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Preparticipation Examination

Preparticipation Examination. Chapter 2. Preparticipation Exam (PPE). Objective – to ensure the health and safety of a physically active individual Focus – dependent on: Specific age group Intended sport/activity. Setting Up the PPE. Exam format Primary care physician

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Preparticipation Examination

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  1. Preparticipation Examination Chapter 2

  2. Preparticipation Exam (PPE) • Objective – to ensure the health and safety of a physically active individual • Focus – dependent on: • Specific age group • Intended sport/activity

  3. Setting Up the PPE • Exam format • Primary care physician • Advantages: familiarity, relationship, privacy • Disadvantages: $$, time commitment of M.D. • Group or station format • Advantages: number of professionals involved, less $$, time efficient • Disadvantages: organization demands, decreased privacy, follow-up difficulty, communication problems

  4. Setting Up the PPE (cont.) • Timing of the exam • 6 weeks prior – permits time to: • Correct minor problems • Refer medical problems to a specialist • Frequency • Entry level exam followed by a limited annual re-evaluation • Entry level exam at each level of participation

  5. Medical History • Comprehensive history • General medical • Orthopedic • Supplemental form for females

  6. Physical Examination physical examination is not intended to be all-encompassing … it is intended to focus on body systems of most concern relative to participant’s sport/activity • Vital signs • Establish baseline physiologic parameters and vital statistics • General medical problems • Past surgery or hospitalizations • Medications (including OTC) • Use of alcohol, tobacco, ergogenic aids

  7. Physical Examination (cont.) • Cardiovascular exam • Auscultation of heart sounds • Check for cardiac abnormalities • History of loss of consciousness, syncope, dizziness, shortness of breath, heart palpitations, and chest pain during or after examination • Pulmonary exam • Auscultate for breath sounds • History of coughing or breathing difficulty • Ear, nose, and mouth may also be checked

  8. Physical Examination (cont.) • Musculoskeletal exam • History of previous injury, including: • Nature of injury • When it occurred • Who evaluated it • Duration of treatment and rehab • Use of special protective equipment • Physical exam (refer to Field Strategy 2.3) • Neurologic exam • History of past head injury, loss of consciousness, amnesia, or seizures • Exam: pupillary examination and reaction to light, cranial nerve assessment, motor-sensory exam, deep tendon reflex testing

  9. Physical Examination (cont.) • Eye examination • Visual acuity • Peripheral vision and depth perception • Nystagmus • Pupil size • Dental examination • Determine number of teeth and last visit to dentist • Exam: gum condition and presence of cavities, dental appliances

  10. Physical Examination (cont.) • Gastrointestinal exam • Digestive system, eating habits, and nutrition • History of heartburn, indigestion, diarrhea, or constipation • Genitourinary exam • Kidney and genitourinary organs • Females – menstrual history, gynecologic symptoms

  11. Physical Examination (cont.) • Dermatologic exam • Identify contagious lesions, skin infections • Other lesions (e.g., warts, acne) • Exam for heat disorders • Environment related – history of cramping, syncope, exhaustion, or heat stroke • Use of medications • Laboratory tests • Not recommended by AAP • Required by some states

  12. Physical Fitness Profile • Identifies weaknesses that may: • Hinder athletic performance or • Predispose the athlete to injury • Establishes a baseline of data in the event an injury does occur

  13. Body Composition and Anthropometry • Body composition • Fat vs. lean tissue • More reliable for determining appropriate weight • Measures: hydrostatic weighting, skinfold measurements • Athletes—12–17% body fat • Anthropometry • Determines individuals’ body type

  14. Maturation and Growth • Growth spurts may play a role in certain injuries • Tanner scale — physical maturation measurement

  15. Flexibility • The total ROM that occurs pain-free in each of the planes of motion • Measured with a goniometer, flexometer, or tape measure • Hypermobility vs. hypomobility

  16. Strength, Power, & Speed • Strength • Ability to produce force in one maximal resistance • Measures can involve isometric, isotonic, or isokinetic testing • Power • Ability to produce force in a given time • Measures include: throwing a medicine ball, vertical jump and reach, single- or two-legged hop for distance, and stair climbing • Speed • Ability to move body mass over time • Can be assessed by timed sprints

  17. Agility, Balance, and Reaction Time • Agility • Ability to change directions rapidly when moving at a high rate of speed • Balance • Body’s coordinated neuromuscular response to maintain a defined position of equilibrium in response to changing visual, tactile, or kinesthetic stimuli • Reaction time • Ability to respond to a stimulus

  18. Cardiovascular Endurance • Ability to sustain submaximal exercise over an extended period

  19. Clearance for Participation • Physician determines the level of participation • Will the condition increase the risk of injury to the athlete or to other participants? • Can participation be allowed if medication, rehabilitation, or protective bracing or padding is used? If so, can limited participation be allowed in the interim? • If clearance is denied for a particular sport, are there other sports or activities in which the individual can safely participate?

  20. Clearance for Participation (cont.) • Rehabilitation Act and Americans with Disabilities Act • Most physicians base their recommendations on the American Academy of Pediatrics Committee on Sports Medicine guidelines

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