What questions should be asked during a sports physical to assess an individual's medical history and current health status?

Essential Questions for Sports Physical Evaluation

A comprehensive sports physical should include specific questions about medical history, cardiovascular health, concussion history, female athlete triad/RED-S risk factors, and musculoskeletal concerns to properly assess an individual's readiness for sports participation.

Cardiovascular Assessment Questions

Cardiovascular screening is critical as it helps identify conditions that may lead to sudden cardiac death during exercise:

• Have you ever had chest pain/discomfort during exercise?
• Have you ever fainted or nearly fainted during or after exercise?
• Do you have a heart murmur or has a doctor ever said you have a heart problem?
• Has any family member died suddenly before age 50 due to heart problems?
• Do you experience shortness of breath or fatigue more quickly than your teammates during exercise?
• Have you ever had high blood pressure or high cholesterol? 1

Concussion History Assessment

Concussion history is important to evaluate risk of recurrent injury:

• Have you ever had a concussion or head injury?
• How many concussions have you had in the past?
• Did you experience specific symptoms after previous concussions (headache, nausea, dizziness, balance problems, memory issues)?
• How long did your symptoms last after previous concussions?
• Did you have any prolonged recovery from previous concussions? 1

Female Athlete Triad/RED-S Screening

For female athletes, specific questions should address components of the Female Athlete Triad/RED-S:

• Have you ever had a menstrual period?
• How old were you when you had your first menstrual period?
• When was your most recent menstrual period?
• How many periods have you had in the past 12 months?
• Are you currently taking any female hormones?
• Do you worry about your weight?
• Are you trying to or has anyone recommended that you gain or lose weight?
• Are you on a special diet or do you avoid certain types of foods?
• Have you ever had an eating disorder?
• Have you ever had a stress fracture?
• Have you ever been told you have low bone density? 1

Musculoskeletal Assessment

Questions about musculoskeletal health help identify potential injury risks:

• Have you had any broken or fractured bones or dislocated joints?
• Have you had any injuries requiring treatment by a doctor?
• Do you currently have any ongoing injuries that are being treated?
• Do you use any special equipment or protective devices for sports?
• Have you ever had surgery?
• Do you have any bone, muscle, or joint injury bothering you now? 2

General Medical History

Additional important questions include:

• Do you have any allergies to medications, foods, or environmental factors?
• Do you have asthma or other respiratory conditions?
• Do you have diabetes or other endocrine disorders?
• Do you have seizures or neurological disorders?
• Do you take any medications regularly (prescription, over-the-counter, supplements)?
• Have you had any recent illnesses lasting more than a week?
• Do you have any skin problems (rashes, pressure sores, etc.)?
• Have you had any recent significant weight loss or gain? 1, 2

Congenital Heart Disease Considerations

For athletes with known or suspected congenital heart disease, additional evaluation is necessary:

• Has a doctor ever diagnosed you with a heart condition?
• Have you ever had heart surgery?
• Do you experience exercise intolerance compared to peers?
• Have you ever been restricted from sports participation due to a heart condition? 1

Important Caveats and Pitfalls

1. Don't rely solely on athlete recall for concussion history - research shows teammates and coaches may provide unreliable information about previous concussions 1

2. Weight stability does not necessarily indicate adequate energy availability - athletes can be in energy balance but still in a state of low energy availability 1

3. Cardiovascular screening questions alone may miss important conditions - consider additional evaluation for athletes with positive family history of sudden cardiac death or personal symptoms 1

4. Mental health screening is often overlooked but should be incorporated into sports physicals as psychological factors can impact performance and overall health 3

5. Athletes may underreport symptoms to avoid being disqualified from participation - create a non-threatening environment and emphasize that the goal is safe participation, not exclusion 4

By systematically addressing these key areas during a sports physical, clinicians can better identify potential health concerns that may affect an athlete's ability to safely participate in sports and develop appropriate management plans to minimize risks.