The Preparticipation Physical Evaluation (PPE), commonly known as a sports physical, is a standardized medical checkup required by most athletic organizations before a girl can be cleared for competitive sports. This evaluation identifies pre-existing medical conditions or injuries that could place the athlete at risk during physical activity. The process is a structured, multi-step assessment, transitioning from a detailed health history conversation to a hands-on physical examination, culminating in a determination of medical eligibility.
Reviewing the Athlete’s Health History
The sports physical begins with gathering historical data by completing an extensive questionnaire and discussing the answers with the healthcare provider to establish a comprehensive health profile. Information collected includes a review of previous surgeries, hospitalizations, and any past concussions or significant orthopedic injuries. A thorough family medical history is also collected, paying particular attention to relatives who may have experienced sudden cardiac death, cardiomyopathy, or other serious inheritable conditions before the age of 50.
For a girl, the medical history includes a required discussion of her menstrual history, which serves as a biological marker for overall health. The provider will ask about the age of menarche (the first menstrual period) and the typical length and regularity of her cycle. Documenting the number of periods she has had in the last year is important because irregular or absent menses can signal an underlying physiological issue. This information helps the provider screen for potential hormonal imbalances or insufficient energy intake, which can impact reproductive and bone health.
The General Physical Examination
Following the historical review, the clinician proceeds with the general physical examination. This phase starts with recording baseline vital signs, including the athlete’s height, weight, and blood pressure, which are tracked over time to monitor growth and health trends. A vision screening is also performed to ensure the athlete’s eyesight meets the demands of her sport and that any necessary corrective lenses are accounted for.
The provider then performs a systemic review of the athlete’s major organ systems. The cardiovascular examination is a focused check, often involving listening to the heart while the athlete is in various positions (standing, lying down, and squatting) to detect subtle heart murmurs. The lungs are listened to for clear breath sounds, which helps screen for conditions like exercise-induced asthma. A check of the abdomen, skin, and neurological status completes this portion of the evaluation before moving on to the functional assessment.
Specific Musculoskeletal and Female Athlete Screenings
This phase focuses on the athlete’s physical readiness and includes screenings tailored to the female athlete’s physiology. The physical examination includes a functional musculoskeletal assessment to check for joint stability, muscle strength, and flexibility. This often utilizes a quick, standardized series of movements called the “2-minute orthopedic examination.” This assessment evaluates the athlete’s range of motion, symmetry, and joint alignment in areas like the shoulders, spine, knees, and ankles, checking for signs of poor core control or improper knee alignment that indicate a higher risk for injury.
This section also addresses conditions specific to the female athlete, such as Relative Energy Deficiency in Sport (RED-S), which involves a mismatch between energy intake and energy expenditure. Menstrual dysfunction, poor bone health, and a history of recurrent stress fractures are potential flags for RED-S, prompting the provider to discuss nutrition and training volume. The provider may also screen for signs of iron deficiency, which is more common in menstruating athletes and can impair endurance and athletic performance.