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No. 5

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Doc’s Digest
Medical Advice from Dr. Sayre
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Getting a Sports Physical

It is a tragic event that will most assuredly capture the headlines. Across the United States, as many as 10 young athletes per year will suddenly collapse and die, victims of an underlying health problem. In an attempt to prevent such catastrophic events, all of the state legislatures have adopted pre-participation physical exam requirements for public-schooled children. Before students can even set foot on the court or field, a licensed health professional must certify that the would-be sports star can physically withstand the rigors of the sport.

But, is it necessary for homeschooling parents to have their children undergo specialized screening prior to a home-based physical education program? In the absence of a pre-participation exam, are your children at risk of sudden death while playing soccer in the backyard?

To answer these questions, we must first address some good news and some bad news. The good news is that although the risk of sudden death is real, it is very small. It has been estimated that about one death will occur per 300,000 high school and college sports participants. The bad news is that determining who is at risk is difficult—sometimes even impossible.

Most of the sudden deaths associated with sports participation are related to heart malformations. Affected individuals are at risk for sudden rhythm disturbances or mechanical failures that give little or no warning of the impending event. Although a careful history and physical examination will uncover many of these malformations, a significant percentage will escape these simple measures.

This places those of us who routinely do pre-participation physical exams in a difficult position. A person’s history and physical exam may indicate there are no underlying health concerns. But when we, as doctors, sign a form certifying an athlete’s eligibility, we do so with the knowledge that there may in fact be something we are missing . . . perhaps a deadly heart defect. It would be great if there were some affordable and fail-safe testing method, beyond the simple history and physical exam, that could be routinely employed. Unfortunately none exists. When coupled with the low odds of having a lethal defect, the specificity and sensitivity of such modalities as electrocardiograms, echocardiograms, and even genetic testing limit the usefulness of these tests for screening purposes.

So what is the bottom line for you, as the parent of a budding athlete?

Well, first of all, you should know that there is nothing magical about the standard sports physical. Barring unusual circumstances, a physician will do pretty much the same evaluation for a routine well-child visit as is done for a pre-participation exam. Unless the child’s history or physical exam tips off the physician that a potential problem exists, additional screening modalities are not helpful.

Second, make sure your child is seen regularly by your family doctor. Remember it is your responsibility to provide an accurate history, including any complaint related to exertion (such as chest pain, breathing difficulties, or fainting), a history of high blood pressure or heart murmur, or a family history of heart-related problems (especially sudden death). Beyond these simple prophylactic measures, the rest is up to the Creator.

About the author

An HSLDA board member since 1997, Dr. Rodger Sayre is a family physician, and his wife Mary is a registered nurse. They live in Tunkhannock, Pennsylvania, and teach their 11 children at home. Dr. Sayre received his medical degree from Thomas Jefferson University in Philadelphia and maintains board certification in family practice. A Geisinger Medical Group associate with a busy practice in Nicholson, Pennsylvania, he is a member of the Christian Medical Association, the American Academy of Family Physicians, and the American College of Sports Medicine.

Please Note

The views of guest columnists may not reflect the views of Home School Legal Defense Association.