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CAQ Review

The Preparticipation Sports Physical Examination

Barkley, Lisa C. MD, FACSM, FAAFP, FSAHM

Author Information
Current Sports Medicine Reports: February 2021 - Volume 20 - Issue 2 - p 65-66
doi: 10.1249/JSR.0000000000000803
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The preparticipation sports physical examination (PPE) is an important examination that provides the team physician with valuable information to address athlete and team wellness (1). The goals of the examination are to 1) establish state of overall physical and psychological health, 2) detect conditions that would preclude the athlete from participating in sport safely (i.e., detecting disabling conditions), 3) prevention — detect or follow-up on previous injuries or medical conditions to be sure that the athlete can participate safely, 4) screen for overall psychosocial needs in adolescents and young adults, and 5) serve as entry point into the health care system for adolescents who do not have a health care home. From the legal and ethical perspective, sharing information from the PPE is subject to Health Insurance Portability and Accountability Act, Family Educational Rights and Privacy Act, and privacy laws. The PPE also provides some protection from liability for the sponsoring institution for the sport by having medical professionals decide on which athletes are eligible.

Timing, Setting and Structure

To optimally meet the above goals, the examination should occur 6 wk to 8 wk prior to the start of practice. This allows time for follow-up on any abnormalities found during the examination and ability to obtain needed treatment. The examination should be incorporated into well child visits and be performed in a private setting that allows for the ability to listen for heart sounds and to counsel athletes on sensitive information. This would ensure that important health maintenance needs, such as vaccinations and anticipatory guidance, are made available. Unfortunately, in the United States, PPE is often the only opportunity that the child can see a health care provider. Thus, it is imperative that sports medicine providers incorporate psychosocial screening for high-risk behaviors and protective factors/assets to facilitate overall well-being. It is important during this examination to visualize the body parts so that they can be screened properly. Athletes should wear clothing that allow for this to happen — shorts, T-shirts, and sports bra for female athletes.


As in most aspects of medicine, the history is the most important aspect of the sports physical. Most states have a standardized sports physical examination form that is completed by the parent/guardian and athlete prior to the examination to help facilitate the process. The history should provide a review of the major body systems, with particular emphasis on previous medical conditions and musculoskeletal injuries, cardiac, personal and family history, previous concussion or neurologic conditions, diet, and menstrual history. The most common reason for an injury in the current season is a previous injury that was not optimally rehabilitated.

Physical Examination

The physical examination focuses on the body systems and a screening of the upper- and lower-extremity musculoskeletal examination. If the athlete has a positive history of medical condition or injury, a more comprehensive examination should occur in that area. The cardiac examination should be performed in multiple positions to facilitate the detection of a murmur typical of hypertrophic cardiomyopathy.

Medical Eligibility Considerations

There are very few conditions that warrant absolute disqualification from sports participation. Most issues can be addressed with modifications to participation or rehabilitation. It is important, especially for adolescent athletes, to make suggestions of what sports an athlete can participate in if the desired sport is considered too high of a risk for safe participation. Sports are classified by risk profiles to assist in making these decisions. Contact sports involve some level of physical interaction among athletes or the sports environment; this includes collision sports involved in tackling or more violent physical contact. Limited contact and noncontact are the other categories. When considering cardiac conditions, sports are classified by the amount of static and dynamic load the activity puts on the left ventricle of the heart. The static component of the exercise creates a pressure load, and the dynamic component creates a volume load. The following are key questions to ask to determine medical eligibility. If this athlete could not do their sport-specific activities because of this condition, would it put this athlete's health at risk? Would it put other athletes' health at risk? Positive answers to these questions warrant determining a plan that would alleviate the concerns.

Diagnostic Testing

There are no diagnostic tests that are recommended for all sports physicals. Endurance athletes and some female athletes with heavy menses may benefit from checking for low ferritin levels or anemia because this can impact overall performance. Athletes with a positive cardiac history or physical may benefit from an EKG and echocardiogram to rule out congenital heart disease or arrythmias. Many collegiate athletes are required to be screened for sickle cell trait because this condition has been associated with sudden cardiac death. The individual profile of the athlete should determine if and what diagnostic testing would be appropriate.


Preparticipation sports physicals are an important aspect of sports medicine. More research is needed to document whether this examination impacts health outcomes.

The author declares no conflict of interest and does not have any financial disclosures.


1. American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, & American Medical Society for Sports Medicine. Preparticipation Physical Evaluation. 5th ed. Itasca (IL): American Academy of Pediatrics; 2019.
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