Module 2: Physical Screening and General Principles of Training

Objectives

On completion of the topic , one should be able to understand

 the goals and objectives of pre-participation physical examination 

 the physical screening and general principles of physical training
 the importance of pre-participation physical examination and sports physical

Introduction

A physical examination is an evaluation of the body and its functions using inspection,
palpation (feeling with the hands), percussion (tapping with fingers), and auscultation
(listening). A complete health assessment also includes gathering information about a
person’s medical history and lifestyle, doing laboratory tests, and screening for disease.

The annual physical examination has been replaced by the periodic health examination. How
often this is done depends on the patient’s age, sex and risk factors for disease. The United
States Preventative Task Force (USPDTF) has developed guidelines for preventative health
examinations that health care professionals widely follow.

Physical screening 

Physical screening is used to ascertain the current musculoskeletal condition of the athlete
and should usually be performed early in the pre-season phase of training.  Screening can also
involve the use of sport specific fitness testing to ascertain the athletes’ preparation for that
particular sport. A physical assessment of the athlete allows your sport physiotherapist to
obtain base data which can:

 Highlight past and current injuries, which can result in specific exercise prescription
for managing the condition and preventing further injury
 Identify inter-player differences – direct conditioning training programs to be set for
various levels of fitness
 Monitor physical changes over time, which is particularly important in the growing
athlete and athlete participating in high training load and/or multiple sports
 Ensure effective physical conditioning – allowing for measurement, review and
modifications to exercise training programs involving sport science and sport
physiotherapy

A typical physical screening of athletes includes analysis of:

 Posture
 Gait assessment
 Muscle length and joint flexibility
 Neuromuscular assessment
 Task-specific testing.
Even the junior team or recreational player who does not consider themself to be an ‘athlete’
can greatly benefit from a base-level screening from a sport physiotherapist on posture and
muscle tightness/ weakness.

Pre-participation physical examination (PPPE)

The pre-participation physical examination (PPPE) is an important step toward safe

participation in organized sports. The purpose of the PPE is not to disqualify or exclude an
athlete from competition, but rather to help maintain the health and safety of the athlete in
training and competition.
Goals and objectives
The goals of a pre-participation sports evaluation can be summarized as follows:
 Determine that the athlete is in general good health.
 Assess the athlete's present fitness level.
 Detect conditions that predispose the athlete to new injuries.
 Evaluate any existing injuries of the athlete.
 Assess the size and developmental maturation of the athlete.
 Detect congenital anomalies that increase the athlete's risk of injury.
 Detect poor pre-participation conditioning that may put the athlete at increased risk.

Importance of Pre-Participation Physical Exam (PPPE)

This is the time of year when hundreds of young athletes are lining up for pre-participation
physical exams (PPPE). Pre-participation physical exams are required for athletes to
participate in middle school and high school sports and summer camps.

With the increased media attention on including electrocardiograms as part of PPPEs for the
purpose of detecting hypertrophic cardiomyopathy, the leading cause of sudden death in
young athletes, pre-participation physical exams are receiving more consideration.
Specifically, sports medicine personnel are reviewing the quality and what is required in
these exams to ensure that they are sufficient to identify young athletes who may be at risk
for further injury or possible sudden death.

What is the purpose of a PPPE?

The purpose of the PPPE is to identify athletes that may be at risk for further injury or illness
and to refer these athletes for additional medical evaluation prior to allowing them to
participate. The specific purposes include the following:

 To identify athletes at risk of sudden death

 To identify medical conditions that may require further evaluation and treatment
before participation
 To identify orthopedic conditions that may require further evaluation and
treatment, including physical therapy, before participation
 To identify at-risk adolescents and young adults who are at risk for substance
abuse, STDs, pregnancy, violence, depression, and so on
 To satisfy legal requirements of athletic governing boards
Identification of athletes who may be at risk for sudden death is currently a hot topic in the
world of sports medicine. Recent studies have indicated that the addition of an
electrocardiogram would identify athletes with hypertrophic cardiomyopathy and that this test
should be a requirement of the PPPE.

General Principles of Physical Training

The aim of physical training is to expose the body safely to stimuli that cause physiological
and structural adaptations to take place. Positive benefits include an increased capacity to
work for longer periods before the onset of fatigue and a rapid return to normal once activity
has ceased.

However, there is still much to be understood by sport scientists regarding training and,
although new training techniques appear frequently, there are several fundamental, and well
established, guidelines which should form the basis for the development of any training
programme.

Training to improve an athlete's performance obeys the principles of training i.e., specificity,
overload, rest, adaptation and reversibility (SORAR).

Specificity

Specificity is an important principle in strength training, where the exercise must be specific

to the type of strength required, and is therefore related to the particular demands of the
event. The coach should have knowledge of the predominant types of muscular activity
associated with his/her particular event, the movement pattern involved and the type of
strength required. Although specificity is important, it is necessary in every schedule to
include exercises of a general nature (e.g. power clean, squat). These exercises may not relate
too closely to the movement of any athletic event but they do give a balanced development
and provide a strong base upon which highly specific exercise can be built.

Overload

When an athlete performs a mobility exercise, he/she should stretch to the end of his/her
range of movement. In active mobility, the end of the range of movement is known as the
active end position. Improvements in mobility can only be achieved by working at or beyond
the active end position.

 Passive exercises involve passing the active end position, as the external force is able
to move the limbs further than the active contracting of the agonist muscles
 Kinetic mobility (dynamic) exercises use the momentum of the movement to bounce
past the active end position

A muscle will only strengthen when forced to operate beyond its customary intensity. The
load must be progressively increased in order to further adaptive responses as training
develops, and the training stimulus is gradually raised. Overload can be progressed by:

 increasing the resistance e.g. adding 5kg to the barbell

 increasing the number of repetitions with a particular weight
  increasing the number of sets of the exercise (work)
 increasing the intensity- more work in the same time, i.e. reducing the recovery
periods

Recovery

The rest periods between physical training are just as important as the training itself, as
muscle damage is repaired and waste is metabolized during these times. The optimum
recovery time is between 24 and 48 hours after exercise. Recovery also can be achieved by
alternating more difficult training days with easier training days, or alternating muscle groups
so you're not working the same muscles continually. Improper recovery can lead to muscle
fatigue, increasing the potential for subsequent injuries.

Adaptation

The rate of adaptation will depend on the volume, intensity and frequency of the exercise
sessions. In their recent investigation Burgomaster et al. (2008) reports that 6 weeks of low-
volume, high-intensity sprint training induced similar changes in selected whole-body and
skeletal muscle adaptations as traditional high-volume, low-intensity endurance workouts
undertaken for the same intervention period.

Hawley (2008), states that the time of adaptation may be quicker for high-intensity sprint
training when compared to low-intensity endurance training, but that over a longer period, the
two training regimens elicit similar adaptations.

Reversibility

Improved ranges of movement can be achieved and maintained by regular use of mobility
exercises. If an athlete ceases mobility training, his/her ranges of movement will decline over
time to those maintained by his/her other physical activities.

When training ceases the training effect will also stop. It gradually reduces at approximately
one third of the rate of acquisition (Jenson and Fisher, 1972). Athletes must ensure that they
continue strength training throughout the competitive period, although at a much reduced
volume, or newly acquired strength will be lost.

According to Michael Brent, the general principle of physical training is divided into seven
principles, which are also known as PROVRBS, an acronym for progression, regularity,
overload, variety, recovery, balance and specificity.

Why Is a Sports Physical Important?

A sports physical can help you find out about and deal with health problems that might
interfere with your participation in a sport. For example, if you have frequent asthma attacks
but are a starting forward in soccer, a doctor might be able to prescribe a different type of
inhaler or adjust the dosage so that you can breathe more easily when you run.
Your doctor may even have some good training tips and be able to give you some ideas for
avoiding injuries. For example, he or she may recommend certain stretching or strengthening
activities that help prevent injuries. A doctor also can identify risk factors that are linked to
specific sports. Advice like this will make you a better, stronger athlete.

Conclusion
General health checks, including physical examinations performed when the patient reported
no health concerns, often include medical screening for common conditions, such as high
blood pressure. A Cochrane review found that general health checks did not reduce the risk of
death from cancer, heart disease, or any other cause, and could not be proved to affect the
patient's likelihood of being admitted to the hospital, becoming disabled, missing work, or
needing additional office visits.
Sports physical which is also known as a pre-participation physical examination is a check-up to
assess a teen's health and fitness as it relates to a sport. It is not the same as a regular physical.
During the sports physical, the health care provider looks for any diseases or injuries that could
make it unsafe to participate in sports and reviews the family's medical history to ensure
additional tests are performed if necessary.

FAQ

Q1. What is the purpose of a PPPE?

Ans:The purpose of the PPPE is to identify athletes that may be at risk for further injury or
illness and to refer these athletes for additional medical evaluation prior to allowing them to
participate. The specific purposes include the following:
A. To identify athletes at risk of sudden death
B. To identify medical conditions that may require further evaluation and treatment
before participation
C. To identify orthopedic conditions that may require further evaluation and
treatment, including physical therapy, before participation
D. To identify at-risk adolescents and young adults who are at risk for substance
abuse, STDs, pregnancy, violence, depression, and so on
E. To satisfy legal requirements of athletic governing boards

Q2. Why is a sports physical important?

Ans: A sports physical can help to find out about and deal with health problems that might
interfere with ones participation in a sport. For example, if someone has frequent asthma
attacks but are a starting forward in soccer, a doctor might be able to prescribe a different
type of inhaler or adjust the dosage so that he can breathe more easily when he run.

Q3. Why specificity is important principles in physical training?

Ans: Specificity is an important principle in strength training, where the exercise must be
specific to the type of strength required, and is therefore related to the particular demands of
the event. The coach should have knowledge of the predominant types of muscular activity
associated with his/her particular event, the movement pattern involved and the type of
strength required. Although specificity is important, it is necessary in every schedule to
include exercises of a general nature (e.g. power clean, squat). These exercises may not relate
too closely to the movement of any athletic event but they do give a balanced development
and provide a strong base upon which highly specific exercise can be built.

Q4. What is a pre-participation exam?

Ans:The pre-participation physical examination (PPPE) is an important step toward safe
participation in organized sports. The purpose of the PPPE is not to disqualify or exclude an
athlete from competition, but rather to help maintain the health and safety of the athlete in
training and competition.

Q5. What is sports performance training?

Ans: Sports performance training simply put is a type of training that is designed to improve
one’s fitness level for the purpose of improving one’s ability to perform a given sport.

Q6. Why do people get involved in physical activity?

Ans:People get involved in exercise for a number of reasons:
A. to improve their health and physical condition,
B. to achieve a sporting ambition,
C. to relive the tension and stress of daily life, and
D. to lose weight, it makes them feel good.
Participating in sport encourages co-operation in team sports, develops the element of
competitiveness, provides a physical challenge and the opportunity to meet new people and
make new friends.

Glossary
Element: An abstract part of something
Predominant: Most frequent or very common
Muscular: Of or relating to or consisting of muscle
Depression: A mental state characterized by a pessimistic sense of inadequacy and a
despondent lack of activity
Reversibility: The quality of being reversible in either direction
Overload: Become overloaded
Stimulus: Any stimulating information or event; acts to arouse action
Orthopedic: Of or relating to orthopedics

References

Godfrey, R.J. et al. (2005) The detraining and retraining of an elite rower: a case study. J Sci
Med Sport, 8 (3), p. 314-320

Hawley, J. (2008) Specificity of training adaptation: time for a rethink? Journal of

Physiology,  586 (Pt 1), p. 1–2.
Burgomaster KA. et al. (2008) Similar metabolic adaptations during exercise after low
volume sprint interval and traditional endurance training in humans .J Physiol. 586. p.151–
160

Landry, G.L. & Bernhardt, D.T. (2003). Essentials of Primary Care Sports Medicine. Human
Kinetics: Champaign, IL.

Maron, B. (March 2, 2010). National Electrocardiography Screening for Competitive

Athletes: Feasibility in the United States? Annals of Internal Medicine, 152(5), 324-355.

Stein, J. (March 2, 2010). Tests could identify at-risk youth athletes. Los Angeles Times: Los
Angeles, CA.

 Krogsbøll, Lasse T; Jørgensen, Karsten Juhl (2012). "General health checks in adults for
reducing morbidity and mortality from disease". Cochrane:
1. doi:10.1002/14651858.CD009009.pub2.

Link Web:
sportsmednq.net.au/pre-season-screening-injury-prevention
emedicine.medscape.com/article
kidshealth.org/en/teens/sports-physicals.html
https://www.who.int/dietphysicalactivity/physical_activity_intensity/en/