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PREPARTICIPATION PHYSICAL EVALUATION PHYSICAL EXAMINATION The physical examination for athletic clearance is general in some ways and specific in others. Vital signs including blood pressure resting heart rate and body-mass-index can help screen for hypertension de- conditioning and malnutrition among other relevant conditions. Cer- tain activities such as weight lifting can raise blood pressure to more than twice normal levels it is important to know where an athlete is starting from. Clearing the cardiovascular system requires specific pro- cedures in different positions. The musculoskeletal system requires a full evaluation of all critical muscles and joints from the neck to the toes of- ten in the form of an 11-point exam not routinely included in an annual wellness physical. Lab tests are considered on a case-by-case basis and are not routinely required for most athletes. CLEARANCE FOR PARTICIPATION Once your athlete is screened based on considerations from their medical history and physical exam the autho- rizing provider signs off in one of three ways 1 cleared without restrictions 2 cleared with specific restrictions or 3 cleared after evaluation or rehabilitation for a spe- cific condition. They latter two may require further testing or treatment prior to the athletes ability to return to sport. Completing your childs PPE well in advance of the start of the season will allow time to respond to any concerns hopefully in time for those two-a- days Summer is Over Is Overuse Injury Right Around the Corner by Dr. Kwabena Blankson Contributor 16-year-old Robin has had the best summer. She traveled to 3 different states with her club soccer team and won 2 tournaments School is about to start and fall soccer practice will begin shortly thereafter. 13-year-old Raymond had the laziest summer ever. He deserved a break after a grueling high school baseball season. But fall baseball looms ahead. He hasnt picked up a bat or jogged 90 feet in almost 3 months. Both of these young athletes are at risk for overuse injury. The most common musculoskeletal injuries in youth are overuse inju- ries including but not limited to Osgood-Schlatter syndrome inflamed lower knee pain patellofemoral pain syndrome kneecap irritation medial tibial stress syndrome shin splints and stress fractures. Studies have estimated the prevalence of youth overuse injury to be as high as 68.These injuries can occur secondary to anatomic issues i.e. muscle tightness foot anatomy ill-fitting equipment inappropriate footwear improper rehabilitation of previous injury biomechanical problems i.e. stride length or gait overuse Robin or from going from underuse to overuse too quickly Raymond. How can a parent identifyprevent these issues 1Talk to your teen. Seems obvious but asking about pain and fatigue is part of your job as a parent. Dont rely on the coach to ask. Some coaches will push athletes in pain a badge oftoughness waiting as a reward at the finish line. But an athlete with a little pain can become an athlete with a lot of pain if proper medical attention is not received.Teach your teen to listen to hisher body and then obey what the body says 2Take a break. Rest is a good thing. No its a great thing.The teen athlete needs adequate sleep 8 hours to rest and recuperate. Training is important. But bear in mind that studies have shown that youth who train more than 16 hours a week are at increased risk of injury requiring medical attention. Other studies report training more hours per week than their age in years is an injury risk factor. Its ok for parents to saytake a day offeven if makes them unpopular with the coach and their teen. Get a doctors note if backup is needed. Finally lets not forget another overuse injury a non-physical one. Psy- chological burnout is real.When a teen has chronic fatigue decreased sports performance and lack of enthusiasm about practice or compet- ing consider burnout. It may not be laziness. It may be a cry for help to an adult who is willing to listen. Keeping workouts fun cross-training resting one to two days per week and taking longer scheduled breaks are all strategies to keep a teen fresh focused and ready to excel in sports school and personal development.