Pre-Participation Screening of Young Athletes

It’s that time of year again when student athletes all over Atlanta are scrambling to get their “sport’s physical”, which is a requirement to be eligible for practice and game participation. Like most other parents, I have waited until the last minute to obtain this seemingly low priority “clearance” for my child who is otherwise healthy. I have no concerns, so why do I have to go through this ritual every year? What does this health screen look for anyway, and why is it important and relevant to me and my child?

The pre-participation physical exam for young athletes, commonly referred to as a “sport’s physical” is no irrelevant ritual. While only a minority of screened athletes are disqualified from participation in sports (about 1%), the pre-participation exam may also uncover important sub-clinical problems that can be addressed without disqualification from the activity.

An excellent, and often overlooked, example would be the use of protective eyewear for athletes with glasses. Many student athletes, when confronted with this choice, will simply play without their prescription glasses, putting them at a significant increased risk of injury. The availability of protective eyewear has increased significantly and the cost has gone down considerably. The pre-participation exam is an important time to discuss options for those requiring corrective lenses and participation should be restricted until adequate measures have been taken.

While the most common reasons for disqualification are musculoskeletal in nature, the identification of cardiac (heart) abnormalities is perhaps the most important reason for this screening. Approximately 0.75 per 100,000 male participants under the age of 35 will die suddenly during athletic activities. Previously undetected congenital heart diseases like “hypertrophic cardiomyopathy” and “coronary artery anomalies” are the most common causes.

So how does the pre-participation exam identify these rare but life-threatening conditions? While the screening history and exam may not reveal all of these cardiac conditions, there are signs and symptoms that can indicate potential risk. These signs and symptoms should not be ignored and their presence should disqualify the athlete until further testing can be done. The history will reveal 64-78% of conditions that may prohibit athletic participation, so it is critical for the parent and athlete to be honest and prepared. The history forms should be filled out when there is time to reflect on the questions and ensure their accuracy. Waiting until the last minute, or when rushing through the office visit, creates conditions that are ripe for error and omission.
The following are just some examples of symptoms that denote high risk for undetected heart disease. Athletes who experience any of these during exertion should be further evaluated:

• Chest discomfort
• Shortness of Breath
• Palpitations
• Fainting or Near-Fainting
Family history is also very important part of the pre-participation exam, and parents should make every effort to know their family history prior to examination. Presence of any of the following in the athlete’s family history are concerning and require additional evaluation:
• Sickle cell trait or disease
• Unexplained sudden death in a family member younger than 50
• History of congenital heart abnormalities
• History of “Hypertrophic Cardiomyopathy”
• History of “Marfan’s syndrome”
Other medical conditions that may restrict participation include:
• Musculoskeletal injuries
• Head and neck injuries
• Convulsive disorders
• Exercise induced asthma
• High blood pressure
• Heat-related illness
• Sickle cell trait
• Solitary organs (especially one kidney)

Clearly the pre-participation exam is an important component of wellness and prevention for children and young adults. The opportunity for identifying potentially threatening conditions is both real and relevant. Preparing ahead of time by completing your child’s medical history and identifying relevant family history is perhaps the most important way to identify silent or undetected problems that put your child at risk.

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Piedmont Urgent Care by WellStreet is your source for all your pre-participation exam needs. We offer sports physicals at all 15 of our locations for just $25! Our urgent care offices are conveniently located throughout Metro Atlanta and are open extended hours seven days a week.