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Preparticipation Physical Examinations — NOT the Same as Annual Wellness Checkups

‘Tis the season when athletes must have turned in their “physical” forms for fall athletics, lest they be turned away from the joy of  “two-a-days” and the coming football/track/cheer/etc. season practices. What makes these checkups different from other checkups?

by Dr. Susan Sugerman | Contributor

The primary goal of preparticipation physical examination (PPE) for athletic clearance is to screen athletes for life-threatening or disabling conditions and for conditions that may predispose to injury or illness in the course of physical activity. A PPE is NOT considered a substitute for an annual comprehensive medical and psychosocial-behavioral wellness exam as recommended by the American Academy of Pediatrics (and often covered as a wellness benefit by major health plans).

PPEs are often conducted in cooperation with your child’s school athletic department as “station examinations” where athletes go from station to station in public areas of a school building or gymnasium to have their medical history reviewed and a physical exam completed, one part at a time.  When done privately at your child’s primary care physician’s office, the PPE may be completed in conjunction with or separate from an annual wellness exam (in accordance with individual office policies). While going to your usual provider for the PPE can be faster and more holistic, the more routinized, station-based approach may be more sensitive to picking up subtle findings.

In Texas, public schools (and often many private schools) use the Texas University Interscholastic League Preparticipation Physical Evaluation form which can be printed from the internet in advance of your child’s appointment.



An athlete’s medical history is the most sensitive predictor of an athlete’s risk during training and competition.  Screening medical history can help your provider determine if any additional testing is needed prior to clearance for participation and includes description of:

• Current and past injuries

• Concussion symptoms

• Cardiac questions

• Medical problems (chronic as well as recent illnesses)

• Menstrual history

• Weight changes

• Medications



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, deconditioning and malnutrition, among other relevant conditions. (Certain 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 procedures in different positions. The musculoskeletal system requires a full evaluation of all critical muscles and joints from the neck to the toes, often 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.


Once your athlete is screened based on considerations from their medical history and physical exam, the authorizing 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 specific condition. They latter two may require further testing or treatment prior to the athlete’s ability to return to sport.  Completing your child’s 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!

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