Teen Health Supervision
Sports Physicals - also called "Pre-Participation Physicals"
States mandate that school athletes have "sports" physicals. The first goal of this evaluation is to ensure the health and safety of the athlete and the second is to maximize athletic performance in athletes with medical conditions.
It is essential to know for which sports or activities participation is anticipated. The potential for injury is different for basketball compared to ping-pong. The level of exertion may be much higher for a cross country runner relative to a Special Olympics runner.
The medical history is the most important tool for evaluating a participant. Some medical conditions may be worsened by participation, or the condition may limit performance. For example, exercise may induce exacerbations of asthma; and of course, poorly controlled asthma will limit endurance. It is important that asthmatics be under good control.
The cardiac examination is extremely important. The athlete should be examined standing as well as supine to listen for murmurs associated with idiopathic cardiomyopathy.
Sudden death during sports is rare but well publicized. In retrospect, many of these individuals had symptoms such as chest pains, palpitations or a history of syncope. The physical examination, however, was normal. For this reason, inquiry should always be made into chest pain, syncope and family history of heart disease/ sudden death.
A complete physical exam should be performed, including measurement of blood pressure. Mild hypertension does not preclude an athlete from participation but should be followed, evaluated and treated if it does not resolve.
Pupil size should be documented as equal or unequal. Following a head injury, one of the first things to be evaluated is the pupil size.
Visual acuity should be evaluated. If there is unilateral uncorrectable poor vision (e.g., a teen with 20/20, 20/100 vision), protective eyewear is necessary for high risk sports such as basketball.
The infamous "hernia check" is important for documenting two normal testes. Males with only one normal testicle should wear a protective cup in sports where there is potential for collision. Finally, orthopedic screening should be performed to evaluate the range of motion and to detect musculoskeletal problems such as scoliosis.
Quick Check: Adolescence