The value of a P.P.E in sports

health todayThe start of the new school year is approaching and, as usual, there will be a lot of excitement surrounding the start of the first term of school. This will be even greater for those who are starting their secondary school education. Along with striving for academic excellence and making new friends, some children will be looking for success through participation in sports.

During the school year, some will be selected to compete for their schools and those who are the top performers, will likely join clubs and be selected for national teams. They deserve encouragement and all possible support in these endeavours. How do you know that your child is ready to
compete safely?

This is where the preparticipation physical evaluation (PPE) or sports physical can be of assistance. The PPE is a tool used to screen sportspersons for any conditions which may make it unsafe for them to participate in sports. Possible life-threatening conditions, current medical conditions and injuries can be identified by a physician and appropriate advice and treatment can be obtained by the athlete.

Potentially life-threatening conditions are those heart problems which can lead to sudden cardiac arrest while playing sports. Factors which may increase the risk of a future injury can be identified and medications can be reviewed to ensure compliance with anti-doping regulations.

In the USA, all high school and collegiate students who plan to participate in organized sporting activities are mandated by law to have a PPE done, usually annually. Professional athletes throughout the world will also have these evaluations done at regular intervals. I believe all competitive sportsperson of all ages should have PPEs done. Persons who were previously sedentary and are starting a new exercise programme should also have an evaluation to ensure they can exercise safely and to get educated on the appropriate approach to their new exercise programme.

The PPE should be done prior to the start of the season. It is recommended that it should be done at least six weeks prior to the start of training so that there is time for further evaluation and treatment of any medical conditions or injuries that are detected. The frequency of the PPE can vary in different places but it is usually done annually at the high school and college levels. The PPE can be conducted by a sports medicine physician or by the sportsperson’s family physician if that is preferred.

The components of the PPE vary according to the level of sports participation, the age of the athlete, the financial resources available and the population which is being screened. The components which are standard in every PPE are a thorough medical and family history and a thorough physical examination. Those sportspersons involved in contact sports such as rugby will probably also have to undergo additional testing which will allow for an easier diagnosis of a concussion if the player has a head injury during the season.

Older athletes are at a higher risk of a heart attack with exercise due to medical conditions such as hypertension and diabetes and should have an electrocardiogram (ECG) done as part of their evaluation. Professional players will have more investigations to ensure adequate health. This will include ECG, echocardiogram and blood tests. If a problem is found on the standard PPE, the doctor will recommend more testing to evaluate it.

At the end of the process, a decision will be made on whether to allow the athlete to participate in sports or not. Some athletes will not be cleared for sports participation immediately due to an illness or injury or further testing may be required. In such instances, a repeat evaluation would be done later and the athlete would be cleared to participate if all issues are resolved. In cases where a potentially life-threatening condition is detected during the evaluation, that athlete would be disqualified from participating in competitive sports.

Currently, we do not perform these evaluations on the majority of our competitive sportspersons in Barbados. This tool is crucial to help us do our best to ensure that all of our competitive sportspersons can participate safely. Education on injury prevention, avoiding burnout and the danger of using harmful substances such as performance-enhancing drugs are also provided.

All schools, clubs and sporting organizations should seek to ensure that all of their sportspersons undergo these evaluations so they can compete safely and have optimal sporting performance.

(Dr Shane Drakes is a specialist in Physical Medicine & Rehabilitation and Sports Medicine. He can be contacted at

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