Preparticipation Physical Examination Research Articles

ECG Characteristics of Young High School Athletes in Northwest Florida

ABSTRACT Background: Sudden cardiac death in young athletes is a rare and tragic occurrence. A preparticipation physical examination (PPE) is widely used to identify athletes who might be at risk of sudden cardiac death. High school athletes in Escambia, Okaloosa, Santa Rosa, and Walton counties in Florida undergo annual sports physicals through a local sports medicine outreach program. A resting electrocardiogram (ECG) was implemented during the 2022 PPE. The aim of this study was to document the efficacy of implementing ECGs and to highlight the cardiac abnormalities identified in young athletes as part of a 1-d PPE. Methods: In total, 1,357 high school athletes (males = 879 and females = 478; age, 15.1 ± 1.3 years) completed a resting 12-lead ECG. These were interpreted by cardiologists using the International Criteria, with abnormal results being further investigated before final sports clearance. Descriptive statistics regarding ECG findings were analyzed. Results: Twenty-three ECGs (1.7%) were classified as “abnormal” and were referred for further testing. Of these, 14 athletes were cleared to participate in sports, and 6 declined further evaluation. Three athletes, all males, were not cleared for sports participation. Of these, 2 athletes presented with Wolf-Parkinson-White syndrome (0.15%), and 1 athlete (0.10%) presented with dilated cardiomyopathy. Conclusion: Adding ECG screening as part of a single-day PPE can be used as a tool in identifying cardiac abnormalities among young athletes. To our knowledge, this is the highest number of athletes screened during a PPE in 1 d nationwide.

Catastrophic Sports Injuries: Causation and Prevention.

➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.

The Preparticipation Orthopedic History and Physical Examination for American Football Players.

The Preparticipation Orthopedic History and Physical Examination for American Football Players.

The Preparticipation Physical Examination for American Football Athletes.

The Preparticipation Physical Examination for American Football Athletes.

Faulty Hip and Pelvis Biomechanics Do Not Differentiate Between 5k Performance in NCAA Division II Cross-Country Runners

Introduction: Excessive hip adduction (HADD) and contralateral pelvis drop (CPD) angles during running are associated with running-related injuries. Their influence on performance is less known. Therefore, we aimed to determine if HADD and CPD could differentiate between high and low race performers, and if there were relationships between CPD, HADD and race performance. Methods: Twenty-six healthy male and female NCAA Division II cross-country runners participated in this prospective study. They underwent 3D motion analysis of their HADD and CPD during pre-participation physical examinations. Times from the first race of the season were converted to International Association of Athletics Federation (IAAF) points and high and low performance groups were created. Pearson correlation coefficients were used to examine the associations between HADD, CPD and IAAF points, and Independent Samples T-tests were used to determine differences in HADD and CPD between high and low performance groups. Results: There were no significant relationships between IAAF points and left HADD (r=0.11, p=0.59), right HADD (r=0.19, p=0.35), left CPD (r=-0.06, p=0.79), or right CPD (r=-0.06, p=0.76). There were no significant differences between high and low performance groups in left HADD (t(24)=0.48, p=0.64), right HADD (t(24)=0.45, p=0.33), left CPD (t(24)=0.62, p=0.27), or right CPD (t(24)=0.53, p=0.30). Conclusions: The RRI biomechanics of excessive CPD and HADD do not influence 5k race performance in collegiate distance runners.

Evaluating Policy Consistency in Preparticipation Physical Evaluations for High School Athletes

Sudden cardiac death in young athletes is a rare but tragic occurrence impacting families, friends, institutions, and communities. The causes of sudden cardiac death often go undetected because of the vague associated symptoms. High school athletes are required to complete a preparticipation physical examination (PPE). However, screening guidelines at the state level are flexible and can lead to an inconsistent cardiovascular assessment of student-athletes. A review of State High School Association guidelines for all 50 states and the District of Columbia evaluated consistency of current PPE policies and found variation in frequency, forms utilized, and who can complete the physical.

Assessing Performing Artists in Medical and Health Practice - The Dancers, Instrumentalists, Vocalists, and Actors Screening Protocol.

Training in the performing arts exposes individuals to often extreme physical and psychological demands, which are linked to high occupational injury rates. The intense demands of performing artists have been likened to those of sport athletes. However, distinct differences in these demands necessitate specialized approaches to the health care of performing artists. Through the Athletes and the Arts collaboration, the American College of Sports Medicine and Performing Arts Medicine Association identified that the creation of a specialized preparticipation screening tool for performing artists would likely enhance health care for performing artists significantly. Based on a thorough review of established assessments and an extensive consultation process with domain experts, a consensus best-practice screening tool was developed: the Dancer, Instrumentalist, Vocalist, Actor (DIVA) Preparticipation Screening. This screening tool is modeled on the athletic preparticipation examination (PPE) in its structure and 30-min target duration. However, DIVA diverges considerably from the PPE in its content to address the specific risks and needs of performing artists. In particular, screening questions and physical examination procedures focus strongly on musculoskeletal injuries and mental health conditions, in response to the preponderance and interactions of these conditions appearing in performing artists. The DIVA tool presented is intended as a "living tool," which can be modified in the future to include new effective assessment techniques as appropriate. Training in the DIVA preparticipation physical examination is included as a core component of the essentials of performing arts medicine continuing education course described in detail in a companion manuscript in this issue.

Athletes and the Arts and Performing Arts Medicine: Leveraging Sports Medical Expertise to Improve the Care of Performing Artists.

Athletes and the Arts and Performing Arts Medicine: Leveraging Sports Medical Expertise to Improve the Care of Performing Artists.

Vaccinations in athletes

The prevention of infections is essential to athletes’ health and performance. Even mild infections can severely affect athletic performance and the eligibility to train and compete. One of the most effective means of avoiding severe infections are vaccinations. However, like the general population, athletes frequently do not receive the recommended vaccinations. This shortcoming is largely based on fear of adverse vaccine reactions, concerns about the efficacy, misinterpretations, negligence, and poor communication. As sports medicine physicians are involved in the regular screening of adolescent, adult, and senior athletes, they are in a unique position to advise on an individual basis about the risks and benefits of an athlete-specific vaccination schedule. Thus, every preparticipation physical examination should be used to check the vaccination status and, if needed, optimize and update the athletes’ vaccination profile. In this clinical review, recommendations for standard, travel, and specific-indication vaccinations in athletes will be given and their efficacy, timing, and administration in the sports context will be discussed. The review will be completed by recommended literature and useful apps for the sports medicine physician involved in the preparticipation physical examination of athletes. Key Words: Standard Vaccinations, Travel Vaccinations, Indication Vaccinations, Tetanus, Diphtheria, Pertussis, Measles, Mumps, Rubella, Hepatitis A/B, SARS-CoV-2, Influenza, Tick-Borne-Encephalitis, Sports

Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study

BackgroundRecent studies reported postural balance disorders in patients and soccer players with groin pain (GP) compared to controls. Since postural balance asymmetry identified after an initial injury contributes for subsequent injuries, identification of this asymmetry in soccer players with GP may highlight the risk of sustaining subsequent noncontact lower extremity musculoskeletal injuries in these players. Therefore, the aims of this study were to (i) examine static and dynamic unipedal postural balance asymmetry in soccer players with GP compared to healthy ones, and (ii) quantify the risk of subsequent noncontact lower extremity injuries in these players. Research questionDo soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls? MethodsIn this prospective case control study, 27 soccer players with non-time loss GP (GP group: GPG), and 27 healthy ones (control group: CG) were enrolled. Static and dynamic unipedal postural balance asymmetry were evaluated with a force platform using symmetry index (SI), and Y-balance test (Y-BT), respectively. Additionally, subsequent noncontact lower extremity musculoskeletal injuries were tracked for 10 months. ResultsThe GPG revealed higher (p < 0.01) SI in eyes closed condition, higher (p < 0.001) side-to-side asymmetry in anterior, posteromedial and posterolateral reach distances and in composite Y-BT score compared to CG. They showed lower (p < 0.001) composite score for injured limb and higher (p < 0.001) side-to-side asymmetry in posteromedial reach distance compared to the cut-off values of 89.6 % and 4 cm, respectively. Moreover, GPG exhibited higher odds (OR= 7.48; 95 % CI = 2.15, 26.00; p < 0.01) of sustaining subsequent injuries compared to CG. SignificanceThe Y-BT should be instituted into existing pre-participation physical examinations to screen for soccer players with non-time loss GP at an elevated risk of sustaining subsequent injuries. This could help coaches and clinicians make valid return to play decisions.

Training volume recommendations and psychosocial outcomes in adolescent athletes

ABSTRACT Objectives Researchers have recommended that youth athletes limit their practice volume to the number of hours/week that they are old in years. We examined sport perceptions, burnout, anxiety, and depressive symptoms among youth athletes who did and did not report playing more hours/week of organized sports than their age. Methods Uninjured athletes aged 13–18 years old completed questionnaires documenting demographics, sport participation volume, health and injury history, depressive symptoms, anxiety, burnout, and sport perceptions during a pre-participation physical examination. We grouped participants as those who reported more hours/week in organized sports than their age (exceeds age/volume recommendation) vs. those who reported equal/less hours/week in organized sports than their age (meets age/volume recommendation). Results Of 161 participants, 21% (n = 33) were in the ‘exceeds age/volume recommendation’ group (age = 15.2 ± 1.3 years; 55% female; 18.7 ± 4.0 hours/week) and 79% (n = 128) were in the ‘meets age/volume recommendation’ group (age = 15.6 ± 1.2 years; 50% female; 10.2 ± 3.4 hours/week). A higher proportion of the ‘exceeds age/volume recommendation’ group agreed with the statement ‘youth in my sport play too many games before college’ than the ‘meets age/volume recommendation’ group (33% vs. 16%; p = 0.03). After adjusting for the effect of age, sport specialization level, and weight, exceeding age/volume recommendations was associated with the perception that youth in sports play too many games before college (aOR = 3.24; 95% CI = 1.26, 8.29; p = 0.01), while burnout (aOR = 0.99; 95% CI = 0.94, 1.06; p = 0.93), anxiety (aOR = 0.97; 95% CI = 0.84, 1.11; p = 0.65), and depressive symptoms (aOR = 0.90; 95% CI = 0.74, 1.10; p = 0.30) were not significantly related. Conclusion Athletes who spend more hours in sport than their age appear to perceive their competition load during youth sports to be excessive. Coaches and providers should monitor athlete’s training hours and perceptions of competition load to offer support and potentially prevent burnout development.

Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

<scp>Multi‐disciplinary</scp> collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with <scp>post‐acute</scp> sequelae of <scp>SARS‐CoV</scp>‐2 infection (<scp>PASC</scp>)

Factorial Validity and Invariance of an Adolescent Depression Symptom Screening Tool.

Depression is among the most common mental health disorders in youth, results in significant impairment, and is associated with a higher risk of suicide. Screening is essential, but assessment tools may not account for the complex interrelatedness of various demographic factors, such as sex, socioeconomic status, and race. To determine the (1) the factor structure of the Patient Health Questionnaire-Adolescent (PHQ-A) for measuring depression in a group of adolescent athletes and (2) measurement invariance between Black and White patients on the PHQ-A. Retrospective cohort design. Data were obtained from a secure database collected at a free, comprehensive, mass preparticipation physical examination event hosted by a large health care system. Participants were 683 high school athletes (Black = 416, White = 267). The independent variables were somatic and affective factors contributing to the construct of depression measured by the PHQ-A and participant race (Black or White). (1) Factors upon which the construct of depression is measured and (2) measurement invariance between Black and White participants. A 2-factor model, involving affective and somatic components, was specified and exhibited adequate fit to the data (comparative fit index >0.90). All items exhibited moderate to high squared multiple correlation values (R2 = 0.10-0.65), suggesting that these items resonated relatively well with participants. The 2-factor model demonstrated noninvariance between Black and White participants (root mean square error of approximation = 0.06-0.08). Overall, the structure of the PHQ-A was supported by a 2-factor model in adolescent athletes, measuring both affective and somatic symptoms of depression. However, a 2-factor PHQ-A structure was not fully invariant for the adolescents sampled across participant groups, indicating that the model functioned differently between the Black and White participants sampled.

COVID Vaccination in Athletes and Updated Interim Guidance on the Preparticipation Physical Examination During the SARS-Cov-2 Pandemic.

The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.

COVID Vaccination in Athletes & Updated Interim Guidance on the Preparticipation Physical Examination during the SARS-CoV-2 Pandemic.

The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.

Is the Preparticipation Physical Examination Replacing the Annual Well Child Examination among Student Athletes?

The goal of the preparticipation physical examination (PPE) is to promote health and safety during competition by screening athletes for injuries and illness. Historically it has been reported that the PPE may be the only medical evaluation that many student athletes receive. Our objective was to evaluate whether student athletes who have participated in our PPEs also receive routine well child care. In addition, we investigated parental perspectives regarding what should be included during the PPE. A 29-question survey was distributed to parents of student athletes during 6 PPE sessions sponsored and hosted at local school districts. Descriptive statistics were used to characterize and summarize the data set. A total of 288 surveys were completed. All our student athletes had a primary care provider (100%), with the overwhelming majority of student athletes (90.9%) having both a well child examination and a PPE annually. Approximately 89% of parents believed that electrocardiograms prevented sudden cardiac death in sports. The majority of parents believed the PPE was an appropriate setting to discuss mental health and substance abuse. The majority of student athletes complete both a well child examination and a PPE annually. Parents believe screening electrocardiograms are effective in preventing sudden cardiac death and that the PPE can prevent injuries from occurring. Parents also believe the PPE can serve as an opportunity to discuss mental health and substance abuse, which is consistent with the most recent PPE monogram. An educational handout should be provided to parents regarding the goals of the PPE.

Low-Energy Availability and the Electronic Preparticipation Examination in College Athletes: Is There a Better Way to Screen?

The electronic preparticipation physical examination (ePPE) is commonly used to identify health conditions that would affect participation in sports for athletes, including disordered eating and/or low energy availability (EA). A secondary analysis was performed using a cohort study of female college athletes attending a Division 1 university between 2008 and 2014. Descriptive statistics and logistic regression analyses were used to explore the association between responses to questions on the ePPE related to eating behaviors and Female Athlete Triad (Triad). Risk categories (low, moderate, or high) were assigned to 239 athletes participating in 16 sports. The majority of responses on the ePPE did not identify athletes associated with moderate-/high-risk categories. Our findings suggest that ePPE may not sufficiently identify athletes at elevated risk for health concerns of the Triad. Our findings suggest that future ePPE may consider validated screening tools for disordered eating to help identify athletes at risk of low EA.

Musculoskeletal practices for the preparticipation physical examination

BackgroundLittle is known about the musculoskeletal (MSK) exam providers use during the Preparticipation Physical Examination (PPE). The primary aims of this study were to determine current practice with regards to the MSK screening exam, if goals are being met, and if there may be opportunities for improvement.MethodsThis cross-sectional survey-based study utilized a REDCap instrument that was distributed to members of the American Academy of Family Physicians (AAFP) and the American Medical Society for Sports Medicine (AMSSM). Questions focused on participant demographics and MSK exam practices for the PPE. Descriptive statistics were used.ResultsThe study had a total of 616 participants with a response rate of 9 %. The majority of respondents (82 %) were familiar with the 4th Edition PPE Monograph and 80 % either moderately or strongly agreed that they use this as a guideline for their MSK screening exam. The 90 s MSK screening test was implemented by 52 % of the participants. The majority of participants use an orthopedic exam as part of their PPE (82 %). Ninety-two percent of participants felt satisfied that their MSK exam would screen for current injury, while only 42 % were satisfied that it effectively screened for future injury. 86 % of participants agree that the MSK exam should be performed, while 26 % said that they don’t perform a physical exam at all.DiscussionThere is a lack of understanding of the PPE Monograph as there is wide variability in MSK screening techniques providers use despite the majority of participants being familiar with the guidelines described in the monograph. Additionally, providers don’t believe that the MSK exam screens for future injury.ConclusionsThe goals of the MSK portion of the 4th Edition PPE monograph are not adequately being met and there is a need for further research to validate screening exams for the prevention of MSK injury.

Sport specialization, sleep, fatigue, and psychosocial ratings: do highly specialized athletes differ from their less specialized peers?

ABSTRACT Objectives To determine if sleep quality, fatigue, anxiety, depressive symptoms, or perceptions of sport participation differ between high-, moderate-, and low-specialized high school athletes with or without prior injuries. Methods During pre-participation physical examinations (PPE), high school athletes completed questionnaires on sport specialization level, history of time-loss orthopedic injury, perceptions of sport participation, as well as sleep quality (Pittsburgh Sleep Quality Index (PSQI)), fatigue, anxiety, and depressive symptoms (Patient-Reported Outcomes Measurement Information System (PROMIS®)). Athletes were grouped according to sport specialization level and history of prior time-loss orthopedic injury. Results A total of 186 athletes completed the study: 49% (n = 92; mean age = 15.3 ± 2.0 yrs; 50% female) were low specialized, 34% (n = 64; mean age = 15.3 ± 1.3 yrs; 47% female) were moderately specialized, and 16% (n = 30; mean age = 15.7 ± 1.1 yrs; 57% female) were highly specialized. Groups were similar for demographics, training volume, and injury history. Compared to the moderate-specialization group, highly specialized athletes reported higher levels of fatigue (3.1 ± 3.7 vs. 1.5 ± 2.2; p = 0.02), anxiety (3.6 ± 4.1 vs. 1.8 ± 2.6; p = 0.02), and depressive symptoms (2.4 ± 4.0 vs. 0.8 ± 2.0; p = 0.02). No differences in psychometric ratings, sleep quality, or perceptions of sport participation were observed between the low/moderate- or low/high-specialization groups. We did not observe any significant differences between groups who did and did not report a history of prior time-loss orthopedic injury. Conclusions Highly specialized high school athletes report higher levels of fatigue, more anxiety symptoms, and more depressive symptoms than their moderately specialized peers, despite no differences in training volume or injury history. Low specialized athletes did not differ from moderately specialized or highly specialized athletes in the aforementioned domains, and there were no differences in sleep quality across specialization groups. These findings add to the current body of literature on early sport specialization by illustrating the distinctive psychosocial implications of sport specialization and demonstrating the need for further prospective research.

Individual Baseline Balance Assessments in a Large Sample of Incoming NCAA Division I Athletes Using a Force Plate System

BACKGROUNDIndividualized baseline testing is resource and time intensive. The use of normative data to approximate changes after a suspected concussion is thus an appealing alternative. Yet, few peer-reviewed, large-sample studies are available from which to develop accurate normative averages of balance using force-plate technology.PURPOSEThis study sought to validate a normative dataset from the force-plate manufacturer and examine the magnitude and nature of sample variability.STUDY DESIGNCross-sectional.METHODSBaseline balance and self-reported sex, sport, and concussion history were assessed in 533 prospective collegiate athletes (45% female) during pre-participation physical examinations. Balance was measured using four stances from the modified Clinical Test of Sensory Interaction and Balance and quantified as Sway Index Scores with the Biodex Biosway Portable Balance System. Group averages are contrasted to data from the force-plate manufacturer. Individual variability around these averages was visualized and analyzed by sex and sport.RESULTSMale student athletes showed significantly more sway in the eyes open, soft stance condition than female athletes. These differences were maintained when concussion history was included as a covariate. Athletes, particularly male athletes, in the high versus low contact sport group showed significantly more sway in the eyes open, soft surface and the eyes closed, hard and soft surface stances.CONCLUSIONThere was substantial individual variability that was partially explained by sex differences and sport differences. The development of normative averages for sway may benefit from consideration of sex and sport. Further studies should characterize other factors that influence baseline balance in collegiate athletes.LEVEL OF EVIDENCE2b