Comprehensive Sports Physical Components for Teenagers
A comprehensive sports physical for teenagers should include a complete personal and family history, physical examination with vital signs, musculoskeletal assessment, and cardiovascular screening to identify conditions that may increase risk of morbidity or mortality during sports participation.
Key Components of the Sports Physical
Medical History Assessment
Personal medical history:
- History of prior injuries or surgeries
- History of concussions and their resolution
- Presence of chronic medical conditions (asthma, diabetes, seizures)
- Current medications and allergies
- Exercise-induced symptoms (chest pain, shortness of breath, syncope)
- Heat-related illness history
Family history (particularly important for cardiovascular screening 1):
- Premature death (sudden/unexpected) before age 50
- Heart disease in close relatives under 50
- Specific cardiac conditions: cardiomyopathy, long QT syndrome, Marfan syndrome
- Family history of exercise-related death or disability
Physical Examination
Vital signs:
- Blood pressure measurement (mandatory for all athletes) 1
- Height and weight (with BMI calculation)
- Vision screening
Cardiovascular assessment:
- Heart auscultation (performed in both supine and standing positions)
- Femoral pulses assessment
- Evaluation for Marfan syndrome physical stigmata
- Assessment for heart murmurs
Comprehensive musculoskeletal examination 2, 3:
- Joint-specific screening for range of motion and stability
- Strength testing of major muscle groups
- Sport-specific functional movement assessment
- Special attention to previously injured areas
Additional systems:
- Respiratory (lung sounds, respiratory effort)
- Abdominal examination
- Skin assessment (for infectious conditions like herpes, impetigo)
- Neurological screening
- Tanner staging for physical maturity assessment (when relevant for contact sports) 1
Special Considerations
Cardiovascular Screening
The American Heart Association recommends the 12-key elements for cardiovascular screening 1:
- Complete personal and family history
- Physical examination focusing on cardiovascular findings
- Blood pressure measurement
While routine ECGs are not mandated in the US (unlike some European guidelines), they may be considered for athletes with concerning history or examination findings 1.
Concussion History and Education
For athletes with prior concussions, detailed assessment should include 1:
- Number and severity of previous concussions
- Duration of symptoms
- Recovery patterns
- Education about concussion recognition and the stepwise return-to-play protocol
Confidentiality Considerations
Adolescents should have an opportunity for private discussion with the physician, particularly for sensitive topics 1:
- Substance use (including performance-enhancing drugs)
- Mental health concerns
- Sexual health
- Disordered eating behaviors
Follow-up Recommendations
- High school athletes should have comprehensive evaluations before initial sports participation and again after 2 years 1
- College athletes should have a complete evaluation upon matriculation, with interim histories and blood pressure measurements annually 1
- Any concerning findings warrant appropriate referral and follow-up before clearance
Pitfalls to Avoid
- Station-based examinations often miss important psychosocial screening and lack confidentiality 1
- Sports-only focus without addressing broader adolescent health issues represents a missed opportunity 4
- Inadequate musculoskeletal assessment is problematic as musculoskeletal problems are the leading cause of sports restrictions (43.4% in one large study) 3
- Overlooking female-specific issues such as the female athlete triad (disordered eating, amenorrhea, osteoporosis)
By conducting thorough sports physicals that address all these components, clinicians can help ensure safer sports participation while identifying conditions that might increase risk of morbidity or mortality during athletic activities.