A safer approach to
work, life and sport


A safer approach to work, life and sport

pre participation physical exam

The Preparticipation Sports Physical (PPE)

Amanda Muscatell 21 July 2016 Last year nearly 8 million students participated in high school athletics, many of which were required to complete a Preparticipation Physical Exam (PPE) before beginning their season. While the aim of the PPE is to determine if a child is physically able to safely participate in a sport, it also examines many areas of your child’s wellbeing and may detect conditions that would otherwise go unnoticed. As fall tryout season approaches make sure you and those around know the importance of a PPE and that your student completes one.*

The Importance of a Preparticipation Physical

1. PPE takes medical and family history into account

The participant’s family history identifies 75% of problems that could prevent them from safely playing sports! 1, 2 Amazing! During this phase of the exam the sport participant and a guardian will be asked about any pre-existing or recurrent family conditions that may impact sport participation. Particular attention will be given to musculoskeletal injuries, prior surgeries and other underlying conditions that could predispose an athlete to injury.

2. PPE includes cardiovascular screening

Approximately one in 300 young athletes has a heart disorder that may increase their risk of sudden cardiac arrest.3 While many of the cases of sudden cardiac death (the leading cause of death in active student athletes4) can’t be detected through traditional screenings, during the PPE questions regarding risk factors and symptoms of cardiovascular disease are asked. If a positive response is indicated by the patient and confirmed by the practitioner then further evaluation may be needed.

3. PPE includes a general health screening

Did you know the PPE represents the sole source of medical evaluation for 30-80% of children and adolescents annually?1,5 That’s right, in addition to determining whether or not a student is fit to play school sports, this exam could detect underlying general health concerns. During the PPE, vital signs (height, weight, vision, blood pressure, etc.) are checked and the athlete may be asked about their nutritional habits, medication/supplement use and other questions relevant to their overall well-being.

Insulating Your School from Risk

By detecting conditions that could be harmful to a student-athlete a school not only reduces the risk of student-athlete injury, but also potential litigation that could come with it. Even if the student-athlete doesn’t have a condition severe enough to prevent them from participating, through the PPE, the school can be made aware of any lesser conditions such as asthma. Prior knowledge of such conditions allows the school’s sports medicine team to take the precautions necessary to reduce the risk of an incident or properly manage one should it occur.

Nationwide PPE Standardization Still Needed

While PPE’s in some form are required by many states, there is great variability from state to state in what each required PPE entails. Where in one state the question of whether an athlete has ever experienced an unexplained seizure is asked, in another state the subject may not be brought up at all. Without such standardization in place, athletes who move to a different state may have a condition go undetected by their new school making the school susceptible to unprepared for incidents. While we are not currently aware of any pending PPE standardization federal bills, the best thing you can do is spread the word of the importance of PPEs and why not having a national standard is dangerous.

*Based on NATA proposed PPE guidelines


1. Goldberg B, Saraniti A, Witman P, Gavin M, Nicholas JA. Pre-participation sports assessment: an objective evaluation.Pediatrics. 1980;66(5):736–745.

2. Risser WL, Hoffman HM, Bellah GG Jr, Green LW. A cost-benefit analysis of preparticipation sports examinations of adolescent athletes. J Sch Health. 1985;55(7):270–273

3. Chandra, N., Bastiaenen, R., & Papadakis, M. (2013, March). Sudden Cardiac Death in Young Athletes. Retrieved July 18, 2016, from http://content.onlinejacc.org/article.aspx?articleid=1659758

4. Drezner JA. Preparing for sudden cardiac arrest: the essential role of automated external defibrillators in athletic medicine: a critical review. Br J Sports Med. 2009;43(9):702-707.

5. Risser WL, Hoffman HM, Bellah GG. Frequency of preparticipation sports examinations in secondary school athletes: are the University Interscholastic League guidelines appropriate? Tex Med. 1985; 81: 35-39.