Sports Physical

Sports physicals? In Urgent care? When I first began practicing, I didn’t think I would be doing a physical exam in urgent care. That’s what Family Med is for, right? Boy was I wrong! Sports physicals are actually very common in urgent care—some urgent care clinics have set up a partnership with local high schools. Also—cue those procrastinators who come in 5 min before closing because the form is due tomorrow!
 
Below you’ll find some few tips and tricks from Urgent Care Boot Camp by HippoEd. I’ve learned a ton about what I can improve on my own sports physicals to ensure the safety of my student athletes. *FYI—I’ve stayed away from mentioning Hypertrophic cardiomyopathy as this is often drilled into us & always the main topic of sports physical—rightfully so but thought I'd highlight other components!

As always, check out Urgent Care Boot Camp by HippoEd--they've been amazing partners in this blog series of tips/tricks and giving you insight into the course: here

Forms
Now, everyone knows student athletes bring in their own forms and requirements, however check out the "gold standard" pre-performance history and physical form by American Academy of Pediatrics (AAP). You cannot go wrong with these forms-links below:

• History form by AAP
• Physical form by AAP

 
Key medical history components: 

• Pre-existing medical problems
• Previous injuries
  • Musculoskeletal—the biggest predictor of a musculoskeletal injury is a previous injury
  • Concussion
  • Head and neck injuries
• Medications and supplements—a great way to ask is “Do you take anything to affect your health or performance?”
• Cardiac history—any chest pain, shortness of breath, palpitations, syncope/presyncope during or after exercise?
• Weight perceptions & menstrual history—key information on eating disorders/ female triad

 
 
Common abnormalities:Vision & Blood Pressure
 
Vision

• What is considered abnormal? When to restrict?

• Less than half correct at 20/40 line in either eye OR
• Two line difference between eyes even within the passing range (e.g. 20/20 and 20/30)
• Consider restricting athletes with abnormal vision until further evaluation by Optometrist/Ophthalmologist

• Functionally one-eyed—best corrected visual acuity in one eye is greater than 20/40
  • These athletes must wear mandatory protective eyewear & cannot participate in sports where goggles cannot be used (e.g. wrestling, boxing) & should not be cleared to play

Blood Pressure: 

• Ensure correct cuff, repeat reading (manual if needed)
• Mild Moderate HTN (Stage 1)—refer to PCP. No restriction—unless other concerning physical exam findings
• Severe HTN (stage 2)—95th% + 12mm Hg OR ≥ 140/90. Restrict from high static sports until controlled
• Check MDCalc for quick pediatric HTN guidelines & plug in numbers to determine which stage: here

 
 
Physical exam pearls
 
CV exam

• Palpate upper and lower extremity pulses (check for coarctation of Aorta)
• Auscultate—Must do in two positions! Seated and supine
• Listen for rate, rhythm, murmur—restrict until cleared by Cardiology if abnormality or concern

 
 
Should I restrict these athletes?

• Concussion: Ensure has followed return to play guidelines
• Seizure disorder: if poorly controlled—no archery, water sports, gymnastics
• Sickle cell trait: no limitation
• Sickle cell disease: high exertion sports contraindicated
• Solitary kidney: no limitation
• Solitary ovary or testicle: no limitation. Solitary testicle must use protective cup for contact sports

Did you learn something new? Check out next week's installment for a summary on common infections & antibiotics!