Pre-participation History

Aka: Pre-participation History, Sports History, Sports Physical

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II. Background: Pre-participation Exam

  1. Perform 6-12 weeks before start of practice
  2. Early exam allows for further evaluation if necessary
  3. Frequency (varies among states and grade level)
    1. College: yearly exam
    2. Middle and High School: Exam at entry of each school
  4. Use standard Pre-participation Physical forms (e.g. Minnesota State High Schoo Leaguel)
    1. http://www.mshsl.org/mshsl/publications/code/forms/physicalExam.pdf

III. Efficacy

  1. Sports Physical helps prevent sudden death
    1. Retrospectively studied young athletes from 1979-2004
    2. Sports Physicals became mandatory in 1982
    3. Sudden Cardiac Death dropped 89% in screened athletes
    4. Corrado (2006) JAMA 296:1593-601 [PubMed]
  2. However, Choosing Wisely Campaign discourages preparticipation physicals
    1. Sudden Cardiac Death is devastating but rare (1 in 150,000 teen athletes per year, <100 in U.S. per year)
      1. Preparticipation physical misses many of these cases
      2. Malhotra (2018) N Engl J Med 379(6): 524-34 [PubMed]
    2. High False Positive Rate that excludes children from Physical Activity
      1. Rowin (2012) Am J Cardiol 110(7): 1027-32 [PubMed]
    3. High False Negative Rate for Hypertrophic Cardiomyopathy
      1. Halkin (2012) J Am Coll Cardiol 60(22):2271-6 [PubMed]
    4. References
      1. Schefft (2019) Am Fam Physician 99(6): 376-82 [PubMed]

IV. History: General

  1. Any new changes in the next year
  2. Hospitalized or surgery
  3. Missing parts (unpaired organs)
  4. Medical problems
    1. Diabetes Mellitus
    2. Mononucleosis (related to Splenomegaly)
    3. Hepatitis
    4. Human Immunodeficiency Virus (HIV)

V. History: Medication (prescribed and over the counter)

  1. General Medications
    1. Insulin
    2. Anticonvulsants
    3. Antihistamines (Heat Injury risk, arrhythmia risk)
    4. Doxycycline (Sunburn risk)
    5. Oral Contraceptive use
    6. Inhaled Bronchodilators
    7. NSAID use and over use
  2. Ergonomic aids (Performance supplements)
    1. Weight loss drugs (e.g. Ephedra or Ephedrine)
    2. Anabolic Steroids
    3. Megavitamins
    4. Creatine

VI. History: Allergy

  1. Medication allergies
  2. Allergic Rhinitis to Pollens
  3. Anaphylaxis or allergy to Stinging Insects or food
    1. Need for epi-pen?
  4. Exercise induced Urticaria

VII. History: Pulmonary

  1. Diagnosis of Exercise induced Asthma or bronchospasm
  2. Cough or Shortness of Breath during or after activity

VIII. History: Cardiovascular

  1. Exertional Syncope (Blackout, Dizziness, Chest Pain)
    1. Hypertrophic Cardiomyopathy
    2. Asthma
    3. Premature Coronary Artery Disease or coronary anomaly
  2. Easily Fatigued
    1. Overtraining
    2. Acute or chronic illness
  3. History of Heart Murmur (Congenital Heart Disease)
  4. History of Hypertension
  5. History of Palpitations (arrhythmia)
    1. Benign (sinus): Gradual onset and better on exertion
    2. SVT: Sudden onset very fast rate, resolved with vagal
    3. Ventricular Tachycardia (e.g. long QT Interval)
    4. Drugs: Tobacco, Caffeine, Alcohol, drugs, supplements
  6. Viral Infection in last month (Myocarditis)
  7. Prior disqualification for heart problem
  8. Family History of Sudden death
    1. Under age 30 years
      1. Hypertrophic Cardiomyopathy
      2. Anomalous Coronary Artery
      3. Marfan's Syndrome
    2. Under age 50 years
      1. Premature Coronary Artery Disease

IX. History: Neurologic

  1. Concussions: Knock-outs, Unconscious, Concussion
    1. Number of lifetime Concussions
    2. Recent Head Injury
    3. Severity of each Head Injury
  2. Seizure history
    1. Is condition controlled?
    2. When was last Seizure?
    3. Anticonvulsants
  3. Neck injury or cervicobrachial injury
    1. Have you had a Burner, Stinger or pinched nerve?
  4. Spinal stenosis
    1. Have you ever had extremity numbness or tingling?

X. History: Environmental Injury

  1. History of Heat Injury
    1. Heat Cramps
    2. Heat Exhaustion
    3. Heat Stroke
  2. Discuss Hydration and Heat Injury prevention
  3. Discuss risk of future Heat Injury

XI. History: Musculoskeletal Injury

  1. Joint Injury, Joint dislocation or joint subluxation
  2. Ligamentous Sprain
  3. Tendinous Strain
  4. Prior Fractures
  5. Persistent dysfunction
  6. History of rehabilitation program
  7. Special equipment use for injury prevention
    1. Knee Braces
    2. Neck rolls
    3. Foot Orthotics
    4. Hearing Aids

XII. History: Eye

  1. Eye or Vision problems
    1. Eye loss
    2. Eye Protection
  2. Vision must be corrected 20/40 or better to participate
    1. Eye Glass or Contact Lens use
    2. Protective eyewear (Single eye)

XIII. History: Immunization

  1. Immunizations current?
    1. Tetanus Vaccine (Td) at age 12 or 16
    2. Measles Mumps Rubella (MMR) twice
  2. Consider additional Vaccinations if not pregnant
    1. Varicella Vaccine if indicated
    2. Hepatitis B Vaccine

XIV. History: Menstrual

  1. Menarche
  2. Last Menstrual Period
  3. Longest time between periods
  4. Number of Menses in last year

XV. History: Weight

  1. Current weight
  2. Highest weight in last year
  3. Lowest weight in last year
  4. Ideal Weight
  5. What would you like to weigh?
  6. Red Flags for Eating Disorder and Anabolic Steroid use
    1. Low weight for expected Ideal Weight
    2. Recent excessive weight loss
    3. Recent rapid weight gain

XVI. History: Social

  1. Family problems
  2. Illicit Drug use and Drug Abuse
  3. Alcohol use
  4. Are you stressed out?
  5. Any problems in school or with friends?
  6. Any need for Contraception
  7. Sexually active?
    1. Sexually Transmitted Disease discussion
    2. Need barrier Contraception (Condoms)?
  8. Safety Issues: Seat Belt, Bike Helmet
  9. Stress Confidentiality!

XVII. References

  1. Kurowski (2000) Am Fam Physician 61(9): 2683-90 [PubMed]
  2. Mirabelli (2015) Am Fam Physician 92(5): 371-6 [PubMed]

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