Components of a Sports Physical Examination
A sports physical examination should include a comprehensive personal and family medical history, physical examination focusing on cardiovascular and musculoskeletal systems, and assessment of vital signs to identify conditions that may increase risk during sports participation. 1
Medical History Components
The history portion should include the following key elements:
Personal History
- Chest pain/discomfort/tightness/pressure related to exertion
- Unexplained syncope or near-syncope
- Excessive and unexplained dyspnea/fatigue or palpitations with exercise
- Prior recognition of a heart murmur
- Elevated systemic blood pressure
- Prior restriction from sports participation
- Prior cardiac testing ordered by a physician
- Previous injuries or surgeries
- History of concussions and their resolution
- Chronic medical conditions
- Current medications and allergies
- Exercise-induced symptoms
- Heat-related illness history
Family History
- Premature death (sudden and unexpected) before 50 years of age due to heart disease
- Disability from heart disease in close relatives under 50 years
- Specific knowledge of genetic cardiac conditions in family members (hypertrophic or dilated cardiomyopathy, long-QT syndrome, Marfan syndrome, or significant arrhythmias)
Physical Examination Components
Vital Signs
- Blood pressure measurement (sitting position)
- Height and weight (with BMI calculation)
Cardiovascular Assessment
- Heart auscultation for murmurs (both sitting/supine and standing positions)
- Femoral pulses to exclude aortic coarctation
- Assessment for physical stigmata of Marfan syndrome
Musculoskeletal Assessment
- 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 examination
- Abdominal examination
- Skin assessment
- Neurological screening
- Tanner staging when relevant for contact sports
Special Considerations for Female Athletes
For female athletes, additional assessment should include:
- Screening for the Female Athlete Triad (low energy availability, menstrual dysfunction, low bone mineral density)
- Menstrual history
- Weight concerns and dieting behaviors
- History of stress fractures
Private Discussion Topics
Adolescents should have an opportunity for private discussion with the physician about:
- Menstrual health and irregularities (for females)
- Nutrition and body image concerns
- Sexual health
- Mental health concerns
- Substance use
Frequency of Examinations
- 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
Common Pitfalls to Avoid
- Relying on non-qualified examiners (e.g., chiropractors or naturopathic clinicians)
- Overlooking the Female Athlete Triad in female athletes
- Assuming that a standard history and physical examination can detect all potentially lethal cardiovascular abnormalities
- Inadequate auscultation environment for detecting heart murmurs
- Failure to perform auscultation in both sitting/supine and standing positions
Clearance Process
The sports physical should result in one of three outcomes:
- Unrestricted clearance
- Clearance with recommendations for further evaluation or treatment
- Disqualification from certain or all sports
Any concerning findings warrant appropriate referral and follow-up before clearance is granted.