Most states actually require that kids and teens have a sports physical before they can start a new sport or begin a new competitive season.
The number one goal is injury prevention.
Sports physicals are more targeted and specifically focus on the physical requirements needed to play a sport.
A standard sports physical includes an examination of a child’s vitals including blood pressure and pulse, while also documenting weight and height increases as growth spurts can place added stress on joints, muscles and bones.
Dr. Mark Booher, Medical Director for the Hendricks Regional Health Sports Medicine Program, is here to discuss the importance of getting your child a sports physical at the start of every sport season.
The Importance of Youth Sports Physicals
Featured Speaker:
Learn more about Dr. Mark A. Booher
Mark Booher, MD
Dr. Mark A. Booher, who practices with Dr. David Harsha at the Hendricks Regional Health YMCA in Avon, is board-certified in sports medicine and family practice. He serves as medical director for the Hendricks Regional Health Sports Medicine Program as well as Rehabilitative Services. In this role, Dr. Booher provides sideline medical support to local student athletes as well as community education opportunities about injury and concussion prevention. He has been named “Best Sports Medicine Doctor” ten years running by participants of The Hendricks County Flyer’s “Best of Hendricks County” contest.Learn more about Dr. Mark A. Booher
Transcription:
The Importance of Youth Sports Physicals
Melanie Cole (Host): The Pre-Participation Physical Evaluation or PPE is an important first step for parents in maximizing the health of your youth athletes for their safe participation in sports. My guest today is Dr. Mark Booher. He’s a sports medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Booher. Tell us what is the PPE?
Dr. Mark Booher (Guest): Thank you, Melanie. I’m happy to be on. The PPE or the Pre-Participation Physical Exam, as you mentioned, is an examination that we do on athletes often at the middle school, high school and collegic level prior to starting their season, prior to the next school year. It’s an exam that we utilize to try to detect any condition that might limit an athlete from participating. It helps us detect if there’s a condition that might predispose an athlete to an injury during their competition. Many states do require pre-participation exams prior to sports activities and so it meets the legal requirements along those lines. It does give us an opportunity to just determine the general health of the athlete and we can answer some of their health-related questions, give them some counseling on lifestyle issues and overall assess their fitness levels for sport.
Melanie: Dr. Booher, what are you looking for in the PPE? What are some of these things that you go over as the evaluation?
Dr. Booher: As part of the PPE, we will put them through a process in which we’re evaluating their blood pressure, their pulse, their height, their weight, their vision. These are often done in stations. You can find two different formats for PPE’s. One is done privately in the primary care sports medicine office with just you individually in the room with the patient in the office setting. Others are often done now in almost more now in what we call a group session or mass sessions where we’ll have stations set up at the high school or the middle school or the college and athletic trainers and physical therapists are assisting us with some of the vital signs. When the athlete gets to me in the back area or in the office, it’s my job at that point in time to put them through a medical exam focusing really aggressively on their heart number one, making sure there’s no issues pulmonary wise, GI, muscular skeletal as well. By the time they get to me, they’ve had blood pressure, they’ve had their pulse, they’ve had their height and weight and what we do right away is, we review the history. There is a required form that has to be filled out prior to the pre-participation physical exam and it really is that health questionnaire. Often times 60-70% of injuries or concerns are going to be raised on the history. So, that’s real important to read that over and go over that with the athlete even before I even put a stethoscope on their chest or do a neuro exam or musculoskeletal exam. We really do take them through a pretty thorough examination but history is often number one.
Melanie: Even we hear so much in the media about sudden cardiac death and there’s been some talk about whether an EKG is included now in this PPE. What do you think about this?
Dr. Booher: At this point in time, there is not yet a recommendation from American Heart Association to actually do EKG’s or echocardiograms at mass screenings. The concern at times with EKG’s is will you have false positive readings that then lead to further, more expensive tests. However, how I look at it is, if there’s anything on the history that indicates any concern whatsoever with anything cardiac, if they’ve had chest pain with exertion, if they’ve had a previous heart murmur, if they’ve been told they shouldn’t exercise, if they’re passing out with exertion, if there’s a family history, if there’s a history with a family member who’s had heart conditions or had sudden death before the age of 50, I often do feel like those individuals it’s a good idea to utilize the EKG as a screen and then often go all the way to the echocardiogram to get a much better picture structurally of the heart itself. While right now, it’s not recommended per se by American Heart and other associations for other reasons, it does have its usefulness. It tends to be a little bit more athlete specific or patient specific at which time we’ll recommend its use. So, currently not being done at some of our mass screenings that we’re doing currently.
Melanie: What about biomechanical analysis? What are you looking for musculoskeletal-wise with children if they’ve got misalignments? Is that going to make a jump in basketball more dangerous for their back? How does that work for kids?
Dr. Booher: Going through the musculoskeletal screen, it allows us to identify if somebody possibly has scoliosis that hadn’t been discovered before; there may be areas of muscle tightness/muscle weakness; anything mechanically on that whole kinetic chain of the body, if there’s a kink in the chain along the way it can predispose to injury. We really, truly want to try to identify any irregularities, whether it’s a leg length discrepancy, a weakness like you mentioned with the back. Is there back pain that indicates that there’s something with a lumbar disc or a stress fracture? Putting them through the musculoskeletal screen it gives us a clue. It might trigger a red flag that we’re then able to take that athlete and then, in participation with athletic trainers, possibly physical therapists, coaches, parents, we can come up with a plan to help that athlete recover from an injury if they’re currently experiencing one but also try to prevent further injuries by making sure their mechanics are where they need to be for their sport.
The Importance of Youth Sports Physicals
Melanie Cole (Host): The Pre-Participation Physical Evaluation or PPE is an important first step for parents in maximizing the health of your youth athletes for their safe participation in sports. My guest today is Dr. Mark Booher. He’s a sports medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Booher. Tell us what is the PPE?
Dr. Mark Booher (Guest): Thank you, Melanie. I’m happy to be on. The PPE or the Pre-Participation Physical Exam, as you mentioned, is an examination that we do on athletes often at the middle school, high school and collegic level prior to starting their season, prior to the next school year. It’s an exam that we utilize to try to detect any condition that might limit an athlete from participating. It helps us detect if there’s a condition that might predispose an athlete to an injury during their competition. Many states do require pre-participation exams prior to sports activities and so it meets the legal requirements along those lines. It does give us an opportunity to just determine the general health of the athlete and we can answer some of their health-related questions, give them some counseling on lifestyle issues and overall assess their fitness levels for sport.
Melanie: Dr. Booher, what are you looking for in the PPE? What are some of these things that you go over as the evaluation?
Dr. Booher: As part of the PPE, we will put them through a process in which we’re evaluating their blood pressure, their pulse, their height, their weight, their vision. These are often done in stations. You can find two different formats for PPE’s. One is done privately in the primary care sports medicine office with just you individually in the room with the patient in the office setting. Others are often done now in almost more now in what we call a group session or mass sessions where we’ll have stations set up at the high school or the middle school or the college and athletic trainers and physical therapists are assisting us with some of the vital signs. When the athlete gets to me in the back area or in the office, it’s my job at that point in time to put them through a medical exam focusing really aggressively on their heart number one, making sure there’s no issues pulmonary wise, GI, muscular skeletal as well. By the time they get to me, they’ve had blood pressure, they’ve had their pulse, they’ve had their height and weight and what we do right away is, we review the history. There is a required form that has to be filled out prior to the pre-participation physical exam and it really is that health questionnaire. Often times 60-70% of injuries or concerns are going to be raised on the history. So, that’s real important to read that over and go over that with the athlete even before I even put a stethoscope on their chest or do a neuro exam or musculoskeletal exam. We really do take them through a pretty thorough examination but history is often number one.
Melanie: Even we hear so much in the media about sudden cardiac death and there’s been some talk about whether an EKG is included now in this PPE. What do you think about this?
Dr. Booher: At this point in time, there is not yet a recommendation from American Heart Association to actually do EKG’s or echocardiograms at mass screenings. The concern at times with EKG’s is will you have false positive readings that then lead to further, more expensive tests. However, how I look at it is, if there’s anything on the history that indicates any concern whatsoever with anything cardiac, if they’ve had chest pain with exertion, if they’ve had a previous heart murmur, if they’ve been told they shouldn’t exercise, if they’re passing out with exertion, if there’s a family history, if there’s a history with a family member who’s had heart conditions or had sudden death before the age of 50, I often do feel like those individuals it’s a good idea to utilize the EKG as a screen and then often go all the way to the echocardiogram to get a much better picture structurally of the heart itself. While right now, it’s not recommended per se by American Heart and other associations for other reasons, it does have its usefulness. It tends to be a little bit more athlete specific or patient specific at which time we’ll recommend its use. So, currently not being done at some of our mass screenings that we’re doing currently.
Melanie: What about biomechanical analysis? What are you looking for musculoskeletal-wise with children if they’ve got misalignments? Is that going to make a jump in basketball more dangerous for their back? How does that work for kids?
Dr. Booher: Going through the musculoskeletal screen, it allows us to identify if somebody possibly has scoliosis that hadn’t been discovered before; there may be areas of muscle tightness/muscle weakness; anything mechanically on that whole kinetic chain of the body, if there’s a kink in the chain along the way it can predispose to injury. We really, truly want to try to identify any irregularities, whether it’s a leg length discrepancy, a weakness like you mentioned with the back. Is there back pain that indicates that there’s something with a lumbar disc or a stress fracture? Putting them through the musculoskeletal screen it gives us a clue. It might trigger a red flag that we’re then able to take that athlete and then, in participation with athletic trainers, possibly physical therapists, coaches, parents, we can come up with a plan to help that athlete recover from an injury if they’re currently experiencing one but also try to prevent further injuries by making sure their mechanics are where they need to be for their sport.
Melanie: What about athletes that might have asthma? Do you discuss with them how they’re going to treat their asthma if they’re going to do some preventive measures before they start their sport?
Dr. Booher: That is a big concern. There are times where an athlete with asthma may, unfortunately, kind of have an asthma attack or a status asthmaticus where that can lead to death. I know it is a rare thing, but 4 out of 40 million athletes can die from an asthma attack on the athletic fields. We do screen them, again, with the questionnaire. Do they have a history of asthma? Are they being followed for it? What medications are they utilizing? Is it an exercised induced asthma? Do they use an inhaler prior to exercise? Or, is it a long standing issue? Often if someone has asthma, I’ll ask them, “Have you ever been hospitalized with asthma? Have you even been intubated with asthma?” If they’re answering “yes” to that, I’m already making this athlete aware, their athletic trainer aware, their parents aware that very strict adherence to their medications, their protocol and monitoring for any deterioration in symptoms so that we can react immediately instead of letting an athlete struggle out on the playing field during an asthma attack and potentially die. Asthma is a very, very important part of the questionnaire and the physical exam. Often during the exam when you’re listening to their lungs, they’ll sound fine. They’re not having an attack, they’re not currently having symptoms, so that’s where the history comes into play, much like the cardiac standpoint where oftentimes, you may not notice or hear something on an exam. But, when you see it in the history, you have to, then, make everybody aware of what’s the potential that could happen. That’s what we’re mostly looking for. We want to make sure we’re aware if there is the possibility that anyone might have something that could lead to sudden death, we really want to be on top of it.
Melanie: Dr. Booher, what a great doctor you are. I can tell and I can hear your passion and enthusiasm for this topic. What about injury prevention for the athletes themselves? Do you discuss with them, because we all know that if they get injured sometimes or get a concussion, they don’t even want to come off the field. They don’t want to have to sit it out; they don’t want to have to miss any particular activity if they’re in the middle of season. Do you discuss with the athlete themselves about injury prevention and concussion information?
Dr. Booher: We do. A lot of those injuries or concussions that I’ve, fortunately, been able to see in the actual office setting gives you a much, much better environment to be able to sit with the athlete and the parent and discuss what the injury is, how we are going to make it better, how we try to prevent this in the future but during the actual pre-participation physical exam itself, if we’ve noticed that an individual has had a recent concussion, for example, I want to know are you still having symptoms? What have you done to this point and time? And get a little more information. How did the injury occur? How many past concussions have you had? There are certain conditions where will not pass your physical exam until you are completely cleared, for example, of a concussion. There are other conditions like you talked about with some of the cardiac issues that they won’t pass activities period. Concussions, for example, they have to have symptom resolution; they have had to gone through the return to play protocol before we allow them back onto the field. It’s very dangerous and very risky to try to continue to participate with a concussion, especially at these younger age groups. They’re very prone to a second concussion. It doesn’t have to be as bad as a hit if they have a second concussion while they’re still trying to recover from the initial concussion. That can lead to a condition called “second impact syndrome” where the brain swells almost irregularly. The skull doesn’t expand so, instead, a swollen brain can choke itself and there have been deaths from second impact syndrome. It is typically at a young age. We’ve not seen these in professional athletes. The young mind is very prone to injury. It’s very, very strict with concussions in terms of when they’re allowed to return to play. They have to be 100% symptom free and have passed our return to play protocol which we have in place at all our schools with the staff. I think, as a general rule, now the general public is much more knowledgeable of concussions compared to 10, 20 years ago. I haven’t run into many issues where parents or coaches are fighting us on return to play like they had in the past.
Melanie: What great information, Dr. Booher. In just the last few minutes, give your best advice to parents about this pre-participation sports physical for their young athletes and why they should come to Hendricks Regional Health for their care.
Dr. Booher: I think for the parents and the athletes, often the first decision is “where do I want to do my physical exam?” Is it something that they want to come to the high school or middle school where we offer the exams and that has its advantages. There can be a cost advantage to that. We’re able to communicate directly with the school and athletic training staff. Oftentimes, it’s not as private as an environment as you might find in the office setting. That has its advantages as well. If an athlete has a condition or a parent has a concern with their athlete, with their child, and they want to talk about it in a more private manner, I often doing the pre-participation physical at my office. It does allow us to sit, talk for a longer period of time and really get into the issues at hand. It may be questions about an eating disorder. It may be just questions about their diabetes or their asthma. There are times when the athlete is more comfortable in the office setting and might talk to me more than they would necessarily at the school. So, you first have to weigh the pros and cons of school versus doing it in the office setting. Secondly, your child has to have a pre-participation physical before they are going to be allowed to participate in that upcoming school year in athletics. Our schools are very strict on this. They have to have it on file. They do not allow them to play. So, it has to be done first and foremost. Thirdly, if parents have questions, it is okay to come in and talk to me during physical exams. They can come in with their athlete if it’s at the school, certainly in the office. They should never, ever be afraid or too shy. Always ask questions. There’s never a bad question. Let’s put it that way. I feel like at Hendricks Regional Health we have excellent sports medicine physicians, myself, Dr. Harsha, excellent orthopedic surgeons, Dr. Ritter, Dr. Prather, Dr. Waits and just a myriad of excellent primary care physicians. We’re staffed very well in the immediate cares and the emergency rooms and we really, truly work together as a team to try to help. It’s not just the athletes. I’m talking about anybody. We truly provide excellent medical service for the entire area. I’m proud to work for Hendricks Regional Health.
Melanie: Thank you so much, Dr. Booher, for being with us today. You’re listening to Health Talks with HRH. For more information, you can go to Hendricks.org. That’s hendricks.org. This is Melanie Cole. Thanks so much for listening.
Dr. Booher: That is a big concern. There are times where an athlete with asthma may, unfortunately, kind of have an asthma attack or a status asthmaticus where that can lead to death. I know it is a rare thing, but 4 out of 40 million athletes can die from an asthma attack on the athletic fields. We do screen them, again, with the questionnaire. Do they have a history of asthma? Are they being followed for it? What medications are they utilizing? Is it an exercised induced asthma? Do they use an inhaler prior to exercise? Or, is it a long standing issue? Often if someone has asthma, I’ll ask them, “Have you ever been hospitalized with asthma? Have you even been intubated with asthma?” If they’re answering “yes” to that, I’m already making this athlete aware, their athletic trainer aware, their parents aware that very strict adherence to their medications, their protocol and monitoring for any deterioration in symptoms so that we can react immediately instead of letting an athlete struggle out on the playing field during an asthma attack and potentially die. Asthma is a very, very important part of the questionnaire and the physical exam. Often during the exam when you’re listening to their lungs, they’ll sound fine. They’re not having an attack, they’re not currently having symptoms, so that’s where the history comes into play, much like the cardiac standpoint where oftentimes, you may not notice or hear something on an exam. But, when you see it in the history, you have to, then, make everybody aware of what’s the potential that could happen. That’s what we’re mostly looking for. We want to make sure we’re aware if there is the possibility that anyone might have something that could lead to sudden death, we really want to be on top of it.
Melanie: Dr. Booher, what a great doctor you are. I can tell and I can hear your passion and enthusiasm for this topic. What about injury prevention for the athletes themselves? Do you discuss with them, because we all know that if they get injured sometimes or get a concussion, they don’t even want to come off the field. They don’t want to have to sit it out; they don’t want to have to miss any particular activity if they’re in the middle of season. Do you discuss with the athlete themselves about injury prevention and concussion information?
Dr. Booher: We do. A lot of those injuries or concussions that I’ve, fortunately, been able to see in the actual office setting gives you a much, much better environment to be able to sit with the athlete and the parent and discuss what the injury is, how we are going to make it better, how we try to prevent this in the future but during the actual pre-participation physical exam itself, if we’ve noticed that an individual has had a recent concussion, for example, I want to know are you still having symptoms? What have you done to this point and time? And get a little more information. How did the injury occur? How many past concussions have you had? There are certain conditions where will not pass your physical exam until you are completely cleared, for example, of a concussion. There are other conditions like you talked about with some of the cardiac issues that they won’t pass activities period. Concussions, for example, they have to have symptom resolution; they have had to gone through the return to play protocol before we allow them back onto the field. It’s very dangerous and very risky to try to continue to participate with a concussion, especially at these younger age groups. They’re very prone to a second concussion. It doesn’t have to be as bad as a hit if they have a second concussion while they’re still trying to recover from the initial concussion. That can lead to a condition called “second impact syndrome” where the brain swells almost irregularly. The skull doesn’t expand so, instead, a swollen brain can choke itself and there have been deaths from second impact syndrome. It is typically at a young age. We’ve not seen these in professional athletes. The young mind is very prone to injury. It’s very, very strict with concussions in terms of when they’re allowed to return to play. They have to be 100% symptom free and have passed our return to play protocol which we have in place at all our schools with the staff. I think, as a general rule, now the general public is much more knowledgeable of concussions compared to 10, 20 years ago. I haven’t run into many issues where parents or coaches are fighting us on return to play like they had in the past.
Melanie: What great information, Dr. Booher. In just the last few minutes, give your best advice to parents about this pre-participation sports physical for their young athletes and why they should come to Hendricks Regional Health for their care.
Dr. Booher: I think for the parents and the athletes, often the first decision is “where do I want to do my physical exam?” Is it something that they want to come to the high school or middle school where we offer the exams and that has its advantages. There can be a cost advantage to that. We’re able to communicate directly with the school and athletic training staff. Oftentimes, it’s not as private as an environment as you might find in the office setting. That has its advantages as well. If an athlete has a condition or a parent has a concern with their athlete, with their child, and they want to talk about it in a more private manner, I often doing the pre-participation physical at my office. It does allow us to sit, talk for a longer period of time and really get into the issues at hand. It may be questions about an eating disorder. It may be just questions about their diabetes or their asthma. There are times when the athlete is more comfortable in the office setting and might talk to me more than they would necessarily at the school. So, you first have to weigh the pros and cons of school versus doing it in the office setting. Secondly, your child has to have a pre-participation physical before they are going to be allowed to participate in that upcoming school year in athletics. Our schools are very strict on this. They have to have it on file. They do not allow them to play. So, it has to be done first and foremost. Thirdly, if parents have questions, it is okay to come in and talk to me during physical exams. They can come in with their athlete if it’s at the school, certainly in the office. They should never, ever be afraid or too shy. Always ask questions. There’s never a bad question. Let’s put it that way. I feel like at Hendricks Regional Health we have excellent sports medicine physicians, myself, Dr. Harsha, excellent orthopedic surgeons, Dr. Ritter, Dr. Prather, Dr. Waits and just a myriad of excellent primary care physicians. We’re staffed very well in the immediate cares and the emergency rooms and we really, truly work together as a team to try to help. It’s not just the athletes. I’m talking about anybody. We truly provide excellent medical service for the entire area. I’m proud to work for Hendricks Regional Health.
Melanie: Thank you so much, Dr. Booher, for being with us today. You’re listening to Health Talks with HRH. For more information, you can go to Hendricks.org. That’s hendricks.org. This is Melanie Cole. Thanks so much for listening.