Time to Get Physical.

From the WebMD Archives

Aug. 16, 2001 -- Football, basketball, soccer, field hockey, swimming -- 'tis the season when team sports crank up, which means 'tis the season for the school sports physical.

The time-honored physical -- required by virtually all schools -- is designed to determine whether a student should participate in team activities, says Patrick Harr, MD, FABFP, a private practice family doctor in Maryville, Mo., and team physician for a local high school and Northwest Missouri State University for almost 30 years.

Whether a primary care physician, the family doctor, a general internist, or a pediatrician performs the physical, "make sure it's done one-on-one -- not with everybody lined up in the school gymnasium," he tells WebMD. "You can't do a thorough physical that way."

In addition to obtaining a good medical history -- of the athlete and his/her family -- the physical gives doctors a good opportunity to "get as much information as possible about risk behaviors: sexual behaviors, drug use, steroids, performance enhancers," says Harr.

Athletes can be disqualified from playing if a doctor suspects any dangerous behaviors, he says. "If you've seen them six months ago, you can get a pretty good idea if they're taking steroids," Harr tells WebMD. "Kids will do anything to be competitive."

What about those well-publicized cases of young athletes dying suddenly?

"It always catches people off guard," says John P. Kugler, MD, a family doctor and chief of primary care at Fort Belvoir, Va. "Most of the time, there is no sign that there is a problem. That's the scary part of it. It is very devastating and very perplexing."

But sometimes a physical can help determine a person's risk for sudden death. The athlete's physical build can indicate Marfan's syndrome, one heart abnormality that can cause sudden death. "It's the tall, thin, lanky athlete who has excessive flexibility," he says. "Some prominent basketball and volleyball players have had this disorder with devastating outcomes."

Giving the doctor as much information as possible -- about family medical history, and about the athlete's history -- is the best prevention of sudden death, Kugler tells WebMD.

In a thorough sports physical, these points should be discussed to assure healthy activity, Kugler says:

  • Family history -- Tell the doctor if there is a family history of sudden death or heart problems, whether in someone under age 40 or not. It might point to a heart abnormality or cholesterol and blood pressure problems.
  • Exercise history -- Discuss the athlete's history related to exercise -- if he or she has ever had chest pain, become lightheaded, or lost consciousness.
  • Asthma and other forms of respiratory disease -- There are good medications that make it possible to control asthma symptoms. Discuss this with the doctor.
  • Blood pressure, vital signs, and heart exam -- By listening to the athlete's heart, the doctor may detect heart murmurs. "[Heart murmurs] also put kids at risk for sudden death," says Kugler.
  • Bones and joints -- Bone deformities and decreased range of motion in neck or back could cause overuse injuries.
  • Immunizations -- Shots should be kept up to date.

Kugler also explains the risks that various sports carry.

Football and other contact sports carry high risk for bone and joint injuries, says Kugler. Depending on the athlete's stage of development, they may need to be more careful, or perhaps wait a year to play, he tells WebMD.

He says that in certain developmental stages, kids can be more at risk for injury than others. For example, in junior high school, some kids are growing a lot faster than others, yet they are playing on the same team.

Girls have the same sorts of injury risks as boys, he tells WebMD. "In many ways, people underestimate the amount of injury risk in some sports like soccer, which so many girls play. There are a fair number of injuries in that sport. It's really much more of a contact sport than is generally given in the media."

Some girls get into excessive exercise -- especially distance runners -- which puts them at risk for premature thinning of bones as well as problems with their periods, Kugler says. "Those things can be managed as long as they talk to their doctor about it." Doctors and parents should also keep alert to excessive weight loss and preoccupation with dieting, signs of anorexia nervosa.

Taking care of your child's health doesn't end with the sports physical. Make sure the coach is also thinking about your child's health, he advises.

"Sports are about having fun, promoting good health, competition, getting some important lessons about teamwork," Kugler tells WebMD. "Parents should always feel that the coach has the child's best interest at heart and not the team's. That's the bottom line." He suggests scheduling a time to talk with your child's coach to find out about his or her sport philosophy.

Parents should also consider whether they're forcing their child to play. "Make sure the child is participating for his or her own sake, not because the parent wants them to," he says.