As we hit August, this is primetime for sports physicals! There has been much debate as to what should be included in routine testing and screening. Generally, we follow the AAP guidance for screening, and encourage use of the standardized tool adopted by multiple medical organizations (see below). Remember to refer to our wonderful local sports med experts if you have questions!
Take-home points for sports physicals:
- In addition to routine history and physical, sports physicals should include specific questions: personal and family history, especially cardiac, bone and joint, asthma (and inhaler use), concussion or seizures, sickle cell, and infectious histories. Review weight and diet including attempted weight loss or gain, supplements to gain weight/muscle, and hydration and eating patterns. With females, review menstrual history.
- Cardiovascular screening is key: the American Heart Association recommends a 12-element screening tool that encompasses personal history, family history, and physical exam. This tool is incorporated into the Preparticipation Physical Evaluation, Fourth Edition (PPE-4) recommended by the AAP. A positive response or exam finding on any item should prompt referral to cardiology. A goal is to identify risk for and prevent sudden cardiac death, which happens in about 100 young athletes annually in the US. Unlike in other countries we have not adopted routine ECG due to cost and number needed to screen.
- Critical parts of the exam include: vision, BP, thorough cardiac exam (murmurs-do valsalva, PMI, pulses, Marfan stigmata), musculoskeletal exam (strength, ROM, functional/sport specific movements), neurologic exam (especially if previous concussion), and skin exam to look for infectious lesions.
- Contraindications to full participation include
- some cardiac disease (discuss with cardiology)
- Atlanto-axial instability (especially in Down syndrome or JIA),
- Infectious diarrhea, conjunctivitis, or actively contagious skin lesions (e.g., HSV, MRSA),
- Fever–increased risk of heat related illness and hypotension,
- Acute splenic enlargement-increased risk of rupture,
- Poorly controlled seizure disorder-especially for swimming, weight-lifting, sports involving heights,
- Hypertension–if> 5mm Hg above 99th percentile for age, avoid heavy lifting & high-static component sports
Have a great week and enjoy seeing all of those athletes in clinic!