What are the steps to perform a youth sport physical?

How to Perform a Youth Sports Physical Examination

A comprehensive youth sports physical examination should follow a systematic approach that screens for potential health risks while promoting safe participation in physical activities, with particular focus on musculoskeletal assessment and cardiovascular screening to prevent morbidity and mortality.

Key Components of the Youth Sports Physical

1. Medical History Review

• Obtain detailed personal and family medical history, focusing on:
  • Previous injuries or surgeries
  • History of concussions
  • Cardiovascular symptoms (chest pain, syncope, dyspnea)
  • Family history of sudden cardiac death or cardiovascular disease
  • Current medications and allergies
  • Previous medical conditions that may affect sports participation

2. Vital Signs Assessment

• Measure and document:
  • Blood pressure (compare to age-appropriate norms)
  • Heart rate
  • Respiratory rate
  • Height and weight (track BMI and growth patterns)

3. Cardiovascular Examination

• Perform thorough cardiac auscultation:
  • Listen for murmurs in standing, supine, and squatting positions
  • Perform auscultation during Valsalva maneuver to detect hypertrophic cardiomyopathy 1
  • Assess for irregular rhythms
  • Check peripheral pulses
  • Evaluate for signs of Marfan syndrome (arm span, pectus excavatum)

4. Musculoskeletal Assessment

• Conduct a comprehensive musculoskeletal examination as this is the leading cause of sports participation restrictions (43.4%) 2
• Assess:
  • Range of motion in all major joints
  • Muscle strength
  • Flexibility
  • Balance and coordination
  • Previous injury sites for proper healing
  • Perform functional movement screening

5. Neurological Screening

• Evaluate:
  • Balance and coordination
  • Reflexes
  • Visual acuity
  • Cognitive function (especially if history of concussion)

6. Respiratory Assessment

• Assess:
  • Lung sounds
  • Exercise-induced asthma symptoms
  • Breathing patterns during rest

7. Abdominal Examination

• Check for:
  • Organomegaly
  • Hernias
  • Tenderness

8. Genitourinary Examination

• For males: examine for hernias, testicular masses, and varicocele 1
• For females: assess for components of female athlete triad (disordered eating, amenorrhea, osteoporosis) 1

9. Skin Assessment

• Check for:
  • Contagious skin conditions (ringworm, impetigo)
  • Proper wound healing
  • Signs of previous injuries

Special Considerations

Sport-Specific Evaluation

• Tailor examination based on the specific sport's demands:
  • Contact sports: emphasize neurological and musculoskeletal assessment
  • Endurance sports: focus on cardiovascular fitness
  • Overhead sports: detailed shoulder and upper extremity examination

Injury Prevention Guidance

• Provide recommendations on:
  • Proper warm-up and cool-down techniques
  • Sport-specific protective equipment
  • Hydration and nutrition strategies
  • Recognition of overtraining symptoms

Overspecialization Assessment

• Evaluate for signs of overtraining or sport specialization:
  • Highly specialized athletes are 59% more likely to report previous injuries 3
  • Athletes who play their primary sport more than 8 months per year have 66% higher risk of lower extremity overuse injuries 3
  • Athletes who participate in their primary sport for more hours per week than their age have 34% higher injury risk 3

Clearance Determination

• Based on examination findings, provide one of three dispositions 2:
  1. Cleared for full participation
  2. Not cleared for participation (approximately 1.9% of athletes)
  3. Cleared with specific follow-up recommendations (approximately 11.9% of athletes)

Documentation and Follow-Up

• Document all findings thoroughly
• Provide clear written recommendations for:
  • Activity restrictions if needed
  • Follow-up evaluations
  • Referrals to specialists when indicated
• Communicate findings to parents, coaches, and school athletic staff as appropriate

Promoting Long-Term Health

• Encourage participation in multiple sports rather than early specialization 4
• Recommend at least 1-2 days off per week from primary sport 4
• Advise taking at least 3 months off throughout the year (in 1-month increments) from the primary sport 4
• For school-aged children, recommend 60 minutes of moderate-to-vigorous physical activity daily 4

By following this systematic approach to youth sports physicals, you can effectively identify potential health risks while promoting safe participation in physical activities that contribute to lifelong fitness and well-being.