If you have ever competed in organized sports, whether at the recreational, high school, collegiate or professional level, you have undoubtedly undergone a pre-participation examination (PPE). Even though this is often a requirement for competition, athletes and parents sometimes may not understand what makes up a PPE or why it is performed.
The purpose of a PPE is to ensure athletes are safe to participate in sport and to maximize the athlete’s health. It is important to note that a PPE is not a substitute for an annual health examination or physical, and conversely, an annual physical does not necessarily qualify as a PPE. One of the main goals of a PPE is to detect any conditions that could predispose an athlete to injury or illness while participating in athletics. Because sudden cardiac death is the leading cause of death in young athletes during exercise, specific attention is directed towards detecting cardiovascular risks. Since athletes are often healthy and do not always have regular contact with physicians, another goal of the PPE is to educate and counsel athletes on healthy behavior.
The PPE consists of two main components- a history and a physical examination. The history component is a series of questions that investigate any prior medical conditions or surgeries, medication use, allergies, family history, and concerning symptoms. This is often provided to athletes in the form of a questionnaire. It should be completed before the PPE and is reviewed during the examination. For younger athletes, the history portion should be completed with the help of a parent or family member. It is important to be as thorough as possible when completing the history portion as the majority of abnormalities identified during a PPE are found based off of answers provided during the history component.
The physical examination component of the PPE at a minimum consists of testing vital signs (height, weight, blood pressure, pulse), vision, as well as a focused examination of the cardiovascular and orthopedic systems. If an athlete has a history of a previous injury or specific illness, this area will be examined in more detail. While additional testing including imaging or lab studies are not required, they may be performed if an abnormality is identified in the history or physical exam.
There are also multiple settings in which a PPE can be conducted. The preferred setting is with a Primary Care Physician at the athlete’s medical home. This setting allows better continuity of care, easier access to medical history and records, and is more private. However, PPEs can also be conducted in a mass setting, often for an entire team or school. Mass PPE events are often held at a school/athletic facility or in an outpatient clinic. This method is often used because it is more efficient.
PPEs should be completed at least 6 weeks before starting athletic participation. This allows enough time to complete any additional testing if required, or rehabilitate any injuries or treat any illnesses identified. If the PPE is performed too close to the start of athletic participation, and further evaluation, treatment or rehabilitation is required, there is a risk of being withheld from participation while this is being completed. A PPE is usually recommended to be completed annually, but this can vary depending on the state, level of play or athletic organization.
At the end of the PPE, the athlete will be given a clearance status. The vast majority of athletes are cleared without any restrictions. If a concern is identified that does not place the athlete at risk of injury or illness while participating in athletics, they are cleared for participation with a recommendation for further testing or evaluation. Rarely, if a condition that places an athlete at risk during athletic participation is identified, or there is concern for such a condition and further testing is needed, the athlete is not cleared and is restricted from participation, either permanently or until further testing can be completed to ensure the athlete is safe to participate in athletics.
Dr. David Wang is a sports medicine physician at Hospital for Special Surgery specializing in the treatment of acute and overuse injuries. His main clinical and research interests are overuse injuries, concussions, viscosupplementation injections, and the pre-participation physical exam. As a former collegiate baseball player, he also has a special interest in the care of baseball players.