The summer months mean lining up sports physicals for student athletes before school starts again. Parents need to be sure their sports-driven teenagers get a careful examination and a thorough notation of their child’s medical history. It’s critical to your student athlete for not only getting the “go-ahead” to play sports but also for staying healthy throughout the sports season.

Primary Care Sports Medicine Specialist Danielle Bass, MD, at NorthShore Orthopaedic & Spine Institute, has enjoyed caring for student athletes for more than 10 years. “The youthful energy and enthusiasm high school student athletes possess is inspirational. Their eagerness to heal and do what it takes to recover quickly from injury is rewarding for a physician charged with their care.”

Dr. Bass notes five medical conditions she watches for when evaluating a student athlete. She says it’s good for parents and the athletes in their lives to be aware of any warning signs and symptoms.

1. Hypertrophic cardiomyopathy

Sudden cardiac death in young athletes is not common (less than 1% per year), but when it does occur it is most likely related to hypertrophic cardiomyopathy (HCM). HCM is a genetic condition. The heart muscle thickens, leading to cardiac death due to an irregular heartbeat (arrhythmia). Sudden cardiac death (and arrest) rates are highest in male and Black athletes; the highest risk being male basketball and football athletes.

“An extensive medical history will rule out risk factors for heart conditions, including a family history of unexplained death from an immediate relative less than 40 years old, chest pain and palpitations,” Dr. Bass notes. “A thorough cardiac exam, involving testing the heart in multiple positions to assess blood flow, also is important.”

A student athlete with any positive risk factors or exam findings, would likely get an electrocardiogram (ECG) and echocardiogram. “Most athletes diagnosed with HCM are given an implantable cardiac defibrillator and restricted from sports.”

2. Athletic heart syndrome

Athlete heart syndrome (AHS) is a benign condition that results in an enlarged heart, affecting about 4% of young athletes.

“It is usually seen in fit athletes that present with cardiac symptoms,” Dr. Bass says, “and students usually develop the syndrome with intense exercise.” Dr. Bass explains that symptoms are like HCM. “The athlete usually needs to stop working out for two to three months, so specialists can determine the cause of cardiac concerns.” A cardiologist makes the final determination.

3. Marfan’s syndrome

Marfan’s syndrome is another rare condition, impacting fewer than 200,000 Americans a year. It’s a genetic disorder of the connective tissue, which supports the body and organs, including the heart. Typically, athletes who are tall and thin, usually playing either volleyball or basketball, are most impacted. Other signs of the syndrome include disproportionately long arms, legs and fingers, heart murmurs and extreme nearsightedness. Dr. Bass says students concerned with Marfan’s should see a cardiologist for further diagnostic testing, and a geneticist to pinpoint a diagnosis.

4. Exercise-induced bronchospasms

Exercise-induced bronchospasms (EIB) is the narrowing of the airways in the lungs when exercising, making it hard to breathe. About 5% to 20% of the general population are impacted by the condition. “These athletes can have difficulty breathing a few minutes into exercise, but some may only present with symptoms a few minutes after recovery,” Dr. Bass notes. Athletes complain of shortness of breath, chest tightness, wheezing, dry cough, fatigue, or even poor performance. The recommended test for the diagnosis of EIB includes an exercises challenge test.

Note that EIB is different from exercise-induced asthma (EIA), which is breathing difficulties while exercising in athletes with a history of chronic asthma.

5. Infectious mononucleosis

Infectious mononucleosis (IM) is a viral syndrome caused by a herpes virus known as the Epstein-Barr virus, and it’s one of the most common human viruses. Early in the diagnosis athletes may feel fatigue with daily activities and it is easy to convince them to take time off to rest. Infectious mononucleosis is treated symptomatically and, with time, patients often return to normal within a few weeks.

One complication that is concerning in athletes is the risk of a ruptured spleen. It usually occurs within the first 21 days of infection. Studies also show these ruptures can occur with little to no trauma or exertion, so it’s recommended athletes stop exercising for 21 days from the day of diagnosis.

“It is important for athletes to realize if they start feeling better, they should still hold off from exercising and contact sports for the first 21 days of diagnosis. The risk of rupturing their spleen is high,” Dr. Bass says. “After the 21 days, athletes can progress back to activity slowly, starting with walking and increasing by 10% in intensity each week.”

Dr. Bass adds other complicated medical issues student athletes might face are heat illness, concussions, seizure disorder and sickle cell trait. 

All high school students are required to have the Illinois High School Association (IHSA) Pre-Participation Physical form updated annually by their physician. This form must be filled out prior to starting the sports season.

Dr. Bass says most student athletes are cleared to participate in their sport of choice. Still, she believes these physical exams are a good checkpoint for students. “I want to be sure the athlete is fit for play, and if injured, it’s safe for her or him to return-to-sport.”

Danielle Bass, MD, is a primary care sports medicine specialist at NorthShore Orthopaedic & Spine Institute in Chicago and its surrounding suburbs. To schedule an appointment for a sports physical with her, call 847.866.7846 or visit her profile page.