American Chiropractic Board of Sports Physicians™

 

Position Paper on the Pre-Participation Physical Examination (PPE)

 

 

1.         The ACBSP™ endorses the performance of PPEs by chiropractors holding a DACBSP® or CCSP® certificate in good standing.  DACBSPs and CCSPs are fully qualified to perform PPEs.

 

2.         The ACBSP recommends that any chiropractor who performs PPEs should do so in accordance with the practical guidelines set forth in Pre-participation Physical Evaluation, 2nd Edition^[i], published by the AAFP, AAP, AMSSM, AOSSM and AOASM.

 

For the purposes of clarity of this position paper, the standard components of history and physical examination are listed below:

 

Components of the History

a.         Recent or chronic injury or illness

b.         Hospitalizations or surgeries

c.         Medications

d.         Allergies

e.         Cardiovascular system

f.          Skin

g.         Neurologic system

h.         Heat illness

i.          Pulmonary system, including asthma

j.          Protective devices

k.         Eyes and vision

l.          Musculoskeletal system

m.        Weight and eating disorders

n.         Psychosocial history

o.         Immunizations

p.         Menstrual history

 

Components of the Examination

a.         Height and weight

b.         Examination of the head, eyes, ears, nose and throat

c.         Examination of the cardiovascular system

d.         Examination of the lungs

e.         Examination of the abdomen

f.          Examination of the male genitalia

g.         Examination of the skin

h.         Examination of the musculoskeletal system, including posture, range of motion, and joint specific testing

i.          Examination of the neurologic system

 

3.         The goal of the cardiovascular portion of the PPE is to reliably obtain a detailed cardiovascular history, perform a competent screening examination and recognize heart disease.  The ACBSP endorses the essential components of the cardiovascular history and screening examination as set forth by the American Heart Association.^[ii]  Specifically, the PPE should include history and examination sections as follows:

 

Cardiovascular History

A.         Due to the great importance of accurate family history, the athlete’s parents should be responsible for completing the history forms.

B.         The cardiovascular history should include questions to ascertain:

1)         Prior occurrence of exertional chest pain/discomfort or syncope/near syncope;

2)         Prior occurrence of excessive, unexpected or unexplained shortness of breath or fatigue associated with exercise;

3)         Past detection of a heart murmur or increased systemic blood pressure;

4)         Family history of premature death (sudden or otherwise), or significant disability from cardiovascular disease in close relative(s) under 50 years old;

5)         Specific knowledge of the occurrence of the following conditions in the family:

i)          Hypertrophic cardiomyopathy

ii)          Dilated cardiomyopathy

iii)         Long QT syndrome

iv)         Marfan syndrome

v)          Clinically important arrhythmias

 

Cardiovascular Examination

 

A.         Precordial auscultation in both supine and standing positions to identify heart murmurs characteristic of left ventricular outflow obstruction.

B.         Assessment of femoral artery pulses to exclude coarctation of the aorta.

C.         Recognition of the physical stigmata of Marfan syndrome.

D.         Brachial blood pressure measurement in the sitting position.

 

4.         The ACBSP recommends and endorses the clearance guidelines for cardiovascular conditions established by the 26th Bethesda Conference.^[iii]  Definitively identified cardiovascular abnormalities should be judged by a qualified cardiologist, where feasible, for final determination of eligibility for future athletic competition.

 

5.         The ACBSP recommends that its certificants work with appropriate national, state and local agencies to promote:

 

a.         The inclusion of DACBSPs and CCSPs in the performance of PPEs and the clearance of athletes for participation in sport.

b.         The inclusion of the expertise of DACBSPs and CCSPs as consulting specialists when biomechanical, postural and neuromusculoskeletal problems are encountered in PPEs performed in the primary care office.

 

6.         The ACBSP recommends that DACBSP and CCSP certificants work professionally and collegially with other health care disciplines in a spirit of cooperation and teamwork for the benefit and welfare of the athlete.

 

Glossary of Abbreviations

ACBSP™          American Chiropractic Board of Sports Physicians™

PPE                 Preparticipation Physical Examination

DACBSP®        Diplomate American Chiropractic Board of Sports Physicians®

CCSP®             Certified Chiropractic Sports Physician®

AAFP               American Academy of Family Physicians

AAP                 American Academy of Pediatrics

AMSSM            American Medical Society for Sports Medicine

AOSSM                        American Orthopaedic Society for Sports Medicine

AOASM                        American Osteopathic Academy of Sports Medicine

 

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