[The Physician and Sportsmedicine]

Ugh! Sports Physicals!

Douglas B. McKeag, MD, MS


For the most part, physicians who take care of athletes tend to view the preparticipation physical exam (PPE) as a necessary but time-consuming and somewhat bothersome evil. It is not fun. It usually occurs at the hottest, most uncomfortable time of the year, and is often sandwiched between regular work responsibilities and family plans. ("I'd love to see you pitch tonight, Ian, but I've got to do sports physicals for 3 hours after work.")

Yet, if we are to believe what we say about the importance of the PPE in the sports medicine network, we need to either do this examination right and be prepared to deal with significant positive findings, or not do it at all.

To rule out or limit athletic participation is not easy, fun, or comfortable. As team physicians, especially at the high school level, we do not do this very often. However, if there is one place where we need to be compulsive and deliberate, it is with the PPE. The line that we walk is narrow; we must not limit potential athletes unnecessarily, but neither can we comfortably ignore findings that may lead to serious, even life-threatening situations. For as unsatisfying as many sports physicians feel the PPE is, it nevertheless represents the single most important opportunity the physician has for influencing the sports medicine system.

This unique influence, however, must be individualized. As sports medicine groups firm up definitions and protocols about what constitutes an adequate PPE (see the second edition of Preparticipation Physical Evaluation (1), to be published by The Physician and Sportsmedicine), we need to realize that this exercise is community dependent, as it should be. The recommendations of national task forces should be seriously considered but viewed in the context of the resources and protocols of individual communities and the needs of individual patients. There is no excuse for doing a subpar screening examination, but the exam should reflect the priorities and attitudes of our communities. The steps suggested by James L. Moeller, MD (see "Contraindications to Athletic Participation: Cardiac, Respiratory, and Central Nervous System Conditions" by James L. Moeller, MD) are clear and to the point, but they will not supply "cookbook" instructions for what to do with any one patient.

It is my feeling that your system is only as good as your PPE. The challenge comes in deciding what you are going to do with the 2% to 8% of individuals whom you find on the screening exam to have significant abnormalities. Are you going to punt or run with the ball? Make a difference and make it better. Serving up a good PPE is not cookbook medicine; it is gourmet medicine.


  1. American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine: Preparticipation Physical Evaluation, ed 2. Minneapolis, New York City, McGraw-Hill, Inc, to be published

Dr McKeag is the Arthur J. Rooney, Sr, professor and vice chairman of the departments of Family Medicine and Orthopaedic Surgery, and the director of primary care sports medicine, at the University of Pittsburgh Medical Center in Pittsburgh. He is also a fellow of the American College of Sports Medicine, former president of the American Medical Society for Sports Medicine, and an editorial board member of The Physician and Sportsmedicine.



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