The Pre-Participation
Physical Examination
Chapter 6
The Pre-Participation Physical
Examination (PPE)

Over the years, the
PPE has gone from a
cursory examination
to a comprehensive
overall assessment of
an athlete’s health
and ability to perform
a sport at the highest
level.
The Pre-Participation Physical
Examination (PPE)
 The
primary goal of the PPE is to help
maintain the health and safety of the
athlete. Other goals include:




Determination of the athlete’s general health
Disclosure of defects that may limit
participation
Detection of condition that may predispose
the athlete to injury
Determination of the optimal level of
performance
The Pre-Participation Physical
Examination (PPE) Goals cont.




Fulfillment of legal and insurance requirements
Evaluation of the level of maturation of younger
athletes
Evaluation of fitness and performance for possible
improvement prior to participation
Provisions of opportunity to counsel youths regarding
personal health issues
Entry of the athlete into the local sports medicine
environment, thereby establishing a doctor-patient
relationship
The Pre-Participation Physical
Examination (PPE)

The PPE should take
place at least six
weeks before the
beginning of the
sports season, so that
if musculoskeletal
problems are found
there will be time to
rehabilitate and
strengthen the areas
of concern.
The Pre-Participation Physical
Examination (PPE)
 The
station-based pre-participation
examination



Many athletes can be examined in the same
setting, often for lower cost.
The athlete is examined by sports medicine
specialists.
Stations include medical history and basic
measurements of blood pressure, height,
weight, eyesight.
The Pre-Participation Physical
Examination (PPE)
 The
station-based pre-participation
examination cont.

Specialists often include family physicians,
orthopedic specialists, physical therapists,
certified athletic trainers, podiatrists, and
pediatricians.
Difficulties with the station-based PPE include
finding volunteer medical specialists and a
location for the examination.
The Pre-Participation Physical
Examination (PPE)
 The
office-based preparticipation
physical examination



The family physician, the usual evaluator, has
access to the complete medical history of the
athlete.
The setting is quiet and allows for the
discussion of multiple health issues.
Immunization history is available and can
easily be updated.
Components of the PreParticipation Physical Examination
 A complete
medical history will identify
approximately 75% of all problems
affecting athletes. The recommended
baseline history includes medical
conditions and disease, surgeries,
hospitalizations, medications, allergies,
immunization status, menstrual history,
pulmonary status, neurological status,
musculoskeletal status, and injuries or
illness since the last exam.
Components of the PreParticipation Physical Examination

The recommended
components of the
PPE include height,
weight, pulse, blood
pressure, eyes,
ears/nose/throat,
heart, abdomen,
genitalia (males only)
skin, and
musculoskeletal.
Clearance
 Clearance,
the term used for physician
permission for athletic participation, is
divided into three categories.



Unrestricted clearance
Clearance after completion of further
evaluation or rehabilitation
No clearance for certain types of sports or for
all sports
Clearance

When an abnormality is found, the physician
must consider several questions.





Does the problem place the athlete at risk for injury?
Is another participant placed at risk of injury because
of the problem?
Can the athlete safely participate with treatment?
Can limited participation be allowed while treatment is
being completed?
If clearance is denied only for certain sports or sports
categories, in what activities can the athlete safely
participate?
Clearance

Sports are classified
based on degree or
level of contact and
strenuousness, which
may result in
clearance for some,
but not all sports.
Recordkeeping




Physical forms are completed and signed by the
physician.
Information from the PPE is available to coaches,
athletic trainers, and the athletic director.
All information contained on the PPE is confidential and
must be treated with the strictest of confidence by storing
the forms in the certified athletic trainer’s or athletic
director’s office under lock and key.
All PPE forms should be kept and stored for a minimum
of seven years after the athlete graduates or leaves the
school.