The preparticipation sports examination for high school and college athletes

A Review of the Anthropometric Characteristics, Grading and Dispensation of Junior and Youth Rugby Union Players in Australia

The grading of Australian junior and youth rugby union players has received substantial media attention in recent years. Media reports have focussed on size mismatches observed between players, especially players with Polynesian heritage, and the concerned parents who fear for the safety of their child owing to perceived mismatches. Although such concerns are well meaning, few media reports recognise the need for substantial evidence to determine the best grading system for junior and youth rugby union players. The current study reviewed relevant literature pertinent to the grading and dispensation of junior and youth rugby union players. Using primary and secondary search strategies, a total of 33 articles reporting the anthropometric characteristics of junior and youth rugby players were identified. Anthropometric data from the literature were compared with normative population data and currently used dispensation criteria. Junior and youth rugby players were found to be taller and heavier than normative population data. Current dispensation criteria, in terms of body mass, were found to vary and it is suggested that criteria be revised and standardised across rugby unions throughout Australia. Although it is acknowledged that other factors are important for grading players, anthropometric characteristics should be considered as potential dispensation criteria to supplement current age-based grading for junior and youth rugby union players. Measuring the body mass and stature of each junior player upon pre-season registration is suggested, which would provide data to establish valid dispensation criteria for the following season.

National Athletic Trainers' Association position statement: Preparticipation physical examinations and disqualifying conditions

OBJECTIVE

To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions.

BACKGROUND

Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties.

RECOMMENDATIONS

Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.

Variation in physical development in schoolboy rugby players: can maturity testing reduce mismatch?

OBJECTIVES

This study set out to pursue means of reducing mismatch in schoolboy rugby players. The primary objective was to determine whether application of previously reported thresholds of height and grip strength could be used to distinguish those 15-year-old boys appropriate to play under-18 school rugby from their peers. A secondary objective was to obtain normative data for height, weight and grip strength and to assess the variation within that data of current schoolboy rugby players.

DESIGN

Cross-sectional cohort study.

SETTING

3 Scottish schools and 'Regional Assessment Centres' organised by the Scottish Rugby Union.

PARTICIPANTS

472 rugby playing youths aged 15 years (Regional Assessment Centres) and 382 schoolboys aged between 12 and 18 years (three schools).

OUTCOME MEASURES

Height, weight and grip strength.

RESULTS

97% of 15-year-olds achieved the height and grip strength thresholds based on previous reported values. Larger mean values and wide variation of height, weight and grip strength were recorded in the schoolboy cohort. However, using the mean values of the cohort of 17-year-olds as a new threshold, only 7.7% of 15-year-olds would pass these thresholds.

CONCLUSIONS

Large morphological variation was observed in schoolboy rugby players of the same age. Physical maturity tests described in earlier literature as pre-participation screening for contact sports were not applicable to current day 15-year-old rugby players. New criteria were measured and found to be better at identifying those 15-year-old players who had sufficient physical development to play senior school rugby.

Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

The 1996 American Heart Association consensus panel recommendations stated that pre-participation cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group on Myocardial and Pericardial diseases of the European Society of Cardiology, which comprises cardiovascular specialists and other physicians from different European countries with extensive clinical experience with young competitive athletes, as well as with pathological substrates of sudden death. The document takes note of the 25-year Italian experience on systematic pre-participation screening of competitive athletes and focuses on relevant issues, mostly regarding the relative risk, causes, and prevalence of sudden death in athletes; the efficacy, feasibility, and cost-effectiveness of population-based pre-participation cardiovascular screening; the key role of 12-lead ECG for identification of cardiovascular diseases such as cardiomyopathies and channelopathies at risk of sudden death during sports; and the potential of preventing fatal events. The main purpose of the consensus document is to reinforce the principle of the need for pre-participation medical clearance of all young athletes involved in organized sports programmes, on the basis of (i) the proven efficacy of systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy-the leading cause of sports-related sudden death-and to prevent athletic field fatalities; (ii) the potential screening ability in detecting other lethal cardiovascular diseases presenting with ECG abnormalities. The consensus document recommends the implementation of a common European screening protocol essentially based on 12-lead ECG.

Optimizing the collegiate preparticipation physical evaluation

BACKGROUND

Today's collegiate student athlete is a highly diverse individual and as such is at higher risk for many health problems both on and off the field.

OBJECTIVE

To determine if a preparticipation evaluation (PPE) can be optimized to help the collegiate team physician and athletic trainer assess both current and past health issues of student athletes.

DATA SOURCES

Utilizing MEDLINE and other medical literature database search engines, the authors conducted detailed literature searches on this subject. Key words used in these searches included preparticipation physical evaluation, collegiate, athlete, cardiovascular, preventive healthcare, high risk, alcohol, tobacco, sexually transmitted disease, motor vehicle accident, adolescent, and female.

METHODS

Approximately 35 articles were selected for review for this report. Authors reviewed articles within their particular area of content responsibility. Personal communications with several sports medicine experts were also conducted.

RESULTS

Twenty-three articles were selected for inclusion, in addition to information obtained from the American College of Sports Medicine and National Collegiate Athletic Association (NCAA) Web sites. Utilizing these sources, as well as guidance and suggestions from other sports medicine physicians, the authors determined that the NCAA-mandated PPE should deliver an overview of the athlete's entire health status.

CONCLUSIONS

As detailed in this report, it is recommended that the NCAA PPE serve as a tool in tracking and assessing both current and past health issues of student athletes. These health issues would include (1) on-field health concerns such as cardiac and musculoskeletal conditions, (2) off-field health concerns (that may adversely impact on-field performance) such as sexual activity and substance abuse, and (3) health issues unique to the female student athlete, such as eating habits, nutritional record, and menstrual history. Primary care physicians should be involved in all PPEs as they have the necessary expertise to recognize potential problems in these areas.

Preparticipation physical examination: selected issues for the female athlete

OBJECTIVE

The purpose of this article was to examine the preparticipation examination (PPE) with regard to the female athlete. Ever-increasing participation of women in competitive sport has created a requirement for more gender-specific sport medicine knowledge. In particular, physicians and other health care professionals should be aware of the triad of disordered eating, amenorrhea (and other menstrual dysfunction), and osteoporosis (or altered bone mineral density) collectively described as the female athlete triad. Suggested additions to the standard PPE may help identify athletes at risk. DATA SOURCES/METHODS: A literature search was carried out using MEDLINE for years 1966 to 2003, with keywords female athlete triad, PPE, female athlete, eating disorders, amenorrhea, and osteoporosis. Further studies were identified through reference lists.

RESULTS

Better recognition and prevention of these problems is essential. At present, there is little evidence-based information available to guide the practicing clinician in this area. It remains to be determined which methods are the most sensitive and specific for detecting the triad disorders, as well as the most economical and time-efficient.

CONCLUSIONS

The PPE offers an excellent opportunity to screen for these entities, as well to initiate early treatment. It is recommended that a standardized form (or part of the form) be developed for the female athlete.

Medical aspects of sports: epidemiology of injuries, preparticipation physical examination, and drugs in sports

The epidemiology of sports injuries helps identify the necessity for medical event coverage, injury risk factors, and potential prevention strategies. The preparticipation examination provides an opportunity for the team physician to identify athletes at risk of injury, to teach injury prevention, and to address athlete wellness. Knowledge of performance-enhancing drugs, nutritional supplements,and banned and legal medications is critical in caring for athletes.

Screening for sexually transmitted diseases during preparticipation sports examination of high school adolescents

In an urban school district, 636 students in grades 9-12 were tested for Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction assays using specimens collected for routine urinalyses during sports physical examinations. Chlamydia and gonorrhea prevalences were 2.8% and 0.7% among males, and 6.5% and 2.0% among females, respectively. Among athletes infected with either sexually transmitted disease (STD), 93.1% reported no symptoms, and treatment was documented for 75.9%. Sports physicals offered a unique opportunity to screen and treat adolescents for STDs and to provide STD-prevention counseling.

Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction

OBJECTIVE

To determine if a physician-administered physical examination and screening questionnaire accurately detects exercise-induced bronchoconstriction (EIB) in adolescent athletes.

STUDY DESIGN

Cross-sectional study of 256 adolescents participating in organized sports from 3 suburban high schools. The number of persons screened positive for EIB by physical examination and questionnaire was compared with the number of persons with EIB diagnosed by a "gold standard" test that consisted of a 7-minute exercise challenge followed by serial spirometry.

RESULTS

We diagnosed EIB in 9.4% of adolescent athletes. The screening history identified persons with symptoms or a previous diagnosis suggestive of EIB in 39.5% of the participants, but only 12.9% of these persons actually had EIB. Among adolescents with a negative review of symptoms of asthma or EIB, 7.8% had EIB. Among adolescents with no previous diagnosis of asthma, allergic rhinitis, or EIB, 7.2% had EIB diagnosed by exercise challenge. Persons who screened negative on all questions about symptoms or history of asthma, EIB, and allergic rhinitis accounted for 45.8% of the adolescents with EIB.

CONCLUSIONS

EIB occurs frequently in adolescent athletes, and screening by physical examination and medical history does not accurately detect it.