Academy of Physical Therapy and Sports in America

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American Acedemy of Physical Therapy and Sport 

Background & Objectives of this article:

The sports physical therapist (SPT) is uniquely qualified to participate in the provision of a pre-preparation physical examination (PPE). PPE is recommended before athletic participation is needed by many jurisdictions. There is little research to support component processes; However, a number of professional organizations have recommendations that direct the PPE process.

Description of Topics & Related Evidence:

This clinical comment highlights the role of physical sports therapists and also current evidence related to the prepartmental physical examination process. Data sources are limited to including professional positions and peer-reviewed publications from 1988 to January 2013.

Relationship with Clinical Practice:

Physical preparation must be useful, comprehensive, and also cost effective for athletes and the health care team. Additional research is shown in many areas of PPE. SPT is a valuable member of the health care team and can be the main facilitator of PPE together with doctors, athletic trainers, athletic organization administrators, and so on.

Well-designed & inclusive PPE can be provided to meet the main objectives of identifying athletes at risk. Controversy continues during the level of components of the cardiac examination and specific components of exercise or in other athletes.

Proof Level:

Keywords: athletes, prepartmental physical examination, screening, sports physical therapy

Sports physical therapy is an area of ​​unique practice which was officially recognized as part of the 1973 (special interest group) by the American Physical Therapy Association (APTA) House of Delegates. A group of physical therapists identify a general knowledge body associated with athlete's physical therapy care as an encouragement for the organization. The aim is to provide opportunities for education, communication and consultation in a wide area of ​​practice known as Sports Medicine. The original name, "Sports Medicine Section" was changed in the 1980s to "Physical Sports Therapy Section" to more accurately reflect group membership. 1 Section Physical Sports Therapy (SPTS) defines sports physical therapy as a special practice that focuses on prevention, evaluation , care, rehabilitation and improvement in the performance of physically active individuals

In the early 1970s, APTA adopted a position statement that supported the development of advanced clinical competency tests. As a result of this position, sports physical therapy was one of four specialized fields initially approved for the development of clinical specialties by APTA in 1981. Led by Tab Blackburn, Terry Malone, and Lynn Wallace, the Sports Council developed and also described competencies that considered specifically for sports physical therapy exercises. This competency is validated by a study that identifies the level of competence & importance of competence for the practice of sports physical therapy that serves to pave the way for the certification of Sports Clinic Specialists (SCS). The first certification examination in sports physical therapy was given in 1988 and 16 physical therapists have been certified as Sports Clinical Specialists (SCS's) by the Council for Certification of Advanced Clinical Competencies (BCACC) now known as the American Board of Physical Therapy Specialties (ABPTS) .1 In the year 2011, there were 968 people who had SCS credentials

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Of the 16 clinical competencies initially identified, after being reviewed from 1991 to 2001, there are now six fields of clinical competence needed.4 These are described as follows:

Rehabilitation / return to activity: Rehabilitation of athletes with disorders, functional limitations, or disabilities focusing on returning athletes to their respective sports.

Acute injury / disease management: Management immediately communicates to acute injury patients or disease associations with athletic activity.

Sports science: Maximizing athletic sports performance, including consideration of training and the influence of factors such as nutrition and the environment on performance.

Medical / surgical considerations: Medical & surgical management of athletes.

Injury prevention: Injury / disease prevention for athletes.

Critical Investigation: Maintenance of current knowledge, applying the principles of evidence-based practice in sports physical therapy & contributing to the body of knowledge in sports physical therapy.

Sports physical therapists have the education and skills needed to evaluate athletes in the musculoskeletal and neuromuscular realms, to make decisions about interventions for injured athletes, and make recommendations about returning to sports.

The responsibility for PPE can be directed to a number of professional people representing sports health care teams - certified athletic trainers, athletic directors, team doctors, sports physical therapists or designated and knowledgeable people. Sports physical therapists certainly have the expertise to coordinate the PPE process in various settings. The key component of PPE is the process of communication between athletes, coaches, parents and other members of the health care team. In the end, the team of doctors, if available, has responsibility for the health & well-being of athletes in collaboration with the health care team. This team can include a number of people - trainers, athletic staff, volunteer parents, medical personnel, student trainers, student managers, and others. After the organizational plan of the PPE is developed, the staff needed can be determined. It is very important that a person be appointed as a coordinator who is identified as a clear authority during the process. This allows clearly defined roles for each individual and greatly enables the athlete's efficient movement throughout the process. All professionals are informed of the objectives, policies and procedures, and the process and how PPE will be carried out. To facilitate PPE, communication with maps describing "flow" and process sequences was developed and shared and training sessions could be used if several "new" providers would be part of the process.

The aim of this clinical commentary is to focus on the role of physical therapists in the field of injury prevention & specifically on their role in planning, coordination, or administration of PPE. In addition, the author discusses the importance of screening for and recognizing medical conditions or injuries that might affect or hinder the participation of athletes.

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Sports & athletic participation can be a positive experience for all age groups by improving fitness, increasing self-esteem, increasing coordination and also providing opportunities for creative cooperation and competition. Participation in sports and athletic activities continues to increase in all walks of life from very young youth sports activities, to high schools and colleges, and finally the baby boomer generation. More high school students play sports than before; more than 7.6 million (55.5%) of all secondary school students participated.5 For the ninth consecutive year, there has been a marked increase in athletic participation at the college level with more than 444,000 students competing in more than 18,000 teams.6 While it is difficult to gather the absolute number of participants, youth sports and baby boomers both show increased participation - perhaps in response to messages about physical fitness through life span. With this increase in participation comes the need for special health care related to the demands of athletes. The first component of the health care process for athletes begins with PPE. PPEs, pre-participation screenings, sports screenings, pre-participation medical evaluations, all are synonym terms used to describe the process that sports participants must complete before participating in sports, training, and competition. For the purpose of this clinical comment, PPE will be used to describe this process. Most organized sports require a kind of preparatory assessment and many sports-related organizations have position statements in PPE.7 For example, all 50 countries require the completion of several types of evaluations before participation in secondary school sports. Nevertheless, the National Federation of Association of State Colleges has chosen not to adopt or require a standard PPE. The National Collegiate Athletic Association (NCAA) and the National Association of Intercollegiate Athletics (NAIA) require preparatory medical evaluations when a student enters an inter-college athletic program.

Health care providers also recognize the need for evaluation of preparation. The Physical Sports Therapy section of APTA develops position papers on pre-preparation screening. 14 The American Medical Association Committee (AMA) on the Medical Aspects of Sport develops statements about the Rights of Sportsmen; one of these rights states that each athlete has the right to adequate health supervision.10 The National Athletics Trainer Association (NATA) developed "Recommendations and Guidelines for Appropriate Medical Coverage of Space Athletes" in 2000 with revisions in 2003 and 2007.11 The NATA document supports determining the readiness of athletes to participate as part of the definition of appropriate medical coverage. In 1997, publications, Doctors and Sports Medicine issued consensus statements from five organizations - the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American Medical Society for Sports Medicine (AMSSM), the American Orthopedic Society for Sports Medicine (AOSSM), and the American Osteopathic Academy of Sport Medicine (AOASM) which summarizes guidelines for screening procedures.15 These same five organizations join the American College of Sport Medicine (ACSM) and publish the 4th edition of Physical Evaluation Preparation (PPE - 4) in 2010.16 PPE - 416 provides the latest comprehensive guidelines for PPE and suggested screening tools and forms.

In a review of the literature on PPE, there is agreement that PPE is not intended to replace the routine health care needs of athletes but can facilitate opportunities for general health care.17 Many goals for PPE have been identified; However, its main goal is always to improve the health and safety of athletes in training and competition, not to exclude them from competition.18 McKeag19 identified 11 clear objectives that distinguish PPE from traditional health care examinations. These are presented in Table 1. The purpose of McKeag is recognized and included in the PPE-4 statement for primary and secondary goals for PPE. The overall and most important goal of PPE is to improve the health and safety of athletes.