When student-athletes think about the start of a new season, there are lots of things that come to mind. Maybe they grew out of their cleats and need to pick up a new pair. They could find that their infielder’s glove is still a bit stiff and could use another oil treatment. Or they might reach out to last year’s team captain for advice on their mechanics.
While all of that feels important, there’s one thing that is often overlooked, but holds the key to playing at all: completing a physical exam.
It’s a yearly ritual for athletes, mandated by the Pennsylvania Interscholastic Athletic Association (PIAA) and by its counterparts in other states, to make sure everyone participating in a sport through school-based programs can do it safely. And although high school sports remain paused in Philadelphia and many of its outlying areas, there remain whispers that the winter season could begin soon. That means student-athletes will need current, completed physicals. But like everything else since COVID-19 struck, that’s not as simple or routine as before.
Getting a Physical Post Covid
Some primary care offices have had difficulty fitting these athletes in on short notice. On top of that, visits come with a co-pay, which could be prohibitive for some, especially if their parents’ occupations have been affected by the COVID-related economic downturn. Free events for physicals typically held over the summer didn’t happen this year, putting some students in a jam. And for some student-athletes, not having their physical exam for this season means that they haven’t seen a doctor at all in almost two full years, so more of them could have developed new medical conditions than in past exams.
That’s why a team of Penn Medicine health care workers from Sports Medicine and Family Medicine teamed up last month to host a free physical clinic on Martin Luther King Day, taking advantage of the day off from school most students had. Modeled after the type of event normally held during the summer, a team of five doctors and seven athletic trainers were able to assure that more than 40 student-athletes from the Philadelphia schools got the check-up they needed.
“We came up with the idea to clear everyone’s schedules and open up a day just for these student-athletes to come in so that they’d be prepared once activities are allowed to resume,” said Dave Aliquo, Penn Medicine’s lead athletic trainer. “We felt that there’d be no better day than Martin Luther King Day to reach out to these families and these kids who have lost out on so many experiences over the last year.”
What Goes Into These Physical Exams? And Why?
Physical exams for student-athletes are similar to a general physical anyone might receive at a doctor’s office, except these focus critically on any conditions that might make playing a competitive sport dangerous for the patient. This includes a special section geared specifically toward heart conditions and establishing concussion baseline tests.
“They also provide an opportunity for athletes and schools to communicate and develop safety plans for conditions such asthma, diabetes management, or allergies,” Aliquo explained.
Since it has been so long since many of the students’ last physicals, doctors and athletic trainers have to keep an eye out for any new conditions that could have developed in the time since. That’s especially possible since many of these athletes’ bodies are still growing.
But because of COVID-19, special attention is being paid to their hearts this time around, according to Kristopher Fayock, MD, the program director of the Primary Care Sports Medicine Fellowship, who helped lead the free physicals event.
“It’s important that a student who had moderate or severe COVID see a cardiologist for clearance prior to return to sport,” said Fayock, who is also an assistant professor in Clinical Family Medicine and Community Health in the Perelman School of Medicine. “Even if they were asymptomatic or had mild symptoms, they should still see their primary care physician for clearance.”
Regardless of whether the student had COVID, Fayock said he’s paying special attention to the cardiovascular-related aspects on the physical. It’s one of the reasons that while many medical appointments moved to telemedicine, physicals still must be done in-person.
The Effect of Super “Offseasons”
Even without factoring in COVID itself, whenever sports do start back up, there are some potential health implications that will be unique to this year. Since COVID-19 struck and many programs shut down in communities nationwide beginning in mid-to-late March — toward the start of spring sports seasons — many athletes have had no organized competition since then. Some haven’t been able to play at all, even informally.
With so many athletes rustier than they ever have been in the past, the chance of injury could be increased. That is especially at the front of mind for Penn Medicine’s Sports and Family Medicine team.
“Most commonly, we’re expecting to see soft tissue sprains and strains in deconditioned athletes who are trying to ramp up,” Aliquo said. “Additionally, deconditioning can lend itself to a higher risk of injuries related to heat or cold exposure as well as mental health issues.”
Fayock emphasized that a “gradual return to sport” will be the best course of action for the young athletes hoping to avoid injuries and maximize their seasons.
Aliquo acknowledged that there will be a desire from many to “make up for lost time.” Fighting that desire to keep athletes safel will fall on athletes and their coaches.
“The best policy is to meet the student athletes where they are and work with coaches to allow them to gradually return to activity,” Aliquo said. “It’s a challenge for sure. But this has been a year full of challenges, and using our physical event from last month as an example, I think we can all continue to meet them.”