1. Pre-participation Physical Exams

2. Objectives Determine the need for PPEs Determine the need for PPEs Understand the goals of PPEs Understand the goals of PPEs Determine the components of a PPE Determine the components of a PPE Establish guidelines for PPEs Establish guidelines for PPEs Identify the legal considerations of PPEs Identify the legal considerations of PPEs

3. Introduction Preceded by signing a waiver granting permission to complete the physical exam Preceded by signing a waiver granting permission to complete the physical exam Complex and time consuming, but worthwhile when done right Complex and time consuming, but worthwhile when done right a team process, with many valuable members a team process, with many valuable members a collection of information used to determine the readiness of athlete for competition a collection of information used to determine the readiness of athlete for competition

4. Introduction Potential to be an expensive process Potential to be an expensive process PPEs should be: PPEs should be: valid and reliable valid and reliable ethical ethical purposeful purposeful Not uniformly regulated at any level Not uniformly regulated at any level Substitutes for a detailed comprehensive physical examination for general health = ??? Substitutes for a detailed comprehensive physical examination for general health = ???

5. PPE Goals Provide an objective, sport-specific musculoskeletal examination. Provide an objective, sport-specific musculoskeletal examination. Obtain negative information that alters participation options. Obtain negative information that alters participation options.

6. PPE Goals Obtain positive information to decrease injury potential and increase performance. Obtain positive information to decrease injury potential and increase performance. Provide a reproducible record for comparison in the future. Provide a reproducible record for comparison in the future. Provide baseline data for sport-specific conditioning. Provide baseline data for sport-specific conditioning.

7. Organizing PPEs – Why? Injury & Illness Prevention Injury & Illness Prevention Must USE data generated by exam Must USE data generated by exam Potential liability if not Potential liability if not Must design PPE effectively Must design PPE effectively

8. Organizing PPEs – Why? Injury & Illness Prevention Injury & Illness Prevention Determine readiness for competition Determine readiness for competition Disqualification Disqualification Know role of team physician, athlete, parents, and other physicians/specialists Know role of team physician, athlete, parents, and other physicians/specialists

9. Organizing PPEs – Why? Compliance with Association Rules Compliance with Association Rules High School High School National Federation of State High School Athletic Associations defers to states - CIF National Federation of State High School Athletic Associations defers to states - CIF College College NCAA, NAIA, etc. NCAA, NAIA, etc. Professional Professional Youth Leagues, Tournaments, etc. Youth Leagues, Tournaments, etc.

10. Organizing PPEs – Why? Educating & Counseling Athletes Educating & Counseling Athletes Some suggest this should be focus of PPE Some suggest this should be focus of PPE Potential to be very useful Potential to be very useful Need the right…. Need the right…. Environment Environment Staff Staff Information Information

11. Organizing PPEs – Why? Compliance with Standards of Practice Compliance with Standards of Practice NATA, BOC, CIF, NCAA, AMA, AHA NATA, BOC, CIF, NCAA, AMA, AHA American Academy of Family Physicians American Academy of Family Physicians American Academy of Pediatrics American Academy of Pediatrics American College of Cardiology American College of Cardiology American Medical Society for Sports Medicine American Medical Society for Sports Medicine American Orthopaedic Society for Sports Medicine American Orthopaedic Society for Sports Medicine American Osteopathic Academy for Sports Medicine American Osteopathic Academy for Sports Medicine

12. Organizing PPEs – When? 6-8 weeks before vigorous activity 6-8 weeks before vigorous activity One season before athlete intends to participate One season before athlete intends to participate

13. Organizing PPEs – When? Occurrence: Occurrence: Upon entering program with yearly health history updates Upon entering program with yearly health history updates Some states require one every 3 years in HS Some states require one every 3 years in HS Every other year w/update in between Every other year w/update in between Every year Every year

14. Organizing PPEs – Where & How? Debate exits, must decide…. Debate exits, must decide…. Information to be obtained from PPE Information to be obtained from PPE Staff Staff Number, training, volunteer/paid, etc. Number, training, volunteer/paid, etc. Facilities & privacy available Facilities & privacy available

15. Organizing PPEs – Where & How? Debate exits, must decide…. Debate exits, must decide…. Time available Time available Expenses & Budget Expenses & Budget Athletes Athletes Number, characteristics (age, sex, etc.) Number, characteristics (age, sex, etc.)

16. Organizing PPEs – Where & How? Office-Based PPEs Office-Based PPEs Who will perform? Who will perform? Benefits of this method? Benefits of this method? Concerns with this method? Concerns with this method?

17. Organizing PPEs – Where & How? Group PPEs & the Station Method Group PPEs & the Station Method Who will perform? Who will perform? Benefits of this method? Benefits of this method? Concerns with this method? Concerns with this method?

18. PPE Design Factors Athlete age and level of competition Athlete age and level of competition 14 year old male soccer player vs. 28 year old free agent in MLB 14 year old male soccer player vs. 28 year old free agent in MLB Sport Sport Specifics for different sports/teams Specifics for different sports/teams Follow-up on information collected Follow-up on information collected Predictability of tests Predictability of tests

19. Common Elements of a PPE Health History Health History Physician’s Exam Physician’s Exam General review of systems, cardiac screening, etc. General review of systems, cardiac screening, etc. Orthopedic Exam Orthopedic Exam Posture, Gait, ROMs, etc. Posture, Gait, ROMs, etc.

20. Common Elements of a PPE Special Tests Special Tests Urinalysis, x-rays, ImPact, etc. Urinalysis, x-rays, ImPact, etc. Physical Fitness Tests Physical Fitness Tests Others? Others?

21. Health History Questionnaire asking specific details of athlete’s health Questionnaire asking specific details of athlete’s health Broken down by system Broken down by system Cardiac Cardiac Pulmonary Pulmonary Neurological Neurological

22. Physician’s Exam General medical overview General medical overview Vitals, vision, etc. Vitals, vision, etc. Auscultation, blood pressure, palpation Auscultation, blood pressure, palpation Neurological screening Neurological screening Hernia check for males Hernia check for males

23. Orthopedic Exam Functional screening of the body’s joints Functional screening of the body’s joints Specific movements are checked for gross motor function Specific movements are checked for gross motor function

24. Special Tests Concussion screening Concussion screening Urinalysis Urinalysis Blood draw Blood draw

25. Physical Fitness Tests VO 2 Max testing VO 2 Max testing Examines the lungs efficiency to exchange gases Examines the lungs efficiency to exchange gases General conditioning tests General conditioning tests Sport-specific tests Sport-specific tests 40-yd dash, broad jump, vertical jump, etc. 40-yd dash, broad jump, vertical jump, etc.

26. Others EKG/ECG EKG/ECG Echocardiogram Echocardiogram Sickle Cell Anemia Sickle Cell Anemia Drug Testing Drug Testing Benefits vs. Risks? Benefits vs. Risks?

27. Legal Considerations Consent Consent Must explain PPE Must explain PPE Athlete must understand explanation Athlete must understand explanation Opportunity for athlete to ask questions Opportunity for athlete to ask questions Sign documenting agreeing to undergo PPE Sign documenting agreeing to undergo PPE Minors = parent signature also Minors = parent signature also

28. Legal Considerations Waiver of Liability – for disqualification Waiver of Liability – for disqualification Athletes/parents may want to play again Athletes/parents may want to play again Recommendation – options…. Recommendation – options…. Tailor waiver to EACH situation – use legal counsel Tailor waiver to EACH situation – use legal counsel Stick to your decision NOT to clear athlete Stick to your decision NOT to clear athlete Document each situation! Document each situation!