Screening in Sport

Introduction[edit | edit source]


Before participation in any sports event, it is recommended that any professional or amateur athlete undergo a preparticipation physical evaluation ( PPE)[1]. The main goal of this screening is to maximize the health of athletes and their safety[2]. Some studies suggested that preparticipation evaluation (PPE) could not prevent the morbidity and mortality during sports[3][4], however, it could help in detecting serious conditions and provide strategies to prevent injuries.[5][6][7]

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[8]. Approximately 30 million athletes younger than 18 years and another 3 million athletes with special needs receive medical clearance to participate in sports every year. A station based PPE is a strategy used to decrease the cost and the time of PPE . By using this approach the athlete cycles through a series of evaluation stations to perform a specific aspect of screening. Separate stations may address vital signs, visual acuity screening, medical history and physical examination[6], orthopedic history and physical examination, updating immunizations, and finally meeting with a clinician to review all of the accumulated data and make a decision regarding clearance.[5]

Importance Of Screening[edit | edit source]

Skyttis athletics tracks.jpg

The International Olympic Committee (IOC) introduced the Youth Olympic Games (YOG) in 2007 to promote sports participation among young children . The IOC Consensus Statement was published in 2009 to highlight the value of PPE. A study [7]conducted by Adami, et al 2019 to assess the efficacy of a comprehensive protocol for illness and injury detection, tailored for adolescent athletes participating in Summer or Winter Youth Olympic Games (YOG) . The study results showed that 12% of the participants in PPE diagnosed with pathological conditions warranting treatment [7]. These conditions could be divided in to :

Aim Of PPE[9]

  1. Ensure Optimal Medical Health (asthma, diabetes, menstrual cycle, depression)
  2. Ensure Optimal Musculoskeletal Health.
  3. Optimize Performance (Nutrition, Psychology, Biomechanics).
  4. Prevent Injury.
  5. Review Medications and Vaccinations.[9]
  6. Collect Baseline Data (Blood Tests, Neuropsychological Testing in Contact Sports).
  7. Develop Professional Relationship with Athlete.
  8. Educate.

Key Recommendations For Practice[edit | edit source]

  1. PPE should occur around 6 weeks before activity to allow for further evaluation or treatment if needed.
  2. History taking is essential especially about (exertional symptoms -a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death.[10]
  3. Athletes with sustained systolic blood pressure of less than 160 mm Hg and diastolic blood pressure of less than 100 mm Hg should not be restricted from playing sports.
  4. Athletes with well-controlled asthma who are asymptomatic at rest and with exertion can be safely cleared to play sports.
  5. Screening blood and urine tests are not recommended for asymptomatic athletes.
  6. Comprehensive PPEs are recommended every two to three years with annual focused history updates in intervening years.[11]

Screening Protocol[edit | edit source]

Medical Screening[edit | edit source]

1.History[edit | edit source]

To identify any underlying medical conditions[12]. It covers many areas like musculoskeletal problems, asthma , hematologic disorders, exercise-induced bronchospasm, concussion, neurologic disorders and more importantly any information about cardiac problems or sudden death . [1] For athletes younger than 18 a parent or guardian should attend the evaluation to give detailed history about the child.[1]

2.Physical Examination[edit | edit source]

A limited general physical examination is recommended[13]. Assessment of ( vital signs, vision, hearing, and the cardiovascular and musculoskeletal systems)[1]The most common abnormal PPE findings are elevated blood pressure and vision problems.[1]Further examination should be based on issues uncovered during the history.[13]

3.Cardiovascular Screening[edit | edit source]
  • Specific questions regarding cardiovascular risk factors should be asked.[13]
  • Initially auscultation of the heart should be performed with the patient in various positions ( standing,supine, squat to stand & valsalva)[13]
  • It is not a demand to perform specific cardiac testing like (electrocardiography [ECG], echocardiography, exercise stress testing) unless patient history or clinical examination suggests this.[13]

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.[14]

Pre-participation Screening

Cardiac Screening

4.Musculoskeletal Screening[edit | edit source]

Time constraints do not allow a full comprehensive assessment of all joints and muscles. Therefore, the aim of musculoskeletal screening is to :

  • Identify sports risk factors among participants especially the young ones .[3]
  • Assess the 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.[9]
  • 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[15].
5.Neurological screening[edit | edit source]
General Medical screening[edit | edit source]
  • Routine Laboratory tests like urine analysis , full blood count ,lipid profile, blood glucose level...etc[13][16].
  • If athlete has any history of anemia .[13]
  • Reviewing medications ( any medications been used by the player)[13]
  • Athletes with diabetes mellitus type 1 or type 2 should be routinely evaluated for foot conditions, sensory functions& reflexes.[13][17]
  • Female player should be asked about their menstrual cycle and any history of Anaemia [16]and medications[13] .

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Mirabelli MH, Devine MJ, Singh J, Mendoza M. The preparticipation sports evaluation. American family physician. 2015 Sep 1;92(5):371-6.
  2. Myers A, Sickles T. Preparticipation sports examination. Primary Care: Clinics in Office Practice. 1998 Mar 1;25(1):225-36.
  3. 3.0 3.1 Andujo VD, Fletcher IE, McGrew C. Musculoskeletal Preparticipation Physical Evaluation—Does it Lead to Decreased Musculoskeletal Morbidity?. Current sports medicine reports. 2020 Feb 1;19(2):58-69.
  4. Kennedy M, Comer F, Young JA, Valasek AE. Increasing primary care follow-up after preparticipation physical evaluations. Pediatric Quality & Safety. 2020 Nov;5(6).
  5. 5.0 5.1 Peterson AR, Bernhardt DT. The preparticipation sports evaluation. Pediatrics in Review-Elk Grove. 2011 May 1;32(5):e53.
  6. 6.0 6.1 Pedraza J, Jardeleza JA. The preparticipation physical examination. Primary care. 2013 Sep 21;40(4):791-9.
  7. 7.0 7.1 7.2 7.3 Adami PE, Squeo MR, Quattrini FM, Di Paolo FM, Pisicchio C, Di Giacinto B, Lemme E, Maestrini V, Pelliccia A. Pre-participation health evaluation in adolescent athletes competing at youth Olympic games: proposal for a tailored protocol. British journal of sports medicine. 2019 Sep 1;53(17):1111-6.
  8. Smith DM. Pre-Participation Physical Evaluations. Sports Medicine. 1994 Nov;18(5):293-300.
  9. 9.0 9.1 9.2 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.
  10. Mick TM, Dimeff RJ. What kind of physical examination does a young athlete need before participating in sports?. Cleveland Clinic journal of medicine. 2004 Jul 1;71(7):587-97.
  11. Leggit JC, Wise S. Preparticipation physical evaluation: AAFP and others update recommendations. American Family Physician. 2020 Jun 1;101(11):692-4.
  12. 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.
  13. 13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association position statement: preparticipation physical examinations and disqualifying conditions. Journal of Athletic Training. 2014;49(1):102-20.
  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.
  15. 15.0 15.1 Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45.,+Siddiqi+AR.+Preparticipation+Evaluation+4.+Essential+Sports+Medicine:+A+Clinical+Guide+for+Students+and+Residents.+2021:45.&ots=nK1IjZNR66&sig=1G1o7IhQsExhis2t51WhFTdNw14
  16. 16.0 16.1 Chisati EM, Nyasa C, Banda AM. Preparticipation physical evaluation: An opportunity for Malawian athletes. Malawi Medical Journal. 2016;28(4):182-4.
  17. Diamond AB, Narducci DM, Roberts WO, Bernhardt DT, LaBella CR, Moffatt KA, Nuti R, Powell AP, Rooks YL, Zaremski JL. Interim guidance on the preparticipation physical examination for athletes during the SARS-CoV-2 pandemic. Clinical Journal of Sport Medicine. 2021 Jan 1;31(1):1-6.