It’s inevitable. It’s 6 pm, you’ve worked all day and you’re hustling to make dinner and get the kids’ homework done, and someone drops the bomb. “Mom, I need my sports physical by tomorrow or I can’t play XYZ!!!!” As a family medicine physician, I can’t tell you how often our office gets this panicked call from parents to get their kids in for a “pre-participation exam”, aka PPE, so they can participate in the activities they want. And all for what? Why is it even important?
The main purpose of PPE’s are really to help uncover any conditions that could predispose children and adolescents to injury and to help counsel kids and families on ways to avoid injury while participating in their favorite activities. If you’ve had to take your child in for one of these, you know that part of it is a questionnaire about family history and symptoms your child may have when exercising. There are certain hereditary medical conditions that can put athletes at risk of sudden cardiac death that we screen for with these questions and examination- Hypertrophic obstructive cardiomyopathy (HOCM) is one of them, and is a condition where the walls of the heart thicken over time and can cause problems with the blood flow and ultimately electrical conduction of the heart. Marfan’s syndrome is another, and is a hereditary problem with the connective tissues of the body, which can cause many issues but most concerning can be problems with the major vessel to the heart- the aorta, and the heart valves. It’s important to tell your doctor if there is a family history of these, or of sudden, possibly unexplained cardiac arrest before the age of 50 in any family members, as this can provide clues that help us look further into the potential for these conditions on our physical examination and history.
A history of any significant bone, joint, or muscle injuries is important to discuss as well. I frequently encounter patients/parents who are afraid we won’t “clear” their athlete for participation if they report these, but it really helps us, as well as the coaches and trainers working with the child, to help with techniques and tools to prevent further or worsening injuries.
Another very important issue to discuss is a history of concussions. The more we learn, the more we know about how seriously repeated concussions can impact someone long term, so continued participation is worth the talk with your doctor about the benefits and risks.
Hopefully, this helps shed some light on why PPEs are required and if nothing else, it’s a good way to make sure your child is getting a yearly check-up too!