A thorough yet efficient exam identifies most problems in school athletes

Additional forms of musculoskeletal evaluation are often performed for athletes to determine their general state of flexibility and muscular strength. While various degrees of hyperlaxity, muscular tightness, weakness, asymmetry of strength or flexibility, poor endurance, and abnormal foot configuration may predispose an athlete to increased risk of injury during sports competition, studies have failed to demonstrate conclusively that injuries are prevented by interventions aimed at correcting such abnormalities.^35-37

TABLE 3
The “90-second” musculoskeletal screening examination

Role for lab tests?

Studies do not support the use of routine laboratory or other screening tests such as urinalysis, complete blood count, chemistry profile, lipid profile, ferritin level, or spirometry as part of the exam (SOR: B).^38-41

Determining clearance

Occasionally, an abnormality or condition is found that may limit an athlete’s participation or predispose him or her to further injury. In these cases, the examining physician should review the following questions:⁵

1. Does the problem place the athlete at increased risk for injury?
2. Is another participant at risk for injury because of the problem?
3. Can the athlete safely participate with treatment (ie, medication, rehabilitation, bracing, or padding)?
4. Can limited participation be allowed while treatment is being completed?
5. If clearance is denied only for certain sports or sport categories, in what activities can the athlete safely participate?

Physicians should base clearance to participate in a particular sport on previously published guidelines, such as the recommendations by the American Academy of Pediatrics, the 26th Bethesda Conference, and the American Heart Association.^7,43,44 Participation recommendations are based on the specific diagnosis, though multiple factors such as the classification of the sport and the specific health status of the athlete affect the decision.⁴⁴

Approach to the patient

While current research demonstrates that the preparticipation physical examination has no effect on the overall morbidity and mortality rates in athletes, these exams may fulfill other objectives. Furthermore, no harmful effects of these examinations have been reported, and the exam has become institutionalized in the athletic and sports medicine community. As such, physicians should base their evaluation on the best available evidence using the standard form shown in “Preparticipation physical evaluation for athletics.”⁶ (A copy of the Preparticipation Physical Evaluation form can be found at www.jfponline.com.) This may require that the physician work with local school systems to assure that they understand what constitutes an appropriate examination.

To assist future patient care decisions and research efforts, a standardized preparticipation physical examination with an associated form similar to the evaluation recommended by the Preparticipation Physical Evaluation Task Force should be uniformly implemented throughout the country. The use of consistent clearance criteria as recommended by the Preparticipation Physical Evaluation Task Force or the American Academy of Pediatrics (“Medical conditions and sports participation,” also available at www.jfponline.com) should be used, studied, and revised as needed.^5,44

In addition to the exam, physicians should consider exploring other aspects of sports participation to assist athletes in reducing the risk of injury. Rules, equipment, or other factors may have a greater effect on decreasing the mortality and morbidity associated with athletic participation. A marked decrease in cervical spine injuries occurred following the rule change in football banning deliberate “spearing”—the use of the top of the helmet as the initial point of contact in making a tackle.⁴¹