A Preparticipation Physical Evaluation (PPE), commonly known as a sports physical, is a required medical assessment for athletes before they can participate in organized sports. The primary goal is to screen for medical conditions that could increase the risk of injury or sudden death during athletic activity. Because Doctors of Chiropractic (DC) specialize in the musculoskeletal system, they are often considered a qualified option for performing this evaluation. Whether a chiropractor can complete this mandatory clearance involves a complex mix of state laws, professional licensing, and specific athletic association rules.
Determining Authority: State Licensing and Signing Power
The ability of a Doctor of Chiropractic to perform and legally sign the Preparticipation Physical Evaluation form is not universal. This authority is dictated by state licensing laws and the specific bylaws of the local or state athletic governing body, such as a high school activities association. The power to perform the physical is distinct from the legal authority to sign the required clearance document, which officially certifies an athlete’s fitness to participate.
Some states and their athletic associations explicitly list DCs among the qualified healthcare providers authorized to sign the final clearance form. For example, the Missouri State High School Activities Association (MSHSAA) allows DCs, alongside Medical Doctors (MDs), Doctors of Osteopathic Medicine (DOs), Physician Assistants (PAs), and Nurse Practitioners (NPs), to certify the examination. Other states, such as Colorado, authorize DCs to perform the physical but may require specific additional training or certification courses.
In contrast, certain high school athletic associations, like the Illinois High School Association (IHSA), restrict signing authority to MDs, DOs, PAs, and NPs, even if the evaluation falls within the DC’s scope of practice. This disparity often leads to disputes between state chiropractic boards and athletic organizations. Athletes must always check the specific form issued by their school or league to see which provider signatures are accepted.
The Required Components of a Sports Physical
A standardized Preparticipation Physical Evaluation consists of two main parts: a comprehensive medical history review and a focused physical examination. The medical history is crucial, identifying over 75% of conditions that may limit participation. It includes questions about past illnesses, surgeries, and previous injuries, especially concussions. Reviewing the family medical history is also essential, focusing on any incidence of early sudden death or heart conditions.
The physical examination screens for medical problems that could lead to serious complications during sports. This includes taking vital signs, such as blood pressure and heart rate, and examining the cardiovascular system to identify risk factors for sudden cardiac arrest, like a pathologic heart murmur. The exam also incorporates a general medical review of the eyes, ears, nose, throat, abdomen, and lungs. Finally, a systematic assessment of the athlete’s musculoskeletal system checks for existing injuries or structural issues.
Chiropractic Focus: Musculoskeletal and Postural Assessment
When authorized to perform a PPE, the chiropractor brings a specialized focus to the examination of the musculoskeletal system. Chiropractors receive extensive training in the evaluation, diagnosis, and management of conditions related to the spine and other joints. This expertise allows for a detailed assessment of an athlete’s physical structure and function that may exceed the depth of a general physical.
The chiropractic assessment involves a systematic screening of range of motion, strength, flexibility, and joint stability throughout the body. Specific attention is paid to postural alignment and the identification of biomechanical imbalances that could predispose an athlete to future injuries. For instance, a DC may detect a functional leg-length difference or an asymmetrical muscle strength pattern that could increase the risk of a ligament tear or chronic joint pain during a season.
This specialized screening is valuable for injury prevention, as it allows for the early detection of underlying issues before they become symptomatic under the stress of high-level athletic training. Chiropractors with post-graduate certifications, such as a Certified Chiropractic Sports Physician (CCSP), are recognized for their advanced clinical skills in performing these comprehensive biomechanical evaluations. By identifying and addressing these risk factors, the DC provides an opportunity for pre-season corrective exercises or modifications to an athlete’s training regimen.
When Other Providers Are Necessary
Even when a Doctor of Chiropractic is authorized to perform the musculoskeletal part of the PPE, a referral to another provider may become necessary under certain circumstances. If the DC identifies a finding outside their primary scope of practice, such as an elevated blood pressure reading or a concerning finding during the cardiovascular screening, the athlete must be referred to a Medical Doctor or Doctor of Osteopathic Medicine for further diagnostic testing. The purpose of the PPE is to screen for risk, and any red flags require immediate follow-up with a provider specializing in that area.
In situations where the school or athletic association form does not accept a DC signature, the athlete must seek an authorized provider, which typically includes MDs, DOs, PAs, and NPs. The process may involve a station-based physical, where the DC performs the musculoskeletal portion, and an authorized medical provider reviews the general medical history and signs the final clearance. To avoid delays, athletes and parents should confirm the list of acceptable providers directly with the school’s athletic department before scheduling the appointment.