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Continuity Clinic Notebook:

 Chapter III. Adolescent Issues

Chapter 3 Index

A. General:
--Approach to the Adolescent Patient
--Managing Problem Health Behaviors in Adolescents
--Health Screening and Prevention Guidelines for Teens

  

Preparticipation Sports Physical:
Often the Only PE Adolescents Receive

Introduction: In private practice, you will be asked to do many preparticipation sports physicals.  Each doctor will need to determine whether this will be a waste of time or a meaningful physical. Opinion: To line up children in the locker room, try and listen to the heart and look for a hernia is not worth the time or effort.  An organized approach to this exam is better.

Pros and Cons of Doing Preparticipation Physical:  Pediatrics 1995;96:1151-1153

Pros

Cons

At least one physical gets done on teenager

Continuity of care is disrupted

Physical health at least assessed since required to have this done

Value of sports physical is not established

Can check urinalysis, blood test, BP, pulse

Not good at picking up serious abnormalities: no advantage to finding causes sudden death

Can pick up orthopedic problems

No good time to do these – usually at night: expensive to have personnel, equipment

Can determine Tanner staging; appropriateness of sport chosen by teenager

No risk taking activities assessed in format
(Psychosocial needs not met)

 

Lack of privacy; personal relationship 

However, 78% of teens get their only physical examinations through the sports physical, so all of us will be doing these exams whether they are productive or not. Different states have different requirements, but most state exams should occur 6-8 weeks before sport once every 2 years.

Sequence to Follow:

1. Take a History: This is the part that is often overlooked in a sports physical.  The most important questions deal with personal and familiy histories of cardiovascular disease.  Other questions might deal with neurologic or musculoskeletal disease.

2. Physical Examination: Use the Station Approach: Either 5 or 6 stations:

  • Station 1: Vital Signs: heart rate before and after exercise, BP, visual acuity, ht/weight

  • Station 2: General Exam: include significant history of past surgery, medical problems.
    Forms are available to use for this history.  This station includes HEENT exam, cardio-pulmonary exam, abdomen, genitalia (Tanner staging) Women MD examines women, men examine men.  Fat determination (calipers) and correlation with sport.
    Provocative measures to screen for hypertrophic cardiomyopathy should be performed. (Murmur decreases with squatting and increases with standing: refer)

  • Station 3: Orthopedic Exam: exam of entire musculoskeletal system ie joint stability,

  • Station 4: Laboratory - hemoglobin, urine dipstick: some say unnecessary

  • Station 5: Review of entire examinations: Review history, physical findings, fat determination, abnormal findings, and make    a recommendation: full participation in all sports, participation in only non-contact sports, no participation.  Refer to Tanner staging; body fat (different amounts/different sports).

Most Common Diagnoses Made: Hernia, varicocele, joint problems (knee), scoliosis, immature Tanner staging for those who want to do contact sports, hypertension, heart murmur, obesity, anorexia, and other eating disorders (female runners), exercise induced asthma, unsuspected anemia, proteinuria (often orthostatic), hematuria (usually benign) menstrual abnormalities.

1. Disposition of Children Examined:

a. Approve Sports Participation: About 98% of children can be involved in sports.  May need to change the sport if specific problems, but always try to allow participation

b. Denial: Most common reasons for sports participation denial: (American Family Physician 2000;61:2683-2690)

  1. Physical features of Marfan’s syndrome

  2. Delayed femoral arterial pulses

  3. Single, wide or fixed splits in the second heart sound

  4. Systolic or diastolic murmurs of G 2/6 or greater

  5. Irregular rhythms; prolonged QT intervals; myocarditis, pericarditis

  6. Hypertension

  7. Orthopedic abnormalities such as joint problems

  8. Poorly controlled convulsive disorders (no archery, riflery, swimming, weight lifting, strength training or sports involving heights)

  9. Sickle cell disease (no high-exertion, contact or collision sports)

  10. Eating disorders : anorexia, bulimia that are not under control

  11. Spleen or liver enlargement

c. Recommend a Different Level of Contact Sport:

Contact Sports

Limited Contact

Noncontact

Basketball, boxing, diving

Baseball, cheer leading, softball

archery, badminton, bowling

Field Hockey, Football, soccer

skiing, squash, gymnastics,

crew, dancing, golf, track

Wrestling, Lacrosse, Rugby

horseback riding, racquetball

Tennis, weight lifting,

Martial Arts

Bicycling

Running

d. Recommend a Different Intensity of Sport:

High to Moderate Intensity

Low Intensity

Boxing, football, hockey, wrestling baseball

bowling, golf

swimming, tennis, football, cycling, track,

 

Lacrosse, soccer

 

*Reference: Krowchuk, DP: Pediatric Annals 1/97.

Preparticipation Sports Physical Examination Record (1 page PDF file)
AAP Form copied from Pediatric Annals Jan 1997

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Department of Pediatrics  |  Medical College of Georgia
 Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004