Before participating in any sporting event, a pre-participation physical evaluation (PPE) is recommended for any professional or amateur athlete . The primary goal of this screening is to maximize the health and safety of the athlete . Several studies have shown that pre-engagement Assessment (PPE) cannot prevent morbidity and mortality during exercise, but it can help detect serious conditions and provide strategies for injury prevention. 
Sports participation and exercise can be a positive experience for people of all ages—by enhancing physical fitness, enhancing self-esteem, enhancing coordination, and providing opportunities for creative cooperation and competition . About 30 million athletes under the age of 18 and another 3 Each year, 1 million athletes with special needs are certified to participate in sport. Site-based PPE is a strategy used to reduce the cost and time of PPE. Using this method, athletes cycle through a series of assessment stations to perform specific aspects of the movement filter. A separate site can address vital signs, vision screening, history and physical examination orthopedic history and physical examination, update immunizations and eventually meet with a clinician to review all accumulated data and make decisions about gap. 
Importance Of Screening
The International Olympic Committee (IOC) launched the Youth Olympic Games (YOG) in 2007 to promote young children’s participation in sport. An IOC consensus statement was published in 2009 to emphasize the value of PPE. A 2019 study by Adami et al.  evaluated the A comprehensive solution for disease and injury detection tailored for teenage athletes participating in the Summer or Winter Youth Olympic Games (YOG). The results of the study showed that 12% of PPE participants were diagnosed with a pathological condition requiring treatment . These conditions can Divided into:
- 4,5 % cardiovascular abnormalities
- 4,5% pulmonary disorders
- 2% infections
- Nervous and psychiatric disorders accounted for 0.4%. 
Aim Of PPE
- Ensuring Optimal Medical Health (Asthma Diabetes Menstrual Cycle Suppression)
- Ensure Optimal Musculoskeletal Health.
- Optimizing Performance (Nutritional Psychology Biomechanics).
- Prevent Injury.
- Review Medications and Vaccinations.
- Collect baseline data (blood tests in contact sports, neuropsychological tests).
- Develop professional relationships with athletes.
Key Recommendations For Practice
- PPE should be done around 6 weeks before the event to allow for further assessment or treatment if needed.
- History taking is essential, especially with regard to (motor symptoms—heart murmur symptoms in Marfan syndrome and a family history of premature severe cardiac disease or sudden death.
- Athletes with systolic blood pressure consistently below 160 mmHg and diastolic blood pressure below 100 mmHg should not be restricted from playing sports.
- Athletes with well-controlled asthma who are asymptomatic at rest and during exercise can safely exercise.
- Screening blood and urine tests are not recommended for asymptomatic athletes.
- Comprehensive PPE is recommended every two to three years, with an annual update of key history in between. 
Identify any underlying medical conditions . It covers many areas such as musculoskeletal problems, asthma, blood disorders, exercise-induced bronchospasm, concussions, neurological disorders, and more importantly, anything about cardiac problems or sudden death.  For young athletes Parents or guardians over the age of 18 should attend the evaluation to provide a detailed medical history about the child. 
A limited general examination is recommended . Evaluation (vital signs, vision, hearing, and cardiovascular and musculoskeletal systems)  The most common abnormal PPE findings are elevated blood pressure and vision problems.  Further inspection should be done based on undiscovered issues In history
- Specific questions about cardiovascular risk factors should be asked. 
- Cardiac auscultation should initially be performed with the patient in various positions (standing, supine, squatting to standing, and valsalva) 
- Specific cardiac tests such as (electrocardiogram [ECG] echocardiography exercise stress testing) do not need to be performed unless the patient’s history or clinical examination suggests otherwise. 
Growing awareness that automated external defibrillators (AEDs) may not always be successful in the secondary prevention of sudden death in athletes from cardiovascular disease highlights the importance of pre-competition screening for the prospective identification of high-risk athletes and the prevention of cardiac events during exercise through selective disqualification. 
Pre-Participation Screening Heart Screening
Time constraints do not allow for a comprehensive comprehensive assessment of all joints and muscles. Therefore, the goals of musculoskeletal screening are to:
- Identify exercise risk factors in participants, especially young adults. 
- Assess recovery from any prior injury and assess for proven (rare) or suspected risk factors for future injury. Athletes playing sports associated with a high risk of injury to specific joints or muscles, such as a swimmer’s shoulder and a pitcher’s elbow, should These areas are specifically assessed. 
- MSK screening includes assessment of muscle asymmetry of muscle strength for range of motion and identification of significant impairment. 
- A complete injury history should be obtained, and any deficits remaining after the injury should be fully assessed to design a rehabilitation program to restore full function .
- History of concussion episode Cervical spinal stenosis or spinal cord injury 
General Medical screening
- Routine laboratory tests, such as urinalysis, complete blood count, blood lipids, blood glucose levels, etc. .
- If the athlete has any history of anemia. 
- Censoring drugs (any drug the player has used)
- Athletes with type 1 or type 2 diabetes should be regularly evaluated for foot condition, sensory function, and reflexes. 
- Female players should be asked about their menstrual cycle and any history of anemia  and medications .
- ↑ Jump up to:1.0 1.1 1.2 1.3 1.4 Mirabelli MH, Devine MJ, Singh J, Mendoza M. The preparticipation sports evaluation. American family physician. 2015 Sep 1;92(5):371-6. https://www.aafp.org/afp/2015/0901/p371
- ↑ Myers A, Sickles T. Preparticipation sports examination. Primary Care: Clinics in Office Practice. 1998 Mar 1;25(1):225-36. https://www.primarycare.theclinics.com/article/S0095-4543(05)70334-1/abstract
- ↑ Jump up to:3.0 3.1 Andujo VD, Fletcher IE, McGrew C. Musculoskeletal Preparticipation Physical Evaluation—Does it Lead to Decreased Musculoskeletal Morbidity?. Current sports medicine reports. 2020 Feb 1;19(2):58-69. https://journals.lww.com/acsm-csmr/fulltext/2020/02000/musculoskeletal_preparticipation_physical.6.aspx
- ↑ Kennedy M, Comer F, Young JA, Valasek AE. Increasing primary care follow-up after preparticipation physical evaluations. Pediatric Quality & Safety. 2020 Nov;5(6).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591121/
- ↑ Jump up to:5.0 5.1 Peterson AR, Bernhardt DT. The preparticipation sports evaluation. Pediatrics in Review-Elk Grove. 2011 May 1;32(5):e53. https://www.researchgate.net/profile/Andrew-Peterson-6/publication/51092808_The_Preparticipation_Sports_Evaluation/links/5655c12308ae1ef929784a3f/The-Preparticipation-Sports-Evaluation.pdf
- ↑ Jump up to:6.0 6.1 Pedraza J, Jardeleza JA. The preparticipation physical examination. Primary care. 2013 Sep 21;40(4):791-9. https://www.primarycare.theclinics.com/article/S0095-4543(13)00082-1/fulltext
- ↑ Jump up to:7.0 7.1 7.2 7.3 Adami PE, Squeo MR, Quattrini FM, Di Paolo FM, Pisicchio C, Di Giacinto B, Lemme E, Maestrini V, Pelliccia A. Pre-participation health evaluation in adolescent athletes competing at youth Olympic games: proposal for a tailored protocol. British journal of sports medicine. 2019 Sep 1;53(17):1111-6. https://bjsm.bmj.com/content/53/17/1111.abstract
- ↑ Smith DM. Pre-Participation Physical Evaluations. Sports Medicine. 1994 Nov;18(5):293-300. https://link.springer.com/article/10.2165/00007256-199418050-00001
- ↑ Jump up to:9.0 9.1 9.2 Brukner P, White S, Shawdon A, Holzer K. Screening of athletes: Australian experience. Clinical Journal of Sport Medicine. 2004 May 1;14(3):169-77.https://journals.lww.com/cjsportsmed/Fulltext/2004/05000/Screening_of_Athletes__Australian_Experience.10.aspx
- ↑ Mick TM, Dimeff RJ. What kind of physical examination does a young athlete need before participating in sports?. Cleveland Clinic journal of medicine. 2004 Jul 1;71(7):587-97. https://europepmc.org/article/med/15320370
- ↑ Leggit JC, Wise S. Preparticipation physical evaluation: AAFP and others update recommendations. American Family Physician. 2020 Jun 1;101(11):692-4. https://www.aafp.org/afp/2020/0601/p692.html
- ↑ Leyk D, Rüther T, Wunderlich M, Sievert AP, Erley OM, Löllgen H. Utilization and implementation of sports medical screening examinations. stress. 2008 Sep;11:14.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680562/
- ↑ Jump up to:13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers’ Association position statement: preparticipation physical examinations and disqualifying conditions. Journal of Athletic Training. 2014;49(1):102-20. https://meridian.allenpress.com/jat/article-abstract/49/1/102/112116
- ↑ Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM, Krauss MD. Recommendations and Sonsiderations related to preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update a Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27;115(12):1643-55. https://www.ahajournals.org/doi/abs/10.1161/circulationaha.107.181423
- ↑ Jump up to:15.0 15.1 Douglas W, Siddiqi AR. Preparticipation Evaluation 4. Essential Sports Medicine: A Clinical Guide for Students and Residents. 2021:45. https://books.google.com/books?hl=en&lr=&id=7DEnEAAAQBAJ&oi=fnd&pg=PR8&dq=Douglas+W,+Siddiqi+AR.+Preparticipation+Evaluation+4.+Essential+Sports+Medicine:+A+Clinical+Guide+for+Students+and+Residents.+2021:45.&ots=nK1IjZNR66&sig=1G1o7IhQsExhis2t51WhFTdNw14
- ↑ Jump up to:16.0 16.1 Chisati EM, Nyasa C, Banda AM. Preparticipation physical evaluation: An opportunity for Malawian athletes. Malawi Medical Journal. 2016;28(4):182-4. https://www.ajol.info/index.php/mmj/article/view/151512/141112
- ↑ Diamond AB, Narducci DM, Roberts WO, Bernhardt DT, LaBella CR, Moffatt KA, Nuti R, Powell AP, Rooks YL, Zaremski JL. Interim guidance on the preparticipation physical examination for athletes during the SARS-CoV-2 pandemic. Clinical Journal of Sport Medicine. 2021 Jan 1;31(1):1-6.