Preparticipation physical evaluation: An opportunity for Malawian athletes.

http://dx.doi.org/10.4314/mmj.v28i4.7 Preparticipation Physical Evaluation (PPE) is the screening of athletes for injuries and some risk factors for disease, with an aim of minimising the risk of injury, disease exacerbation, and even sudden death during training and competition. Generally, PPE is conducted prior to athletic performance, and athletes who are identified as unfit are subsequently excluded from or advised against participation and referred for medical consultation.1 Following evidence on its successes in reducing the incidence of sudden death among athletes,1,2 PPE is currently being practiced in most parts of the world. However, Malawi currently does not implement PPE as an integral part of the basic requirements for sports participation. This may be, among other reasons, because of financial constraints, lack of interest among Malawi’s sporting administrators, and the public’s lack of knowledge about PPE and its benefits. This exposes Malawian athletes to risks that might be avoided after being detected by routine medical screening, such as PPE. The major components of PPE include medical screening, musculoskeletal screening, and performance screening.3–6 The medical screening section of PPE obtains information about an athlete’s personal and family medical history, general health, history of previous injuries, and relevant information related to all body systems. Examination of body systems, blood tests, and diagnostic imaging investigations are also conducted.3 The general medical examination includes measurements of pulse rate, blood pressure, respiratory rate, peak flow rate, fundoscopy, visual acuity, and skin measurements. Blood and radiographic investigations may include a full blood count, blood glucose and lipid tests, x-rays, and ultrasound scanning. The musculoskeletal screening section of PPE uses special tests to assess tone, power, coordination, reflexes, and range of motion of the limbs.3 The performance screening section uses special functional tests and quality of movement tests to assess areas that may not have an impact on health but could affect performance.3 Athletes of all levels and ages are encouraged to undergo PPE.7 Although there are currently no globally accepted standardised procedures for carrying out PPE,7–9 its potential benefits are enormous. For example, athletes may be affected by conditions that do not have clear symptoms and can only be detected through periodic screening.10 Cardiovascular conditions, such as hypertrophic cardiomyopathy, congenital coronary artery anomalies, or arrythmogenic right ventricular cardiomyopathy, are naturally silent until a potentially fatal arrhythmia occurs. Such cardiovascular conditions may be detected earlier through careful cardiovascular screening during PPE. In that way PPE helps to identify pathologic conditions early to enable timely intervention and management with the hope of reducing future morbidity and mortality.10 Commentary Preparticipation physical evaluation: An opportunity for Malawian athletes