Factors at Play in the Athletic Preparticipation Examination
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The medical community continues to benefit when physicians reexamine topics that have been widely written about, as authors Kurowski and Chandran have done in this issue of American Family Physician.1 However, their debate over the preparticipation physical examination deals less with content (well defined and agreed to in the 1997 monograph “Preparticipation Physical Exam”2) than with theory.
What they debate is the worthiness of the examination. In an effort to give adequate consideration, one must look at the function and goals of the preparticipation examination. The purpose of the preparticipation physical examination is not so much to disqualify athletes with life-threatening conditions. It is to establish primary care in adolescents who frequently do not have a physician, to provide an opportunity for adolescents to talk to a physician about sports-related or development issues and to identify any health risks inherent in a particular sport. Adolescents are notoriously difficult to reach. A sports physical is a way to build rapport with a teenager, which frequently leads to discussion about other issues. It is an opportunity to update immunizations, identify eating disorders and obesity, discuss sexual health, counsel about drug, tobacco and alcohol use and to warn athletes of the dangers of anabolic steroids. It is an opportunity to discuss asthma, allergy and infection control. Physicians can review a sports program to make sure that parents and coaches are using adequate safety equipment and training procedures and are knowledgeable about athletes' needs for hydration and first aid. It is also a way to alert coaches about ongoing health problems that might require accommodation.
Indeed, there is a sound philosophy behind preparticipation physical examinations. Sports medicine, and specifically primary care sports medicine, has advanced to the point where there are practically no conditions that disqualify an athlete from all forms of physical activity. We know that physical activity becomes a powerful adjunct to the ongoing treatment of many chronic illnesses. It is essential that physicians involved in the preparticipation examination have the knowledge and skill to help patients find appropriate activities in which to participate. To do otherwise would be to do the athlete a disservice. Disqualification is a choice of last resort. The introduction of exercise in youth has proved to be one of the most powerful and beneficial tools that prevention-minded physicians have available. Active persons are healthier, happier and live much longer than inactive persons. Various risk factors that prey on large segments of our population are minimized with good exercise habits throughout life.
The argument against the preparticipation physical examination is moot. Consideration of the preparticipation examination confirms it as a valid and important point in rendering quality health care. Consider the goals accomplished by a good preparticipation physical examination:
Legal conditions are met for the institution involved.
Conditions that might adversely affect an athlete during sports participation can be identified. These conditions primarily involve the cardiac and orthopedic systems but are not limited to them.
Conditions that have the potential to predispose an athlete to subsequent injury, such as incomplete healing of a previous injury, can be detected.
The overall general health of the athlete can be determined.
A relationship, on the part of the athlete, has begun with the team physician that will continue during athletic participation.
A venue has been opened that will enable the athlete to discuss various nonathletic concerns.
Appropriate advice and feedback can be given concerning such areas as nutrition, warm-up, cool-down and proper conditioning.
A network to support the health care of that person has been established or enlarged.
Preventive concerns, such as seat belts, drinking and other high-risk behaviors common to the adolescent age group, can be addressed.
The preparticipation physical examination should and, we are confident, will remain a significant part of a well-run sports medicine program. When done appropriately, and for the right reasons, it serves an extremely useful function. As with all successful medical endeavors, the right people with the right philosophy must be involved to make it work.
Douglas B. McKeag, M.D., M.S., is professor and chair of the Department of Family Medicine at Indiana University School of Medicine, Indianapolis, Ind.
Robert E. Sallis, M.D., is assistant clinical professor at UCR/University of California-Los Angeles Biomedical Sciences Program. He is codirector of sports medicine fellowship at Kaiser Permanente Medical Center in Fontana, Calif.
Address correspondence to Douglas B. McKeag, M.D., M.S., Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN 46202.
1. Kurowski K, Chandran S. The preparticipation athletic evaluation. Am Fam Physician. 2000;61:2683–90.
2. Smith DM, Preparticipation Evaluation Task Force. Preparticipation physical evaluation. 2d ed. American Academy of Family Physicians. Minneapolis: The Physician and Sportsmedicine, 1997.
Copyright © 2000 by the American Academy of Family Physicians.
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