Around this time every year, approximately a million Texas student athletes are preparing to practice or play for school teams, club teams or camp teams - and most require a pre-participation sports physical. Central Texas is no exception.

The Texas athletic governing body, the University Interscholastic League, and all area public schools require the physicals prior to a student being permitted to practice or to play.

Although it is extremely rare, area student athletes have been known to collapse on the field due to injury, overheating or as the result of undiagnosed heart problems. A Central Texas student football player was saved on the sideline just last year after his heart went into rapid fibrillation that was regulated by the use of a defibrillator and quick CPR. Although a sports physical can't necessarily prevent such incidents, it at least gives students and their parents information on health concerns that are detected during the physical. It also gives health professionals a chance to address conditions that may affect a student's play, such as nutrition, dehydration and injury prevention.

"The most important part of a pre-participation physical is the medical history," says Kelly Gettig, RN, Certified Pediatric Nurse Practioner, who will be one of about 40 volunteers who will provide free sports physicals in the Round Rock area. "The screening questionnaire is required by the UIL every year, but area school requirements are a bit more stringent. They want every athlete to have a full physical evaluation every year from the seventh grade on up."

The physical pays special attention to a student's heart, lungs, muscles and bones. It also offers the opportunity for a knowledgeable health professional to ask questions about previous illnesses, injuries or family history of early sudden death that might call for additional evaluation by a specialist.

Students with a primary care physician usually get their sports physical in their doctors' offices. But many families don't have insurance, don't have a regular health care provider or find that the deadline has sneaked up on them and school is almost ready to open. Some can still take advantage of the free sports physicals being offered Saturday, August 11, 2007 by Dell Children's and the Central Texas Pediatric Nurse Practitioners.

What to Expect in a Sports Physical

"Ours will be a station-based sports physical," comments Kelly. "Students should arrive with a parent prepared to fill out a screening questionnaire or print one from the UIL Web site and complete it in advance. For convenience, boys should wear a T-shirt and shorts; girls T-shirt, shorts and a sports bra."

The event is geared toward middle school and high school age teens, although some elementary school children have been evaluated in the past. It will be held at the Lone Star Circle of Care in the Round Rock Health Clinic building, 2120 North Mays, Suite 430, in Round Rock. Although the volunteers expect to see mostly area students, it is open to all Central Texas students.

Kelly describes the stations a student will visit.

Heart/Lungs - A thorough cardiac exam, including blood pressure, heart rate, evaluation of heart sounds, discussion of family history of sudden death or cardiac death before age 50. "A student who feels faint or dizzy during exercise, becomes abnormally tired or short of breath, has experienced chest pain or has an abnormal heart rhythm probably needs further evaluation. We are much more concerned with symptoms that show up during exercise and signs of hypertrophic cardiomyopathy (thickening of muscle walls that make it harder for the heart to work) that might show up in the history." Although it is rare, the majority of unexpected deaths are heart related.

"We also screen closely for signs of exercise-induced asthma such as cough, wheeze or shortness of breath with exercise. Athletes with asthma need a plan of care focused on prevention of symptoms with an inhaled bronchodilator such as albuterol."

Internal organs - Abdominal assessment, including hernias, organ abnormalities or injuries, genitalia, discussion of weight and eating disorders. "We also calculate BMI and do counseling for general weight issues, whether the individual is too heavy or too thin. We counsel all kids about heat stroke and dehydration. Overweight students are much more susceptible to dehydration during intense exercise."

Eyes - Vision check. "We catch lots of kids with visual abnormalities or who need corrective lenses. If a student has one eye functioning at less than 20/40, he or she needs to be evaluated by an ophthalmologist before clearance to play."

Muscles & Bones - Fourteen points are checked, essentially looking for signs of old injuries, swelling, pain, tenderness and decreased range of motion or strength. "It is always better to have this exam early if possible because many issues can be corrected through physical therapy. An ongoing injury can prevent a student from starting sports at the beginning of the season."

Neurological evaluation - Students who have a history of head injury need close evaluation of neurological symptoms of concussion such as headache, vision changes and memory loss. If an athlete continues to participate and symptoms have not completely cleared, he is at risk for serious brain injury from something called 'second impact syndrome.'"

Skin - Examined from head to toe, looking for abnormalities or rashes. "Skin disorders can indicate a range of disorders that we can address and discuss during the exam."

Ears, Nose, Throat - "We are looking for subtle signs of eating disorders or substance abuse such as chewing tobacco. We also can check for signs of typical problems such as viruses, colds, allergies and ear disorders. These issues would not prevent clearance for sports, but they are addressed as with any thorough physical examination."

"Our greatest responsibility is determining who is cleared to play and who is not. It is quite rare for an athlete to be restricted from sports, but a small percentage will require further evaluation by a specialist. Players need to come with a parent or guardian because other relatives cannot give permission for the student to be evaluated," continues Kelly. "In addition parents usually know the answers to the medical history questions, such as family history of heart disease and chronic health problems like asthma, allergies, sensitivity to insect bites, previous surgical procedures and medications. Students often do not know or recall the detailed information that is needed to thoroughly complete their screenning questionnaire and overall risk for serious sports-related injury of illness."

Kelly Gettig, RN, CPNP
Dell Children's Medical Center Trauma Unit
Member of Central Texas Pediatric Nurse Practitioners

Certified pediatric nurse practitioners like Kelly will be completing the sports physicals. Nurse practitioners are registered nurses who have advanced medical training in diagnosis and management of medical conditions. They work closely with physicians and practice both in medical specialty offices and in primary care physician offices where many conduct sports physicals.