Annual physical important to prevent sports injuries

The incidents have been as shocking as they are tragic.

The most recent occurred just days ago when Jon Ross Snell, a seventh-grader, collapsed during football practice at George Walton Academy. He remains hospitalized in critical condition. Adam Smith, a 16-year-old Buford High School varsity basketball player, died last weekend after collapsing following a workout.

Doctors say such incidents underscore why annual physical exams are a crucial part of the back-to-school season.

Indeed, every student participating in sports is required at the beginning of the academic year to complete a pre-participation physical evaluation form, issued by the American Academy of Pediatrics, said Ralph Swearngin, executive director of the Georgia High School Association.

That form, he said, includes a health history and evaluations that are a normal part of a physical exam.

“Medical doctors tell me that by looking at those things, they can identify kids who might have medical problems, such as sickle cell trait, that would keep them from participating in sports,” Swearngin said. “If any telltale signs — a heart murmur or history of family members dying young with cardiac problems, for instance — pop up, they refer students back to their family doctor or to a specialist.”

Even so, doctors say, parents should make their child’s pediatrician their first line of defense against sports injuries.

“Two of the leading causes of sudden cardiac death are inherited,” said Dr. David Marshall, medical director of sports medicine at Children’s Healthcare of Atlanta. “That means family history is extremely important in preventing hypertrophic cardiomyopathy [heart disease] and Marfan syndrome.”

While there are benefits to mass health screenings done at school, Marshall said there are limitations because the physician doesn’t have access to a students’ medical history, family medical history or parental verification of that history, items a child may forget to mention on the sports physical questionnaire.

“The mass school physical allows you to screen a large amount of kids in a short period time, so it’s cost effective,” Marshall said. “But in terms of having a good detailed cardiac exam, it may be too noisy if done in a gym or locker room and the parents and medical records are often absent. Therefore it is difficult to verify past medical history.”

Ideally, Marshall said, kids should get both a sports physical and an annual exam by their personal doctor.

“Most teens view their sports physical as their yearly trip to the doctor,” he said. “If that means just a mass screening at a school, you miss the opportunity to discuss sensitive issues such as drug abuse, birth control and sexuality.”

Kids, he said, are more apt to be honest in the privacy of an examination room with their pediatrician than in a crowded gym.

Although nearly 10 million kids play sports across the country, Marshall said that only one in 200,000 actually experiences sudden cardiac death.

A much less tragic but more common problem, he said, is overuse, when a regimen of play and training is so intense that a kid’s body rebels, a condition that accounts for more than half of all sport injuries in his practice.

Also of major concern, Marshall said, is the fact that Georgia does not require all coaches to be CPR certified.

“Early response can make a huge difference in saving a kid’s life,” he said.

While athletic injuries seem to be happening more frequently, Swearngin said they have always been a major issue.

“They’re just getting more attention because we’re now more aware of problems,” he said.

Swearngin, a member of the National Federation of State High School Associations rules committee, which writes and publishes the regulations for high school sports, said that minimizing risks to youth is of major concern.

“We rely on medical advice but we’re not sitting back thinking we have all the answers,” he said. “We’re always looking to see if we can do a better job.”