Sport Medicine

SPORTS PHYSICALS

Need and cost

In the US alone, millions of athletes undergo preparticipation evaluations, and millions of healthcare hours are spent on performing these evaluations each year. Because the yield of significant abnormalities in this relatively healthy population is low, the cost-effectiveness of these evaluations has been questioned.

Philosophy

The approach to preparticipation evaluations varies depending on the practitioner and practice situation, as well as on the athlete, his or her level of competition, and the institution and its requirements. At this time, 50 of 51 states (including the District of Columbia) require some form of physical evaluation before participation in sports at the high school level, of which some are legal requirements. Some practitioners approach sports physicals as thorough, periodic health evaluations, whereas others consider these evaluations to be risk-based screening examinations. Neither approach is perfect, and no universal standard exists for what constitutes an adequate or appropriate evaluation for this population.

To complicate matters further, the positional statement of the American Medical Association (AMA) regarding such evaluations is vague and may be interpreted in many ways. According to the AMA, every athlete has the right to a thorough preseason evaluation. Typically, these evaluations are not considered substitutes for thorough medical care, and they are described as screening tools with the purpose of identifying high-risk situations.

Main issues

The main athletic assessment issues can be classified into 3 categories: administrative, coaching/athletic, and medical.

Athletic directors are the ones who usually address the administrative issues, which are often based on institutional policy and on local, state, or national laws. These administrative issues involve liabilities, matters to do with insurers, and the rights of athletes to participate in competitive sports. The administrators rely on the physician to assess athletes for compliance with the relevant administrative codes.

The coaching/athletic issues involve both the coaches and athletes. The athletes want medical clearance so they can safely compete and train. If they have a history of injuries or medical problems, the athletes desire information about how to treat or rehabilitate those conditions to improve their performance and safety. Coaches are interested in fielding a team of healthy athletes. When injuries or illness preclude their athletes from competing, coaches need to know the time period that is required for the injury or illness to heal so they can make decisions about finding capable substitutes. Both athletes and coaches depend on the physician to help them in making these types of decisions.

Medical issues are handled by the physician, athlete, coaching staff, and administrators. The goal is to ensure, as completely and accurately as possible, that an athlete with a specific medical condition can compete safely. Achieving this goal is usually straightforward, but a particular situation can become complicated. Although a number of guidelines are available, many are difficult to interpret or implement. Furthermore, some conditions that affect an athlete's participation in sports do not have clear-cut guidelines. The physician's role is vital in these cases. He or she must not only determine the athlete's safety but also assist team coaches in making decisions about administrative and legal matters.

Goals and objectives

The goals of a preparticipation sports evaluation can be summarized as follows:

 1. Determine that the athlete is in general good health.

 2. Assess the athlete's present fitness level.

 3. Detect conditions that predispose the athlete to new injuries.

 4. Evaluate any existing injuries of the athlete.

5.  Assess the size and developmental maturation of the athlete.

6. Detect congenital anomalies that increase the athlete's risk of injury.

7. Detect poor preparticipation conditioning that may put the athlete at increased risk.

For excellent patient education resources, visit eMedicine's Public Health Center. Also, see eMedicine's patient education articles Walking for Fitness and Strength Training, as well as the Medscape article Sports Medicine in the Primary Care Setting.

Source hxxp://emedicine.medscape.com/article/88972-overview