Saturday, March 31, 2012

Pre-participation Sports Exam

We are nearing the time of year we have kids lining up to do sports physicals.  When asked why they are in the office, many simply say: "to get the form signed".  I suspect they do not realize the importance of WHY the form must be signed.  I view the physical as a time to reinforce good habits: eating well, sleeping adequately, exercising, and making overall good choices.  

We review risks that might cause health problems with a sport, such as family history of heart problems or sudden death, as well as a personal history of passing out, chest pain, or concussions.

I have had a handful of patients that knowingly or unknowingly leave out pertinent information on these forms.  My two biggest areas of concern are sudden cardiac death and concussion. With both of these the exam might be normal, but the kids are not safe to play and can be cleared for play medically without the examiner knowing a complete history.

If you do not know a family history, as in the case of adoption, please write that on the form.

Please do not omit a previous concussion or injury.  

Please do not "forget" that you get dizzy with exercise. 

These are important! These questions are often the only clue that there might be a problem, since the physical exam is often NORMAL even with life-threatening conditions.  

My son plays hockey. There has been a great awareness in the hockey community about concussions. His club covered the cost of ImPACT testing for all players before the season started. This involves baseline testing to see what each player can do before a head injury to have a comparison. There is high hopes of this testing allowing better return to play guidelines, but its reliability has been questioned by some experts. 
Did I take my son for testing? You bet!  

Sudden Cardiac Death & Concussion Comments

  • Sudden cardiac death is caused by over 20 different problems but remains overall rare, between 10-25 cases per year of athletes under 30 years old. Another way to look at it:  6-15 SCD per 1,000,000 athletes per year.  If you have a family history of SCD or a sudden death from heart disease under age 50, or if you have ever passed out/blacked out during exercise or get chest pain with activity, you might be at increased risk and a further evaluation should be done. Bring these up at your exam!
  • 90% of SCD occurs during or shortly after exertion or exercise. 
  • Risk of SCD increases around 17-23 years of age, and college athletes have about twice the risk as high school athletes. 
  • Cardiomyopathies (damaged heart muscle), anatomic abnormalities, myocarditis (infection of the heart muscle), and arrhythmias (rhythm changes) can all cause SCD in young athletes. Often the exam is normal and the only clue to a problem is the family history or the personal history of pain or dizziness/passing out with exercise. Talk about these at your exam!
  • Concussions can happen from bumps, falls, or sudden movements of the head. Even mild concussions need to heal completely before resuming any at - risk activity.  Recognizing the risk and stopping play are important. Symptoms of concussion can be found here. Do not return to play if you suspect you have a concussion! It can be fatal or lead to permanent brain injury!
  • Both Kansas and Missouri have relatively new concussion rules. This is important because it involves education of the athletes and their families. We are seeing an increased number of kids with concussions due to the increased awareness. Next step: better prevention and treatment...
  • Kansas has a required form to be completed before sports at the high school level here.  By Kansas law, the physical must be done AFTER May 1st, but BEFORE the season starts, so please plan accordingly.
  • Missouri's form is here
Some quick well visit tips:

  • Yearly well visits are recommended for all children over 3 years of age to review growth, development, safety, nutrition, and more. (They are recommended more frequently prior to that!)
  • Most insurance companies only cover ONE well visit per year after 3 years of age. Sports physicals are not considered separately, so if you need the form signed for your high school athlete, plan ahead.
  • Well visits are a time to catch up on vaccines... please don't tell your child "no shots" will be done. The vaccine schedule changes yearly, and we might need to give vaccines!
  • Visit our website ahead of time to consider questions that should be answered and topics that will be covered.
  • To streamline the visit, bring all forms needed to your appointment pre-filled out.  This really helps, trust me!
  • Register each of your children on our website to get updates and announcements as well as an email reminder before your visit.

Please request an appointment on line or call (913-888-4567- leave a message on line 1 if after hours) to schedule your child's annual check up for the summer. Spots fill quickly!

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