Pre-Season Evaluation in Sport
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Introduction[edit | edit source]
Goals and Objectives[edit | edit source]
The overall goal of the Pre-Season Evaluation or Preparticipation Exam is to ensure the health and safety of an athlete in training and competition. It is a screening tool to assess athletes for injuries, illness or other factors that may put the athlete or others at risk. This tool is designed to be inclusive and not to just exclude athletes from participation. Only about 0.3% to 1.3% of athletes are reported to be denied clearance to participate, and 3.2% to 13.9% of athletes require further assessment before being allowed to participate.
The PSE is not a substitute for regular health assessments by the athlete's primary care physician, BUT for many athletes the PSE may be the only access to a medical caregiver and this may be the most extensive, focused health examination they will have access to.
Primary and secondary objectives of the PSE are listed in Table 1.
|Primary Objectives||Secondary Objectives|
Exercise is Medicine[edit | edit source]
The American College of Sports Medicine (ACSM) has created the global initiative "Exercise is Medicine" (EIM). Regular exercise improves the health of people and prevents many non-communicable diseases. An active lifestyle is not only relevant to elite athletes, but to all people. The ACSM created a pre-participation screening algorithm. Download the infographic from here.
You can also read these articles:
More information can also be found here: Exercise is Medicine
Administration of PSE[edit | edit source]
Timing and Frequency[edit | edit source]
Ideally the PSE should be performed at least 6 weeks prior to the start of practice. This allows for adequate time to identify and address any issues that arise during the assessment. The recommended frequency of the PSE is once a year. However various medical associations have different recommendations. For example:
- American Heart Association - every 2 years during maturation
- American Academy of Paediatrics - every year until the age of 21 years
- American Academy of Family Physicians - every 1 to 3 years
- Preparticipation Physical Evaluation 5th edition writing group - every 2 to 3 years with annual comprehensive questionnaire updates
The frequency can be flexible depending on the history of the athlete, their age, the type of sport or activity, etc.
PSE Team and Setting[edit | edit source]
Often only one sports clinician for example a physiotherapist performing the PSE, but it can also be performed by a multidisciplinary team of various professionals. The PSE can be performed with just the individual athlete present or in a multi-person and multi-stage set-up. Typically individual assessments will be performed at the clinician's consulting rooms. Different models of multi-stage set-ups can be used. Table 2 summarises the advantages and disadvantages of multi-stage evaluations.
This article provides the sports physical therapist's perspective on preparticipation screening: Preparticipation screening–the sports physical therapy perspective. 
Components of the Pre-Season Evaluation[edit | edit source]
Medical History[edit | edit source]
- Questionnaires are often used
- Medical and family history should be included
- Kurowski and Chandran reported that the personal and family history of an athlete reveals 64 - 78% of conditions that could prohibit or alter sports participation - showing that history taking is a sensitive tool. Furthermore, it has been reported that 88% of general medical conditions can be detected from the history alone and 67% to 75% of musculoskeletal conditions pertinent to sports participation can be detected.
|Medical Conditions Included in History|
Allergies to medications
High blood pressure
Sickle cell trait or disease
- Questions that cover all the components of the PSE should be included
- Sports specific components to be included such as previous injuries, rehabilitation etc.
- Read more:
- Examples of questionnaires and forms:
Vital Signs[edit | edit source]
- Blood pressure
- Heart rate
- Respiration Rate
- Pulse oximetry (SpO2)
- Growth and maturation in children
- Read more: The WHO Child Growth Standards
- Physical activity as a vital sign
- An initiative from Exercise is Medicine is to advocate for the incorporation of the Physical Activity Vital Sign (PAVS) into assessments
- Read more: EIM Physical Activity Vital Sign
- Physical activity as a vital sign: a systematic review
|Total minutes per week of physical activity (multiply #1 by #2)||___ minutes per week|
Eye Examination[edit | edit source]
- Visual acuity should be assessed, poor vision may lead to decrease in performance and injuries
- Snellen eye chart is used
- In sports where there is a high risk of eye injuries, eye protection is key.
- Traumatic eye injuries are the leading cause of noncongenital blindness in people younger than 20 years
- Sports with a high risk of eye injury include sports played with a ball, bat, puck, stick or racquet (e.g. lacrosse, hockey, baseball, basketball, softball) or sports where participant's are likely to be hit (martial arts).
- A functionally one-eyed athlete has a best corrected visual acuity of 20 / 40 or worse in the affected eye
- Functionally one-eyed athletes should wear protective eyewear in all sports, regardless of the level of risk involved
- Read more: Eye Injuries
Musculoskeletal Examination[edit | edit source]
- Address any concerns from the subjective history
- Upper and lower quadrant screens
- Joint specific examinations if indicated
- Further assessment as required include:
- Active / passive range of motion
- Special tests
Neurological Examination[edit | edit source]
- history of previous concussion/head injuries
- seizure disorders
- recurrent stingers or burners
- prior transient quadriparesis or cervical cord neuropraxia
Cardiovascular Examination[edit | edit source]
- This is an important part of the PSE:
- Sports clinicians need to address cardiovascular concerns in the personal history of the athlete (specific questions about exertional chest pain, unexplained syncope, excessive exertional and unexplained dyspnea or fatigue, prior recognition of heart murmur and elevated systemic blood pressure)
- If any of the above are positive, referral to a physician or cardiologist is necessary before the can be cleared for sport and physical activity
- A family history of premature death before age 50 due to heart disease need to be considered as well as disability from heart disease in close relatives
- Sudden cardiac death in athletes affects 1 - 3/100 000 competitive athletes younger than 35 years.
- Frequent causes are: hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, coronary artery disease in older athletes and channelopathies in children
- Recommended readings:
Pulmonary Examination[edit | edit source]
- This is often done in conjunction with the cardiovascular examination
- Conditions that require further investigation:
- Abnormal coughing, shortness of breath, breath sounds
- Exercise-induced bronchospasm
- Pulmonary insufficiency
Other Medical Examinations[edit | edit source]
- Mental health screening
- Urogenital exam
- Gastrointestinal exam
- Integumentary exam
Special Considerations[edit | edit source]
This can arise from questionnaires completed, or through discussions and developing a rapport with the athlete.
- Substance abuse
- Female athlete triad
- Relative energy deficiency in sport
- Post Covid complications
- Transgender athletes
- Athletes with a disability
- Suspected intentional trauma
Determining Clearance[edit | edit source]
Clearance Considerations[edit | edit source]
- Is the athlete at risk?
- Are others at risk?
- Is participation safe during treatment?
- Can limited participation be allowed?
- Can the athlete be cleared for certain sports?
Clearance Categories[edit | edit source]
- No reservations, clear for all sports
- Passed with conditions
- Athlete has medical problem and needs follow-up
- Follow-up must be prior to activities
- Passed with reservations
- No collision sports
- No contact sports
- Failed with reservations
- Not cleared for requested sport
- Contact not permitted; non-contact allowed
- Failed with conditions
- Can be reconsidered after condition has been addressed
- Cannot be cleared for any sport or any level of competition
Classification of Sports[edit | edit source]
Resources[edit | edit source]
- Application of ACSM's Updated Exercise Preparticipation Health Screening Algorithm
References[edit | edit source]
- Kiara Spooner. ACSM Pre-Participation Screening Algorithm. Available from: https://www.youtube.com/watch?v=yrceh6BAQGA [last accessed 25/02/2023]
- Magal M, Riebe D. New preparticipation health screening recommendations: what exercise professionals need to know. ACSM's Health & Fitness Journal. 2016 May 1;20(3):22-7.
- Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M, Pescatello LS. Updating ACSM's Recommendations for Exercise Preparticipation Health Screening. Medicine and science in sports and exercise. 2015 Nov;47(11):2473-9.
- Maloy W, Schroeder J, Rhodehouse B. Athlete Preparticipation Physical Evaluation. Sports Medicine and Arthroscopy Review. 2021 Dec 3;29(4):200-6.
- Laskin, J. Pre-Season Evaluation in Sport. Course. Plus, 2023
- Sanders B, Blackburn TA, Boucher B. Preparticipation screening–the sports physical therapy perspective. International journal of sports physical therapy. 2013 Apr;8(2):180.
- MacDonald J, Schaefer M, Stumph J. The Preparticipation Physical Evaluation. American family physician. 2021 May 1;103(9):539-46.
- Kurowski K, Chandran S. The preparticipation athletic evaluation. American family physician. 2000 May 1;61(9):2683-90.
- Golightly YM, Allen KD, Ambrose KR, Stiller JL, Evenson KR, Voisin C, Hootman JM, Callahan LF. Physical Activity as a Vital Sign: A Systematic Review. Preventing Chronic Disease. 2017 Nov 30;14:E123-.
- Toldi JP, Thomas JL. Evaluation and management of sports-related eye injuries. Current sports medicine reports. 2020 Jan 1;19(1):29-34.
- Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45.
- Robles AG, Palamà Z, Nesti M, Tunzi RM, Delise P, Cavarretta E, Penco M, Romano S, Sciarra L. Sport Related Sudden Death: The Importance of Primary and Secondary Prevention. Journal of Clinical Medicine. 2022 Aug 11;11(16):4683.
- Crawford MH. Screening athletes for heart disease. Heart. 2007 Jul 1;93(7):875-9.
- Hajduczok AG, Ruge M, Emery MS. Risk Factors for Sudden Death in Athletes, Is There a Role for Screening?. Current Cardiovascular Risk Reports. 2022 Oct;16(10):97-109.
- Aspetar. Sudden Cardiac Arrest in Sports. Available from: https://www.youtube.com/watch?v=rYrdKyhQ1oM [last accessed 27/01/2023]
- Aspetar. Why do super-fit, young athletes suffer sudden cardiac arrest? Available from: https://www.youtube.com/watch?v=ZlSW7QAllBg [last accessed 27/01/2023]
- ACSM. Application of ACSM's Updated Exercise Preparticipation Health Screening Algorithm. Available from: https://www.youtube.com/watch?v=slTQ4rYD_Eo [last accessed 25/01/2023]