Pre-Participation Exams

Written by:
Shawn Eddy
Senior Associate Athletic Trainer
Louisiana State University

It's the middle of March, our Spring sports are in full swing; winter sports are wrapping up and much of the country is caught up in March Madness. It's also at this time that I start looking at Semester schedules, getting in touch with coaches as well as compliance and academic offices as to when their teams are reporting and when orientation meetings are being held for the sole purpose of coming up with a Pre-Participation Exam (PPE) schedule.

Over the years, we have seen changes to our PPEs. Some of these changes have been necessitated by NCAA rule changes, others by the tragic occurrences that have been taking place in sports at all levels, sudden deaths. Currently at LSU, we are doing PPEs 6-7 times a year depending on when the sports teams report. However, we have two primary dates: the Sunday prior to start Summer semester and the Sunday prior to start of Fall semester. Not only do Freshman and Transfers receive PPEs, but our returning athletes do as well. All Freshman and Transfers undergo a complete physical while returnees go thru a "recheck" process. These rechecks are done within the first week of classes in the Fall. At that time we are able to follow-up on any injuries or illnesses that are unresolved from the prior season or summer vacation. The recheck exam provides us the opportunity to re-assess vital signs, heart and lung function, height/weight and follow-up on any orthopedic injuries. In the end, every student-athlete (S-A) will complete a physical each year prior to sport competition.

The most recent addition (since around 2001) to our PPE has been the implementation of Echocardiograms (ECHO). While we continue to do the standard ECG, our team of physicians felt this would be a helpful addition to our standard protocol. Every S-A receives an ECHO at the beginning of their eligibility at LSU; the decision is not based on one's history. Our Team Cardiologist, along with a Radiological Technician, is on-site to administer, observe, and read the ECHO during physicals to rule out any pathology that may predispose an athlete to heart ailments. There is controversy both within our Conference as well as nationally as to the real benefit to doing an ECHO. The three primary arguments are: (1) the cost of performing an ECHO, (2) the liability and potential cost to the Department is something is found, and (3) the reliability of the ECHO to actually uncover pathology. For LSU, the cost has been offset by the fact that the echocardiogram equipment has been donated; so has the time of both the Team Cardiologist and Radiological Technician. As for concerns over liability, our Administration agrees that accepting a scholarship athlete to LSU will sometimes bring the potential fro medical problems. Our medical personnel would rather accept responsibility versus not knowing what potential problems may exist. Finally, uncovering pathology, even if the chances are slim, would be well worth it if it meant the difference between life and a catastrophic cardiac event. The most critical pathology that could be uncovered is Hypertrophic Cardiomyopathy (a thickening of the left ventricular wall). This can be clearly evaluated by an Echocardiogram. As of 2010, several more universities have added the ECHO to the PPE regimen.

Height, weight, pulse rate, blood pressure, orthopedic evaluation, and general health evaluation are still a major part of each PPE. Each S-A also has blood drawn. With the blood evaluation, our physicians are assessing the S-A's general health as well as identifying those athletes with sickle cell trait, and potentially sickle cell disease. LSU includes a psychological screening tool that is evaluated by our contracted sports psychologist. This is used to pre-screen new student-athletes for a multitude of psychological, social, academic, and substance abuse issues. Additional areas of medical concern that are evaluated during the PPE are oral evaluations and eye examinations. The oral exams, performed by one of our Team Dentists, are done to rule out early stage oral cancers. In addition to oral exams, mouth molds are taken so that custom mouthpieces and be made for those sports that require mouth guards. Our eye exams check for any changes in vision since their last evaluation. Any functional testing that an ATC would like to do for an individual or team is done around the time of the PPE but is not generally a part of the scheduled exams.

Once a S-A completes his or her athletic eligibility, they receive an exit physical. The exit exam has allowed us to follow-up of any unresolved issues that an athlete may have or had in their athletic career that needs additional follow-up.

The PPE gives us an opportunity to uncover pathologies and orthopedic injuries. The simple introduction of rehabilitation could potentially strengthen joints that would be more vulnerable to injury. It is not unusual to find elevated blood pressure during physicals. This can be effectively treated prior to the start of one's season. Most important is the blood work that could uncover the life threatening condition, sickle cell. With conditions such as sickle cell, knowledge is power. Adjustments can be made to practices and conditioning workouts that would accommodate the special needs of these individuals. While we recognize that PPEs are time consuming for all of the individuals involved, we all agree that they are one of the most critical parts of our pre-season preparation.