Transcript Pre-Participation Physical Examinations

Pre-Participation Physical
Examinations
What is a PPE?
• Comprehensive assessment of an athlete's
overall health and ability to perform a
sport at the highest level.
• Emphasizes the areas of greatest concern
in sports participation
• Identifies problems with Medical History
History of PPEs
• Short physical (5 minutes or less)
– Overall health
– Check the heart
– Check for existence of any hernias
• Later
–
–
–
–
More questions
Limited physical examinations
Urinalysis
Sports – clearance statement for physician to sign off on
• Today
– Maintain the health and safety of the athlete
Goals of a PPE
• General Health
• Detect defects that may limit participation or
predispose to injury
• Fulfillment of legal and insurance requirements
• Maturation level and optimal level of performance
• Evaluate fitness and performance for possible
improvement prior to participation
• Approval for athletes with health issues to participate
(diabetes = participation, but needs access to medical
services)
• Counseling on personal health
• Athlete entering Sports Medicine environment (doctorpatient relationship)
Timing of PPE
• Minimum of 6 weeks prior to beginning of their
sport season
– End of school year or mid-summer
– Gives time for musculoskeletal injuries to be rehabed
and strengthen prior to season
• Any athlete rehabed over summer should be reevaluated
prior to receiving full clearance
• Performed either in doctor’s office or in a
stationed-based environment
Station-Based PPE
• Several specialists involved and responsible for specific aspects
of the PPE
–
–
–
–
–
Medical hx
Height, weight, body fat %, and eye sight
Vital Signs (blood pressure and pulse)
Physical Examinations (Ortho Screening)
Medical Clearance
• Specialists can include:
– Family Physicians or Pediatricians
– Orthopedic Specialists and Podiatrists
– Athletic Trainers and Physical Therapists
• 78 % of teenagers get their only physical exams through sports
physicals
• 74 % of sports specific injuries can be determined with a
complete hx
Station-Based PPE
Advantages and Disadvantages
• Advantages
– Low Cost
– Multiple athletes at the same time and setting
– Seeing several different Sports Medicine Specialists
• Disadvantages
– Recruitment of volunteer specialists
– Facility for station-based exams
Office-Based PPE
• Health screening done usually by family
physician
– Able to review immunization hx
– Quiet setting allowing for discussion of multiple
health issues
What’s included in a PPE?
• Medical History
–
–
–
–
–
Medical conditions and diseases
Surgeries and hospitalizations
Medications (Rx, OTCs, and supplements)
Allergies
Immunization, pulmonary, neurologic and musculoskeletal
statuses
– Injuries and illnesses since last exam
• Measurements
• Orthopedic Exam
Components of PPE cont.
• Body parts assessed
–
–
–
–
–
–
–
–
Eyes
Ears
Nose
Throat
Heart
Abdomen
Skin
Musculoskeletal system and joints (not all joints need to be
tested)
• Example on page 91 in text
Orthopedic Exam
• Purpose is to identify congenital or acquired
musculoskeletal problems
• Basic ROM of major joints in the body
• Checking joints for any soft tissue injuries
– i.e. Duck walk
• X-rays can be used to determine maturation
level (most common body part is the wrist)
Clearance for Participation in Sports
• Clearance: Permission granted by a physician,
based on an athlete’s physical exam, to
participate in a sporting event
– Unrestricted clearance
– Clearance after completion of further evaluation or
rehab
– No clearance for certain types of sports or for all
sports
What if something is found
in the PPE?
• Two Components must be considered to limit or deny
participation:
– An abnormality or condition is found
– And it may limit an athlete’s participation or predispose
him/her to further injury
• The physician must consider the following questions:
• Does the problem place the athlete at increased risk of injury?
• Is another participant placed at risk of injury because of the
problem?
• Can the athlete safely participate with tx?
• Can limited participation be allowed while tx is being completed?
• If clearance is denied for only certain sports or sports categories, in
what activities can the athlete safely participate?
Sports Classification based on
Contact
CONTACT OR COLLISON
LIMITED-CONTACT
NONCONTACT
BASKETBALL
BASEBALL
BODY BUILDING
DIVING
CHEERLEADING
BOWLING
FOOTBALL – TACKLE
FIELD EVENTS
CREW OR ROWING
RODEO
HIGH JUMP
DANCING
SKI JUMPING
POLE VAULT
DISCUS
SOCCER
FOOTBALL-FLAG
JAVELIN
WATER POLO
GYMNASTICS
SHOT PUT
WRESTLING
HORSEBACK
GOLF
RUGBY
ICE SKATING
RUNNING
MARTIAL ARTS
X-COUNTRY
SWIMMING
FIELD HOCKEY
SOFTBALL
TENNIS
ICE HOCKEY
SNOWBOARDING
TRACK
BOXING
SKATEBOARDING
WEIGHT LIFTING
LACROSSE
VOLLEYBALL
TABLE TENNIS
Concussions in Contact Sports
• Types of Concussions
– Contrecoup: brain is bruised on the opposite of the impact due to the
rebound effect (hit a stationary or moving object while in motion)
– Coup: Injury is seen at the sight of impact (hit while stationary)
• Grade of severity of concussions
– Mild : No LOC, Mild to no PTA (clears in <30 mins), Transient
confusion, Sx lasting < 15 min.
– Moderate: No LOC or LOC < 1 min, PTA and postconcussion signs and
Sx lasting > 15 or 30 min but < 24 hours.
– Severe: Any LOC or LOC lasting > 1 min., PTA lasting > 24 hrs.,
postconcussion signs and Sx lasing > 7 days
• Magic Number : 3
– After 3 concussions (mild or medium) an athlete can be disqualified from
contact sports
– After 2 severe concussions the same disqualification is possible
Who has access to PPEs?
• Must be available to Coaches, Athletic Trainers, and
Athletic Directors
• Information wasted if not available
– An athlete with weak and inflexible hamstrings
• Is not a condition that will preclude full clearance but may lead to
injury later during the season
• Coaches and Athletic Trainer can work in the off-season to improve
flexibility and increase strength to reduce risk of injury
– Athlete with an allergy to bees
• A coach w/out prior knowledge of this would put the athlete at
medical risk if stung
Where are PPEs kept?
• All information contained on the PPE form must be
kept strictly CONFIDENTIAL!
• Can be kept under lock and key in:
– Athletic Director’s office
– Athletic Trainer’s office
• Coaches should review the PPEs prior to the beginning
of the season
• All PPEs should be kept for a minimum of seven years
after the athlete graduates or leaves the school
• Legal requirement to minimize risk to the School
District or University