Physicals: What You Need to Know
sports physical should be more than just getting a form for a student
By Deborah L. Squire, MD and Dennis Clements, MD, PhD, MPH
year more than seven million high school students participate in
interscholastic athletics. Almost all of these athletes are required
to undergo a physical evaluation prior to starting practice.
the vast majority of students, these physicals serve as their only
contact with the health care system, and should not be considered
as an annual inconvenience.
purpose of the sports physical is to:
medical or musculoskeletal conditions that might make participation
in a particular sport unsafe
Screen for any previously undetected health problem
Assure that any previous injuries have been adequately rehabilitated
so that the athlete is not at risk for further injury
But these visits can also provide an opportunity to educate athletes
and parents about injury prevention, conditioning, and training
appropriate for level of physical maturity, as well as healthy nutritional
approaches to sport participation.
youth are seen in mass screenings in high schools or sports medicine
clinics; such physicals should not replace an annual evaluation
by the students primary care provider.
at an annual evaluation a pediatrician can incorporate the essential
elements of the pre-sports physical into a yearly checkup. With
access to the medical record, including growth charts and previous
blood pressures, chances of identifying medical problems are significantly
addition, referrals to specialists for additional evaluation are
more easily coordinated by the primary care provider.
Timing for the sports physical is very important. Ideally, the sports
physical should be at least six to eight weeks prior to start of
practice. Too often parents forget how quickly the year has gone,
and end up scheduling a visit in urgent fashion -- She needs
this form filled out today because tryouts are tomorrow.
does not allow sufficient time for any further evaluation of a newly
found medical condition or rehabilitation of an injury. Unfortunately,
this may keep an athlete from trying out for a sport.
History Is Key
Studies show that the vast majority of significant medical conditions
identified at pre-participation evaluations are picked up through
a detailed history.
many schools use limited, outdated sports physical forms, pediatricians
have access through the American Academy of Pediatrics to a more
complete, standardized form endorsed by the majority of sports medicine
organizations in the US.
and athletes should jointly complete the history portion of any
sports form prior to arriving at the office to assure accurate responses.
Family history is especially important.
death or significant disability from cardiovascular disease in a
close relative under 50 years of age or specific knowledge of close
relatives with certain cardiovascular conditions such as hypertrophic
cardiomyopathy, long QT syndrome, or Marfans syndrome, all
require further evaluation and, in many cases, clearance by a cardiologist
before participation in sports.
A complete nutritional history, including use of supplements, is
also important. The sports physical provides an early opportunity
to identify athletes with disordered eating patterns, and those
at risk for a true eating disorder.
is where a growth chart covering several years is essential. In
addition to dietary intake information (servings of dairy, fruits,
vegetables, meat, soda), information should be obtained about the
athletes highest and lowest weight over the past 12 months,
as well as the athletes perceived ideal weight.
pediatrician should ask about use of any pathogenic weight control
behaviors, such as self-induced vomiting, use of laxatives or diet
pills, or excessive exercise. If an athlete is developing disordered
eating patterns, careful follow-up and early intervention is critical
in preventing a potential life-threatening condition.
Diet for Performance
Many athletes are interested in the best diet for athletic performance
or to gain weight. For endurance athletes, like cross country runners
or soccer players, it is important that at least 55 percent of their
total calories come from carbohydrates like breads and pasta. This
saturates their muscles with glycogen, the optimum energy source
for working muscles.
adolescents age 15 to 18 need only 0.8 gram of protein per kilogram
(2.2 pounds) of body weight each day. Some adolescent athletes who
are training intensively and trying to put on muscle mass may need
as much as 1.5 gm of protein per kilogram body weight per day.
many American children, their standard diet already fulfills this
need; rarely are expensive protein supplements needed -- or helpful.
Vegetarian athletes need to pay special attention to both their
protein and iron intake.
During the school year, most adolescents exist in a state of relative
dehydration -- they just dont drink enough throughout the
addition to the recommended eight to 10 glasses of liquid as baseline,
athletes with fluid losses in sweat may require as additional 1
to 3 liters of fluid per day. Attention to hydration is important
both to maximize athletic performance as well as decrease susceptibility
to heat illness.
for fluid intake are:
16 ounces of water 30 to 60 minutes before activity
Drink 4 to 8 ounces water every 15 to 30 minutes during activity
Drink 16 ounces (1 pint) water for every pound of weight lost after
Signs and symptoms of heat illness should be reviewed. Any athlete
exercising in the heat who experiences muscle cramps, dizziness,
nausea, severe headache, or unusual muscle weakness should stop
exercising, get in as cool a place as possible and start drinking
sports programs are now willing to reschedule or cancel practices
when conditions of extreme heat and humidity occur.
Many athletes who want or need to lose weight (body fat) do not
have the luxury of consultation with a dietitian.
athletes can follow some basic guidelines:
activity (walking, running, biking) can be increased by 30 minutes
Consume more fruits and vegetables
Water should be the primary fluid source; Drink less soda, juice,
and sports drinks
Use reduced-fat or fat-free dairy
Limit use of butter, margarine, mayonnaise, and dressings. Mustard
can be used on sandwiches and salsa on salads and baked potatoes
Portion sizes of meat can be decreased, and only served at one meal
Never try to lose more than two pounds per week
Weight training can play an important role in preventing athletic
injuries as well as improving athletic performance. Weight training
can serve to balance the strength in muscle groups around specific
joints and reduce the risk of injury; consultation with an athletic
trainer, physical therapist or sports medicine physician may help
design such programs.
the adolescent grows and develops, the design and goal of a weight
training program changes.
the pre-teen, a program using lighter weights with 12 to 15 repetitions
per set and a maximum of two sets per exercise will improve muscle
strength by causing more of the muscle fibers to respond to nerve
stimulation; a significant increase in muscle bulk will not occur
until after the athlete stops growing taller.
is important that proper technique be used by the athletes, and
that careful stretching is done before and after lifting to maintain
or improve flexibility.
It is important for the one-season athlete to maintain fitness throughout
the year by engaging in at least 30 minutes of moderately vigorous
activity five days a week.
anticipation of the start of the season, slowly advance training
loads to reduce the risk of stress fractures. Workouts should be
increased by no more than 10 percent per week.
means that fall sport athletes need to begin their conditioning
program early in the summer to be ready when school practices officially
Finally, for the female athlete, attention should be paid to menstrual
athlete who hasnt begun menstruation by age 16 or misses more
than three consecutive cycles after regular monthly cycles are established
should be evaluated for nutritional adequacies as well as other
hormonal abnormalities that can affect menstrual function. Missing
repetitive periods is not normal for an athlete.
history of stress fractures should prompt evaluation for the female
athlete triad: eating disorder, menstrual abnormalities, and
L. Squire, MD , is a physician in Dukes Childrens Primary
Care department. Dennis Clements, MD, PhD, MPH, is the chief medical
officer of Duke Children's Hospital. For more information, visit
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educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.