Screening in Sport
Original Editor - Naomi O'Reilly
In the endeavours to optimize effects of sports participation and training, unfortunate side-effects should be minimized. Indeed, the devastating impact of Cardiac Arrest (CA) or Sudden Death (SD) in athletes has shocked societies and sports spectators all over the world. Preventive measures, specifically pre-participation screening have been advocated by the European Society of Cardiology (ESC) and have subsequently been implemented in some sporting communities. The EACPR Sports Cardiology section answers below our key questions on pre-participation screening.
Sports participation and athletics can be a positive experience for all age groups - by boosting fitness, enhancing self‐esteem, enhancing coordination and providing an opportunity for creative cooperation and competition. Participation in sports and athletic activities has continued to increase at all levels of society from the very young youth sports activities, to high school and college, and finally to the baby boomer generation. More high school students are playing sports than ever before; more than 7.6 million (55.5%) of all high school students participate.5 For the ninth consecutive year, there has been a marked increase in athletics participation at the collegiate level with more than 444,000 student athletes competing on more than 18,000 teams.
Aim of Screening
The primary aim of the PPE as performed in other countries would appear to be the detection of cardiovascular abnormalities to prevent sudden death among young athletes. The Australian medical screening program has a broader perspective and is aimed at improving the health of the athlete. The medical screening of these high performance athletes has a number of aims:
- Prevent Sudden Death
- Ensure Optimal Medical Health (asthma, diabetes, menstrual, depression)
- Ensure Optimal Musculoskeletal Health
- Optimize Performance (Nutrition, Psychology, Biomechanics)
- Prevent Injury
- Review Medications and Vaccinations
- Collect Baseline Data (Blood Tests, Neuropsychological Testing in Contact Sports)
- Develop Professional Relationship with Athlete
With the help of sports medical screening examinations, early recognition of risks and diseases is possible. It is perfectly clear that this can contribute towards a considerable reduction in health risk, particularly of sudden cardiac death.The German Society for Sports Medicine and Prevention (DGSP) has issued a new S1 Guideline "Guideline for Sports Medical Screening Examination", which, for the first time, specifies evidence-based recommendations and quality standards for sports medical screening examinations outside professional sport or elite teams. The aim is to detect latent or present disease which might be a risk to the sportsman or sportswoman. These checkups are intended for beginners and returnees in all age groups and for ambitious hobby or high performance sportsmen and women. The checkup includes questions on the personal medical history, the family history, sporting activities and internal and orthopedic investigations.
A good estimate of the acceptance and use of sports medical screening investigations can be obtained with the current PACE study (PACE: Performance, Age, Competition, Exercise), which has already analyzed the marathon and half-marathon performances of more than 300,000 sportsmen aged between 20 and 80 (18). As part of this project, a scaled online questionnaire has been developed and translated into six languages. This puts questions about performance, training planning, habits and sports medical screening examinations. The present study has evaluated information from about 10,000 long distance runners about the use and performance of sports medical screening examinations.
Pre-participation cardiovascular screening is the systematic practice of medically evaluating large, general populations of athletes before participation in sports for the purpose of identifying (or raising suspicion of) abnormalities that could provoke disease progression or sudden death. Indeed, identification of the relevant diseases may well prevent some instances of sudden death after temporary or permanent withdrawal from sports or targeted treatment interventions. In addition, the increasing awareness that automated external defibrillators (AEDs) may not always prove successful in the secondary prevention of sudden death for athletes with cardiovascular disease underscores the importance of pre-participation screening for the prospective identification of at-risk athletes and the prophylactic prevention of cardiac events during sports by selective disqualification. 
Although some critics have questioned the effectiveness of cardiovascular screening, overwhelming support for the principle of this public health initiative exists in both the medical and lay communities. The efficacy of the various athlete screening strategies is not easily resolved in the context of evidence-based investigative medicine.
Time constraints do not allow a full comprehensive assessment of all joints and muscles. Therefore, the aim of musculoskeletal screening is to assess recovery from any previous injury and to assess the presence of proven (very few) or suspected risk factors for future injury. Athletes involved in sports associated with high risk of specific joint or muscle injuries, such as, swimmers’ shoulders and pitchers’ elbows, should have specific assessments performed on these areas.
A full injury history should be taken, and any deficits remaining post-injury should be fully assessed with a view to designing a rehabilitation program to restore full function. Frequently, athletes will have resumed full athletic participation following a significant injury and yet still have considerable limitations in strength, range of movement, proprioception,and so forth.The questionnaire asks the athlete to describe the nature and date of any previous injury and to list any residual problems. Athletes are asked to describe the nature, date, and symptoms of any current injury.
Athletes require a strong foundation in a diverse range of athletic qualities in order to tolerate the progressively advanced training loads and competitive demands of their chosen sport. The improvement of foundation movements that underpin these athletic qualities early in the athletes' development pathway is one of the key recommendations of long term athlete development models.  The foundation movements typically involve variations of squatting, lunging, jumping, pushing, pulling and bracing.3‐6 Typically these movements are objectively assessed using some form of functional movement assessment criteria in order to screen athletes for dysfunctional movement patterns in an attempt to alleviate injury risk through addressing incorrect movement patterns.7 The Functional Movement Scale (FMS™) by Cook is by far the most popular screening tool used to provide an objective assessment of movement in sports performance research and is typically synonymous with the term “Functional Movement".
The Athletic Ability Assessment can be used as an assessment tool for athlete profiling, as well as be used to assess changes in functional movement ability over time (by making multiple measurements on the same athlete following a training intervention). In order to confidently assess changes in an individual it is necessary to obtain an estimate of the measurement error that might arise solely from the tester(s). The specific objectives of this study were to determine the absolute error with one tester rating the same movements one week apart (intra‐tester reliability) as well as determining the error associated with different testers scoring the same performance (inter‐tester reliability).
- European Society of Cardiology. How to Conduct Pre-Participation Screening in Athletes. http://www.escardio.org/The-ESC/Communities/European-Association-for-Cardiovascular-Prevention-&-Rehabilitation-(EACPR)/News/How-to-conduct-pre-participation-screening-in-athletes (accessed 8 May 2016).
- Pre participation Screening - The Sports Physical Therapy Perspective. LRBarbara Sanders, PT, PhD, SCS, FAPTA,1 Turner A. Blackburn, PT, MEd, ATC,2 and Brenda Boucher, PT, PhD, CHT, OCS, FAAOMPT2
- Brukner P, White S, Shawdon A, Holzer K. Screening of athletes: Australian experience. Clinical Journal of Sport Medicine. 2004 May 1;14(3):169-77.
- Leyk D, Rüther T, Wunderlich M, Sievert AP, Erley OM, Löllgen H. Utilization and implementation of sports medical screening examinations. stress. 2008 Sep;11:14.
- Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM, Krauss MD. Recommendations and Sonsiderations related to preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update a Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27;115(12):1643-55.
- Ian McKeown, Kristie Taylor‐McKeown, Carl Woods, and Nick Ball. Athletic Ability Assessment: A Movement Assessment Protocol for Athletics. The International Journal of Sports Physical Therapy, Volume 9, Number 7, December 2014, Page.862