The opportunities for chiropractors to provide important musculoskeletal information to athletes are formidable. An estimated 25 million American youths regularly participate in organized sports.1 Thirty-five states require yearly physicals for high-school sponsored sports, and four other states require a physical, ranging from once only to every three years.2 As the coordinator or participant in a sport's pre-participation screening program, the chiropractor is uniquely positioned to determine areas often given cursory evaluation in other settings. This is assuming that the level of knowledge is matched to the task at hand. However, knowledge is often not enough when attempting to coordinate large groups of people through a multi-station process. It is important that the novice examiner become part of a preparticipation exam team to gain an experience level necessary to anticipate and coordinate large group management prior to attempting a primary role.
The specific goals of the examination are to:
A protocol for administration of the examination follows:
3. Which type of examination format will better suit the institution based on the numbers of individuals being examined, the facilities for the examination, and the intent of the examination?
Send letters explaining to parents the intent of the examination, who is performing the examination, and an opportunity for the parent to call and ask questions. This letter would include an informed consent section to be signed by the parents.
After the examination is performed, parents and students are given an evaluation summary with a copy sent to the coach and placed in the student's file. The information would include:
There are no standard legal guidelines in most states. However, based on a screening for serious problems and those problems which may increase chance of injury for a specific sports profile, recommendations should be made. Generally, there are four levels of recommendations:
Dependent on the type of examination, the components of the preparticipation evaluation may vary. The constant components would include:
A General Health Questionnaire
The focus of the examination is to screen for known problems: disease, organ dysfunction (or absence), prior injuries, allergies, current medications, and familial tendencies. There are two tendencies to focus on are, one rare (but catastrophic), the other, common (but often undetected). The first is sudden death, often due to undetected cardiac abnormalities such as hypertrophic cardiomyopathy, which can cause sudden death.
Check for a family history of cardiac disease/death at a young age, and a personal history of syncope or heat intolerance. Marfan's syndrome should also be screened for with family history and on the physical examination.
The second condition is exercise induced bronchospasm. This condition may occur in as many as 15 percent of adolescents. Clues are exertional dyspnea or a complaint of wheezing during or after exercise.
Evaluation of Vitals
Evaluation of anthropometric measurement such as height, weight, body type, body fat composition, and general range of motion.
Medical Evaluation
The age of the athlete will also influence the focus of concern.7 Children 6-10 are more involved in spontaneous play, but becoming increasingly involved in organized sports. The focus of the examination in this group is on scoliosis, congenital anomalies, visual problems, and mesenchymal disorders such as Marfan's. In the young athlete, generally 11-15, the focus shifts to more complex areas such as psychosocial influences. Particular attention is given to questioning regarding sexual activity, drug and alcohol use, and a determination of physical maturity with regard to risk of injury in contact sports.
The most appropriate time for a preparticipation physical is six weeks prior to the season. This usually gives adequate time to further investigate any areas of concern or follow a prescribed program of stretching or strengthening.
Summary of Preparticipation Exam Stations | ||
| Station | Tests | Equipment Needed |
| Check in | * Medical history | * Questionnaire & pens |
| * Blood pressure | * BP cuff and stethoscope | |
| * Pulse | * Watch | |
| * Height | * Scale | |
| * Weight | * Scale | |
| * Vision | * Eye chart | |
| * Urinalysis | * Urine cups & strips | |
| * Body fat measurement | * Calipers | |
| Flexibility | * Sit and reach | * Sit and reach box |
| * Goniometric joint | * Goniometers measure | |
| Strength | * Sit-ups | * Watch, and mat |
| * Push-ups or | * Mat | |
| * Squats | * Squat bench & weights | |
| Power | * Vertical jump | * Jump flags or chalk/tape measure |
| * Medicine ball throw | * medicine ball & tape measure | |
| Anaerobic endurance | * Jumping jacks in 1 min | * Watch |
| * 20-yard dash, or | * Tape, tape measure, stopwatch | |
| * Shuttle run, or | * Five tennis balls,stopwatch, tape | |
| * Hexagon drill, or | * Goniometer, tape, ruler, stopwatch | |
| * Sit-ups in 1 min. | * Watch, mat | |
| Aerobic | * Step test, or | * Metronome, step box, endurance and stopwatch |
| * Mile run, timed | * Stopwatch | |
| General medical | * Medical exam. | * Standard medical bag evaluation |
| * Orthopedic neurologic exam | * History forms from entry | |
| Checkout | * Records review | * Forms from previous stations |
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
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Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
