Sports Physicals
A 15 y/o male comes in for a physical to play football today. This is his first visit to
the clinic. They have moved from Iowa, no records have been obtained.
1. What questions do you need to ask to clear him to participate in sports?
Have the residents give you questions they feel are important, compare to the AAP
approved pre-participation form attached.
2. What medical conditions should automatically disqualify them from
participation?
Certain cardiac diseases/illness disqualify them from sports participation. See
appendix A for list modified from the 2008 clinical report on Medical Conditions
affecting sports participation (attached).
3. What medical conditions require further workup, evaluation, or
consultation?
Many disease/illness require further evaluation or consultation. See appendix A
4. What sports are considered high to moderate intensity? What sports are
considered low intensity?
The intensity of the sport may affect ability to participate for specific medial
conditions/illnesses. See Appendix B
5. What sports are considered non-contact or limited contact?
Knowing the category of contact for sports will help to determine if your patients
should play the sport of interest based on their medical disease/illness. Many disease
states may limit athletes to limited or non-contact sports. See Appendix C for listing of
limited contact & non-contact sports from the 2008 AAP clinical Report (attached).
6. During questioning he brings up that he would like to start a weight lifting
program that the other members of his team are doing. What advice will you
give him about strength training?
Strength Training:
We often get many questions from adolescents about what kind of strength training
program they can participate in. Here are the overall recommendations from the AAP
Committee on Sports Medicine & Fitness (see attached).
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1. Strength training programs for preadolescents and adolescents can be safe and
effective if proper resistance training techniques and safety precautions are followed.
2. Preadolescents and adolescents should avoid competitive weight lifting, power lifting,
body building, and maximal lifts until they reach physical and skeletal maturity.
3. When pediatricians are asked to recommend or evaluate strength-training programs
for children and adolescents, the following issues should be considered:
a) Before beginning a formal strength-training program, a medical evaluation should
be performed by a pediatrician. If indicated, a referral may be made to a sports
medicine physician who is familiar with various strength training methods as well
as risks and benefits in preadolescents and adolescents.
b)Aerobic conditioning should be coupled with resistance training if general health
benefits are the goal.
c) Strength training programs should include a warm-up and cool-down component.
d)Specific strength training exercises should be learned initially with no load
(resistance). Once the exercise skill has been mastered, incremental loads can be
added.
e) Progressive resistance exercise requires successful completion of 8 to 15 repetitions
in good form before increasing weight or resistance.
f) A general strengthening program should address all major muscle groups and
exercise through the complete range of motion.
g)Any sign of injury or illness from strength training should be evaluated before
continuing the exercise in question.
You may refer to the recommendations for further details & explanation.
6. How do you modify the questions & physical for special needs children?
Discuss in detail the type of disability, current & potential complications of their medical
disease/disability, and which sport(s) they would like to participate in. Compare with the
AAP suggested questions for pre-participation physical evaluation for the athlete with
special needs (attached).
7. How do you perform a musculoskeletal sports examination?
Examination
Test of:
Stand facing the examiner
AC joints, general habitus
Look at ceiling, floor, lateral ear to
shoulder
C-spine motion
Shrug shoulders
Trapezius strength
Abduct 90 degrees with resistance.
Deltoid strength
Full external rotation of shoulders
Shoulder motion (should be 90 degrees)
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Flex and extend the elbows
Elbow motion (should be 150 degrees)
With arms in 90 degree flexion, pronate
and supinate the arms.
Elbow and wrist motion
Spread fingers, make fists.
Hand/finger deformities.
Tighten and relax the quads.
Duck walk
Symmetry, leg lengths, ankle or knee
effusions
Hip, knee, ankle motion
Walk back to examiner
Shoulder symmetry, scoliosis
Touch toes with knees straight
Scoliosis, hip motion, hamstring
tightness
Toe walk, heel walk
Calf symmetry, leg strength
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Appendix A:
No sports participation:
Cardiac:
Cardtis
Hypertrophic Cardiomyopathy
Coronary artery anomalies
Arrythmogenic RV cardiomyopathy
Acute Rheumatic Fever with Carditis
Ehlers Danlos syndrome, vascular form
ID:
Infectious diarrhea (if moderate-severe, dehydrated)
May participate if the following is done:
Genetic:
Atalantoaxial instability
assess risk of spinal cord injury
H/O:
Bleeding disorder
evaluation by hematologist
Neoplasm
assessment by oncologist
Sickle Cell
Avoid sports that entails overexertion,
overheating, dehydration, chilling, or high
altitude
Cardiac:
HTN:
BP >99th +5mmgh for age/gender/ht
eval by HTN specialist & avoid weight
Lifting body building, high static sports until
stable
BP >95th for age/gender/ht (sustained)
eval of cause, possible referral to specialist
Congenital heart disease
eval by cardiologist
Dysrhythmias:
eval by cardiologist
Long QT, malignant, symptomatic WPW, heart
block, fx hx of sudden death, defibrillator
Heart murmur
If innocent
may participate
If not innocent
eval by cardiologist
Structural heart disease
Marfans, Mitral valve disease, anthracyline use
eval by cardiologist
Pulm Htn
GI:
Vasculititits (ie Kawaski)
eval by cardiologist
Malabsorption, short bowel
assess for malnutrition, deficits resulting
in coagulation or other defects
Enlarged liver
Acute = avoid sports, Chronic = assess
for collision/contact or limit contact sports
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May participate if the following is done:
ID:
Neuro:
Skin infections:
Herpes, Molluscum, warts, staph/strep, scabies,
tinea
Avoid contact during contagious periods
Infectious Diarrhea
May consider if not dehydrated or mild
CP
eval to asses functional capacity
to perform specific activity
Hx of serious head/spine trauma
assess for collision, contact or limited
contact sports
Hx of simple concussion, multiple concussions
no participation while symptomatic or
deficits in judgment/cognition are detected
Myopathies
needs assessment by specialist
Seizure d/o
Poor control
assess for collision, contact or limited
contact sports. Avoid archery, riflery, swim,
weight lifting, strength training
Other:
Hx of heat illness
determine presence of predisposing
conditions &/or behaviors, prevention
Organ transplant
strategy
assess for collision, contact or limited
contact
sports
Enlarged spleen
acute =avoid sports, chronic = individual
assessment
Pulm
CF
assessment by pulmonologist with graded
exercise testing
Psych:
Eating disorders
medical & psychiatric assessment
Renal:
1 kidney
assessment for contact, collision, &
limited contact sports to reduce risk of
injury to remaining kidney
Rheum:
JIA
radiographs of cervical spine to assess risk
of cervical spine injury
HLA-B27:
cardiovascular assessment for complications
during exercise test
Dermatomyositis, SLE, Raynaud:
cards assessment, asses for risk of fractures
& avascular necrosis due to chronic steroids
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Appendix B:
High to moderate intensity sports
High-to-moderate
dynamic and static
demands
High-to-moderate
dynamic, low static
demands
High-to-moderate
static, low dynamic
demands
(Boxing)
Crew/rowing
Cross-country
skiing
Cycling
Downhill skiing
Fencing
Football
Ice hockey
Rugby
Sprinting
Speed skating
Water polo
Wrestling
Badminton
Baseball
Basketball
Field hockey
Lacrosse
Orienteering
Race walking
Racquetball
Soccer
Squash
Swimming
Table tennis
Tennis
Volleyball
Archery
Auto racing
Diving
Horseback riding
(jumping)
Field events
(throwing)
Gymnastics
Karate/judo
Motorcycling
Rodeo
Sailing
Ski jumping
Water skiing
Weight lifting
Low intensity
sports
Low-dynamic and
low-static
demands
Bowling
Cricket
Curling
Golf
Riflery
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Appendix C:
Classification of sports- contact based
Contact
Basketball
Boxing
Cheerleading
Diving
Extreme sports
Field Hocky, Ice
Hockey
Tackle Footaball
Limited Contact
Adventure racing*
Baseball
Bicycling
Caneoing/Kayaking: white water
Fencing
Field events: High jump, pole
vault
Floor Hockey
Gymnastics
Lacrosse
Martial Arts
Redeo
Rugby
Skiing, Ski jumping
Soccer
Team Handball
Ultimate Frisbee
Water Polo
Wrestling
Touch/Flag Football
Handball
Horseback riding
Martial Arts
Raquetball
Skating: ice, in-line, roller
Skiing: cross country, water
Skateboarding
Softball
Squash
Volleyball
Weight lifting
Windsurfing or surfing
Non Contact
Badminton
Bodybuilding
Bowling
Caneoing/Kayaking: flat water
Crew/rowing
Curling
Dance
Field events: discus, javelin,
shot
Golf
Orienteering
Power Lifting
Race walking
Riflery
Rope Jumping
Running
Sailing
Scuba Diving
Swimming
Table tennis, Tennis
Track
* Adventure racing = 2 or more: orienteering & navigation, cross country
running, mountain biking, paddling, and climbing & rope skills
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