A physical is a crucial requirement for all professional athletes. A correct evaluation will not only improve their safety, but will also guide them to maximum performance. However, there is not yet a consensus among the different medical organizations on exactly what this examination should include.

Recently, a team from FC Barcelona’s medical services – led by Dr. Ricard Pruna – published an article in the Medicina Clínica (Clinical Medicine) magazine, describing the protocol followed by the club to evaluate its professional sportsmen and women, especially soccer players. This is a summary of its main conclusions.

Main Aims of the Examination

A health check must detect situations which, despite not showing obvious symptoms, may endanger athletes subject to the highest demands. At the same time, it will enable the identification of any predisposition to certain types of injury, thereby reducing the risks. In addition to safety, it will be helpful in guiding athletes through the activities they should do in order to achieve maximum performance, including essential aspects, such as nutritional recommendations.

Structure of the Exam

Given the complexity of the evaluation, it should be carried out by a multidisciplinary team that includes, not only the doctor in charge, but also physiotherapists, nutritionists, physical trainers, sports psychologists, podiatrists or other specialist physicians. And although there will be regular physical examinations throughout the competition, the initial in-depth assessment must be carried out during the pre-season. This will enable the most appropriate decisions to be made.

This initial assessment includes the following parts:

• A medical record, similar to a conventional record but also including sports history such as injuries suffered and their treatments, possible nutritional supplements, doping controls, etc.
• A nutritional assessment which enables suitable, personalized guidelines to be designed.
• A complete, physical examination that includes practically all body systems: respiratory, digestive, nervous, endocrine, vision, etc., also including complete blood and urine tests and body composition, in order to determine the athlete’s percentage of fat and muscle. As part of this examination, special emphasis will be placed on assessing the musculoskeletal and cardiovascular systems:
  • Musculoskeletal assessment: this is essential to identify current or past injuries and possible sequelae, to determine the possible risk factors for the athlete and to design preventative programs. In the case of soccer, special attention should be paid to muscle, tendon and ligament injuries.
  • Cardiovascular assessment: high-intensity exercise may increase the risk of problems, such as sudden death. Although it only happens in two out of every 100,000 athletes per year, due to their importance and seriousness they tend to have a huge social and media impact.

A well-structured protocol is useful to identify a good number of susceptible athletes, but there is not yet a universal consensus on the tests to be included. For example, FIFA and UEFA recommend performing an imaging test such as an echocardiography in these reviews, but other institutions only consider it necessary when there are already suspicions raised from the medical records and previous tests. In the FC Barcelona medical team, this evaluation includes both a medical record and a physical examination, as well as a resting electrocardiogram, an echocardiogram and a stress test.

Main Conclusions

A medical exam is a must for all professional athletes. Given its importance and complexity, a thorough initial pre-competition assessment should be carried out by a multidisciplinary team of health professionals. A correct health examination will optimize the athlete’s performance and reduce the risk of ill