Sports physicals are more than a check-up
Katie Atkins has always been active and participated in sports. Katie, 14, will be an eighth grader at South Allegheny Middle/Senior High School this year and plays soccer for the school and on a travel team. She also plays volleyball and is a cheerleader.
Her mom, Carrie Atkins, says she always worries about her kids getting injured.
“All the time,” says Carrie, “especially now that she’s had a concussion. It’s something that I’m always going to be afraid of because I know what that protocol is for her to recover and it’s lengthy.”
That concussion happened a year and a half ago when Katie took a soccer ball to her head.
“She experienced some headaches and they got worse through the day,” says Carrie. “Bright light affected her. She had to stay away from television and the computer screen and had to rest her eyes in a dark room for 48 hours.”
Fortunately, it was Katie’s first concussion and she went into the protocol to heal.
“I was scared,” admits Carrie, “but I thought with a concussion, it was her head. I didn’t realize all of the effects that it had on the rest of her body.”
Now that Katie is healed, she’s back on the field. That meant getting cleared to play by her doctor and getting her annual sports physical examination, often called the pre-participation physical examination (PPE).
“They checked our height and weight and they did do some tests like blood pressure and checked for any aches or pains or if anything was happening with our knees and joints,” says Katie. “If you told them you had pain, they did more testing and told you whether it would prevent you from any sport you want to play.”
Her travel team does not require a sports physical, but schools do and some even offer free physicals.
What do doctors look for during a PPE? Dr. Edward Snell, head of the Primary Sports Medicine Division at Allegheny Health Network and team physician for the Pittsburgh Pirates, sits on many panels that oversee and advise on sports medicine issues including the Pennsylvania Interscholastic Athletic Association.
“We’re trying to identify any problem that could be detrimental to the health of the child,” Snell explains. “We look at several things including a very detailed past medical history and past family history. That allows us to identify any problem that could be fatal or to think that this person may be at risk for further injury.”
Katie Atkins experienced headaches that got worse through the day. She saw her doctor for a physical and he determined when she could return to activities.
Snell says one of the most important parts of the sport physical is taking a detailed history of the student athlete and a detailed family medical history. The goal is to clear kids to play and not to rule them out.
“We’re very proactive and not restrictive,” says Snell. “We’re trying to enable physical activity among our kids.”
Parents should know that a PPE does not replace a regular annual checkup. Sports physicals focus on medical history and the child’s ability to play a certain sport. The doctor or nurse will check vital signs such as pulse and blood pressure and will measure height and weight. They will check vision to determine whether a child needs corrective lenses. They’ll also perform a fitness check of the heart, lungs and abdomen and joints like knees and ankles
Snell says taking the medical history is key in learning about potential cardiac issues.
“We’re looking for coronary anomalies that could cause problems with kids when they become active,” he says. “We’re looking for heart problems.”
Snell says there is always a debate among physicians as to whether more cardiac testing should be done on student athletes to identify potential problems before they become life-threatening.
“We have a lot of kids who go out for different types of sports and each one of them has a different kind of stress on your cardiovascular system,” he explains. “Currently, we don’t recommend any kind of cardiovascular testing at this point unless there’s something on history or exams that raises the red flag. From the other standpoint, there are a lot of people in this country who think we should be doing at least an EKG. There is that push toward that but we’re not there yet at the high school level.”
Dr. Edward Snell
Snell weighed in on the topic of further cardiac testing saying, “Do I think we could pick up a lot more problems if we screen for cardiovascular disease? The answer is probably yes. Do I think it would lead to unnecessary testing? The answer, again, is yes.”
Still, the standards in place right now are that unless there is a red flag that warrants further testing, the PPE does not require further cardiovascular screening yet.
One other important point is to look at a student athlete’s concussion history.
“We want to make sure that they had appropriate screening or that we’ve looked at their brain to make sure it’s functioning well enough that they can function at their sports,” says Snell. The same is true for rehabilitation from any orthopedic injuries making sure the child has recovered enough to play.
Snell recommends a child’s regular doctor perform the PPE because he or she is familiar with the patient’s history, and that it be done at least six weeks before the sport begins. Timing of a PPE can depend on the sport or school district. In Pennsylvania, a valid PPE cannot be authorized by a medical provider before June 1 for the upcoming school year.