Sports Physicals

Careful sports physicals for student athletes and active adults. We find hidden injury risks before you train or compete, at Remix Medical in Houston, TX.

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By Uday Khosla, MD · NephrologistReviewed Apr 7, 20242 min read

Key takeaways

A sports physical (pre-participation physical evaluation, or PPE) combines a focused history and exam centered on the cardiovascular, musculoskeletal, and neurologic systems, ending in a clearance decision.
It is required annually by most states for school sports and is best done in the office at least six weeks before the season, so any issue found can be evaluated in time.
A routine screening ECG or echocardiogram is not part of a standard sports physical; further cardiac testing is added only when the history or exam raises concern.
Red flags — exertional chest pain or fainting, a concerning murmur, an unresolved concussion, or a family history of sudden cardiac death — pause clearance for further evaluation rather than ending participation.
Evidence that the sports physical prevents injury or sudden death is limited, but it remains the standard entry point to sport and a chance to connect athletes to care, especially those without a regular physician.

Playing sports and exercising is a fun way to stay healthy and fit. However, the physical demands of playing a sport or beginning a new exercise program may put one's health at risk. From young children starting little league to adults training to run a marathon, anyone starting a new training program should first undergo a sports physical to ensure they are in physical condition to start pushing their bodies.

Did You Know?

40 percent of all sports-related injuries occur in children ages 5 to 14. An estimated 30 million children ages 14 and under play sports in the U.S. every year, of which more than 3.5 million are injured. The most common injuries are sprains and strains, which can put a player out for several games. Children who are just starting a new sport or training schedule are at the greatest risk of developing an injury.

Who Should Get a Sports Physical?

Anyone starting a new physical routine should get a sports physical. Some schools and club teams require them before an athlete can participate in sports. Even adults starting a new class at the gym will benefit from getting a sports physical prior to starting a new fitness regimen.

What's checked	Why
Heart & lungs	Screen for conditions that could be dangerous during exertion
Joints & muscles	Catch old injuries that need attention before play
History	Prior concussions, asthma, and family heart history matter

What Will My Provider Look For During a Sports Physical?

Providers are on the lookout for several factors that may affect a person's ability to safely play a particular sport. The exam may include an analysis of family or personal health history, as well as a person's resting and active vital signs. An exam will also include evaluation of current joint health, muscle strength, and flexibility. The sports physical can help identify pre-existing conditions that may interfere with a person's ability to safely train or compete, potentially preventing the development of severe injuries or health complications.

What Happens If a Problem Is Discovered?

Often, patients can go on to participate in sports and other physical activity with some training modifications that can help reduce the risk of injury. For example, a person with a knee injury may need to wear a brace and utilize specific stretching exercises designed to increase flexibility and strength.

How it's performed

The evaluation combines a focused history and a physical examination. The history covers personal and family cardiac history — including any exertional chest pain, fainting, or family history of sudden cardiac death — along with prior concussions, asthma, injuries, medications, and a mental-health screen. The examination records vital signs and visual acuity and focuses on the cardiovascular, musculoskeletal, and neurologic systems, using standardized PPE forms. A routine screening ECG or echocardiogram is not part of a standard sports physical and is added only when the history or exam raises concern. The visit ends with a clearance decision: cleared, cleared with modifications, or referred for further evaluation before participation.

How to prepare

Bring prior medical records, a list of medications and supplements, immunization records, and any school or league forms that need to be completed. Come prepared to give an accurate personal and family history, particularly any fainting, chest pain, palpitations, or a relative who died suddenly at a young age. Wear clothing that allows a musculoskeletal examination.

What to expect after

If the athlete is cleared, no follow-up is needed until the next required evaluation, typically annually. If a concern is identified, the athlete is referred for the appropriate work-up — cardiology for cardiac red flags, neurology or a concussion protocol for head-injury concerns — and clearance is revisited once that evaluation is complete. Where a condition limits certain activities, the goal is to find a safe way to keep the athlete participating, often with modifications, rather than to disqualify them.

Outcome

The outcome is a documented clearance decision and, importantly, the identification of the small number of athletes who need further evaluation before they compete. The sports physical is the standard, and in most states legally required, entry point for sports participation, though it is worth noting honestly that evidence for its effectiveness at preventing injury or sudden cardiac death is limited. Its clearest value is a structured chance to catch red-flag cardiac and musculoskeletal findings and to serve as an entry point to care for athletes without a regular physician.

Frequently asked

Sports Physicals questions, answered

What is a sports physical?

It's an exam that checks whether it's safe for you or your child to play a sport. It reviews heart and lung health, joints, and medical history to catch anything risky before the season.

What does a sports physical include?

A review of your history plus a check of the heart, lungs, joints, and general health. Prior concussions, asthma, and a family history of heart problems get special attention.

Why are sports physicals important?

They can catch conditions that could be dangerous during exertion, like certain heart problems, and address old injuries before they worsen. It's a safety check, not a formality.

What findings would delay clearance to play?

Fainting or chest pain with exercise, or a family history of sudden cardiac death, prompts a closer look before clearance. Your doctor guides the next steps.

What should I bring to a sports physical?

Bring a list of medications, your medical and immunization history, and any prior injury records. Come prepared to mention fainting, chest pain, or family heart history.

Your care team

Internal Medicine clinicians at Remix Medical.

Every clinician at Remix Medical is board-certified and owns the practice — so the physician in your exam room is the one making decisions about your care.

Everald Manning, MD
( 4.6 · 177 Google reviews)
Primary Care Physician
Montrose — Upper Kirby · Northwest Houston — Jones Road
Board certifiedAccepting new
Kaveh Samani, MD
( 4.8 · 245 Google reviews)
Internal Medicine Physician
Montrose — Upper Kirby · Northwest Houston — Jones Road
Board certifiedAccepting new

SpecialtyInternal MedicineTypeDiagnostic testBody locationCardiovascular, musculoskeletal, and neurologic systems (whole-body screening exam)CPT code99385 (new patient, preventive, age 18-39); 99386 (new patient, preventive, age 40-64); 99395 (established patient, preventive, age 18-39); 99396 (established patient, preventive, age 40-64)

Also called Sports Physical, Pre-Participation Physical Evaluation, PPE, Athletic Physical, Pre-Participation Exam, Sports Clearance Exam

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated April 7, 2024. Medically reviewed by Uday Khosla, MD.