Article submitted by Kay Funk, MD
For student athletes who participate in high school and middle school sports, the Washington Interscholastic Activities Association requires a preparticipation physical evaluation. This standardized exam requires a good cardiopulmonary examination, a good musculoskeletal examination, and an accurate history certified by the responsible parent. Members of Yakima County Medical Society have volunteered to provide low cost examinations for many years.
Dr. Ray Snyder, grew up in Yakima, and has been in the organizer of the YCMS/Yakima School District sports physicals since 1996.”I started as a volunteer when I came back to town in 1994; that’s when the screening exams were done at Davis. We used a multi-station format and we had many more student athletes at that time. I think that the maximum was around 1200; it was crazy in those days.”
“The Davis facility was challenging, particularly because it had no air conditioning and the exams were usually done during the summer. So when Franklin (Middle School) had a nice new facility, we inquired about the possibility of using that, taking advantage of the air conditioning, and the fact that it was all on one floor. Franklin became our facility in 2001.”
“There were some changes besides the facility. We didn’t have enough manpower for all of the previous stations and still get out of there before 11 o’clock. So, when I took over, I tried to make the stations a more efficient use of provider time. And I remember, to everyone’s joy, we cancelled the hernia/GU check.”
“It wasn’t really a necessity in a sports physical. We did pick up a few varicoceles and undescended testicles, but those do not preclude sports participation. An undescended testicle or other unilateral organ indicates extra protection, but does not preclude participation.”
The number of student athletes decreased when the WIAA requirement was changed to every other year instead of every year. Students entering grades 7 through 12 participate. Dr. Snyder says, “We work with the Yakima School District and include Union Gap Middle School. The middle school students are asked to come earlier, and we do this to make the experience more family friendly.” In recent years more parents accompany their students, which is always welcome.
“The most important function of the preparticipation sports physical is detecting those orthopedic and medical conditions that may preclude safe participation, practice, or competition. There might also be conditions that need further evaluation, or result in modification of the sport, or modification of the equipment, or use of more protective equipment. ”
“And in our community, one of the most important services that we provide is that many of the students would not be able to participate in after school athletic activities without this inexpensive, but quality, sports physical that meets the WIAA criteria. If we did not have this event, they might be doing much less healthy things after school. And I feel that’s the best service that we provide. Many of those children are underserved, don’t have primary care doctors, and can’t afford to go to a medical clinic.”
According to the Preparticipation Physical Evaluation Consensus Statement Monograph, “the cornerstone of the preparticipation evaluation is a medical history. A complete history will identify 75% of problems affecting athletes… to increase the information obtained, the athlete and parent should complete the history form together before the examination. The parents should sign the history form. Ideally, the physician reviews it with the athlete before the physical exam.”
Dr. Snyder has closely followed recent controversy in the management of concussion in student athletes. “The culture of recognition and management of concussion is slowly changing. It is no longer a coach’s decision or a parent’s decision; it has become a medical decision, demanded by the Zackery Lystedt Law. An athlete suspected of having a concussion must be evaluated not just by a health care provider; it is recommended that the health care provider be trained in the evaluation and management of concussion. And the student must be released by that provider before he or she can return to athletic participation. That has taken the pressure off of the coaches and parents.”
The understanding of cardiac anomalies associated with increased risk of cardiac sudden death with physical exertion has also evolved in recent years. However, these congenital anomalies are still very difficult to detect. In office-based exams, screening electrocardiograms are more frequently recommended. At the YCMS sports physicals, stethoscope exam is used for detection of abnormal heart sounds, which may lead to diagnosis of hypertrophic cardiomyopathy, which is the most common cause of sudden death in athletes.
But Dr. Snyder relates, “The best tool to screen for athletes at risk for cardiac sudden death is the history; the personal and family history. History of dizziness or syncope, or palpitations with exercise.” For the athlete’s safety and for medical-legal reasons, it is imperative that a parent validates the history and make sure that it’s accurate; that is why we do not accept a questionnaire that is not signed by the parent(s).
Overuse injuries are the most common injury in sports, and can be prevented with preseason exercise conditioning program, which is recommended for 6-8 weeks prior to the first practice. Even some of the devastating injuries, such as ACL tear, may be prevented with some preseason conditioning training. Inadequately rehabilitated injuries can also be picked up on the preparticipation screening exam.
Asthma, including exercise asthma, requires special management in the athlete. Dr. Snyder says, “It is so unfortunate that, in this day and age when we have such great asthma treatment, someone would have to limit, or not enjoy their sport because of uncontrolled asthma. The pulmonary exam may detect asthma and really help that athlete. I am still angry that I wasn’t treated adequately [during my high school sports]; once I had my Proventil inhaler I was a new person.”
“Hypertension is pretty common in this stimulating environment, and requires further evaluation. The screening blood pressure check is a sitting unilateral blood pressure measurement. If the result is outside the standard parameters, the athlete is kept supine for 10 minutes and rechecked.”
“We have wonderful volunteers from nursing, physical therapy, primary care doctors and several specialists, such as cardiology. We have Physician Assistants, Nurse Practitioners, certified Athletic Trainers (ATLs) from the schools, and student Athletic Trainers who help with the height and weight measurements. The Family Medicine residents have participated, and that is a great avenue for students who did not have primary care doctors to be introduced to primary care. The Osteopathic medical students help with the blood pressure stations, and observe and learn, because they do not yet have the credentials required by WIAA.”
The 2011 Sports Screening on June 6th, 6PM at Franklin Middle School provided screening for over 175 students. Our website now allows volunteers to sign up by email. Contact Charlene Upton at firstname.lastname@example.org to register. Please sign up early. Your participation is critical!
References for Physicians and Volunteers:
Preparticipation Physical Evaluation, 4th Edition
Consensus statement of the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine
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The Preparticipation Sports Examination In Children And Adolescents
Sudden Death in Athletes
Sports Concussion – Protecting Youth Athletes From Concussions
The Sports Trauma and Overuse Prevention (STOP)