The Importance of Sports Physical Exams

Female doctor checking teen patient's throat
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The reports of deaths in recent years of athletes have pushed many schools to require a yearly preparticipation sports physical exam. A preparticipation exam is also endorsed by the National Federation of State High School Associations. Hopefully, a thorough history (a discussion of your child's symptoms and overall health) and physical exam will help to target children who may be at risk of health problems while playing sports.

Who should do these examinations? It's a good idea to see your pediatrician. Although your child will likely have a thorough physical exam and they will make sure that he is physically able to participate in sports, if you just have a sports physical, you will be less likely to also go to your pediatrician for a yearly well-child exam.

Benefits of Seeing Your Pediatrician

What is the benefit of seeing your pediatrician instead? In addition to the sports physical, your pediatrician will be able to discuss other problems, such as acne or your child's chronic medical problems. Your pediatrician will also likely discuss other important topics, such as how your child is doing in school and he or she will do counseling about nutrition, safety, injury prevention, avoiding using drugs, depression, alcohol and cigarettes, puberty, and sex education, and being safe on the Internet. Your pediatrician will also have all of your child's old records, including growth charts, and will be more familiar with your families medical history and can review his overall growth and development.

Will a doctor that you have never seen before doing a one-time sports physical catch the fact that your child hasn't started puberty yet or isn't growing as tall as they should be?

During a group sports physical at school or if you go to a clinic offering $10 or $15 sports physicals, they will likely do what is required by the sports physical participation form, including checking your child's weight, height, blood pressure, heart rate, and the physical exam, but they may not have the resources to discuss other important health and safety topics. And if they do find a problem, such as a heart murmur, scoliosis, or hernia, you will likely have to see your pediatrician for further management anyway.

Key Features of the Sports Physical Exam

Wherever the exam is done, according to the American Academy of Pediatrics, some key features of the exam should be:

  • A complete medical history and physical examination, including a blood pressure check
  • Precordial auscultation (listening to the heart) in both the supine (laying down) and standing positions

Important parts of your child's history that might indicate he is at risk of having health problems while playing sports include:

  • Having symptoms while exercising, including chest pain, shortness of breath, fatigue or syncope/near-syncope (fainting)
  • Having a heart murmur or high blood pressure in the past
  • Having other family members with a 'history of premature death (sudden or otherwise), or significant disability from cardiovascular disease in close relative(s) younger than 50 years old or specific knowledge of the occurrence of certain conditions (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, long QT syndrome, Marfan syndrome, or clinically important arrhythmias).

Sport's physicals do have the benefit of being convenient, with many schools bringing a doctor to the school to do the exams, and they are often less expensive than seeing your pediatrician, however, if you have the opportunity, a full well-child visit by your pediatrician may be better than a quick sports physical.

Also, if you live in a state that does not require a yearly preparticipation physical exam, you might want to see your pediatrician before your child plays any sports anyway, especially if your child has any of the risk factors mentioned above.

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  • American Academy of Pediatrics. Preparticipation Physical Evaluation, 4th edition Forms

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.