Importance of Pre-Participation Physical Exams

doctor's examination table

By Brittney Lang, MS, ATC, SCAT
Athletic Trainer
MUSC Health Sports Medicine

Many young athletes must go through a yearly exam which is referred to as a pre-participation physical exam (PPPE) in order to continue to participate in sports and/or summer camps. These exams are essential and are required by most organizations. They also have very beneficial medical information for athletic trainers and other health care professionals that may be in contact with the athlete. These exams should be taken seriously and used for the protection of the athlete.

Pre-participation physical exams have been around for quite a while but over the years have become more extensive and necessary. In the past most exams were just a basic physical and maybe a musculoskeletal evaluation. Now the exams have become a little more extensive to include looking at past medical history as well as going through a physical exam, to include: vitals, height and weight, vision exam, orthopedic evaluations, fitness testing and other testing. More sports medicine professionals are pushing to have electrocardiograms performed during testing to help rule out an underlying cardiac issue that may not be detected in the physical exam. This big push is in part due to the rise in sudden cardiac deaths in young athletes. Though for many of the athletes having an ECG is not always a test that is accessible or financially feasible unless absolutely necessary.

The reason for the exam is to identify any athletes that may be at risk for further injury or illness. This also allows for those athletes to be referred on to proper health care professionals that can examine the athlete more extensively if necessary. Some conditions for referral might be:

  • Prior orthopedic injury or current injury that may need further evaluation or treatment.
  • Health problems that could lead to cardiac issues or sudden death, ie. heart problems, sickle cell anemia, hypertension.
  • Other medical conditions that could pose a risk for the athlete further down the line.
  • Issues that are related to mental health, substance use/abuse or other risky behavior, eg. eating disorders, self harm
  • Prior concussions or other head injuries.
  • Or female related issues, such as endometriosis, amenorrhea, anemia, pregnancy.

The medical history portion of the exam is a vital portion of the test. This information is key in determining if the athlete may have any of the issues stated above as well as any possible family history or other issues the athlete may have that is not tested in the physical portion of the exam.

If the athlete is fairly healthy most are cleared to participate in sports or physical activity. Though some can be cleared with possible restrictions such as an athlete with asthma can play but needs to have an inhaler with them in case at all times. This is vital medical information that is used by athletic trainers and other medical professionals that may be caring for these individuals on a regular basis. This medical information will help to keep the athletes safe and help prevent future issues. As athletic trainers we tend to be in regular contact with these athletes and even if an athlete may be cleared, if you feel they should be referred for further evaluation for anything it is up to you to speak up and make that call.

There tends to be two different ways to administer the exam. An athlete can be seen by their primary care physician and have them perform the exam. This way tends to be more personal and the doctor tends to already know your past medical history but can be more expensive for some. Or many schools or health care facilities will have a mass exam and the athletes rotate through stations and then are seen by a sports medicine healthcare professional at the end to go through the physical portion and ask follow questions as needed. Here the athletes are moved through the exam as efficiently and quickly as possible and the athlete does not always know the doctor and may not feel as comfortable to ask questions or let them know about things. This way tends to usually be cheaper as it is very discounted or sometimes free due to the high volume of people that will be seen. For some areas this is important for the athletes and their parents especially those from low income backgrounds or those who may not have insurance that helps pay for doctor visits.

The pre-participation physical exam is required by schools and other organizations for any sport or physical activity participation. The forms are legal documents stating whether an athlete is healthy enough to play safely or not. If the school or organization were to allow an athlete to participate without clearance from a physician and something were to happen there is the potential for major lawsuits.

The pre-participation physical exam has continued to evolve through the years to better evaluate the athletes as health conditions and sports change. We as health care professionals need to continue to be advocates for the athletes and do what we can to help them and make sure all medical needs are addressed. The exam is a guide for us to better care for them in the future.

The sites listed below are the forms necessary for the pre-participation physical exam in our local areas. It is necessary to print and fill out these forms prior to being seen by the doctor. The forms used by the school systems are very similar so make sure the correct forms are being used for the athlete’s particular school. 

Berkeley County and Dorchester County Schools use similar forms as Charleston County but may have other forms that need to be filled out as well.