a past history of difficulty breathing, loss of consciousness without head trauma, or a family history of cardiac abnormalities. Combined with abnormal findings or murmurs on an auscultation exam, such athletes should be restricted from play until an echocardiogram can be performed, and the athlete is examined by a component cardiologist or other heart specialist according to the guidelines proposed by the American College of Cardiology and the American Heart Association.[15]
An interprofessional team consists of a sports medicine team physician, as well as his associated medical staff (including, physician’s assistants, nurse practitioners, nurses, physical therapists, and athletic trainers must work in conjunction with athletes, coaches, and in the case of young athletes their parents/guardians to achieve the best possible outcomes.
The ultimate goal of the preparticipation screening is to identify at-risk athletes for morbidity and mortality commonly associated with athletes. Therefore providers have an ethical responsibility to rely on the entire healthcare team to provide adequate care and screening for athletes in our care.
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