But before they are cleared to play, each must undergo a preparticipation physical evaluation (PPE). These exams, typically required by the school, are performed by health care providers in a variety of settings – sometimes in a clinic, other times at school or in a community setting. The primary purpose of which is to detect conditions that may place young athletes at risk for an adverse event related to sports participation. However, the PPE should also:
- Evaluate the general health of the athlete
- Provide an opportunity to discuss high-risk behaviors, preventive care measures, and nonathletic concerns
- Meet legal and insurance requirements
Several primary care and sports medicine organizations have partnered with one another to develop a standardized approach to the PPE. Called the PPE Monograph, it is a detailed guide for clinicians to perform a comprehensive PPE aimed at high school and college athletes. The PPE includes questions about the athlete’s past and current health, questions about the athlete’s family health history, in addition to past and current injury history. At the high school level, it is recommended that both parents and student athletes complete the medical history, to ensure accuracy of the information collected. It is then the responsibility of the physician to perform an examination, and assess the information collected during the PPE and determine whether the athlete can safely participate in competitive athletics. Rarely are athletes permanently disqualified from participation due to PPE findings. Less than 1% of high school athletes are permanently disqualified from participation.
PPE forms required for participation in high school sports in Utah, can be found at:
http://www.uhsaa.org/sportsmed.html Note there are 2 sets of forms: Form A and Form B. Form A is completed when students enter a new school (for example they will need a Form A completed for middle school or junior high school, and again when they enter high school). Form B must be completed each year for intervening years.
Ideally the PPE is done anywhere from 4-8 weeks prior to the start of the competitive season. This provides ample opportunity for the athlete to follow-up on health conditions, or to rehabilitate lingering musculoskeletal injuries. In Utah, PPEs can be performed by a licensed health care provider.
Key conditions to detect during the PPE include:
- Cardiac concerns (especially a family history of sudden death before the age of 40,
- Chest pain during exercise, or fainting during exercise),
- Past history of concussion (increases the likelihood of future concussion),
- Asthma (to optimize management with appropriate medications and/or training modifications)
- Musculoskeletal injuries.
In female athletes we also keep a keen eye out for eating disorders, menstrual disturbance (missing your periods), and bone injures like stress fractures. These 3 conditions are together known as the Female Athlete Triad.
The PPE is an essential component of sports participation. It is an opportunity to ensure the health and safety of young athletes. Health care providers at Intermountain Healthcare, in both primary care and Sports and Exercise Medicine are willing, able and available to see your children and family members be the best they can be.