What is involved in a sports physical at a doctor's office?

Sports Physical Examination in the Office Setting

A sports physical examination should include a comprehensive cardiovascular screening, musculoskeletal assessment, and medical history review to identify conditions that could increase risk during athletic participation, with the primary goal of preventing sudden cardiac death and activity-related injuries.

Core Components of the Sports Physical

Medical History Assessment

The sports physical must begin with a detailed personal and family history focusing on cardiovascular risk factors 1:

• Cardiovascular screening questions should assess for personal history of chest pain, syncope, excessive dyspnea, palpitations, or exercise intolerance 1
• Family history must identify sudden cardiac death in relatives under age 50, inherited cardiac conditions (hypertrophic cardiomyopathy, long QT syndrome, arrhythmogenic cardiomyopathy), or Marfan syndrome 1
• Previous injuries including concussions, fractures, ligament tears, and any musculoskeletal conditions that required treatment 2
• Current medications and supplements that could affect athletic performance or mask underlying conditions 3

Physical Examination Elements

Cardiovascular Assessment

The cardiovascular examination is critical for identifying conditions that increase sudden cardiac death risk 1:

• Vital signs including resting heart rate and blood pressure measurement 1
• Cardiac auscultation in both supine and standing positions to detect murmurs suggestive of hypertrophic cardiomyopathy or valvular disease 1
• Femoral pulse palpation to screen for coarctation of the aorta 1
• Physical stigmata of Marfan syndrome including arm span, high-arched palate, and joint hypermobility 1

Musculoskeletal Examination

A systematic musculoskeletal assessment identifies conditions that could lead to injury during sports participation 2:

• Spine examination evaluating for scoliosis, kyphosis, and range of motion 4
• Joint stability testing of shoulders, knees, and ankles to identify ligamentous laxity or previous injury 4
• Strength assessment of major muscle groups, particularly comparing bilateral symmetry 4
• Flexibility testing to identify muscle tightness that increases injury risk 4

Vision and Neurological Assessment

• Visual acuity testing for both near and distance vision to ensure adequate vision for sport-specific demands 4
• Neurological screening including balance testing, coordination assessment, and evaluation for any residual deficits from previous concussions 3

Sport-Specific Considerations

The examination should be tailored to the specific demands of the athlete's sport 1:

• Contact sports require more thorough evaluation of previous concussions, cervical spine stability, and organ protection (single kidney, enlarged spleen) 1
• Endurance sports necessitate careful cardiovascular screening given the higher demands on cardiac output 1
• Collision sports demand assessment of protective equipment compatibility and any conditions that increase catastrophic injury risk 1

Critical Decision Points

When Additional Testing is Required

Electrocardiography should be considered for athletes with concerning personal or family history, abnormal cardiac examination findings, or those participating in high-level competitive sports 1:

• Athletes with family history of sudden cardiac death or inherited cardiac conditions 1
• Presence of cardiac murmurs that do not clearly represent innocent flow murmurs 1
• Athletes reporting exertional chest pain, syncope, or excessive dyspnea 1

Disqualification Considerations

The examining physician has the ethical and medical obligation to restrict participation when cardiovascular risk is disproportionately high 1:

• Absolute contraindications include severe aortic stenosis, hypertrophic cardiomyopathy with high-risk features, and Eisenmenger syndrome 1
• Relative contraindications require individualized assessment with sports cardiology consultation, including mild structural heart disease and controlled arrhythmias 1

Common Pitfalls to Avoid

• Station-style examinations conducted in schools undermine the primary care relationship and fail to provide comprehensive preventive care 1
• Focusing solely on clearance rather than using the visit as an opportunity for comprehensive adolescent preventive services including mental health screening, substance abuse assessment, and sexual health counseling 1
• Inadequate cardiovascular screening by failing to ask specific questions about exertional symptoms or family history of sudden death 1
• Clearing athletes with unresolved concussion symptoms or inadequate recovery time from previous injuries 3

Integration with Ongoing Care

Sports physicals should not replace annual comprehensive preventive health visits but rather complement ongoing primary care 1:

• The sports physical provides an opportunity to reinforce the importance of the medical home 1
• Forms should incorporate preventive health assessment tools beyond just clearance for sports 1
• Athletes should maintain regular preventive care visits that address broader health concerns including mental health, nutrition, and injury prevention 1