Chapter 6 The Pre-Participation Physical Examination
I. The Pre-Participation Physical Examination (PPE)
A. Over the years, the PPE has gone from a cursory examination to a comprehensive assessment of
an athlete’s health and ability to perform a sport at the highest level.
B. The primary goal of the PPE is to help maintain the health and safety of the athlete. Other goals
include:
1. Determination of the athlete’s general health.
2. Disclosure of defects that may limit participation.
3. Detection of conditions that may predispose the athlete to injury.
4. Determination of the optimal level of performance.
5. Classification of the athlete according to individual requirements.
6. Fulfillment of legal and insurance requirements.
7. Evaluation of the level of maturation of younger athletes.
8. Evaluation of fitness and performance for possible improvement prior to participation.
9. Provision of opportunities to compete for students with specific health issues that may preclude
a blanket approval.
10. Provisions of opportunity to counsel youths regarding personal health issues.
11. Entry of the athlete into the local sports-medicine environment, thereby establishing a
doctor-patient relationship.
C. The PPE should take place at least 6 weeks before the beginning of a sports season, so if
musculoskeletal problems are found, there will be time for rehabilitation and strehgthening
of the areas of concern.
D. The station-based pre-participation physical examination
1. Many athletes can be examined in the same setting, often for lower cost.
2. The athlete is examined by sports-medicine specialists.
3. Stations include medical history and basic measurements of blood pressure, height, weight,
and eyesight.
4. Difficulties with the station-based PPE include finding volunteer medical specialists and a
location for the examination.
E. The office-based pre-participation physical examination
1. The family physician, the usual evaluator, has access to the complete medical history of the
athlete.
2. The setting is quiet and allows for the discussion of multiple health issues.
3. Immunization history is available and can easily be updated.
II. Components of the Pre-Participation Physical Examination
A. A complete medical history will identify approximately 75% of all problems affecting athletes.
The recommended baseline history includes medical conditions and disease, surgeries,
hospitalizations, medications, allergies, immunization status, menstrual history, pulmonary
status, neurological status, musculoskeletal status, and injuries or illness since the last exam.
B. The recommended components of the PPE include: height, weight, pulse, blood pressure, eyes,
ears/nose/throat, heart, abdomen, genitalia (males only), skin, and musculoskeletal.
III. Clearance
A. Clearance, the term used for physician permission for athletic participation, is divided into 3
categories.
1. Unrestricted clearance.
2. Clearance after completion of further evaluation or rehabilitation.
3. No clearance for certain types of sports, or for all sports.
B. When an abnormality is found, the physician must consider several questions.
1. Does the problem place the athlete at risk of injury?
2. Is another participant placed at risk of injury because of the problem?
3. Can the athlete safely participate with treatment?
4. Can limited participation be allowed while treatment is being completed.
5. If clearance is denied only for certain sports or sports categories, in what activities can the
athlete safely participate?
C. Sports are classified based on degree or level of contact and strenuousness, which may result in
clearance for some but not all sports.
IV. Recordkeeping
A. Physical forms are completed and signed by the physician.
B. Information form the PPE is available to coaches, trainers, and the athletic director.
C. All information contained on the PPE, is confidential and must be treated with the strictest
security; forms are to be stored in the certified athletic trainer’s or athletic director’s office
under lock and key.
D. All PPE forms should be kept and stored for a minimum of 7 years after the athlete graduates
or leaves the school.