Transcript Chapter 6: The Pre-Participation Physical Examination

UNIT 2A: ROLES & RESPONSIBILITIES IN
ATHLETIC TRAINING
CHAPTER 6: THE PRE-PARTICIPATION PHYSICAL
EXAMINATION
Sports Medicine 1
Ms. Whittington
The Pre-Participation Physical
Examination

The pre-participation
physical examination
(PPE) has been an integral
part of sports for decades
 GOAL IS TO HELP
MAINTAIN THE HEALTH
AND SAFETY OF ATHLETE!
The Pre-Participation Physical
Examination
PPE:
comprehensive
assessment of:
Overall
health
Ability to perform a sport
at the highest level
Emphasizes areas of
concern in sports
participation
Identifies problem areas
in athlete’s history
The Pre-Participation Physical
Examination
 Goals
of the PPE
 Determine
overall general
health
 Identify defects that may
limit participation
 Detect conditions that may
predispose athlete to injury
 Determine optimal level of
performance
 Fulfillment of legal &
insurance requirements
 Evaluation
of maturity
level of younger athletes
 Evaluation of fitness &
performance PRIOR to
participation
 Opportunity to counsel
youths regarding
personal health issues
 Entry of athlete into a
SM environment 
establish doctor/patient
relationship
The Pre-Participation Physical
Examination

Timing of the PPE
 should
take place about 6 weeks prior to
beginning of sport season ~ end of school
year/mid-summer
 Allows
time to further evaluate or treat discovered
problems
 Most
commonly examined in doctor’s office by 1
physician (typically your primary care doctor)
 1.
station-based PPE
 2. office-based PPE
The Pre-Participation Physical
Examination

Station-Based PPE Exam screens athletes by several
different specialists responsible for specific aspects of
the exam  team approach
 Family
physicians
 Orthopedic specialists
 Certified Athletic Trainers
 Physical therapists
 Podiatrists
 Pediatricians
 Cardiologists
The Pre-Participation Physical
Examination

Station-Based PPE Exam
 Advantages
 Low
cost
 Time efficient
 Athlete will see several
specialists
 Disadvantages
 Recruitment
of volunteer
physicians, therapists, etc
 Facility space
The Pre-Participation Physical
Examination

Office-Based PPE is
completed at a
traditional doctor’s
office  family
physician
 Advantage…family
physician has a complete
history of the patient as
a base for exam…quiet
setting…review
immunization history
Components of the PPE

Medical history is the
most important aspect!
 identifies 75% of
problems affecting
athletes
 Helpful
to have
parents/guardians
involved during process
Key Concept
PPE exam is needed to help identify
athletes at risk of specific types of injuries
and identify preventive techniques to avoid
injury
 Relationship between athlete and physician
 Goal is to maintain the health and safety
of the athlete

Components of the PPE

Baseline history information includes:
Medical conditions/diseases
 Surgeries
 Hospitalizations
 Medications
 Allergies
 Immunization status
 Menstrual history
 Pulmonary status
 Neurologic status
 Musculoskeletal status
 Injures/illnesses since last exam

Components of the PPE

PPE is also a screening tool  identify areas of concern
Height
 Weight
 Pulse
 Blood pressure
 Eyes
 Ears/nose/throat
 Heart
 Abdomen
 Genitalia (males only)
 Skin
 Musculoskeletal

Clearance for Participation in Sports

Most important & difficult decision of
the PPE…the decision of clearance
 Permission
granted by a physician,
based on an athlete’s physical
examination to participate in a sporting
event

3 categories
 1.
unrestricted
 2. clearance after completion of further
evaluation or rehabilitation
 3. no clearance for certain types of
sports or all sports
Clearance for Participation in Sports

How do physicians make the decision if there is
an abnormality or condition found?
 Does
it place the athlete at more risk of injury?
 Is another participant at risk of injury because of
it?
 Can the athlete safely practice with treatment?
 Can limited participation be allowed while
treatment is being completed?
 If clearance is denied for certain sports/categories,
what activities can the athlete safely participate?
Clearance for Participation in Sports

Sports Categories/Classifications
Divide
sports into an area based on
degree/level of contact or physical
exertion
Contact/Collision
sports = HIGH RISK
Limited contact = some risk
Noncontact = low risk
Table 6-2: Classification of Sports by Contact
CONTACT/COLLISION
LIMITED-CONTACT
NONCONTACT
Basketball
Baseball
Archery
Football
Gymnastics
Bowling
Boxing
Horseback riding
Crew/rowing
Ice hockey
Cross-country
Discus, javelin, shot-put
Lacrosse
Softball
Golf
Soccer
Volleyball
Running
wrestling
Windsurfing/surfing
Swimming
Recordkeeping

Information gathered through PPE
must be made available to
coaches, certified athletic trainers,
and the athletic director


STRICTLY CONFIDENTIAL! 
HIPAA


Especially for pre-existing injuries,
illnesses, conditions & allergies
Secure location (office under lock &
key)
Kept for a minimum of 7 years
Conclusion
PPE has evolved over the past decade  now a
comprehensive approach to medical assessment
of athletes
 PPE should be completed during pre-season

 Office
or station-based evaluation
Clearance is the most important step in any PPE
 Ultimate goal is to allow athletes to compete
safely  prevent sudden death in young athletes

What is SCD?

Sudden Cardiac Death (or Arrest)
 Condition
in which the heart suddenly and unexpectedly
stops beating
 Often
cause an arrhythmia which inhibits normal blood flow
through body
 Often
the first sign that someone is suffering from SCA is
fainting
Why does it happen?



Heart disease
Physical stress
Inherited disorders
 Long
QT syndrome
 Abnormal
pattern on an
EKG
 Hypertrophic
Cardiomyopathy
 Thinkening
of heart muscles
 Typically the left ventricle
Why should AT’s care about this?


Because as far as I am concerned – this is the
scariest thing that could happen while I am
supervising an athletic event or practice!!
Often there is no warning – people just drop dead
So what’s the big deal?

Should a cardiac screening be a part of all PPE’s?

Advantages
 Save
a life
 Not an invasive test

Disadvantages
 Cost
 Time
Please use complete sentences to
answer the following questions…
1.
2.
3.
4.
5.
What are the 3 major flaws the author finds with requiring
athletes to get cardiac screening done?
Cardiac screening will result in unavoidable deaths to those
who undergo further tests – is this a reasonable risk to take
just to save the same number of lives? Why or why not?
How many Italian athletes are told they cannot participate
after receiving their EKG? Is it acceptable to remove more
athletes from sports to rule on the side caution?
What is the stance of the American Heart Association on the
cardiac screening of all athletes?
Do you think we should require cardiac screening as part of
all PPE’s done? Why or why not? (This should be at least 10
sentences long and well thought out)