PERSONAL HEALTH; In Thorough Physicals, Athletes Must Perform
By JANE E. BRODY
Published: October 21, 2003
As many sports participants know from bitter experience, there is a risk of injury and, sometimes, serious injury associated with most vigorous activities, even running and swimming.
And like most who love their chosen activities, this risk is never uppermost in one's mind and perhaps even ignored entirely. Witness the number of cyclists -- children and adults -- who refuse to wear protective helmets.
When it comes to school-sponsored activities, the importance of preventing sports-related illness or injury should be paramount. First, youngsters tend to think of themselves as invulnerable. So adults must do the sober thinking for them.
Second, no school wants to be held liable for negligence when an athlete suffers the consequences of a problem that could have and should have been foreseen. This means nearly every school requires its athletes to undergo athletic evaluations before they play sports.
Although most potential problems can be found through a careful personal and family medical history, as discussed last week, the actual examination should not be given short shrift.
Two critical areas of concern are the cardiovascular system and the musculoskeletal system, according to Dr. Michael C. Koester, a pediatric sports specialist at the Good Shepherd Medical Center in Hermiston, Ore.
Is the Heart Healthy?
The stethoscope is the physician's most valuable tool for detecting possible cardiovascular problems. It should be used while the child is standing and lying down, Dr. Koester wrote in the September issue of Contemporary Pediatrics.
Although most heart murmurs are relatively innocuous, some have serious causes.
If a murmur is detected, the doctor has to decide based on its nature if a further evaluation is warranted. Among the serious causes, for example, is an enlarged left ventricle, the main pumping chamber of the heart. Abnormal heart sounds, along with other physical characteristics like a hunched upper back, arm span greater than height, unusually long legs and myopia may indicate Marfan syndrome, a congenital disorder.
Each problem -- an enlarged heart or Marfan syndrome -- can result in sudden death during vigorous activity, and each must be thoroughly evaluated by a specialist before the child is allowed to play a physically demanding sport.
The cardiovascular exam should also include blood pressure readings, which may have to be repeated several times if a reading is high.
But, Dr. Koester said, elevated blood pressure need not keep an athlete sidelined while it is being further investigated unless the pressure is extremely high or accompanied by kidney or cardiovascular damage.
But even if it is only moderately high, blood pressure abnormalities must be treated, preferably through diet, exercise and weight loss, if needed, and medication if that is not enough.
The body parts most likely to be seriously hurt during sports activities are the leg muscles, the knees, the ankles and the shoulders.
Even young children can pull hamstrings, sprain or break ankles, tear knee ligaments and damage cartilage or wreck shoulder joints.
If injuries like these are not properly diagnosed, treated and rehabilitated, Dr. Koester said in an interview, they can result in repeated reinjury and long-lasting disability.
In a typical case, a young athlete sprains an ankle, limps around for a week, tapes it up and goes back to playing, only to reinjure it a few weeks later because it never had a chance to heal fully and because supporting muscles were not sufficiently strengthened to protect it.
Dr. Koester, who conducts hundreds of the exams each year, urges examiners to perform an 11-part screening exam for musculoskeletal problems.
*With the child standing straight facing the examiner, the thigh muscles should be tightened and the child's overall body symmetry observed.
*Assess the neck range of motion by asking the child to look at the ceiling, floor and over both shoulders and to touch each ear to the corresponding shoulder.
*Test shoulder strength by having the child raise the arms to the side, palms down, and resist the examiner's attempt to push down on the forearms.
*Have the child extend arms forward at a 45-degree angle, pointing thumbs down, and try to resist the examiner's downward pressure on the forearms.
*Test for shoulder rotation by having the child place one arm and then the other behind the back.
*With arms outstretched to the side, palms up, have the child flex and extend the elbows.
*With the child's arms at the sides and the elbows bent at 90 degrees, test for wrist health by having the child turn the hands facing up and then face down.
*Have the child make a fist and open and spread fingers to check for deformities and swelling.
*Ask the child to stand straight with back to the examiner to check for back and hip symmetry.
*Ask the child, with knees straight, to touch the toes, return to a neutral position and then arch the back to check for spinal abnormalities and tight hamstrings.
*Have the child stand balanced on one foot and hop up and down three or four times and then repeat the process with the other foot.
Vision and Vitamins
Vision in each eye should be checked, and any child with less than 20/40 corrected vision in one eye should be told to avoid sports like basketball that present a serious risk of eye damage, or be compelled to wear protective eye gear while playing.
Young athletes should also be questioned about their use of supplements, particularly those reported to increase strength or stamina or foster rapid weight loss. Most are useless, but some can be harmful.
All athletes should be advised about staying well hydrated, which may include consuming sports drinks when large amounts of fluid are lost during a workout or game.
But, according to Dr. Koester, routine laboratory tests are not a necessary part of a sports exam. Even if a child is anemic, as many teenage girls and young women are, this is not a reason to exclude someone from an activity, he said. In fact, very few disorders absolutely disqualify a child from participating in a desired sport. In 2,739 sports exams, experts at the Mayo Clinic found that just one child in 100 was disqualified from a chosen activity.
Keep in mind that while a medical problem may make one sport inadvisable, that does not mean a ban on all physical activities, Dr. Koester emphasized.
''We don't want to discourage children from athletic participation,'' he said. ''But we certainly should direct them into appropriate activities.''
In the best of worlds, a preparticipation exam would be conducted on entry into high school and college, and a more focused exam repeated annually, Dr. Koester said. But, he added, given the millions of children involved, a more realistic goal would be exams every other year.
Drawing (Drawing by Toni Zules)