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Chapter 26: Health Promotion and Preventive Health Aspects of Sports Medicine

Cindy Y. Lin; Ivy Lim; Benedict Tan

INTRODUCTION

A comprehensive sports medicine program should incorporate sports pre-participation screening and injury prevention. Physical activity promotion, athletic pre-participation examination, and exercise prescription are other essential aspects of sports medicine that comprise the focus of this chapter.

ATHLETIC PRE-PARTICIPATION EXAMINATION

The athletic pre-participation examination (PPE) is a standard sports medicine practice with the primary goal of providing medical clearance for sports participation and promoting the health and safety of athletes in training and competition. The aims of the PPE include identifying medical conditions and musculoskeletal injuries that require treatment or that may be associated with an increased risk of morbidity or mortality during sports participation. Please see Figs. 26–1 and 26–2 for examples of a preparticipation physical examination and a clearance form.

Figure 26–1

Example of a preparticipation examination form.2 (©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.)

It represents a form for physical examination. Heading says History form. It also says, this is to be filled before visiting the doctor. It has date of examination, name, date of birth, Sex, age, grade, school, sports participating in blanks to be filled.Also needs to be filled, if in case have any allergy to any medication, foods, allergens or stinging insects. It has a series of questions with Yes/No answers. Questions include 1) If any doctor has denied permission for any kind of sports. 2)Any ongoing medical condition? 3) Ever spent a night in the hospital? 4) Ever had surgery? Next comes questions related to heart during exercise. Ever passed out during or after exercise? Ever had discomforts or pain or tightness or pressure in the chest during exercise? Heart ever skips a beat or races too fast? Has doctor told you have any heart problems like High BP, High cholesterol, murmuring, infection in heart? Has doctor ever prescribed any heart check like ECG, EKG or echocardiogrm? Ever felt loghtheaded or short of breath? Ever had an unexplained seizure? ever get more tired than friends during exercise? Then comes questions related to heart health of the patients family. Like, Any family member died of heart attack, or at the age of 50 including a car accident or drowning or sudden infant death syndrome? anybody has hypertrophic cardiomyopathy? Marfan syndrome? arrhythmogenic right ventricular cardiomyopathy?long QT syndrome?short QT syndrome?brugada syndromes? or catecholaminergic polymorphic ventricular tachycardia? anyone has heart problem or pacemaker or implanted defibrillator? anyone has unexplained fainting or seizures or drowning? Next is bone or joint related questions. Includes ever had a bone, muscle, tendon, ligament or joint injury that caused you miss a game? any fractured or dislocated bones?any injury that required x-rays, CT scan, MRI, injections, therapy, cast, brace, crutches? ever had any stress fracture?have you had an x-ray for neck instability or atlantoaxial instability? down syndrome or dwarfism? do you use brace or orthotics or assistive devices? any bone, muscle or joint injury bothering you? anytime joints became painful, swollen, redness or warm?any history of juvenile arthritis or connective tissue disease? And then some medical questions like do you cough, wheeze or have breathing difficulty while exercising, ever used inhaler? taken asthma medicine? any family history of asthma? born with a missign kidney or testicles or eye or something? pain in the genital area? any infectious mononucleosis within the last month?rashes or pressure sores or skin problems? ever had herpes or MRSA infection?had any head injury or concussion?prolonged headache? memory problems? history of seizure disorder?headches during exercises? numbness, tingling, weakness in arms or legs? muscle cramps frequency? sickle cell traits?eye injuries? wear contact lenses or glasses? eye gear or protective eyewear? any worries about weight? any suggestions on weight gain or loss? any special diets being followed? any eating disorder encountered? any concers that would like to be discussed with doctor? For females, ever had menstrual periods? when was the first? how many in the last 1 year? There is a blank space for any answers written yes. And the athlete has to sign along with parents/guardian with date that he has understood the questions and answered to the best of his/her knowledge.
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Figure 26–2

Sample clearance form.2 (©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.)

It represents a form issued by the physician clearing an athlete for any kind of sports. It has Name, Sex, Age and Date of birth columns. Clearance for any sports or any restrictions with some treatment prescribed. If Not cleared, what is the reason, what kind of sports and what can be done for clearance. Then it says that the physician has checked the candidate thoroughly, he/she doesnot have restrictions for any kind of sports, a copy of the examination copy is available and can be retreived on request from either patients or their parents. And If there occurs any problems during the sports, he may rescind the clearance until the problem is resolved and may explain the potential consequences to the athlete or his/her parents. Then comes Physicians name, Date, Address, Phone number, Signature, Qualification. And blank spaces for any emerency allergies or other information.
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The PPE timing, frequency, and protocol are determined by individual sport governing bodies. Generally, it is advised that the PPE is performed prior to initial participation in organized sports teams, with interim medical history updates and physician follow-up as indicated, usually annually.

Most PPEs occur during individual medical office visits or in a station-based mass athlete screening setting. There are advantages and disadvantages to both methods, including differences in cost, privacy, efficiency, continuity of care, and ease of education and counseling.1

The PPE should include taking a general medical history of prior and existing medical conditions and musculoskeletal injuries, exercise history, prior hospitalizations or surgeries, family and social history, medications, supplements, and medication and environmental allergies. Critical elements of the physical examination include general appearance; vital signs; vision screening; examination of the cardiac, pulmonary, abdominal, musculoskeletal, and dermatological systems; and genitourinary examination in males. A comprehensive PPE form has been created through the collaboration of the American College of Sports Medicine (ACSM), American Academy of Family Physicians, American Academy of Pediatrics (AAP), American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports and is available through the AAP and shown in Figures 26–1 and 26–2.2 Routine laboratory testing and imaging tests are not recommended as a part of the standard PPE ...

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