Sports Physicals – One of the most important visits to your doctor

by Dr. Bonnie Carter

 

As seen in the Odessa American Medical Matters:

http://www.oaoa.com/people/health/medical_matters/article_2c3a7a7e-9063-11e7-919c-133b45db6b47.html

 

It’s that time of year again …time for sweaty teenage boys and girls to flock to clinics and gyms for sports physicals. While parents and kids just want to get in and out as quick as possible, there’s a method to our madness and why we do these physicals. And, no, it’s not an initiation or torture ritual to embarrass you!

One of the most important things to evaluate during a sports physical is your heart. Sudden cardiac death can occur in an athlete due to hypertrophic cardiomyopathy that is undiagnosed. Names like Hank Gathers and Reggie Lewis echo in our minds when we put that stethoscope to your chest. These, and others like them, were young athletes in the prime of their life and peak physical condition that dropped dead during their sport from a silent heart condition. There are signs and an astute clinician can pick up on them. This is one of the reasons that I hate mass physicals in gyms … you just can’t hear as well when you’re listening for an arrhythmia or heart murmur. Truly the best place to have your physical done is with your primary care physician because we know you and are more likely to pick up on a minute difference from your baseline.

The other major thing we are evaluating is your neurologic status and history of concussions. Recent studies have brought the long-term effect of concussions to the forefront, and both physicians and coaches are more aware of their consequences. The management and our approach to concussions has changed drastically just in my time in medicine. When I was a resident in 2003, we would only pull someone from the game if they had a complete loss of consciousness or their symptoms lasted more than 15 minutes. Now, we pull anyone who has symptoms of a concussion and they can’t return to activity for at least a week. (There is a protocol established by the U.I.L.) This is safer for the athlete because cumulative injury is a risk and can lead to much worse damage and even death. A lot of questions on the sports physical forms are centered around concussions, and this is why.

While working as the university physician at West Texas A&M, I saw a lot of concussions in our athletes. Additionally, I saw some sequelae (a condition that is the consequence of a previous disease or injury) of multiple prior concussions including memory issues, personality changes, attention deficit and depression, to name a few. Can you guess which sport had the most history of concussions when I would do the physicals at W.T.? It wasn’t football … it was actually cheerleading!

Now that we’ve covered your head and your heart, that leaves the rest of your body. Yes, we are looking at all your joints to make sure your body can handle the stress of the sport, but we are also looking at your vision, your blood pressure, your skin, your thyroid, your abdomen, if your periods are regular, your gait and several other things. Every question on that form is a clue to the mystery that is you. We clinicians are really just detectives, trying to follow the clues and make the diagnosis. And yes, the dreaded hernia check is important because if you have a defect and you work out, you can make it worse. An incarcerated hernia is no laughing matter and is a medical emergency.

So next time you drag your child to their sports physical, remember it is not just a rubber-stamp visit. In fact, it is probably one of the most important visits they may make to the doctor’s office.