What to Know About Student-Athlete Sport Physicals and EKG Screening

In most cases, this pre-participation physical exam can be handled by the student’s pediatrician or primary care provider as part of a regular annual wellness check. Just download a sports physical form from the school’s website and bring it for the doctor to fill out.

“The best time to get this done is six to eight weeks before the start of the season,” says Tracy Zaslow, MD, a primary care sports medicine physician at Cedars-Sinai Pediatric Orthopaedics. “That way, if you need to get any additional testing or other workup, you have time to do it and not interfere with the season.”

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If a sports physical uncovers any abnormal heart results, the student should see a cardiologist, who may recommend an electrocardiogram (EKG). An EKG tests the athlete for underlying heart conditions that might put them at risk during intense exercise.

What Is a Sports Physical and Why Does It Matter?

A sports physical is a medical exam designed to make sure an athlete doesn’t have any medical conditions that would make it unsafe for them to participate.

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Issues that might limit an athlete’s participation:

• A previous injury or condition that reduces the athlete’s movement
• An underlying heart condition
• A seizure disorder, which could disqualify the athlete from certain sports, including water sports

How to Prepare Your Child for a Sports Physical

First, look up the school’s sports physical requirements. These should be available on the school’s website. You can also find information at the American Academy of Pediatrics.

The athlete’s medical history and their family medical history both provide vital information, said Zaslow.

“When families complete the history form, it’s important that it’s not just the kid or the parent doing it alone—they really need to sit down and do it together,” she said.

And she points out a sex-specific topic to consider: menstruation.

“Make sure their menstrual cycle is regular, because sometimes that’s the first overt sign that they may not be getting adequate energy to support their athletic activity.”

What Happens During a Sports Physical?

A pre-participation physical includes many of the same elements as an annual wellness exam, but with some additional sports-related components.

What a sports physical includes:

• Personal and family medical history, such as
  
  • Past injuries (sprains, concussions, broken bones)
  • Past symptoms felt during exercise (chest pain, dizziness, trouble breathing)
  • Chronic conditions, such as asthma or diabetes
  • Allergies
  • Family history of heart disease
• Physical exam
  
  • Blood pressure
  • Heart and lung assessment
  • Review of muscle, bone and joint health and biomechanics
  • Vision screening

Your pediatrician knows your child’s medical history and family medical history.

Zaslow says poor eyesight is one of the most common abnormal findings during a sports physical exam.

“Vision is super important,” she said. “An athlete might have to judge when a ball is coming at them. If they need glasses, they should have a solid pair of sports goggles or wear contact lenses.”

Where Should You Go to Get a Sports Physical?

When your child needs a sports physical, their primary care provider is the best place to start, Zaslow said.

“Your pediatrician knows your child’s medical history and family medical history,” she said. “They have all your previous weights and heights and labs, and that can help avoid repeat testing.”

Young athletes can also get their sports physicals at urgent care or walk-in pharmacy clinics. Schools sometimes arrange pop-up clinics for students.

Most pediatricians are not sports medicine specialists. If they have concerns about musculoskeletal issues—for example, if the child has had a previous injury and may not have recovered full strength or range of motion—they will refer the athlete to a primary care sports medicine physician or pediatric orthopedist.

Any indications of a heart condition, such as an abnormal blood pressure reading, should be referred to a pediatric cardiologist, preferably a sports cardiologist. This doctor may recommend an EKG.

What Is an EKG and What Does It Detect?

An EKG—also known as an ECG—is a painless procedure during which small stickers attached to wires are placed on the skin. The wires connect to a machine that measures the heart’s electrical activity and prints out a graph of the results.

“With an EKG, we’re screening for any preexisting conditions in the heart’s electrical system and structure,” said sports cardiologist Eli Friedman, MD, director of the Cedars-Sinai Sports Cardiology program in the Smidt Heart Institute at Cedars-Sinai. “We can get some information about the heart’s arteries, as well.”

What’s normal for an athlete’s EKG screening is sometimes not normal for non-athletes.

The experience level of the people performing an EKG for a student-athlete is important. The stickers must be placed correctly to get an accurate reading. The experience of the medical provider interpreting the athlete’s EKG readout is also vitally important, said Friedman.

“A sports cardiologist understands the unique cardiovascular features of young athletes,” he said. “Because what’s normal for an athlete’s EKG screening is sometimes not normal for non-athletes.”

Should Every Student-Athlete Get an EKG?

High-profile reports of young athletes suffering sudden cardiac arrest appear in the news from time to time.

These occurrences are very rare: about 1 in 200,000 athletes every year.

The U.S. Department of Health and Human Services’ Office of Inspector General has issued a consumer alert regarding fraudulent cardiovascular testing schemes exploiting people’s fears around sudden cardiac arrest in young athletes. Friedman recommends that any decision to undergo cardiac testing be made in consultation with your doctor.

If a family wants their young athlete to have an electrocardiogram, I support their decision.

EKGs are better at identifying possible underlying cardiovascular conditions in young athletes than sports physicals and medical histories alone, said Friedman, but families often don’t understand why the test is being done and what the results mean. He cautions that a positive EKG result doesn’t always mean there’s something wrong, and it can lead to expensive follow-up testing and athletes being benched from participation unnecessarily.

“If a family wants their young athlete to have an electrocardiogram, I support their decision, as long as the test is performed correctly and interpreted to the best practice standards,” he said. “Our expert staff at the Cedars-Sinai Sports Cardiology program is ready to provide appropriate, timely and experienced care for any family that chooses to get an EKG for their young athlete or is referred to us for further cardiac testing.”

Who May Benefit Most From Cardiac Screening?

Friedman reiterates that sudden cardiac death in young people is very rare. But he says there are reasons that some athletes should be referred for EKGs and potentially additional cardiac testing:

• Symptoms
  
  • Any type of chest discomfort, particularly when they are exerting themselves
  • Disproportionate shortness of breath, dizziness, lightheadedness, fainting or feeling like they will faint, particularly during exercise
  • Skipping or racing heartbeats
• High-risk family history
  
  • Known family history of heart disease before the age of 50, including close family members outfitted with defibrillators or pacemakers
  • Family history of sudden cardiac death or unexplained death, such as by drowning or car accident
• Choice, as long as the family is made aware of the risks, benefits and alternatives and they are prepared to deal with the outcome should there be an abnormal result

What Happens After an Abnormal EKG?

If there is an abnormal finding during an EKG, the athlete will likely be advised to undergo additional testing, which may include:

• Echocardiogram: an ultrasound test that uses sound waves to show real-time images of the heart in action
• Stress test: monitors the heart during high-intensity activity, usually performed on a treadmill or stationary bicycle ergometer
• Cardiac MRI: using an MRI machine to provide high-resolution images of the heart
• Holter or event monitor: a portable EKG worn for 24 hours or longer to record the heart's electrical activity over time
• Blood tests
• Genetic tests

Depending on the outcome of any follow-up testing, the athlete may be cleared for play, cleared with monitoring, or placed under temporary or permanent activity restrictions.

It’s important to know most cardiac conditions are manageable, and an experienced sports cardiologist can provide guidance for a return to training and play.