Preparticipation Physical Evaluation in Sport

  • James A. Onate
  • Daniel R. Clifton
Reference work entry


In 1976 the American Medical Association’s Committee on Medical Aspects of Sports recognized the importance of the preparticipation physical evaluation (PPE) and recommended completion of a PPE prior to athletic participation. The American Academy of Pediatrics fourth edition (PPE-4) monograph, published in 2010, is a consensus document on sports related PPE consisting of contributions from seven health care organizations. Although the PPE was initially intended to fulfill school-based legal and medical requirements, the primary goal of the current examination is to maximize safe participation by adolescents in physical activities. However, research-based evidence supporting the efficacy of the PPE to ensure safe participation, particularly regarding musculoskeletal injury, is lacking. Future multisite studies need to be implemented to assess the potential benefits of preparticipation physical evaluations on reducing the incidence of serious medical problems. Utilization of the current PPE-4 screening form and its impact on the healthcare of the physically active should be a major area of inquiry in the medical field.


Preparticipation Evaluation Athletic Screening Musculoskeletal Examination 


  1. American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine et al (2010) PPE preparticipation physical evaluation, 4th edn. American Academy of Pediatrics, Elk Grove VillageGoogle Scholar
  2. American Medical Association (1976) Medical evaluation of the athlete: a guide. American Medical Association, ChicagoGoogle Scholar
  3. Bahr R (2016) Why screening tests to predict injury do not work – and probably never will…: a critical review. Br J Sports Med 50:776–780CrossRefGoogle Scholar
  4. Best TM (2004) The preparticipation evaluation: an opportunity for change and consensus. Clin J Sport Med Off J Can Acad Sport Med 14:107–108CrossRefGoogle Scholar
  5. Bews DC, Baillie JH (1969) Preplacement health screening by nurses. Am J Public Health Nations Health 59:2178–2184CrossRefGoogle Scholar
  6. Brumitt J, Heiderscheit BC, Manske RC et al (2013) Lower extremity functional tests and risk of injury in division III collegiate athletes. Int J Sports Phys Ther 8:216–227Google Scholar
  7. Caswell SV, Cortes N, Chabolla M et al (2015) State-specific differences in school sports preparticipation physical evaluation policies. Pediatrics 135:26–32. Scholar
  8. Charap MH (1981) The periodic health examination: genesis of a myth. Ann Intern Med 95:733–735CrossRefGoogle Scholar
  9. Chun J, Haney S, Difiori J (2006) The relative contributions of the history and physical examination in the preparticipation evaluation of collegiate student-athletes. Clin J Sport Med 16:437–438Google Scholar
  10. Dodson JM (1925) The American medical association and periodic health examinations. Am J Public Health NY 15:599–601CrossRefGoogle Scholar
  11. DuRant RH, Pendergrast RA, Seymore C et al (1992) Findings from the preparticipation athletic examination and athletic injuries. Am J Dis Child 146:85–91Google Scholar
  12. Garrick JG (2004) Preparticipation orthopedic screening evaluation. Clin J Sport Med Off J Can Acad Sport Med 14:123–126CrossRefGoogle Scholar
  13. Glover DW, Maron BJ (1998) Profile of preparticipation cardiovascular screening for high school athletes. JAMA 279:1817–1819CrossRefGoogle Scholar
  14. Gomez JE, Landry GL, Bernhardt DT (1993) Critical evaluation of the 2-minute orthopedic screening examination. Am J Dis Child 147:1109–1113Google Scholar
  15. Gribble PA, Hertel J, Plisky P (2012) Using the Star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train 47:339–357CrossRefGoogle Scholar
  16. Han PKJ (1997) Historical changes in the objectives of the periodic health examination. Ann Intern Med 127:910–917CrossRefGoogle Scholar
  17. Kucera KL, Marshall SW, Kirkendall DT et al (2005) Injury history as a risk factor for incident injury in youth soccer. Br J Sports Med 39:462–462CrossRefGoogle Scholar
  18. Lehr ME, Plisky PJ, Butler RJ et al (2013) Field-expedient screening and injury risk algorithm categories as predictors of noncontact lower extremity injury: field screens predict lower extremity injury. Scand J Med Sci Sports 23:e225–e232CrossRefGoogle Scholar
  19. Ljungqvist A, Jenoure P, Engebretsen L et al (2009) The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes march 2009. Br J Sports Med 43:631–643. Scholar
  20. Magee J, Almekinders L, Taft T (2003) HIPAA and the team physician. Sports Med Update 4–7Google Scholar
  21. McHugh MP, Tyler TF, Tetro DT et al (2006) Risk factors for noncontact ankle sprains in high school athletes: the role of hip strength and balance ability. Am J Sports Med 34:464–470CrossRefGoogle Scholar
  22. Padua DA, Marshall SW, Boling MC et al (2009) The landing error scoring system (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: the JUMP-ACL study. Am J Sports Med 37:1996–2002CrossRefGoogle Scholar
  23. Padua DA, DiStefano LJ, Beutler AI et al (2015) The landing error scoring system as a screening tool for an anterior cruciate ligament injury-prevention program in elite-youth soccer athletes. J Athl Train 50:589–595CrossRefGoogle Scholar
  24. Pearsall AW, Kovaleski JE, Madanagopal SG (2005) Medicolegal issues affecting sports medicine practitioners. Clin Orthop 433:50–57Google Scholar
  25. Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB (2006) Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther 36:911–919CrossRefGoogle Scholar
  26. Rechel JA, Yard EE, Comstock RD (2008) An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train 43:197–204CrossRefGoogle Scholar
  27. Roberts NT (1959) The values and limitations of periodic health examinations. J Chronic Dis 9:95–116CrossRefGoogle Scholar
  28. Rowntree L (1944) National program for physical fitness: revealed and developed on the basis of 13,000,000 physical examinations of selective service registrants. J Am Med Assoc 125:821–827CrossRefGoogle Scholar
  29. Smith NJ, Stanitski CL, Dyment PG et al (1985) The preparticipation examination of athletes: comparison of single and multiple examiners. Am J Dis Child 139:657–661CrossRefGoogle Scholar
  30. Smith HC, Johnson RJ, Shultz SJ et al (2012) A prospective evaluation of the landing error scoring system (LESS) as a screening tool for anterior cruciate ligament injury risk. Am J Sports Med 40:521–526CrossRefGoogle Scholar
  31. Söderman K, Alfredson H, Pietilä T, Werner S (2001) Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 9:313–321CrossRefGoogle Scholar
  32. US Department of Education (2016) Family educational rights and privacy act (FERPA). Accessed 16 Oct 2016
  33. US Department of Health and Human Services (2016) Summary of the HIPAA privacy rule. Accessed 16 Oct 2016

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Health and Rehabilitation SciencesThe Ohio State UniversityColumbusUSA
  2. 2.Jameson Crane Sports Medicine InstituteThe Ohio State University Wexner Medical Center, The Ohio State UniversityColumbusUSA

Section editors and affiliations

  • Andrew McIntosh
    • 1
  1. 1.CremorneAustralia

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