Sports Physical Evaluation for Teenage Females
A comprehensive sports physical for teenage females should include screening for the Female Athlete Triad, cardiovascular risk factors, musculoskeletal assessment, and a private discussion addressing sensitive topics specific to adolescent female athletes. 1, 2
Key Components of the Evaluation
History and Interview
Personal medical history:
- Previous injuries or surgeries
- History of concussions and their resolution
- Chronic medical conditions
- Current medications and allergies
- Exercise-induced symptoms
- Heat-related illness history 2
Family history:
Female Athlete Triad screening questions: 1
- Menstrual history (age at first period, most recent period, number of periods in past 12 months)
- Weight concerns and dieting behaviors
- Special diets or food avoidance
- History of eating disorders
- History of stress fractures
- Bone density concerns
Physical Examination
Vital signs:
Cardiovascular assessment:
- Heart rate and rhythm
- Murmurs
- Femoral pulses 1
Musculoskeletal examination:
- 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 2
Additional systems:
- Respiratory assessment
- Abdominal examination
- Skin assessment
- Neurological screening 2
Special Considerations for Female Athletes
Female Athlete Triad Assessment
The Female Athlete Triad consists of three interrelated components: 1
- Low energy availability (with or without disordered eating)
- Menstrual dysfunction
- Low bone mineral density
Indications for DXA scanning: 1
- History of DSM-V diagnosed eating disorder
- BMI ≤17.5 kg/m², <85% estimated weight, or recent weight loss of ≥10% in 1 month
- Menarche ≥16 years of age
- ≤6 menses over 12 months
Private Discussion
Teenage female athletes should have an opportunity for private discussion with the physician about: 2
- Menstrual health and irregularities
- Nutrition and body image concerns
- Sexual health
- Mental health concerns
- Substance use
Clearance Recommendations
- Full clearance: No concerning findings
- Limited clearance: Conditions that require monitoring or modification of activities
- Temporary disqualification: Conditions requiring treatment before return to play
- Permanent disqualification: Conditions with unacceptable risk 3
Frequency of Evaluation
- High school athletes: Comprehensive evaluations before initial sports participation and again after 2 years
- College athletes: Complete evaluation upon matriculation, with interim histories and blood pressure measurements annually 2
Common Pitfalls to Avoid
Overlooking the Female Athlete Triad: Many providers focus solely on cardiovascular screening but miss critical components of the triad that can lead to stress fractures, amenorrhea, and long-term bone health issues 1
Inadequate privacy for sensitive discussions: Teenage female athletes need confidential time with providers to discuss menstrual health, body image concerns, and other sensitive topics 2
Relying on non-qualified examiners: Sports physicals should be performed by physicians or appropriately trained healthcare providers, not by chiropractors or naturopathic clinicians who lack formal training in these evaluations 1
False sense of security: Standard history and physical examinations have limitations in detecting all potentially lethal cardiovascular abnormalities 1
Failure to involve parents in history completion: For minors, parents should be responsible for completing the history form to ensure accuracy 1
By following this comprehensive approach to sports physicals for teenage female athletes, providers can help ensure safe participation while addressing the unique health concerns of this population.