1. Preparticipation Physical Evaluation Dr. Hamed Abbasi

2. Introduction
Sports participation and athletics can be a positive experience for all age groups – by boosting fitness, enhancing self-esteem, enhancing coordination and providing an opportunity for creative cooperation and competition.
Participation in sports and athletic activities has continued to increase at all levels of society

3. Preparticipation Physical Evaluation(PPE)
PPE is an important step toward safe participation in organized sports.
The purpose of the PPE is not to disqualify or exclude an athlete from competition,
but rather to help maintain the health and safety of the athlete in training and competition.

4. Preparticipation Physical Evaluation(PPE)
PPE programs for athletes provide unique opportunity to provide information to: the player, family, team physician, coaching staff, athletic trainers and others, that may be useful in preventing injury and enhancing performance.

5. Goals of the PPE
• Determination of the general health of the athlete • Disclosure of defects that may limit participation • Detection of conditions that may predispose the athlete to injury • Determination of optimal level of performance • Classification of the athlete according to individual qualifications • Fulfillment of legal and insurance requirements for organized athletic programs •

6. Goals of the PPE
Evaluation of size and level of maturation of younger athletes
Improvement of fitness and performance
Provision of opportunities for students to compete who have either physiologic or pathologic health conditions that may preclude blanket approval
Provision of the opportunity to counsel youths and answer health and personal questions
Entry of the athlete into the local sports medicine system establishing a doctor‐patient relationship that continues

7. Administration of PPE There are no standard protocols for the timing,
frequency,
or content of evaluations.
the governing organizations, institutions, or available resources often guide these decisions.

8. Administration of PPE There is no single right way to organize a PPE.
Some elements should be considered in order to ensure a comprehensive and consistent medical examination.
These include:
1.qualifications of the screener,
2.timing of the examination,
3.method of the examination,
4.frequency of the examination,
5.and routine laboratory screening.

9. Frequency and Timing
Many researchers recommend the PPE be done weeks before the first competition
This allows time for follow-up and for rehab of injuries identified that were previously unknown
Frequency recommendations are variable, however
Some recommend it be performed at the beginning of the sport season, others at the beginning of the year

10. Organization and administration
there are generally two types of examinations:
group
and office-based,
as well as two types of formats:
straight-line format
and space available format.

13. ESSENTIAL ELEMENTS OF THE PPE
Medical History
Medical Examination
Musculoskeletal examination
Performance testing

14. Components of the PPE History
Most studies suggest that approximately 70 percent of problems are identified during the PPE through adequate history taking alone
athlete’s personal medical history (immunizations, removal of spleen, hepatitis, surgeries, etc.)
family medical history (asthma, diabetes, genetic disorders, alcohol abuse, cardiovascular disease prevalence, etc.)
personal orthopedic history (previous injuries, surgeries, rehabilitation, etc.)

15. Components of the PPE
General history: Hospitalizations, surgeries, chronic medical problems, or illnesses since the previous examination.
Cardiovascular risk factors: Dizziness, lightheadedness, syncope during or after exercise; chest pain and palpitations during or after exercise; shortness of breath and fatigue out of proportion; high blood pressure, high cholesterol, recent viral illnesses (mononucleosis, myocarditis); family history of hypertrophic cardiomyopathy or of sudden cardiac death prior to 50 years of age; family history of Marfan syndrome; cocaine use or anabolic steroid use; prior restrictions to athletic participation due to cardiovascular concerns.

16. Components of the PPE
Dermatologic: Current skin problems such as warts, rashes, acne, herpes, or blisters.
Drug use: Medication usage, including prescription and over-the- counter; allergy information should be obtained, including allergy to medications, as well as to the environment, food, and/or insects; drug or alcohol abuse in athlete or family members; steroid usage.
Female athletes: Menstrual history, including age of onset (menarche), most recent menstruation, regularity of cycle, and any missed cycles (amenorrhea); adequate nutrition and calcium intake; any irregular eating habits.
Heat-related illness: Prior incidences of problems with the heat, including heat cramps, exhaustion, stroke, or malignant hyperthermia.

17. Components of the PPE
Musculoskeletal: Type and severity of prior injury, such as sprains, strains, fractures; swelling or pain; past treatment and rehabilitation of any prior injuries.
Neurologic: Frequent headaches, migraines, and/or seizures.
Concussion: Incidence, type, and severity of prior head injuries; presence of concussive symptoms.
Spinal Injury: Prior burners or stingers, any numbness or tingling in arms, legs, hands, or feet.
Pulmonary: Shortness of breath, wheezing, or coughing during or after activity; seasonal allergies; any episodes of exercise- induced asthma.

18. Components of the PPE
Solitary organs: Prevalence of one paired organ (eye, testes, kidney, etc.).
Weight: Questions regarding body image, perceived ideal weight, and recent weight changes.
Other: Depression, anxiety, general stress

19. Components of the PPE Medical Exam
The general medical examination starts with some vital statistics of the athlete such as age, sex, height, weight, blood pressure, and heart rate.
The exam then proceeds to evaluate various body regions and systems, including head, eyes, ears, nose, throat, chest, abdomen, skin condition, genitalia, and possible hernia.
The general medical examination is designed to identify the presence of common medical conditions.

20. Components of the PPE
Musculoskeletal examination is designed to assess the integrity of the athlete’s joints and muscles.
may include an assessment of major joints; manual, isotonic, or isokinetic muscle strength assessment; and joint flexibility.
Consideration of the demands of an athlete’s particular sport is essential during this examination.
The more extensive this examination, the more powerful the PPE can be as an injury prevention tool.

21. Components of the PPE Cardiovascular Screening
ECGs and echocardiograms to improve identification of those at risk

22. Components of the PPE Sports specificity
Flexibility, strength, power, anaerobic endurance, aerobic endurance
Establish flexibility with a sit-and-reach test and goniometer measurements
Establish strength with manual exercises, dynamometers
Establish power with power activities (vertical jump, etc.)
Establish anaerobic endurance with specific activity (40-yard dash, shuttle run, sit-ups in one minute, etc.)
Establish aerobic endurance with specific activity (distance in a twelve-minute run, step-test, submaximal treadmill or bicycle tests, etc.)14

25. Components of the PPE
Neurological exam for those in collision/contact sports
IMPACT or other neurological screening exam for baseline

26. Personnel Physicians Dentist Podiatrist Nurse Physicians Assistant
Physical Therapist
Athletic Trainer
Massage Therapist
Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning Specialist
Social Worker

27. Sports Medicine Human Performance Management Injury
Exercise Physiology
Practice of Medicine
Biomechanics
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage

28. Medical Disqualification
Decisions
Passed:
Unconditional
No reservations
Cleared for all activities and all levels of exertion
No current or preexisting medical problems
No contraindications for collision or contact sports
Passed with conditions:
Has a medical problem that needs follow-up
Able to participate in sports at present
Follow-up must occur before athletic participation
Passed with reservations:
No collision sports
No contact sports
Failed with reservations:
Not cleared for requested activity (may be considered for other sports)
Collision not permitted, contact limited
Contact not permitted, noncontact sports allowed
Failed with conditions:
-Can be reconsidered after medical problem is addressed
Failed:
Cannot be cleared for any sport or any level of competition