Sports Medicine: Just the Facts

CHAPTER 12 • THE PREPARTICIPATION PHYSICAL EXAMINATION 69

TABLE 12-1 Classification of Blood Pressure by Age in Children, Adolescents, and Adults

MAGNITUDE OF HYPERTENSION*
MILD (STAGE 1) MODERATE (STAGE 2) SEVERE (STAGE 3) VERY SEVERE (STAGE 4)
AGE GROUP (MMHG) (MM HG) (MM HG) (MM HG)

Children
6–9 years
Systolic BP 120–124 125–129 130–139 > 140
Diastolic BP 75–79 80–84 85–89 > 90
10–12 yr
Systolic BP 125–129 130–134 135–144 > 145
Diastolic BP 80–84 85–89 90–94 > 95
Adolescents
13–15 years
Systolic BP 135–139 140–149 150–159 > 160
Diastolic BP 85–89 90–94 95–99 > 100
16–18 yr
Systolic BP 140–149 150–159 160–179 > 180
Diastolic BP 90–94 95–99 100–109 > 110
Adults

18 years
Systolic BP 140–159 160–179 180–209 > 210
Diastolic BP 90–99 100–109 110–119 > 120

SOURCE: Aadapted from the 26th Bethesda Conference on Recommendations for Determining Eligibility for Competition in Athletes with
Cardiovascular Abnormalities.
ABBREVIATION: BP =blood pressure.
*Applies to patients who are not receiving antihypertensive drugs and who are not acutely ill. When the systolic and diastolic BP measurements fall into
different categories, the higher category should be selected to classify that patient’s BP status. In adults, isolated systolic hypertension is defined as
systolic BP = 140 mmHg and a diastolic BP <90 mmHg and staged appropriately. Blood pressure values are based on the average of three or more
readings taken at each of two or more visits after the initial screening

TABLE 12-2 The Two-Minute Musculoskeletal
Examination for Screening Athletes During the
Preparticipation Examination

INSTRUCTIONS OBSERVATION

Stand facing examiner Acromioclavicular joints,
General habitus
Look at ceiling, floor, over both Cervical spine motion
shoulders; touch ears to shoulders
Shrug shoulders (examiner resists Trapezius strength
at 90°)
Abduct shoulders 90°(examiner Deltoid strength
resists at 90°)
Full external rotation of arms Shoulder motion
Flex and extend elbows Elbow motion
Arms at sides, elbows 90°flexed; Elbow and wrist motion
pronate and supinate wrists
Spread fingers; make fist Hand or finger motion and
deformities
Tighten (contract) quadriceps Symmetry and knee
effusion; ankle effusion
“Duck walk” four steps (away from
examiner with buttocks on heels)
Back to examiner Shoulder symmetry, scoliosis
Knees straight, touch toes Scoliosis, hip motion,
hamstring tightness
Raise up on toes, raise heels Calf symmetry, leg strength

SOURCE:Sports Medicine: Health Care for Young Athletes. Evanston,
IL, American Academy of Pediatrics, 1983.

TABLE 12-3 Areas for Emphasis During the

Preparticipation Physical Examination of Youth Athletes

SOURCE:Tanji JL: Am Fam Physician42(2), 397–402, Aug 1990.

General

Height

Weight

Body habitus

(especially for

weight-determined

sports)

Skin

Jaundice

Herpetic lesions

Impetigo

Severe acne

Visual acuity

Severe myopia

Amblyopia

Single eye

Funduscopic

Detached retina Early

atherosclerotic

changes

Diabetic Retinopathy

Lungs

Asthma

Bronchitis

Cardiovascular

Murmurs

Uncontrolled

Hypertension

Cyanosis

Abdomen

Hepatosplenomegaly

Masses

Back

Scoliosis

Kyphosis

Lordosis

Genitourinary

Single testicle Hernia

Testicle mass

Neurologic

Gross coordination

Gait abnormalities

Musculoskeletal

Knee and ankle

ligaments

Shoulder instability

Elbow stability

Anterior Knee Pain

Muscular

Development

Marfan’s Syndrome