Why Your Teen Needs A Sports Physical

Participating in sports can be taxing on a student's physical and mental health. In some cases, students may not even notice when issues appear. Since many conditions can worsen if left untreated, students need to have a yearly sports physical, or preparticipation exam, to maintain good health throughout their sport.

Matthew J. Rachwalski, DO, a physician specializing in sports medicine with the Franciscan Physician Network, explains what you should know about sports physicals for student athletes.

What Is The Purpose Of Sports Physicals?

In Indiana and Illinois, student athletes are required to have an annual sports physical, or preparticipation exam, before trying out for school sports programs. The form, completed by a medical provider, is typically valid for 365 days.

"A preparticipation exam is done annually for a student-athlete to be eligible to participate in their sport," Dr. Rachwalski said. "It's done for a couple different reasons. You want to determine athletes' ability to participate in their sports safety while also maintaining a healthy lifestyle."

When Should A Sports Physical Be Done?

While the sports physical needs to completed before tryouts for a sports team, parents may want to schedule their child’s preparticipation exam earlier. If your child’s doctor identifies any health concerns that could prevent your child from participating in sports, this may give additional time to treat them.

"Even though I usually say it's kind of dependent on the athlete and what sports they participate in, we typically like to have participation exams done at least a month or two before your season starts," Dr. Rachwalski said. "If for some reason something does come back as a red flag screening or there's some positive finding on your exam that requires further workup, you want to have the opportunity to get those tests and have a definitive answer for how you move forward before the season starts.

"I've seen times where a student-athlete comes in the day before a sports physical or even a week before with something atypical, like when I'm listening to them, I hear a heart murmur."

Dr. Rachwalski explains that in situations like this, they will need further testing, such as an EKG, which may happen on a different day, alongside the time surrounding insurance approvals and scheduling the appointment.

"If they don't give adequate lead time on that, they may delay them from participating in a sport," Dr. Rachwalski said. "Of course, most of these kids that are coming in want to be involved. They don't want to be missing time away from the field or board or wherever the case may be."

How Long Does A Completed Preparticipation Exam Remain Valid?

While it's important for student-athletes to have a preparticipation exams each year, keeping these exams up-to-date is crucial to avoid new and overlooked health concerns.

"I always remind my student-athletes that health is a constantly evolving thing," Dr. Rachwalski said. "As you go through sports, sometimes you get some bumps along the way.

What Are Red Flags For Sports Participation In Student Athletes?

Dr. Rachwalski explains that there are common "red flags" or health concerns that he sees in his office which may prevent sports participation, revolving around:

• Vision
• Heart
• Breathing
• Musculoskeletal injury

"We'll always look at vision since it would be hard for these young athletes to compete if they can't see very well," Dr. Rachwalski said. "We try to screen their vision to be better than 20 over 40. And that can be corrected if they're wearing corrective lenses."

If an athlete needs access to corrective lenses, Dr. Rachwalski suggests they reach out to an optometrist or ophthalmologist. These professionals can guide students to appropriate eyewear for the sport they're playing.

"Other red flags that might require further screening tests can be if a student-athlete is having episodes where they're passing out, nearly passing, having heart palpitations or shortness of breath and trouble keeping up with their co-athletes," Dr. Rachwalski said.

Dr. Rachwalski also emphasized musculoskeletal injury as a common red flag. He explained that if a student is dealing with the injury at the time or if it's an ongoing issue, he will screen them to determine if it's something that prohibits them from playing and if it requires rehabilitation.

Students can face several other health conditions that can prevent them or delay them from participating in school sports, such as:

• Sprains and strains
• Concussions
• Contagious diseases
• Diabetes
• Mental health

Does An Injury Negate A Sports Physical?

"While participating in a sport, you might wind up with an injury, resulting in a change in your health and how you function," Dr. Rachwalski said. "This is why I think it's great for student-athletes to have a school with good athletic training staff that can help out. And a lot of times, some of the little bumps and bruises along the way can be addressed with your athletic trainers at the school, and they can help keep you moving along and keep you healthy to participate.

"Still, if you have an injury that requires a little bit more evaluation, that may not mean that your sports physical is invalid, but it may mean that your circumstances have changed where you require further treatment or evaluation," Dr. Rachwalski continued. "So these preparticipation exams are good for a year, but if things change in your health, then that may change the way you're able to participate in your sport."

What Should Athletes Avoid Before A Preparticipation Exam?

Like other exams, screenings and procedures in healthcare, it's recommended that student-athletes avoid certain activities to receive more accurate results from their sports physicals.

"I would say it's probably best to go into your physical without working out immediately before it because that could alter your blood pressure and heart rate," Dr. Rachwalski said. "It's best to avoid caffeine for the same reasons resulting in a false negative test."

What Is Covered Within A Preparticipation Exam?

When it comes to the several areas of physical and mental health covered within a preparticiation exam, Dr. Rachwalski refers to the series of questions within the IHSAA or Indiana High School Athletic Association Preparticipation Physical Evaluation forms. (Illinois has similar forms)

The PPE form aims to provide well-being for high school athletes by identifying their health risk factors before they participate in sports. These risk factors are reviewed through physical exams and medical history.

"The PPE form goes through and breaks down the different parts that are important," Dr. Rachwalski said. "They also ask a series of screening questions to be reviewed and filled out by the patient and guardian. There are areas focused on general medical health, mental health, medications, and allergies, including drug and environmental allergies."

Supplements

"Another thing that's a big focus for a lot of our student-athletes, in addition to medications, is if they're taking any supplements," Dr. Rachwalski said. "We see a lot of kids that have started trying different health supplements and it allows us as the provider to have an opportunity to discuss what they may be putting in their body and what may address safety concerns. Many of these products aren't regulated by the FDA, so there's a lot of oversight in health and safety on those bottles."

Sports And Medical History

The screening test will have questions for the student-athlete to determine if they've ever been held out of sports and space to fill out why, if applicable. There are also more open-ended questions for the student-athlete and their guardian to emphasize if there are any medical issues or illnesses they would like to discuss.

Heart Health

"Heart health is a big concern that we're continuing to emphasize in these exams, so be prepared for questions about heart health," Dr. Rachwalski said.

Athletes will come across questions regarding noticeable issues when exercising, chest discomfort or tightness, shortness of breath, heart rate and even heart health history and previous heart-related tests.

Students should also be asked if they have an underlying condition that doesn't prevent them from doing any specific activities.

Breathing

"Breathing is another area we emphasize," Dr. Rachwalski said. "We get a lot of asthmatics. We get a lot of seasonal allergies. A lot of things like that. Especially in the state of Indiana, where there's a lot of farming. As the seasons change and the farmers are cutting crops up and harvesting them or planting and tilling the soil, we get a lot of stuff that gets spread in the air, so that's important."

Mental Health

"A lot of mental health issues, eating disorders and similar responses can come about when people have an unrealistic picture of themselves or feel pressured to either gain weight or lose weight or do things like that," Dr. Rachwalski said. "We'll always ask them how they feel about their weight or if anyone has told them to lose or gain weight and how exactly they are approaching it," Dr. Rachwalski said.

Menstrual Concerns

"For our female student-athletes, we'll ask about their menstrual cycle," Dr. Rachwalski said. "Even after concerns about the triad, there is disorder, bone tissues, and gonorrhea, whether or not they have a period. Those things all go hand in hand. A lot of times, we'll have a screen to confirm that they don't have these issues because they could lead to a lot of long-term problems if left alone."

Even after these several topics, the PPE forms and providers also discuss concussions, seizures, vision, family history and more general screening questions.

"There's a lot that goes into the exam," Dr. Rachwalski said. "Then we do a full formal physical exam on them, screening their height, weight, vision and blood pressure. We check their heart rate, and we check their vision. Afterward, we'll do a full overall exam, head-to-toe exam, to look at their cardiovascular health, their lungs, abdomen and even review their musculoskeletal exam."

Some students will visit their primary doctor for their sports physical exam. Still, others may participate in a "mass screening," where they'll go to their school and their school will have an event.

How Are Heart Screenings Involved During A Preparticipation Exam?

The heart plays a big role in physical activity and sports performance. Due to several health concerns that can surround the heart, providers make sure that student-athletes are not showing any potential signs of a heart condition before returning to their sport.

"The first thing we'll do is check blood pressure, heart rate and listen to their heart to see if we hear any irregularities, any murmurs, as they can be signs of value issues or a heart defect," Dr. Rachwalski said. "These screenings help us with heart conditions potentially present from birth for some valvular diseases."

Dr. Rachwalski emphasizes the importance of asking athletes about their family history since some heart conditions can be present from the student's birth and passed on from generation to generation. He also explains that providers will ask about the student's history of fainting, heartbeat rate and skipping along with a pulse check to determine if they're facing an irregular heartbeat.

Depending on your clinical submission, you may also have your heart examined through an EKG, a stress test or a halter monitor.