The Pre-Season Physical

April 2nd, 2010 by Andrea Bennett

How to help student athletes get a top-notch pre-season sports exam.

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It’s yet another appointment to cram into your busy end-of-summer schedule, and loads of paperwork besides. But as a prime opportunity to help your child stay healthy, consider the annual physical much more than an annual nuisance.

The pre-season screener is meant to check for undetected health problems, assess medical or musculoskeletal issues that could make playing a sport unsafe, and ensure that previous injuries have been fully rehabilitated. A good exam also gives parents the chance to ask about injury prevention, conditioning, nutrition, and age-appropriate training. The more thorough the exam, the easier it will be for you to monitor your child’s general health going forward.

There is no nationalized sports physical, though in 2004 six medical organizations banded together to form something that comes close. Created by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society of for Sports Medicine, American Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine, the Pre-participation Physical Evaluation is widely used by the associations’ 160,000 members and other healthcare providers. Many individual states, however, have their own standard forms for high school sports participation exams, which you can find by searching your state’s high school activities association.

According to Dr. Chris Manoue, associate professor of orthopedic surgery at the University of South Carolina Sports Center and a team physician of the Carolina Gamecocks, “Most physicians have their own form and a routine set of questions. They should all include the standards, such as whether the adolescent has allergies, surgeries, or injuries and whether there’s a family history of disease.” (See the form USC uses here.)

Even though physicals vary in their comprehensiveness—and, in many cases, from state to state—there are steps you can take to ensure your child gets the best exam possible.

See a specialist (or your primary care physician). Dr. Manoue recommends that parents ask their child’s regular physician, or a doctor specializing in sports or orthopedics, to do the exam. “A lot of high school kids don’t have a regular doctor,” says Dr. Manoue. “For some, [the physical] is the only time they have contact with the health care system.” Each year, his medical team conducts a “mass physical” for 700 kids, free of charge; he also notes that urgent care centers or other medical facilities may charge as little as $20 for an exam. Still, if you have the opportunity and the resources, these sorts of quickie physicals shouldn’t replace a thorough annual screening, especially for competitive athletes who may have special health considerations.

Keep timing in mind. Ideally, sports physicals should take place at least six weeks before the season begins. If your child plays a fall sport, make room for the physical in your family’s summer calendar.

Know your family history. “The most important thing on the exam, especially for younger kids, is a cardiac history,” says Dr. Manoue. Does he have chest pains or shortness of breath, or fatigue easier than other kids? Has anyone in the family died before age 50 from heart problems?” Dr. Manoue notes that USC’s practice is to conduct an exhaustive physical, including blood work and history, at the beginning of a student athlete’s career and every year after that. Do a little investigation into your family’s health: If you have close relatives with cardiovascular conditions such as hypertrophic cardiomyopathy, long QT syndrome, cardiac arrest, or Marfan’s syndrome, your child may need the clearance of a cardiologist.

Keep tabs on diet. Failing a physical for obesity—or for being severely underweight—is a bigger problem than simply hindering your kid’s ability to take part in the sports season. Dr. Lyle Mason, team physician for the NBA’s Utah Jazz, performed physicals on Utah high school athletes for 25 years. “I didn’t always pass these kids,” he says. “I’d sometimes have to ask myself, ‘Could I see this kid dying on the field?’ If the answer was ‘yes,’ I’d unfortunately have to fail his physical.”

Dr. Mason notes that most physicians now use a standard of body mass index (BMI) to determine whether students are over- or underweight. The number is calculated from a person’s weight and height, and is widely considered a reliable indicator of body fat. The BMI calculator on the website for the Centers for Disease Control and Prevention can help you assess your child’s BMI.

Visiting a regular physician can be crucial for kids with weight issues, since fluctuations over time won’t be well-documented if he or she sees a different doctor each year. If your child may be dealing with an eating disorder—including overeating, anorexia, or bulimia—Dr. Manoue notes that some kids are entitled to privacy. “Over the age of 18, there are confidentiality issues,” he says, adding that a good physician will develop a rapport with the athlete and do his or her best to provide sensitive consultation. “Most times if an athlete’s competitiveness is challenged, they’ll see the light.”