As we approach the start of a new school year and practices begin for fall sports, it's time to update pre-participation physicals, or sports physicals.

The Montana High School Association states that, "a physical exam must be performed for each student in order for that student to be considered eligible for participation in an Association Contest. Physical exams must be completed prior to the first practice. ... This certification is valid for a period of one school year."

Before the exam, parents will need to complete a medical history questionnaire about their child. These questions cover the child's personal and family history of cardiovascular disease, neurological or musculoskeletal disorders. Questions also assess issues that may affect an athlete's health, such as medication, illicit drug and supplement use; obesity or eating disorders; and hearing or vision problems.

Beginning this year, the MHSA executive board has approved a more detailed pre-participation form. The form includes new questions about personal and family cardiac history and the cardiac health of the student.

The exam portion of the pre-participation physical includes assessment of the athlete from head to toe, including screening for vision and hearing difficulties, height, weight and vital sign abnormalities. The health care provider will assess the abdomen, lungs, heart and musculoskeletal system. Males will be screened for hernias.

One of the primary objectives of the sports physical is to attempt to identify cardiovascular abnormalities that may cause sudden death in student athletes, most commonly in male athletes. Many of these disorders have no signs or symptoms, which make them difficult to detect. Fortunately, the rate of sudden death of male athletes is very low.

The most common reason for excluding athletes from participating in sports activities are musculoskeletal concerns. The knees and ankles, as well as any joint that the athlete needs to use in the sport, will be examined for swelling, pain or movement difficulties.

The health care provider will assess the athlete for a history of concussion and neck injuries. Post-concussion symptoms can continue for weeks. These may consist of headaches, dizziness, sensory changes or mental difficulties. An athlete must be free of these symptoms for at least one week before he or she can participate further in sports.

A second concussive injury while still recovering from the first can cause serious, even fatal, head injuries. Injuries of the neck, or cervical spine, can cause "burners" or "stingers." These symptoms are due to irritation or stretching of nerves in the neck or shoulder. The athlete should be free of neck pain or limited movement to be cleared for sports participation.

Pre-participation physicals can be performed at a specialized clinics or by your medical provider as a physical or part of an annual well-child exam. A comprehensive examination allows discussion of health issues concerning your child as well as topics such as peer pressure, nutrition, avoiding drugs, tobacco and steroids.

You can find pre-participation forms at the MHSA Web site - www.mhsa.org - or they are usually available at your medical provider's office.

Please contact your medical provider for an appointment to schedule a pre-participation physical for your child.

Jamie Granger is a family nurse practitioner at Grant Creek Family Practice in Missoula.