PREVENTION: PRE-PARTICIPATION PHYSICAL EXAMS Annise Nalepa, ATC, LAT Tarleton State University

What is a PPE and why is it important? How thorough are the physicals? Is your paperwork really screening for all risk factors or is it just the bare minimum? Pre-participation physicals are a crucial part of physical health and determining if an athlete is healthy enough to compete. This seminar will discuss what should be included in a PPE and how you can make sure the athlete is safe.

Pre-Participation Physical Exams  Primary  Detect Pre-disposing injuries  Detect life-threatening/disabling injuries  Meet legal/insurance requirements  Secondary  Determine general health  Counsel health related issues  Assess fitness levels

Personal Physician vs. Station Exam  (+)Access to medical record  (+)Know athlete Personally  (+)Can institute preventive care  (-)Time Consuming  (-)Expensive  (-)Not all PCP know sports  (+)Faster  (+)Economical  (+)Fundraiser  (+)Station Exam  (-)Physician unfamiliar with history  (-)Need to have someone review chart at end PersonalPhysician Station Exam

PPE different for each Population  Pre-Adolescent  Determine Life Threatening  Medications  Allergies  Congenital Abnormalities

PPE different for each Population  High School  Screening by unfamiliar physicians  Determine minimum level of health  Heath education

PPE different for each Population  College  Comprehensive health physical  Investment in athlete  Obtain PMH  Meet and Greet

Components

Vital Signs  Height  Weight  Vision  Blood Pressure  Heart Rate

Personal History  Cardiac  Pulmonary  Neurological  Heart illness  Musculoskeletal  Allergies

Physical Exam  Joint Flexibility/ROMs  Shoulder  Knee  Ankle  Hip  Trunk  Elbow  Wrist/Finger

Orthopedic Clearance  Full Unlimited  Limited  Clearance Withheld Until…  No Athletic Participation

Cardiac Concerns

Cardiac Stats  CVD Sudden Death in Athletes: (56%)  29% occurred in blacks  54% in high school students  82% with physical exertion during competition/training  11% occurred in females

12 AHA Questions  Personal History  Exertional Chest Pain/Discomfort  Syncope/Near Syncope  Excessive exertional and otherwise unexplained, dyspnea/fatigue associated with exercise  Previous recognition of a precordial murmur  Elevated systemic BP  Family History  Premature death before age of 50 related to heart disease in one or more relatives  Disability from heart disease in a close relative less than 50 years old  Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan’s syndrome, or clinically important arrhythmias  Physical Examination  Heart Murmur  Femoral pulses to exclude aortic coarctation  Physical stigmata of Marfan’s syndrome  Brachial artery blood pressure (sitting position)

Concussion History / Testing

BESS Testing  Balance Error Scoring System  Concussion Baseline  Inexpensive yet time consuming

ImPACT  Computer-based concussion baseline testing  Expensive yet efficient

Natasha’s Law  Required Concussion training for Coaches and ATs  Physician Clearances  Education

Education   Heads Up: Concussion in HS Sports  S/S  Management

Form Examples

Other Topics:  Determine MD/DO/DC  Insurance  Require School Issued Form for consistency