Screening in Sport: Difference between revisions

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* neurological and psychiatric disorders in 0.4%.<ref name=":2" />         
* neurological and psychiatric disorders in 0.4%.<ref name=":2" />         


'''Aim Of PPE'''<ref name="Screening of Athletes" />
'''Aim Of PPE'''<ref name="Screening of Athletes">Brukner P, White S, Shawdon A, Holzer K. Screening of athletes: Australian experience. Clinical Journal of Sport Medicine. 2004 May 1;14(3):169-77.</ref>
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#Ensure Optimal Medical Health (asthma, diabetes, menstrual,&nbsp;depression)
#Ensure Optimal Medical Health (asthma, diabetes, menstrual,&nbsp;depression)
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== Screening Protocol  ==
== Screening Protocol  ==
=== Medical Screening ===
=== Medical Screening ===
'''1.History''' 


to identify any underlying medical conditions<ref name="Utilization and implementation of sports medical screening examinations">Leyk D, Rüther T, Wunderlich M, Sievert AP, Erley OM, Löllgen H. Utilization and implementation of sports medical screening examinations. stress. 2008 Sep;11:14.</ref>. It covers many areas like musculoskeletal problems, asthma , hematologic disorders, exercise-induced bronchospasm, concussion, neurologic disorders and more importantly any information about cardiac problems or sudden death . <ref name=":3" /> For athletes younger than 18 a parent or guardian should attend the evaluation to give detailed history about the child.<ref name=":3" />
===== '''1.History''' =====
To identify any underlying medical conditions<ref name="Utilization and implementation of sports medical screening examinations">Leyk D, Rüther T, Wunderlich M, Sievert AP, Erley OM, Löllgen H. Utilization and implementation of sports medical screening examinations. stress. 2008 Sep;11:14.</ref>. It covers many areas like musculoskeletal problems, asthma , hematologic disorders, exercise-induced bronchospasm, concussion, neurologic disorders and more importantly any information about cardiac problems or sudden death . <ref name=":3" /> For athletes younger than 18 a parent or guardian should attend the evaluation to give detailed history about the child.<ref name=":3" />


'''2.Physical Examination'''
===== '''2.Physical Examination''' =====
A limited general physical examination is recommended<ref name=":6">Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association position statement: preparticipation physical examinations and disqualifying conditions. Journal of Athletic Training. 2014;49(1):102-20.</ref>. Assessment of ( vital signs, vision, hearing, and the cardiovascular and musculoskeletal systems)<ref name=":3" />The most common abnormal PPE findings are elevated blood pressure and vision problems.<ref name=":3" />Further examination should be based on issues uncovered during the history.<ref name=":6" />


assessment of vital signs, vision, hearing, and the cardiovascular and musculoskeletal systems.<ref name=":3" />The most common abnormal PPE findings are elevated blood pressure and vision problems.<ref name=":3" />
===== ''3.Cardiovascular Screening'' =====


A good estimate of the acceptance and use of sports medical screening investigations can be obtained with the current PACE study (PACE: Performance, Age, Competition, Exercise), which has already analysed the marathon and half-marathon performances of more than 300,000 sportsmen aged between 20 and 80 (18). As part of this project, a scaled online questionnaire has been developed and translated into six languages. This puts questions about performance, training planning, habits and sports medical screening examinations. The present study has evaluated information from about 10,000 long distance runners about the use and performance of sports medical screening examinations.<ref name="Utilization and implementation of sports medical screening examinations" />
* Specific questions regarding cardiovascular risk factors should be asked.<ref name=":6" /> 
 
* Initially auscultation of the heart should be performed with the patient in  various positions ( standing,supine, squat to stand & valsalva)<ref name=":6" />
==== Pre-participation Screening  ====
* It is not a demand to perform specific cardiac testing  like (electrocardiography [ECG], echocardiography, exercise stress testing) unless  patient history or clinical examination suggests this.<ref name=":6" />  
 
==== Cardiovascular Screening  ====


The increasing awareness that automated external defibrillators (AEDs) may not always prove successful in the secondary prevention of sudden death for athletes with cardiovascular disease underscores the importance of pre-participation screening for the prospective identification of at-risk athletes and the prophylactic prevention of cardiac events during sports by selective disqualification.<ref name="Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism">Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM, Krauss MD. Recommendations and Sonsiderations related to preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update a Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27;115(12):1643-55.</ref>
The increasing awareness that automated external defibrillators (AEDs) may not always prove successful in the secondary prevention of sudden death for athletes with cardiovascular disease underscores the importance of pre-participation screening for the prospective identification of at-risk athletes and the prophylactic prevention of cardiac events during sports by selective disqualification.<ref name="Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism">Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM, Krauss MD. Recommendations and Sonsiderations related to preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update a Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27;115(12):1643-55.</ref>
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=== Musculoskeletal Screening ===
===== 4.Musculoskeletal Screening =====


Time constraints do not allow a full comprehensive assessment&nbsp;of all joints and muscles. Therefore, the aim of musculoskeletal&nbsp;screening is to :  
Time constraints do not allow a full comprehensive assessment&nbsp;of all joints and muscles. Therefore, the aim of musculoskeletal&nbsp;screening is to :  
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* Assess the recovery from any previous&nbsp;injury and to assess the presence of proven (very few) or suspected&nbsp;risk factors for future injury. Athletes involved in sports&nbsp;associated with high risk of specific joint or muscle injuries,&nbsp;such as, swimmers’ shoulders and pitchers’ elbows, should&nbsp;have specific assessments performed on these areas.<ref name="Screening of Athletes" />
* Assess the recovery from any previous&nbsp;injury and to assess the presence of proven (very few) or suspected&nbsp;risk factors for future injury. Athletes involved in sports&nbsp;associated with high risk of specific joint or muscle injuries,&nbsp;such as, swimmers’ shoulders and pitchers’ elbows, should&nbsp;have specific assessments performed on these areas.<ref name="Screening of Athletes" />


'''MSK Screening''' includes the assessment of  range of motion, muscle asymmetry, muscle strength, and to identify significant injuries.<ref name=":5">Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45.</ref>  
* '''MSK Screening''' includes the assessment of  range of motion, muscle asymmetry, muscle strength, and to identify significant injuries.<ref name=":5">Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45.</ref>
 
A full injury history should be taken, and any deficits remaining post-injury should be fully assessed with a view to&nbsp;designing a rehabilitation program to restore full function<ref name=":5" />.


Frequently,&nbsp;athletes will have resumed full athletic participation&nbsp;following a significant injury and yet still have considerable&nbsp;limitations in strength, range of movement, [[proprioception]],and so forth.The questionnaire asks the athlete to describe the nature&nbsp;and date of any previous injury and to list any residual problems. Athletes are asked to describe the nature, date, and symptoms&nbsp;of any current injury.<ref name="Screening of Athletes">Brukner P, White S, Shawdon A, Holzer K. Screening of athletes: Australian experience. Clinical Journal of Sport Medicine. 2004 May 1;14(3):169-77.</ref><br>
* A full injury history should be taken, and any deficits remaining post-injury should be fully assessed with a view to&nbsp;designing a rehabilitation program to restore full function<ref name=":5" />.  


=== Performance Screening ===
===== 5.Performance Screening =====


Athletes require a strong foundation in a diverse range of athletic qualities in order to tolerate the progressively advanced training loads and competitive demands of their chosen sport. The improvement of foundation movements that underpin these athletic qualities early in the athletes' development pathway is one of the key recommendations of long term athlete development models.<ref name="p5">Pre participation Screening - The Sports Physical Therapy Perspective. LRBarbara Sanders, PT, PhD, SCS, FAPTA,1 Turner A. Blackburn, PT, MEd, ATC,2 and Brenda Boucher, PT, PhD, CHT, OCS, FAAOMPT2</ref>&nbsp;<ref name="Escardio">European Society of Cardiology. How to Conduct Pre-Participation Screening in Athletes. http://www.escardio.org/The-ESC/Communities/European-Association-for-Cardiovascular-Prevention-&amp;-Rehabilitation-(EACPR)/News/How-to-conduct-pre-participation-screening-in-athletes (accessed 8 May 2016).</ref>&nbsp;The foundation movements typically involve variations of squatting, lunging, jumping, pushing, pulling and bracing.3‐6 Typically these movements are objectively assessed using some form of functional movement assessment criteria in order to screen athletes for dysfunctional movement patterns in an attempt to alleviate injury risk through addressing incorrect movement patterns.7 The [[Functional Movement Screen (FMS)|Functional Movement Scale (FMS™)]] by Cook is by far the most popular screening tool used to provide an objective assessment of movement in sports performance research and is typically synonymous with the term “Functional Movement".<ref name="p5" />  
Athletes require a strong foundation in a diverse range of athletic qualities in order to tolerate the progressively advanced training loads and competitive demands of their chosen sport. The improvement of foundation movements that underpin these athletic qualities early in the athletes' development pathway is one of the key recommendations of long term athlete development models.<ref name="p5">Pre participation Screening - The Sports Physical Therapy Perspective. LRBarbara Sanders, PT, PhD, SCS, FAPTA,1 Turner A. Blackburn, PT, MEd, ATC,2 and Brenda Boucher, PT, PhD, CHT, OCS, FAAOMPT2</ref>&nbsp;<ref name="Escardio">European Society of Cardiology. How to Conduct Pre-Participation Screening in Athletes. http://www.escardio.org/The-ESC/Communities/European-Association-for-Cardiovascular-Prevention-&amp;-Rehabilitation-(EACPR)/News/How-to-conduct-pre-participation-screening-in-athletes (accessed 8 May 2016).</ref>&nbsp;The foundation movements typically involve variations of squatting, lunging, jumping, pushing, pulling and bracing.3‐6 Typically these movements are objectively assessed using some form of functional movement assessment criteria in order to screen athletes for dysfunctional movement patterns in an attempt to alleviate injury risk through addressing incorrect movement patterns.7 The [[Functional Movement Screen (FMS)|Functional Movement Scale (FMS™)]] by Cook is by far the most popular screening tool used to provide an objective assessment of movement in sports performance research and is typically synonymous with the term “Functional Movement".<ref name="p5" />  

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Introduction[edit | edit source]

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Before participation in any sports event, it is recommended that any professional or amateur athletes to take part in preparticipation physical evaluation ( PPE)[1]. The main goal of this screening is to maximize the health of athletes and their safety[2]. Some studies suggested that preparticipation evaluation (PPE) could not prevent the morbidity and mortality during sports[3][4], however, it could help in detecting serious conditions and provide strategies to prevent injuries.[5][6][7]

Sports participation and athletics can be a positive experience for all age groups - by boosting fitness, enhancing self‐esteem, enhancing coordination and providing an opportunity for creative cooperation and competition[8]. Approximately 30 million athletes younger than 18 years and another 3 million athletes with special needs receive medical clearance to participate in sports every year. A station based PPE is a strategy used to decrease the cost and the time of PPE . By using this approach the athlete cycles through a series of evaluation stations to perform a specific aspect of screening. Separate stations may address vital signs, visual acuity screening, medical history and physical examination[6], orthopedic history and physical examination, updating immunizations, and finally meeting with a clinician to review all of the accumulated data and make a decision regarding clearance.[5]

Importance Of Screening[edit | edit source]

Skyttis athletics tracks.jpg

The International Olympic Committee (IOC) introduced the Youth Olympic Games (YOG) in 2007 to promote sports participation among young children . The IOC Consensus Statement was published in 2009 to highlight the value of PPE. A study [7]conducted by Adami, et al 2019 to assess the efficacy of a comprehensive protocol for illness and injury detection, tailored for adolescent athletes participating in Summer or Winter Youth Olympic Games (YOG) . The study results showed that 12% of the participants in PPE diagnosed with pathological conditions warranting treatment [7]. These conditions could be divided in to :

  • 4,5 % cardiovascular abnormalities
  • 4,5% pulmonary disorders
  • 2% infections
  • neurological and psychiatric disorders in 0.4%.[7]

Aim Of PPE[9]

  2. Ensure Optimal Medical Health (asthma, diabetes, menstrual, depression)
  3. Ensure Optimal Musculoskeletal Health.
  4. Optimize Performance (Nutrition, Psychology, Biomechanics).
  5. Prevent Injury.
  6. Review Medications and Vaccinations.[9]
  7. Collect Baseline Data (Blood Tests, Neuropsychological Testing in Contact Sports).
  8. Develop Professional Relationship with Athlete.
  9. Educate.

Key Recommendations For Practice[edit | edit source]

  1. PPE should occur around 6 weeks before activity to allow for further evaluation or treatment if needed.
  2. History taking is essential especially about (exertional symptoms -a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death.[10]
  3. Athletes with sustained systolic blood pressure of less than 160 mm Hg and diastolic blood pressure of less than 100 mm Hg should not be restricted from playing sports.
  4. Athletes with well-controlled asthma who are asymptomatic at rest and with exertion can be safely cleared to play sports.
  5. Screening blood and urine tests are not recommended for asymptomatic athletes.
  6. Comprehensive PPEs are recommended every two to three years with annual focused history updates in intervening years.[11]

Screening Protocol[edit | edit source]

Medical Screening[edit | edit source]

1.History[edit | edit source]

To identify any underlying medical conditions[12]. It covers many areas like musculoskeletal problems, asthma , hematologic disorders, exercise-induced bronchospasm, concussion, neurologic disorders and more importantly any information about cardiac problems or sudden death . [1] For athletes younger than 18 a parent or guardian should attend the evaluation to give detailed history about the child.[1]

2.Physical Examination[edit | edit source]

A limited general physical examination is recommended[13]. Assessment of ( vital signs, vision, hearing, and the cardiovascular and musculoskeletal systems)[1]The most common abnormal PPE findings are elevated blood pressure and vision problems.[1]Further examination should be based on issues uncovered during the history.[13]

3.Cardiovascular Screening[edit | edit source]
  • Specific questions regarding cardiovascular risk factors should be asked.[13]
  • Initially auscultation of the heart should be performed with the patient in various positions ( standing,supine, squat to stand & valsalva)[13]
  • It is not a demand to perform specific cardiac testing like (electrocardiography [ECG], echocardiography, exercise stress testing) unless patient history or clinical examination suggests this.[13]

The increasing awareness that automated external defibrillators (AEDs) may not always prove successful in the secondary prevention of sudden death for athletes with cardiovascular disease underscores the importance of pre-participation screening for the prospective identification of at-risk athletes and the prophylactic prevention of cardiac events during sports by selective disqualification.[14]

Pre-participation Screening

Cardiac Screening

4.Musculoskeletal Screening[edit | edit source]

Time constraints do not allow a full comprehensive assessment of all joints and muscles. Therefore, the aim of musculoskeletal screening is to :

  • Identify sports risk factors among participants especially the young ones .[3]
  • Assess the recovery from any previous injury and to assess the presence of proven (very few) or suspected risk factors for future injury. Athletes involved in sports associated with high risk of specific joint or muscle injuries, such as, swimmers’ shoulders and pitchers’ elbows, should have specific assessments performed on these areas.[9]
  • MSK Screening includes the assessment of range of motion, muscle asymmetry, muscle strength, and to identify significant injuries.[15]
  • A full injury history should be taken, and any deficits remaining post-injury should be fully assessed with a view to designing a rehabilitation program to restore full function[15].
5.Performance Screening[edit | edit source]

Athletes require a strong foundation in a diverse range of athletic qualities in order to tolerate the progressively advanced training loads and competitive demands of their chosen sport. The improvement of foundation movements that underpin these athletic qualities early in the athletes' development pathway is one of the key recommendations of long term athlete development models.[16] [17] The foundation movements typically involve variations of squatting, lunging, jumping, pushing, pulling and bracing.3‐6 Typically these movements are objectively assessed using some form of functional movement assessment criteria in order to screen athletes for dysfunctional movement patterns in an attempt to alleviate injury risk through addressing incorrect movement patterns.7 The Functional Movement Scale (FMS™) by Cook is by far the most popular screening tool used to provide an objective assessment of movement in sports performance research and is typically synonymous with the term “Functional Movement".[16]

The Athletic Ability Assessment can be used as an assessment tool for athlete profiling, as well as be used to assess changes in functional movement ability over time (by making multiple measurements on the same athlete following a training intervention). In order to confidently assess changes in an individual it is necessary to obtain an estimate of the measurement error that might arise solely from the tester(s). The specific objectives of this study were to determine the absolute error with one tester rating the same movements one week apart (intra‐tester reliability) as well as determining the error associated with different testers scoring the same performance (inter‐tester reliability).[18]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Mirabelli MH, Devine MJ, Singh J, Mendoza M. The preparticipation sports evaluation. American family physician. 2015 Sep 1;92(5):371-6.
  2. ↑ Myers A, Sickles T. Preparticipation sports examination. Primary Care: Clinics in Office Practice. 1998 Mar 1;25(1):225-36.
  3. ↑ 3.0 3.1 Andujo VD, Fletcher IE, McGrew C. Musculoskeletal Preparticipation Physical Evaluation—Does it Lead to Decreased Musculoskeletal Morbidity?. Current sports medicine reports. 2020 Feb 1;19(2):58-69.
  4. ↑ Kennedy M, Comer F, Young JA, Valasek AE. Increasing primary care follow-up after preparticipation physical evaluations. Pediatric Quality & Safety. 2020 Nov;5(6).
  5. ↑ 5.0 5.1 Peterson AR, Bernhardt DT. The preparticipation sports evaluation. Pediatrics in Review-Elk Grove. 2011 May 1;32(5):e53.
  6. ↑ 6.0 6.1 Pedraza J, Jardeleza JA. The preparticipation physical examination. Primary care. 2013 Sep 21;40(4):791-9.
  7. ↑ 7.0 7.1 7.2 7.3 Adami PE, Squeo MR, Quattrini FM, Di Paolo FM, Pisicchio C, Di Giacinto B, Lemme E, Maestrini V, Pelliccia A. Pre-participation health evaluation in adolescent athletes competing at youth Olympic games: proposal for a tailored protocol. British journal of sports medicine. 2019 Sep 1;53(17):1111-6.
  8. ↑ Smith DM, Hunter S. Preparticipation physical evaluation. Physicians; 1997.
  9. ↑ 9.0 9.1 9.2 Brukner P, White S, Shawdon A, Holzer K. Screening of athletes: Australian experience. Clinical Journal of Sport Medicine. 2004 May 1;14(3):169-77.
  10. ↑ Mick TM, Dimeff RJ. What kind of physical examination does a young athlete need before participating in sports?. Cleveland Clinic journal of medicine. 2004 Jul 1;71(7):587-97.
  11. ↑ Leggit JC, Wise S. Preparticipation physical evaluation: AAFP and others update recommendations. American Family Physician. 2020 Jun 1;101(11):692-4.
  12. ↑ Leyk D, Rüther T, Wunderlich M, Sievert AP, Erley OM, Löllgen H. Utilization and implementation of sports medical screening examinations. stress. 2008 Sep;11:14.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association position statement: preparticipation physical examinations and disqualifying conditions. Journal of Athletic Training. 2014;49(1):102-20.
  14. ↑ Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM, Krauss MD. Recommendations and Sonsiderations related to preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update a Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27;115(12):1643-55.
  15. ↑ 15.0 15.1 Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45.
  16. ↑ 16.0 16.1 Pre participation Screening - The Sports Physical Therapy Perspective. LRBarbara Sanders, PT, PhD, SCS, FAPTA,1 Turner A. Blackburn, PT, MEd, ATC,2 and Brenda Boucher, PT, PhD, CHT, OCS, FAAOMPT2
  17. ↑ European Society of Cardiology. How to Conduct Pre-Participation Screening in Athletes. http://www.escardio.org/The-ESC/Communities/European-Association-for-Cardiovascular-Prevention-&-Rehabilitation-(EACPR)/News/How-to-conduct-pre-participation-screening-in-athletes (accessed 8 May 2016).
  18. ↑ Ian McKeown, Kristie Taylor‐McKeown, Carl Woods, and Nick Ball. Athletic Ability Assessment: A Movement Assessment Protocol for Athletics. The International Journal of Sports Physical Therapy, Volume 9, Number 7, December 2014, Page.862
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