Performing Sport Physicals

[Jarrodmac10]

Hey everyone, are PTs able to perform sport physicals/ medical clearance on athletes? I remember a while back in high school a friend of mine was cleared by a chiro. So can PTs legally clear athletes following a typical "sports physical", like a primary physician?

Also, please no bashing of chiropractors this time lol.

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[atstudent]

I'm not quite sure I understand what you're asking. You mean like a pre-participation examination? The professionals who are allowed to sign off on a pre-participation exam will vary by state, but I'd be shocked if there is ANY state that would allow a physical therapist to do so. Rightfully so. A physical therapist has ZERO business doing that sort of thing. Neither does an athletic trainer.


Here in Illinois the IHSA and the Illinois State Board of Education allows physicians (MD/DO), physician assistants, and advanced nurse practitioners to sign a physical form.

 

[Jarrodmac10]

Yes medical clearance/ pre-participation.

 

[Akiramay]

As far as my patients who were athletes trying to get back to sports, they had to be cleared by their physician. Though the documentation I had of the progress they were making in therapy contributed to that physician's decision. The same thing would go for a worker's comp patient. We aren't the ones to tell them that they can go back to work. But we document the patient's improvement and current functional limitations which helps in that process.

 

[Fiveoboy11]

I'm not quite sure I understand what you're asking. You mean like a pre-participation examination? The professionals who are allowed to sign off on a pre-participation exam will vary by state, but I'd be shocked if there is ANY state that would allow a physical therapist to do so. Rightfully so. A physical therapist has ZERO business doing that sort of thing. Neither does an athletic trainer.


Here in Illinois the IHSA and the Illinois State Board of Education allows physicians (MD/DO), physician assistants, and advanced nurse practitioners to sign a physical form.

Nice emphasis on ANY and ZERO there buddy. I've had a few of these pre-participation and other physicals. Lame waste of time and nothing more than a liability waiver. To clarify, no PT would attempt doing a pre-participation medical physical as we're well aware that's not appropriate. However, pre-participation functional and MSK assessment is within the scope of PT. Perhaps medical physicals should be updated to current medical knowledge and forego the many useless standardized tests and focus the examination on each patient. The way I've seen my physicals done an RN could do just as well.

 

[Fiveoboy11]

As far as my patients who were athletes trying to get back to sports, they had to be cleared by their physician. Though the documentation I had of the progress they were making in therapy contributed to that physician's decision. The same thing would go for a worker's comp patient. We aren't the ones to tell them that they can go back to work. But we document the patient's improvement and current functional limitations which helps in that process.

Interesting, I've had many physicians defer to me to decide on return to sport and work.

IMO, if an athlete has a MSK injury that is being managed by physical therapy, the physical thearpist should be deciding on returning to sport. If it is a medical condition, i.e. concussion or something else not directly managed by PT, then a physician should be clearing them.

Check the evidence as there's quite a bit published in physical therapy journals regarding return to sport guidelines following various injuries including about post op ACL with/without participation in football/baseball/basketball/soccer/running, knee cartilage repair, lateral ankle sprains (JOSPT).

Here's the guidelines for the physical therapist in occupational health published by the ortho section of the APTA:
http://www.orthopt.org/content/special_interest_groups/occupational_health/occupational_health_guidelines

Looks to me like the stance of the APTA is that PT's are qualified to clear for return to sport, but not return to work?

 

[Jarrodmac10]

Nice emphasis on ANY and ZERO there buddy. I've had a few of these pre-participation and other physicals. Lame waste of time and nothing more than a liability waiver. To clarify, no PT would attempt doing a pre-participation medical physical as we're well aware that's not appropriate. However, pre-participation functional and MSK assessment is within the scope of PT. Perhaps medical physicals should be updated to current medical knowledge and forego the many useless standardized tests and focus the examination on each patient. The way I've seen my physicals done an RN could do just as well.

I agree with the RN comment.

 

[truthseeker]

I agree that a PT or ATC should not ever be the professional solely responsible for the clearance of an athlete with regard to a pre-participation physical. We just don't listen to enough hearts. That being said, I do participate in the physicals. I look for things that might make them at risk for injury. I check flexiblity, balance and strength. I have been the person responsible for clearing someone 6 months after a shoulder labrum surgery (within the physical and at the request of the surgeon) I do my portion, then the nurse practiioner or MD comes in and looks for things that could kill them.

Both parts are useful, but the one that the medical person does is obviously more critical.

I was involved in one where the kid was ultimately diagnosed with Kawasaki syndrome and referred to cardiology. I don't know of any PTs or ATCs or DCs that would have the training to catch that one.

 

[atstudent]

I agree that a PT or ATC should not ever be the professional solely responsible for the clearance of an athlete with regard to a pre-participation physical. We just don't listen to enough hearts. That being said, I do participate in the physicals. I look for things that might make them at risk for injury. I check flexiblity, balance and strength. I have been the person responsible for clearing someone 6 months after a shoulder labrum surgery (within the physical and at the request of the surgeon) I do my portion, then the nurse practiioner or MD comes in and looks for things that could kill them.

We participate in physicals for our local high schools each year. We work along with a couple of local doctors' offices to do this. In the past, our company has used the physical therapists to do orthopedic screenings. Now we typically use our athletic trainers so that our PTs don't have to take away from seeing patients.

Our staff does orthopedic screenings, coaches handle height/weight and eye chart, and then the kids go back to see one of the docs. It works great and we can see a lot of kids in a short amount of time..

 

[Jarrodmac10]

What about PTs with a SCS cert?

 

[atstudent]

What about PTs with a SCS cert?

What about them? No PT should be allowed to sign off on a pre-participation examination form. Nor should a chiropractor, a nurse, an athletic trainer, occupational therapist, etc.

None of us are qualified to do so. Nor would I want the liability associated with it!

 

[Jarrodmac10]

What about them? No PT should be allowed to sign off on a pre-participation examination form. Nor should a chiropractor, a nurse, an athletic trainer, occupational therapist, etc.

None of us are qualified to do so. Nor would I want the liability associated with it!

Hmm curious, I've heard of multiple chiropractic clinics in my area (WA) who perform them, so I'm sure liability isn't an issue. Also, if a chiro or PT noticed some sort of anomaly, one which that is out of their scope, wouldn't they be able to refer?

 

[Socrates25]

Disclaimer: I'm a pediatrician and have done probably 200 sports physicals so far this year.

1. PTs are fine to sign off on a "return to sport" eval for a SPECIFIC musculoskeletal injury, but you have no business signing off on a general sports physical evaluation.

2. Chiros shouldnt be doing it either and I'd sue the ass off of them when they inevitably miss something because they are so focused on the spine they dont know how to evaluate anything else.

If sports physicals were ONLY about evaluating musculoskeletal issues, then I would have no problem with a PT doing them, but when you do a real sports physical you are supposed to check out the "whole patient."

I've blocked kids from participating in sports due to a host of rheumatological, cardiac, and neurological reasons. You want to sign off on a general sports physical you'd better be comfortable with that.

 

[atstudent]

Hmm curious, I've heard of multiple chiropractic clinics in my area (WA) who perform them, so I'm sure liability isn't an issue. Also, if a chiro or PT noticed some sort of anomaly, one which that is out of their scope, wouldn't they be able to refer?

Does a PT or a chiropractor have the educational background to do a hernia check? Or check for testicular torsion? Those are medical things.

I don't know what is allowed in Washington. I posted what professions were allowed to sign a pre-participation exam form in Illinois. Chiropractors have tried, but they continue to be denied.

I know that I don't want my name on a physical form clearing an athlete and then he die and come to find out he has an enlarged heart.

I think PT, athletic trainers, and/or chiropractors can all play a role in the physical exam process, but I don't believe they should be signing off on it..

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Socrates and I cross-posted. I agree completely...

 

[Jarrodmac10]

Does a PT or a chiropractor have the educational background to do a hernia check? Or check for testicular torsion? Those are medical things.

I don't know what is allowed in Washington. I posted what professions were allowed to sign a pre-participation exam form in Illinois. Chiropractors have tried, but they continue to be denied.

I know that I don't want my name on a physical form clearing an athlete and then he die and come to find out he has an enlarged heart.

I think PT, athletic trainers, and/or chiropractors can all play a role in the physical exam process, but I don't believe they should be signing off on it..

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Socrates and I cross-posted. I agree completely...

I think I need to speak with PTs in-person in my state. As far as the hernia comment goes, I agree completely. But you don't think a PT has the proper training to catch abnormal heart rhythms? I don't start PT school until this fall, but after reviewing my curriculum it seems like a year of cardio-pulmonary PT would suffice. Sorry for my ignorance, I just know that my sports physicals as a child consisted of routine palpation, auscultation, and sometimes some percussion, along with BP and the occasional CN assessment. It wasn't until I was 17 that I was checked for hernias and testicular torsion.

 

[truthseeker]

I think I need to speak with PTs in-person in my state. As far as the hernia comment goes, I agree completely. But you don't think a PT has the proper training to catch abnormal heart rhythms? I don't start PT school until this fall, but after reviewing my curriculum it seems like a year of cardio-pulmonary PT would suffice. Sorry for my ignorance, I just know that my sports physicals as a child consisted of routine palpation, auscultation, and sometimes some percussion, along with BP and the occasional CN assessment. It wasn't until I was 17 that I was checked for hernias and testicular torsion.

I learned to look at EKGs in PT school, but once I vomited the BASIC information back onto the test, I had no business whatsoever making any judgements regarding heart rhythms/murmurs etc . . . or clearing a kid for anything except for MSK injuries and return to sport based upon that limited issue.

Yes, some PTs work in cardiac rehab but they are not making critical decisions with regard to ekg readings. They are probably identifying things other than "normal" or variations of someones typical rhythms but they always have cardiologists as backup. Similarly, PTs are educated in brain anatomy and function but do you really think that it is the PT deciding or diagnosing where someone's tumor or CVA might be? If they were it would strictly be speculation, not diagnosing. In those areas we know only enough to be dangerous. Same goes for AT and DC.

 

[Jarrodmac10]

I learned to look at EKGs in PT school, but once I vomited the BASIC information back onto the test, I had no business whatsoever making any judgements regarding heart rhythms/murmurs etc . . . or clearing a kid for anything except for MSK injuries and return to sport based upon that limited issue.

Yes, some PTs work in cardiac rehab but they are not making critical decisions with regard to ekg readings. They are probably identifying things other than "normal" or variations of someones typical rhythms but they always have cardiologists as backup. Similarly, PTs are educated in brain anatomy and function but do you really think that it is the PT deciding or diagnosing where someone's tumor or CVA might be? If they were it would strictly be speculation, not diagnosing. In those areas we know only enough to be dangerous. Same goes for AT and DC.

Thanks for the response.

 

[Fiveoboy11]

Disclaimer: I'm a pediatrician and have done probably 200 sports physicals so far this year.

1. PTs are fine to sign off on a "return to sport" eval for a SPECIFIC musculoskeletal injury, but you have no business signing off on a general sports physical evaluation.

2. Chiros shouldnt be doing it either and I'd sue the ass off of them when they inevitably miss something because they are so focused on the spine they dont know how to evaluate anything else.

If sports physicals were ONLY about evaluating musculoskeletal issues, then I would have no problem with a PT doing them, but when you do a real sports physical you are supposed to check out the "whole patient."

I've blocked kids from participating in sports due to a host of rheumatological, cardiac, and neurological reasons. You want to sign off on a general sports physical you'd better be comfortable with that.

I will concede all day long that physicians know the most about serious and life threatening medical conditions, especially noticing subtle signs/symptoms that would become more serious with exertion. I do not think PT's should be signing off on the medical aspect of a pre-participation physical. PT's can handle MSK injuries that are specific and non specific whether it's related to pre-participation, return to sport/work or not, we do it all day long. IMO what a PT can do is help a patient avoid a life changing event with respect to MSK injury/exacerbation/re-injury that has long term sequelae and notice symptoms that warrant referral to a physician, a physician can help a patient avoid a life threatening event but I don't understand why there isn't stress testing involved in pre-participation as it seems that heart failure is the most common cause of death in youth with sport participation. At the same time, there is a continuum of knowledge IMO. Consider that personal trainers put people through exertional exercise all the time (how often is physician clearance involved). I'm unaware of any correlation between personal trainers and death/life threatening events, but I've seen many patient's who have been injured while undergoing an exercise routine with a personal trainer. I think all of this implies that every single person who participates in vigorous exercise should be cleared by their physician first. If so, where's the evidence to support that? I'm assuming serious life threatening emergencies due to exertion/sport become more common as people age. Has anyone else noticed all the recommendations for patient's to talk to their physician before beginning any exercise routine? Just sit on your couch for 2 months until you see your physician to begin your water aerobics or walking program. That sounds dangerous to me.

 

[truthseeker]

I think I see that a lot. "consult your physician before beginning any exercise program."

 

[Jarrodmac10]

View attachment ImageUploadedBySDN Mobile1345137819.143322.jpg
Here's another....

 

[Jarrodmac10]

See above.

 

[truthseeker]

I know they do them but I don't think they should.