Pre-Participation Physical Examinations


The pre-participation physical examination (PPE) 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.

The (PPE) has the following goals:

  • Identify medical and orthopedic problems that may place the athlete at risk for injury or illness
  • Identify correctable problems that may impair the athlete’s ability to perform
  • Maintain the health and safety of the athlete
  • Assess fitness level for specific sports
  • Educate athletes and parents concerning sports, exercise, injuries and other health related issues
  • Meet legal and insurance requirements

The PPE is generally a formal requirement prior to participation in junior high, high school, college or professional sports, and interim exams are done annually if required or indicated. The qualifications of the health care professionals who perform the PPE are based on practitioner availability, clinical expertise and individual state laws. The PPE is best done in a medical setting to ensure proper equipment and appropriate privacy; however, the large number of athletes involved, limited time for the exam and deadlines for participation often require the PPE to be done in a format of multiple “stations,” with several health care providers each focusing on their areas of expertise. The PPE comprises several parts: past medical history, sport-specific history, family history and physical exam.


History of any of the following should be made available to the health care provider:

  • Allergies
  • Asthma
  • Birth defects
  • Chicken pox
  • Diabetes
  • Eating disorders
  • Glasses/contacts
  • Heart murmur
  • Heart problems
  • Heat problems
  • Hepatitis
  • Hernia
  • High blood pressure
  • Kidney disease
  • Measles
  • Medications
  • Menstrual history
  • Mental disorders
  • Mononucleosis
  • Pneumonia
  • Rheumatic fever
  • Seizures
  • Sickle cell trait or disease
  • Tuberculosis


History of any of the following should be made available to the health care provider:

  • Orthopedic injuries (sprains, fractures, dislocations) or surgeries
  • Back or neck injuries
  • Dental trauma
  • Chest pain with exercise
  • Feeling faint or having passed out with exercise
  • Excessive shortness of breath or fatigue with exercise
  • “Burners” or “stingers” — caused by contact that produces burning pain that moves into the extremity
  • Withholdings from participating in a sport for medical reason


History of any of the following should be made available to the health care provider:

  • Heart disease or high blood pressure
  • Diabetes
  • Unexpected death before the age of 50


The following should be checked during the physical exam:

  • Pulse rate
  • Blood pressure rate
  • Height
  • Weight
  • Vision
  • Hearing


  • Head — eyes, ears, throat, teeth, neck
  • Thorax — heart, lungs, chest wall
  • Abdomen — liver, spleen, kidney, intestines
  • Genitalia — sexual maturity, testicles, hernias
  • Neurological — reflexes, strength, coordination
  • Orthopedic — joints, spine, ligaments, tendons, bones (pain, range of motion, strength)
  • Other exams (laboratory, electrocardiogram, x-rays) may be done at the discretion of the health care provider.

After a thorough history and physical exam, the health care provider will make a participation decision by answering the following questions:

  • Is there a problem that places the athlete at increased risk of injury?
  • Is any other participant at risk of injury because of this problem?
  • Can the athlete safely participate with treatment of the problem?
  • Can limited participation be allowed while treatment is indicated?
  • If clearance is denied for certain activities, in what activities can they safely participate?
  • Is consultation with another healthcare provider necessary to answer the above question?

Restriction from participation must be made based upon the best medically objective evidence on an individual basis, and it is determined with the musculoskeletal, cardiac and aerobic demands of the proposed activity in mind.

If clearance is denied, recommendations for correction prior to participation should be communicated and a follow-up evaluation should be scheduled. If acute illnesses or correctable conditions are resolved, clearance should be given.

Although the PPE may identify health problems or needs not associated with exercise, it should not be used to replace ongoing medical care or routine checkups with primary care physicians.


Reprinted with permission of the American College of Sports Medicine. Copyright © 2011 American College of Sports Medicine. This brochure is a product of ACSM’s Consumer Information Committee. Visit ACSM online at

Fotografía de Alex E Proimos usada bajo Licencia de Creative Commons