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PE DIATRIC S
Offer Opportunity to Screen for Serious Conditions
Sports physicals — a prerequisite for
participation in high school athletics —
represent an important opportunity to quickly
screen for a variety of conditions that could
place the young athlete at risk, according to
Jason Hove, MD, a family medicine physician
at UCLA Health in Redondo Beach, who
provides exams for high school athletes.
“This is a time when we can pose very
specific questions about response to exercise,”
Dr. Hove explains. “Often when children
and adolescents go for their regular doctor
visits, they aren’t asked about these specific
The most important concerns for Dr. Hove
and colleagues are cardiac conditions that can
lead to sudden death when the athlete is at full
exertion, the most common of which is known
as hypertrophic obstructive cardiomyopathy.
“This is a congenital condition that has
nothing to do with your level of training,”
Dr. Hove says.
In the course of a sports physical, the
physician asks about family history of heart
disease or sudden death, as well as about any
symptoms that have been experienced during
exercise in the past — such as chest pain,
shortness of breath or fainting — that could
be a symptom of an underlying condition.
During a cardiac exam the physician listens to
all parts of the heart, and patients are asked to
perform specific maneuvers that would bring
out the murmurs that can be linked to the
sudden death syndrome.
“This is a very straightforward evaluation,”
Dr. Hove says. “A primary-care physician can,
with the appropriate guidelines, listen for a
murmur. The vast majority of kids aren’t
going to have it, but if they do, it needs to
be further evaluated.”
While heart conditions are the most serious,
the sports physical is designed to detect a
number of other potential red flags, Dr. Hove
notes. One is a history of concussions,
particularly for athletes in sports that are
prone to them, such as football and soccer.
A growing number of schools are having
athletes in such sports take baseline
Sports physicals represent
an important opportunity to
quickly screen for a variety of
conditions that could place the
young athlete at risk.
neurocognitive tests so that the results can
be compared with those on tests after a
potential concussion during the season.
Other conditions of interest in sports
physicals include a history of asthma or other
respiratory issues; any chronic-injury problem;
and, for girls, the so-called female-athlete triad
— characterized by being underweight and
having irregular menstrual periods — leaving
them particularly prone to experiencing stress
fractures. Girls who are diagnosed with the
latter condition can be helped with proper
nutrition, Dr. Hove explains.
“Many of these conditions do not preclude
participation,” concludes Dr. Hove. “Some
require a further workup, and others require
further evaluation by a specialist. The
important thing is to make sure that before
any high school athlete is cleared to play, he
or she has been appropriately screened.”
Vital Signs Winter 2014 Vol. 61