The Sports Physical: Why is it Important
For over 30 years, the American Heart Association (AHA) has been setting the guidelines for sports participation via sports physicals for young athletes, helping to identify those who risk death or injury. The goal of the sports physical is to look at the >7.6 million athletes that are participating in high school sports each year, to identify and manage chronic health conditions and provide anticipatory guidance to related sports; thus, encouraging safe participation.
The problem with sports physicals is that the AHA guidelines are not often followed, and it is not necessarily an effective screening tool for athletes regarding sudden cardiac death. The current standards were evaluated and approved by the AAP, AAFP, American College of Sports Medicine, American Medical Society for Sports Medicine, and the American Orthopedic Society for Sports Medicine. The primary objective for these guidelines is to screen for conditions that may be life-threatening or disabling, focusing mainly on the heart.
According to the AHA, the annual incidence of sudden cardiac death in high school aged teens is 1:100,000. These athletes can be previously asymptomatic, which is why a good assessment and history is important. What your provider is looking for is structural cardiac issues and fatal arrhythmias.
The most common genetic cardiac disorder is hypertrophic cardiomyopathy (enlargement of the heart) accounting for nearly 36% of sudden death in young athletes. This genetic enlargement of the heart can cause fatal cardiac rhythms when the heart is under stress. Another genetic issue is Marfan’s syndrome. This is a connective tissue genetic disorder that can cause aortic dissection with blunt force trauma to the chest.
If you are seeing someone who is not familiar with your history, such as an urgent care provider, you may be denied clearance until evaluated by a cardiologist for things such as radiating heart murmurs, diastolic heart murmurs, history of myocarditis, elevated systolic blood pressures, syncope, or Marfan’s stigmata.
There are other qualifying or disqualifying components of the physical that must be included. For male athletes, there is a genital exam. There is a higher incidence of hernias and testicular torsion associated with static athletics. Peak incidence, according to the American Cancer Society, for testicular cancer is between the ages of 15-35, making the scrotal exam extremely important.
The skin exam is relevant, as common dermatological issues such as impetigo and tinea (ring worm) can be exclusionary issues until cleared. Neurological exams help to rule out concussion and spinal cord abnormalities that could be aggravated or exasperated with sports. The vision exam is important as well, the recommended guidelines are 20/40 or better. Recent illnesses such as mononucleosis can disqualify a participant due to the high risk of splenic rupture.
The sports physical is an opportunity to evaluate potential life-threatening anomalies, discuss concerns in health, and to identify at risk populations. Ask your provider about the results of the exam, discuss your concerns regarding sports, concussions, ideal body weight and overall health. Your provider is there to help guide your young athlete to be the best they can be, while maintaining optimal health. If your provider requests that you follow up with a specialist, requires further testing, or denies participation, just remember there is a reason and that is to prevent catastrophic results of improper clearance.