1. The Pre-Participation Physical Examination
Chapter 6

2. The Pre-Participation Physical Examination (PPE)
Over the years, the PPE has gone from a cursory examination to a comprehensive overall assessment of an athlete’s health and ability to perform a sport at the highest level.

3. The Pre-Participation Physical Examination (PPE)
The primary goal of the PPE is to help maintain the health and safety of the athlete. Other goals include:
Determination of the athlete’s general health
Disclosure of defects that may limit participation
Detection of condition that may predispose the athlete to injury
Determination of the optimal level of performance

4. The Pre-Participation Physical Examination (PPE) Goals cont.-
Fulfillment of legal and insurance requirements
Evaluation of the level of maturation of younger athletes
Evaluation of fitness and performance for possible improvement prior to participation
Provisions of opportunity to counsel youths regarding personal health issues
Entry of the athlete into the local sports medicine environment, thereby establishing a doctor-patient relationship

5. The Pre-Participation Physical Examination (PPE)
The PPE should take place at least six weeks before the beginning of the sports season, so that if musculoskeletal problems are found there will be time to rehabilitate and strengthen the areas of concern.

6. The Pre-Participation Physical Examination (PPE)
The station-based pre-participation examination
Many athletes can be examined in the same setting, often for lower cost.
The athlete is examined by sports medicine specialists.
Stations include medical history and basic measurements of blood pressure, height, weight, eyesight.

7. The Pre-Participation Physical Examination (PPE)
The station-based pre-participation examination cont.-
Specialists often include family physicians, orthopedic specialists, physical therapists, certified athletic trainers, podiatrists, and pediatricians.
Difficulties with the station-based PPE include finding volunteer medical specialists and a location for the examination.

8. The Pre-Participation Physical Examination (PPE)
The office-based preparticipation physical examination
The family physician, the usual evaluator, has access to the complete medical history of the athlete.
The setting is quiet and allows for the discussion of multiple health issues.
Immunization history is available and can easily be updated.

9. Components of the Pre-Participation Physical Examination
A complete medical history will identify approximately 75% of all problems affecting athletes. The recommended baseline history includes medical conditions and disease, surgeries, hospitalizations, medications, allergies, immunization status, menstrual history, pulmonary status, neurological status, musculoskeletal status, and injuries or illness since the last exam.

10. Components of the Pre-Participation Physical Examination
The recommended components of the PPE include height, weight, pulse, blood pressure, eyes, ears/nose/throat, heart, abdomen, genitalia (males only) skin, and musculoskeletal.

11. Clearance
Clearance, the term used for physician permission for athletic participation, is divided into three categories.
Unrestricted clearance
Clearance after completion of further evaluation or rehabilitation
No clearance for certain types of sports or for all sports

12. Clearance
When an abnormality is found, the physician must consider several questions.
Does the problem place the athlete at risk for injury?
Is another participant placed at risk of injury because of the problem?
Can the athlete safely participate with treatment?
Can limited participation be allowed while treatment is being completed?
If clearance is denied only for certain sports or sports categories, in what activities can the athlete safely participate?

13. Clearance
Sports are classified based on degree or level of contact and strenuousness, which may result in clearance for some, but not all sports.

14. Recordkeeping
Physical forms are completed and signed by the physician.
Information from the PPE is available to coaches, athletic trainers, and the athletic director.
All information contained on the PPE is confidential and must be treated with the strictest of confidence by storing the forms in the certified athletic trainer’s or athletic director’s office under lock and key.
All PPE forms should be kept and stored for a minimum of seven years after the athlete graduates or leaves the school.