Preparticipation Examination
Chapter 2
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Preparticipation Exam (PPE)
• Objective – to ensure the health and safety of a
physically active individual
• Focus – dependent on:
– Specific age group
– Intended sport/activity
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Setting Up the PPE
• Exam format
– Primary care physician
• Advantages: familiarity, relationship, privacy
• Disadvantages: $$, time commitment of M.D.
– Group or station format
• Advantages: number of professionals involved,
less $$, time efficient
• Disadvantages: organization demands,
decreased privacy, follow-up difficulty,
communication problems
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Setting Up the PPE (cont.)
• Timing of the exam
– 6 weeks prior – permits time to:
• Correct minor problems
• Refer medical problems to a specialist
• Frequency
– Entry level exam followed by a limited annual
re-evaluation
– Entry level exam at each level of participation
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Medical History
• Comprehensive history
– General medical
– Orthopedic
– Supplemental form for females
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Physical Examination
physical examination is not intended to be
all-encompassing … it is intended to focus
on body systems of most concern relative
to participant’s sport/activity
• Vital signs
– Establish baseline physiologic parameters and vital
statistics
• General medical problems
– Past surgery or hospitalizations
– Medications (including OTC)
– Use of alcohol, tobacco, ergogenic aids
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Physical Examination (cont.)
• Cardiovascular exam
– Auscultation of heart sounds
– Check for cardiac abnormalities
– History of loss of consciousness, syncope, dizziness,
shortness of breath, heart palpitations, and chest pain
during or after examination
• Pulmonary exam
– Auscultate for breath sounds
– History of coughing or breathing difficulty
– Ear, nose, and mouth may also be checked
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Physical Examination (cont.)
• Musculoskeletal exam
–
History of previous injury, including:
• Nature of injury
• When it occurred
• Who evaluated it
• Duration of treatment and rehab
• Use of special protective equipment
–
Physical exam (refer to Field Strategy 2.3)
• Neurologic exam
–
History of past head injury, loss of consciousness,
amnesia, or seizures
–
Exam: pupillary examination and reaction to light, cranial
nerve assessment, motor-sensory exam, deep tendon
reflex testing
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Physical Examination (cont.)
• Eye examination
–
Visual acuity
–
Peripheral vision and depth
perception
–
Nystagmus
–
Pupil size
• Dental examination
–
Determine number of teeth
and last visit to dentist
–
Exam: gum condition and
presence of cavities, dental
appliances
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Physical Examination (cont.)
• Gastrointestinal exam
– Digestive system, eating habits, and nutrition
– History of heartburn, indigestion, diarrhea, or
constipation
• Genitourinary exam
– Kidney and genitourinary organs
– Females – menstrual history, gynecologic
symptoms
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Physical Examination (cont.)
• Dermatologic exam
– Identify contagious lesions, skin infections
– Other lesions (e.g., warts, acne)
• Exam for heat disorders
– Environment related – history of cramping, syncope,
exhaustion, or heat stroke
– Use of medications
• Laboratory tests
– Not recommended by AAP
– Required by some states
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Physical Fitness Profile
• Identifies weaknesses that may:
– Hinder athletic performance or
– Predispose the athlete to injury
• Establishes a baseline of data in the event an injury
does occur
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Body Composition and Anthropometry
• Body composition
– Fat vs. lean tissue
– More reliable for determining appropriate weight
– Measures: hydrostatic weighting, skinfold
measurements
– Athletes—12–17% body fat
• Anthropometry
– Determines individuals’ body type
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Maturation and Growth
• Growth spurts may play a role in certain
injuries
• Tanner scale — physical maturation
measurement
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Flexibility
• The total ROM that occurs
pain-free in each of the
planes of motion
• Measured with a goniometer,
flexometer, or tape measure
• Hypermobility vs.
hypomobility
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Strength, Power, & Speed
• Strength
– Ability to produce force in one maximal resistance
– Measures can involve isometric, isotonic, or isokinetic
testing
• Power
– Ability to produce force in a given time
– Measures include: throwing a medicine ball, vertical jump
and reach, single- or two-legged hop for distance, and
stair climbing
• Speed
– Ability to move body mass over time
– Can be assessed by timed sprints
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Agility, Balance, and Reaction Time
• Agility
– Ability to change directions rapidly when moving at a
high rate of speed
• Balance
– Body’s coordinated neuromuscular response to maintain
a defined position of equilibrium in response to changing
visual, tactile, or kinesthetic stimuli
• Reaction time
– Ability to respond to a stimulus
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Cardiovascular Endurance
• Ability to sustain submaximal exercise over an
extended period
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Clearance for Participation
•
Physician determines the level of participation
1. Will the condition increase the risk of injury to the
athlete or to other participants?
2. Can participation be allowed if medication,
rehabilitation, or protective bracing or padding is used?
If so, can limited participation be allowed in the interim?
3. If clearance is denied for a particular sport, are there
other sports or activities in which the individual can
safely participate?
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Clearance for Participation (cont.)
• Rehabilitation Act and Americans with Disabilities Act
• Most physicians base their recommendations on the
American Academy of Pediatrics Committee on Sports
Medicine guidelines
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