Do I Really Need A Medical Before I Play Sports?
Increasingly many sporting events require that the competitors taking part have a Sports Medical or Pre-Participation Screen prior to the event. The competitor will usually then have to present a certificate signed by a medical professional to state that they are medically fit to take part. For many patients, particularly those who are very fit and exercise regularly this can seem like an unnecessary bureaucratic exercise. However, there is some sound reasoning behind this form filling.
The Benefits of Pre-Participation Screening
- Identifying an Underlying Illness: Undoubtedly the most important aspect of pre-participation screening is to establish if there is any underlying illness that might cause an athlete (and by athlete I mean anyone who moves) to become seriously ill during exercise. The introduction of a pre-participation screen for young athletes in Italy led to a 89% decrease in the incidence of sudden death due to heart disease.
- Helping People With An Underlying Disease: For those people with an underlying disease it can be difficult finding out what is the right intensity and frequency of exercise. A Pre-Participation Screen helps give a broader understanding the current state of health of the athlete so that their exercise regime can be tailored to suit there needs.
- Establishing a Baseline of Health: Another benefit of Pre-Participation screening is that if it is done well it can provide a nuanced assessment of the athletes health so that illness and injuries can be mitigated against where possible.
- Improving performance: Another advantage of a pre-participation screen is that it provides a great opportunity to discuss factors that may help performance and reduce the risk of injury such as diet, supplements, training load and mental approach.
What Does The Pre-Participation Screen Involve
- Getting to know you: Finding out about you is one of the most important aspects of the pre-participation screen. Finding out about your lifestyle can help identify any health risks, sources of support or distraction and can thus help to create a tailored plan to help improve performance.
- Understanding your past medical history: While taking a medical history is routine for most doctors, a clear understanding of an athletes past medical history is absolutely vital as past illness or injury is the strongest predictor of future illness or injury. Therefore, it’s crucial that any previous problems have been adequately addressed.
- Your Sports History: In the pre-participation screen it is of paramount importance for the doctor to find out your training schedule, current fitness levels, planned events or matches, equipment used and goals for the season. That allows the doctor to help you plan to avoid injury, give advice on managing training load and give you tips on monitoring your recovery.
- Nutritional Assessment: There are a number of injuries and illnesses where a significant contributing factor is the wrong nutritional approach being taken. The pre-participation screen gives an opportunity to review with you whether the diet and supplements you are taking is optimal for you.
- Your Family History: It is important for the doctor to be aware of your family history. Obviously there are a huge number of disease that can run in families but it’s important for the sports doctor to find out if there are any in your family that will prevent you from running!
- Physical Examination: While many medical providers give very comprehensive sports medical examination it is possible to be so all-encompassing that many aspects of the examination are irrelevant. That’s why it is important that the examination is tailored to you and the sports that you play. For example, the risk of injury are different for a ballet dancer than a Rugby Union prop forward and each would need a different approach. Participants in contact sport might benefit from a concussion assessment but that would be irrelevant for people in non contact sports. The important thing is to check for the most serious and worrying potential conditions and then tailor the rest of the examination to fit the athlete.
- Other tests: Any other investigations need to be tailored to you and your sports based on the findings in your examination and from your discussion with the doctor. For people taking part in endurance events I think a screening ECG (electrocardiogram) that looks at the electrical conduction through the heart is a really good idea. In the study from Italy I mentioned earlier where many lives were saved from sudden cardiac death a crucial part of the screening process was the ECG. This quick and relatively simple test can help identify a myriad of potential abnormalities. It is important to remember that sudden cardiac death in people playing sport is very rare. However, the death of someone who is otherwise fit and healthy playing the sport they love is absolutely devastating. The European recommendations reflect this and advise that fit and healthy young people who participate in sport should have a screening that includes an ECG. This has been supported by FIFA and World Rugby.
So while it might seem tempting to try to persuade your doctor just to go ahead and sign the flimsy bit of paper saying that your fit and healthy to take part in your next big event, having a thorough and tailored pre-participation screen can be a huge benefit. It can make sure you get to the start line in peak condition but more importantly, it can ensure you also make it to the finish line.
Dr Hugh Coyne