Screening in Sport: Difference between revisions

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== Introduction  ==
== Introduction  ==
[[File:Exe2.jpg|thumb]]
Before participation in any sports event, it is recommended that any professional or amateur athlete undergo a preparticipation physical evaluation '''( PPE)'''<ref name=":3">Mirabelli MH, Devine MJ, Singh J, Mendoza M. The preparticipation sports evaluation. American family physician. 2015 Sep 1;92(5):371-6.


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 Cardioloy (ESC) and have subsequently been implemented in some sporting communities. The EACPR Sports Cardiology section answers below our key questions on pre-participation screening.<ref name="Escardio">European Society of Cardiology. How to Conduct Pre-Participation Screening in Athletes. http://www.escardio.org/The-ESC/Communities/European-Association-for-Cardiovascular-Prevention-&amp;amp;amp;amp;amp;-Rehabilitation-(EACPR)/News/How-to-conduct-pre-participation-screening-in-athletes (accessed 8 May 2016).</ref>
https://www.aafp.org/afp/2015/0901/p371</ref>. The main goal of this screening is to maximize the health of athletes and their safety<ref>Myers A, Sickles T. Preparticipation sports examination. Primary Care: Clinics in Office Practice. 1998 Mar 1;25(1):225-36.


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.<ref name="5">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</ref> 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.<ref name="5">PREPARTICIPATION SCREENING – THE SPORTS PHYSICAL THERAPY PERSPECTIVEfckLRBarbara Sanders, PT, PhD, SCS, FAPTA,1 Turner A. Blackburn, PT, MEd, ATC,2 and Brenda Boucher, PT, PhD, CHT, OCS, FAAOMPT2</ref>
https://www.primarycare.theclinics.com/article/S0095-4543(05)70334-1/abstract</ref>. Some studies suggested that preparticipation evaluation '''(PPE''') could not prevent the morbidity and mortality during sports<ref name=":4">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.


== Aim of Screening  ==
https://journals.lww.com/acsm-csmr/fulltext/2020/02000/musculoskeletal_preparticipation_physical.6.aspx</ref><ref>Kennedy M, Comer F, Young JA, Valasek AE. Increasing primary care follow-up after preparticipation physical evaluations. Pediatric Quality & Safety. 2020 Nov;5(6).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591121/</ref>, however, it could help in detecting serious conditions and provide strategies to prevent injuries.<ref name=":0" /><ref name=":1">Pedraza J, Jardeleza JA. The preparticipation physical examination. Primary care. 2013 Sep 21;40(4):791-9.


The primary aim of the PPE as performed in other countries&nbsp;would appear to be the detection of cardiovascular abnormalities&nbsp;to prevent sudden death among young athletes. The&nbsp;Australian medical screening program has a broader perspective&nbsp;and is aimed at improving the health of the athlete.&nbsp;The medical screening of these high performance athletes&nbsp;has a number of aims:<ref name="Screening of Athletes" />  
https://www.primarycare.theclinics.com/article/S0095-4543(13)00082-1/fulltext</ref><ref name=":2">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.


#Prevent Sudden Death
https://bjsm.bmj.com/content/53/17/1111.abstract</ref>
#Ensure Optimal Medical Health (asthma, diabetes, menstrual,&nbsp;depression)  
 
#Ensure Optimal Musculoskeletal Health  
Sports participation and athletics can be a positive experience for all age groups - by boosting fitness, enhancing self‐esteem, enhancing [[Coordination Exercises|coordination]] and providing an opportunity for creative cooperation and competition<ref>Smith DM. Pre-Participation Physical Evaluations. Sports Medicine. 1994 Nov;18(5):293-300.
#Optimize Performance (Nutrition, Psychology, Biomechanics)  
 
#Prevent Injury  
https://link.springer.com/article/10.2165/00007256-199418050-00001</ref>. 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<ref name=":1" />, 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.<ref name=":0">Peterson AR, Bernhardt DT. The preparticipation sports evaluation. Pediatrics in Review-Elk Grove. 2011 May 1;32(5):e53.
#Review Medications and Vaccinations<ref name="Screening of Athletes" />  
 
#Collect Baseline Data (Blood Tests, Neuropsychological Testing in Contact Sports)  
https://www.researchgate.net/profile/Andrew-Peterson-6/publication/51092808_The_Preparticipation_Sports_Evaluation/links/5655c12308ae1ef929784a3f/The-Preparticipation-Sports-Evaluation.pdf</ref> 
#Develop Professional Relationship with Athlete  
 
#Educate
=== Importance Of Screening ===
[[File:Skyttis athletics tracks.jpg|thumb]]
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 <ref name=":2" />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 <ref name=":2" />. These conditions could be divided in to :       
 
* 4,5 % cardiovascular abnormalities
* 4,5% [[Pulmonary Rehabilitation|pulmonary disorders]]
* 2%  [[Infection Prevention and Control|infections]]
* neurological and psychiatric disorders in 0.4%.<ref name=":2" />       
 
'''Aim Of PPE'''<ref name="Screening of Athletes">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.https://journals.lww.com/cjsportsmed/Fulltext/2004/05000/Screening_of_Athletes__Australian_Experience.10.aspx</ref>
#
#Ensure Optimal Medical Health ([[Asthma|asthma,]] [[diabetes]], [[Menstruation and Menstrual Rehab|menstrual cycle]],[[Depression|&nbsp;depression]])
#Ensure Optimal Musculoskeletal Health.
#Optimize Performance (Nutrition, Psychology, Biomechanics).
#Prevent [[Injury Prevention and Body Mechanics|Injury]].
#Review Medications and Vaccinations.<ref name="Screening of Athletes" />
#Collect Baseline Data (Blood Tests, Neuropsychological Testing in Contact Sports).
#Develop Professional Relationship with Athlete.
#Educate.
 
=== Key Recommendations For Practice ===
 
# PPE should occur  around 6 weeks before activity to allow for further evaluation or treatment if needed.
# 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.<ref>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.
 
https://europepmc.org/article/med/15320370</ref>
# Athletes with sustained systolic [[Blood Pressure|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.
# Athletes with well-controlled [[asthma]] who are asymptomatic at rest and with exertion can be safely cleared to play sports.
# Screening blood and urine tests are not recommended for asymptomatic athletes.
# Comprehensive PPEs are recommended every '''two to three''' years with annual focused history updates in intervening years.<ref>Leggit JC, Wise S. Preparticipation physical evaluation: AAFP and others update recommendations. American Family Physician. 2020 Jun 1;101(11):692-4.
 
https://www.aafp.org/afp/2020/0601/p692.html</ref>


== Screening Protocol  ==
== Screening Protocol  ==
=== Medical Screening ===


=== Medical Screening  ===
===== '''1.History''' =====
 
To identify any underlying medical conditions<ref name="Utilization and implementation of sports medical screening examinations">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.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680562/</ref>. It covers many areas like musculoskeletal problems, asthma , hematologic disorders, exercise-induced bronchospasm[[Assessment and Management of Concussion|, concussion]], neurologic disorders and more importantly any information about [[Cardiac Valve Defects|cardiac]] problems or sudden death . <ref name=":3" /> For athletes younger than 18 a parent or guardian should attend the evaluation to give detailed history about the child.<ref name=":3" />
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.<ref name="Utilization and implementation of sports medical screening examinations">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.</ref>  


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.<ref name="Utilization and implementation of sports medical screening examinations" />
===== '''2.Physical Examination''' =====
A limited general physical examination is recommended<ref name=":6">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.


==== Pre-participation Screening  ====
https://meridian.allenpress.com/jat/article-abstract/49/1/102/112116</ref>. Assessment of ( vital signs, vision, [[Hearing in the Elderly|hearing]], and the cardiovascular and musculoskeletal systems)<ref name=":3" />The most common abnormal PPE findings are elevated blood pressure and vision problems.<ref name=":3" />Further examination should be based on issues uncovered during the history.<ref name=":6" />


==== Cardiovascular Screening ====
===== ''3.Cardiovascular Screening'' =====


Preparticipation 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 preparticipation screening for the prospective identification of at-risk athletes and the prophylactic prevention of cardiac events during sports by selective disqualification.&nbsp;<ref name="Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism" />  
* Specific questions regarding cardiovascular risk factors should be asked.<ref name=":6" /> 
* Initially auscultation of the heart should be performed with the patient in various positions ( standing,supine, squat to stand & valsalva)<ref name=":6" />
* It is not a demand to perform specific cardiac testing  like ([[Electrocardiogram|electrocardiography]] [ECG], echocardiography, exercise stress testing) unless  patient history or clinical examination suggests this.<ref name=":6" />


<span style="font-size: 13px; font-weight: normal;">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.&nbsp;</span><ref name="Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism">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.</ref>
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.<ref name="Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism">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.


https://www.ahajournals.org/doi/abs/10.1161/circulationaha.107.181423</ref>
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=== Musculoskeletal Screening  ===
===== 4.Musculoskeletal Screening =====
 
Time constraints do not allow a full comprehensive assessment&nbsp;of all joints and muscles. Therefore, the aim of musculoskeletal&nbsp;screening is to :
 
* Identify sports risk factors among participants especially the young ones .<ref name=":4" />
 
* Assess the recovery from any previous&nbsp;injury and to assess the presence of proven (very few) or suspected&nbsp;risk factors for future injury. Athletes involved in sports&nbsp;associated with high risk of specific joint or muscle injuries,&nbsp;such as, swimmers’ shoulders and pitchers’ elbows, should&nbsp;have specific assessments performed on these areas.<ref name="Screening of Athletes" />
 
* '''MSK Screening''' includes the assessment of [[Range of Motion|range of motion]], muscle asymmetry, [[Muscle Strength Testing]], and to identify significant injuries.<ref name=":5">Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45.
 
https://books.google.com/books?hl=en&lr=&id=7DEnEAAAQBAJ&oi=fnd&pg=PR8&dq=Douglas+W,+Siddiqi+AR.+Preparticipation+Evaluation+4.+Essential+Sports+Medicine:+A+Clinical+Guide+for+Students+and+Residents.+2021:45.&ots=nK1IjZNR66&sig=1G1o7IhQsExhis2t51WhFTdNw14</ref>
 
* A full injury history should be taken, and any deficits remaining post-injury should be fully assessed with a view to&nbsp;designing a rehabilitation program to restore full function<ref name=":5" />.


Time constraints do not allow a full comprehensive assessment&nbsp;of all joints and muscles. Therefore, the aim of musculoskeletal&nbsp;screening is to assess recovery from any previous&nbsp;injury and to assess the presence of proven (very few) or suspected&nbsp;risk factors for future injury. Athletes involved in sports&nbsp;associated with high risk of specific joint or muscle injuries,&nbsp;such as, swimmers’ shoulders and pitchers’ elbows, should&nbsp;have specific assessments performed on these areas.<ref name="Screening of Athletes" />
===== 5.Neurological screening =====


A full injury history should be taken, and any deficits remaining postinjury should be fully assessed with a view to&nbsp;designing a rehabilitation program to restore full function. Frequently,&nbsp;athletes will have resumed full athletic participation&nbsp;following a significant injury and yet still have considerable&nbsp;limitations in strength, range of movement, proprioception,and so forth.The questionnaire asks the athlete to describe the nature&nbsp;and date of any previous injury and to list any residual problems.Athletes are asked to describe the nature, date, and symptoms&nbsp;of any current injury.<ref name="Screening of Athletes">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.</ref><br>  
* History of concussion, seizure disorder, [[Cervical Arterial Dysfunction|cervical spine stenosis]], or [[Spinal cord anatomy|spinal cord injury]].<ref name=":6" />


=== Performance Screening  ===
===== General Medical screening =====


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 theathletes' development pathway is one of the key recommendations of long term athlete development models.<ref name="5">ATHLETIC ABILITY ASSESSMENT: A MOVEMENT ASSESSMENT PROTOCOL FOR ATHLETESfckLRIan McKeown, PhD,corresponding author1,2,3,5 Kristie Taylor‐McKeown, PhD,4 Carl Woods,6 and Nick Ball, PhD2</ref>&nbsp;<ref name="Escardio" />&nbsp;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 Screen (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".<ref name="5">ATHLETIC ABILITY ASSESSMENT: A MOVEMENT ASSESSMENT PROTOCOL FOR ATHLETESfckLRIan McKeown, PhD,corresponding author1,2,3,5 Kristie Taylor‐McKeown, PhD,4 Carl Woods,6 and Nick Ball, PhD2</ref>
* Routine Laboratory tests like urine analysis , full blood count ,lipid profile, blood glucose level...etc<ref name=":6" /><ref name=":7">Chisati EM, Nyasa C, Banda AM. Preparticipation physical evaluation: An opportunity for Malawian athletes. Malawi Medical Journal. 2016;28(4):182-4.


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).<ref name="AAA">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</ref><br>  
https://www.ajol.info/index.php/mmj/article/view/151512/141112</ref>.
* If athlete has any history of anemia .<ref name=":6" />
* Reviewing medications ( any medications been used by the player)<ref name=":6" />
* Athletes with '''diabetes mellitus type 1 or type 2''' should be routinely evaluated for foot conditions,  sensory functions& reflexes.<ref name=":6" /><ref>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.</ref>
* Female player should be asked about their menstrual cycle and any history of [[Anaemia]] <ref name=":7" />and medications<ref name=":6" /> .


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== References   ==
<div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1tqH1CXhZx_Xwp6fBGVDXVMSBawBTpZBgPMW1eEi79ZQC9oMFJ|charset=UTF-8|short|max=10</rss>
</div>
== References<br>  ==


<references />  
<references />  


[[Category:Sports_Injuries]] [[Category:Sports_Medicine]]
[[Category:Sports_Injuries]]  
[[Category:Sports_Medicine]]

Latest revision as of 13:00, 27 June 2023

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Introduction[edit | edit source]

Exe2.jpg

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]

  2. Ensure Optimal Medical Health (asthma, diabetes, menstrual cycle, depression)
  3. Ensure Optimal Musculoskeletal Health.
  4. Optimize Performance (Nutrition, Psychology, Biomechanics).
  5. Prevent Injury.
  6. Review Medications and Vaccinations.[9]
  7. Collect Baseline Data (Blood Tests, Neuropsychological Testing in Contact Sports).
  8. Develop Professional Relationship with Athlete.
  9. 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. https://www.aafp.org/afp/2015/0901/p371
  2. ↑ Myers A, Sickles T. Preparticipation sports examination. Primary Care: Clinics in Office Practice. 1998 Mar 1;25(1):225-36. https://www.primarycare.theclinics.com/article/S0095-4543(05)70334-1/abstract
  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. https://journals.lww.com/acsm-csmr/fulltext/2020/02000/musculoskeletal_preparticipation_physical.6.aspx
  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).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591121/
  5. ↑ 5.0 5.1 Peterson AR, Bernhardt DT. The preparticipation sports evaluation. Pediatrics in Review-Elk Grove. 2011 May 1;32(5):e53. https://www.researchgate.net/profile/Andrew-Peterson-6/publication/51092808_The_Preparticipation_Sports_Evaluation/links/5655c12308ae1ef929784a3f/The-Preparticipation-Sports-Evaluation.pdf
  6. ↑ 6.0 6.1 Pedraza J, Jardeleza JA. The preparticipation physical examination. Primary care. 2013 Sep 21;40(4):791-9. https://www.primarycare.theclinics.com/article/S0095-4543(13)00082-1/fulltext
  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. https://bjsm.bmj.com/content/53/17/1111.abstract
  8. ↑ Smith DM. Pre-Participation Physical Evaluations. Sports Medicine. 1994 Nov;18(5):293-300. https://link.springer.com/article/10.2165/00007256-199418050-00001
  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.https://journals.lww.com/cjsportsmed/Fulltext/2004/05000/Screening_of_Athletes__Australian_Experience.10.aspx
  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. https://europepmc.org/article/med/15320370
  11. ↑ Leggit JC, Wise S. Preparticipation physical evaluation: AAFP and others update recommendations. American Family Physician. 2020 Jun 1;101(11):692-4. https://www.aafp.org/afp/2020/0601/p692.html
  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.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680562/
  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. https://meridian.allenpress.com/jat/article-abstract/49/1/102/112116
  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. https://www.ahajournals.org/doi/abs/10.1161/circulationaha.107.181423
  15. ↑ 15.0 15.1 Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45. https://books.google.com/books?hl=en&lr=&id=7DEnEAAAQBAJ&oi=fnd&pg=PR8&dq=Douglas+W,+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. https://www.ajol.info/index.php/mmj/article/view/151512/141112
  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.
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