Sports Physical Exam for Clearance: What's Included

What is the purpose of a sports physical?

The primary goal of a pre-participation physical exam is safety — identifying conditions that could put an athlete at risk during vigorous exercise 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance. Secondary goals include detecting and addressing existing injuries before they worsen, reviewing general health, and ensuring up-to-date immunizations.

The exam is not designed to be a comprehensive annual checkup. It focuses specifically on conditions relevant to athletic participation, particularly the cardiovascular system and the musculoskeletal system 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance. Six major medical organizations — including the American Academy of Pediatrics and the American Academy of Family Physicians — collaborated on the 5th-edition PPE Monograph to standardize this evaluation 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance.

What does a sports physical include?

A standard pre-participation physical evaluation typically covers 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance:

Medical history (the most important part) - Personal history of fainting, chest pain, or shortness of breath with exertion - History of concussion, significant head injury, or prior loss of consciousness 2Ref 2Patricios JS, Schneider KJ, Dvorak J, et al. (2023).Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport — Amsterdam, October 2022.Supports deferral of return to sport until concussion symptoms resolve and a clinician clears the athlete; basis for the PPE concussion history elements - Family history of sudden cardiac death or heart disease before age 50 - Known heart conditions, asthma, diabetes, sickle cell trait, or bleeding disorders - Prior surgeries or injuries that have not fully healed - Current medications and supplements

Physical exam - Blood pressure and pulse - Heart and lung exam — listening for murmurs or abnormal rhythms - Vision screening - Abdomen — checking organ size (particularly relevant in contact sports) - Musculoskeletal screen — range of motion, joint stability, prior injury sites - Skin exam — relevant for contact sports (looking for conditions like herpes gladiatorum or ringworm that affect clearance in wrestling)

Clearance decision Most athletes receive unrestricted clearance. A small number are cleared with conditions (for example, requiring a cardiologist consultation before returning to contact sports). Temporary deferrals may occur if a condition needs further evaluation first.

Who should perform the sports physical?

A sports physical can be performed by:

• A primary care physician or family medicine doctor — the preferred option, because they know your full medical history 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance
• A sports medicine physician — well-suited for athletes with prior injuries or complex musculoskeletal histories
• A nurse practitioner or physician assistant — appropriate for straightforward cases

Some schools offer group physicals at clinics staffed by multiple providers. These are convenient but may miss context that your personal physician would catch. If you have any cardiac history, prior serious injury, or complex medical background, seeing your own clinician is worth the extra step 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance.

Gale's primary care clinicians can perform pre-participation physical exams and provide clearance documentation.

What happens if something is found?

When an examiner identifies a concern, the outcome depends on what was found:

• A heart murmur — most are benign functional murmurs common in young athletes, but some require an echocardiogram to confirm before clearance is granted 3Ref 3Maron BJ, Friedman RA, Kligfield P, et al. (AHA/ACC Task Force) (2014).Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology.AHA/ACC guidance on cardiovascular preparticipation screening including the 14-element history-and-physical approach and the evidence base against routine ECG screening in the US
• Elevated blood pressure — may require repeat measurement or further evaluation before clearance
• Prior concussion with ongoing symptoms — return to sport may be deferred until symptoms resolve and a concussion specialist clears the athlete 2Ref 2Patricios JS, Schneider KJ, Dvorak J, et al. (2023).Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport — Amsterdam, October 2022.Supports deferral of return to sport until concussion symptoms resolve and a clinician clears the athlete; basis for the PPE concussion history elements
• Unhealed prior injury — may require physical therapy or orthopedic clearance before contact sports
• Controlled asthma — generally cleared with a written action plan and access to a rescue inhaler

A deferral or conditional clearance does not necessarily mean the athlete cannot compete — it means additional information is needed first.

Cardiac screening at the PPE: what the guidelines say

The American Heart Association recommends a 14-element history-and-physical cardiovascular screen at the PPE rather than routine electrocardiography for all athletes 3Ref 3Maron BJ, Friedman RA, Kligfield P, et al. (AHA/ACC Task Force) (2014).Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology.AHA/ACC guidance on cardiovascular preparticipation screening including the 14-element history-and-physical approach and the evidence base against routine ECG screening in the US. The 14 elements span personal and family history items (prior fainting with exertion, family history of sudden cardiac death before age 50, known heart conditions) and physical exam findings (heart murmur, elevated blood pressure).

An EKG or echocardiogram may be ordered if the history or physical exam reveals a specific cardiac concern — but routine EKG screening is not the standard recommendation in the United States 3Ref 3Maron BJ, Friedman RA, Kligfield P, et al. (AHA/ACC Task Force) (2014).Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology.AHA/ACC guidance on cardiovascular preparticipation screening including the 14-element history-and-physical approach and the evidence base against routine ECG screening in the US. If you have a personal or family history of a cardiac abnormality, discuss it with your clinician before the PPE.

How far in advance should I schedule a sports physical?

Schedule the physical at least four to six weeks before the sport season begins 1Ref 1MacDonald J, Schaefer M, Stumph J (2021).The Preparticipation Physical Evaluation.Describes the goals, components, timing, and setting recommendations for the PPE; supports the preference for the medical home and the 5th-edition monograph guidance. This gives time to:

• Arrange any follow-up testing that may be needed (cardiology, imaging)
• Complete physical therapy if an injury issue is identified
• Obtain required documentation before team registration deadlines

Many schools and leagues require a physical performed within the past year. Check your program's specific requirements, since some require a new physical each year while others accept a recent exam.