Going to Rehab: Pre-Participation Examinations

August 10, 2012

Making its second appearance on the blog, I’m bringing back “Going to Rehab.” This will allow me to talk about anything sports medicine (as if I don’t anyway!). These are more issues that I see in athletic training and how it pertains to everyday athletic healthcare.

Prior to exercise, prior to sports participation, and prior to many different physical activities a physical examination by a physician is often required. There are many parts to a physical exam it will vary by the activity and age, etc. So what is so important about the physical examination and how can this help the athlete?

One of the most fundamental but very important pieces is the first one. The health history form. This form will help the healthcare professional to get to know you as a human body. We want to know about previous health problems and it is important that you disclose as much as you can. If you’ve broken a bone, I want to know it on this form. If you or anybody in your family has had heart problems, I need to know it! Sometimes these questions seem so mundane, but you never know when one day that little bit of information may save your life.

Next on your journey through the physical exam is probably to get some vital signs. Things like a blood pressure reading, pulse, and an eye screening would probably fall into this category. We have an idea what “normal” is for most people, but if we know that your blood pressure is typically 130/80 then I’m not going to panic on the field when your blood pressure is 130/80! On the other hand, if you typically have a blood pressure of 130/80 and now all of the sudden it is 110/60 then I’m going to have some concern. An eye screening is using that wonderful Snellen Eye Chart that so many of us love. And it’s simply a screening that we can use to possibly refer you to an optometrist if needed for glasses or contacts.

Moving on with our athletes we will then do an orthopedic screening. For us, our athletic trainers and maybe physical therapists handle this portion of the process. We run through some quick joint movements and muscle strength testing. We also get to find out how inflexible all of our high school kids are! This can give us an idea of what we may need to help you prevent injury before it happens!

Finally it’s time to send you to the doctor’s office. In the office, the physician is going to listen to your heart and lungs. Ideally they are going to review your examination up to that point and ask questions about anything on your medical history. They will have a look in your ears, nose and throat. Then for the males, the best part is yet to come (rolling eyes). It’s the part that everybody laughs at, but it is important to rule out hernias and testicular problems with a quick screening of the genitalia. For many, this is the end of the line. The doctor signs the physical form and you’re out the door.

I think that the physical exam is pretty straightforward. People laugh about it, but it is important.

I think that probably where the controversy comes into play is when we start adding additional things to the exam.

Tragedies over the last few years have led to many believing that an echocardiogram needs to be a part of the physical examination. This test is intended to screen for something like an enlarged heart or other heart abnormalities. Unfortunately, costs and effectiveness remain two obstacles that must be overcome before this can become a standard in a sports physical. There have been numerous deaths in what appear to be healthy student-athletes that cause speculation about whether this test would have saved that individual’s life.

Lastly a relatively new test that is slowly making its way into a “standard physical exam” is some form of neurocognitive screening. In our clinic and with our high schools, we use the ImPACT test but there are others out there such as CogSport, ConcussionVitalSigns, and even just a simple Sideline Assessment. If we do this as a baseline screening during the physical exam process, then we have additional information to use if the athlete suffers a concussion.

I think a physical examination is crucial. It gives the school, the coaches, and most importantly the medical staff a look into a particular athlete’s health. Each athlete is different and it’s important that those of us patrolling the sidelines know these things. You just never know; it may someday save your life.

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