Why sports physicals are important – especially after a COVID-19 diagnosis

With league and school sports beginning to resume after a prolonged COVID-prompted off season, many young athletes are heading back to the field again.

Having a sports physical is an important step before getting back into the game – especially after a having COVID-19 symptoms or a diagnosis.

But what exactly is a sports physical and why are they needed? In this Q & A, Dr. Matthew Kornswiet, a sports medicine pediatrician in the CHOC Primary Care Network, answers these questions and more.

Coaches and parents should continue to follow safe return to sports guidelines from the Centers for Disease Control & Prevention and locally, the California Interscholastic Federation and California Department of Public Health.
Does having COVID-19 affect my child’s ability to play sports safely?

If your child had symptoms of or tested positive for COVID-19 at any point, it is important that they see their provider before returning to sports.

Research shows that sometimes after a COVID-19 infection, a patient has a small risk of developing myocarditis (inflammation of the heart) or multisystem inflammatory syndrome in children, also known as MIS-C, an inflammation of multiple areas of the body.

Even if your child had a sports physical recently, it is important that children have another physical exam after a COVID-19 infection before returning to sports.

In some cases, providers may recommend additional tests for your child’s heart or that they see a cardiologist, or heart doctor, for further evaluation. This is to ensure that children are safe to return to sports.

What is a sports physical and why are they important?

A sports physical helps determine whether it’s safe for a child to participate in a sports or athletics. They can also help uncover and treat health problems that might interfere with participation. The provider may also offer tips to help with training and injury prevention.

What should I expect at a sports physical?

A sports physical is divided into two halves: the medical history and the physical exam.

During the medical history portion, the provider will ask key questions about serious illnesses among family members; current or previous medical conditions, such as asthma, epilepsy or diabetes; past injuries; and more.

During the second half of the visit the provider will perform a physical exam. The physical exam will measure the athlete’s vital signs; check the athlete’s heart and lungs; evaluate strength and flexibility; vision; and more.

The provider will also ask questions about the athlete’s mental health, use of drugs, alcohol or dietary supplements, including steroids or other so-called “performance enhancers” and weight-loss supplements.

What happens after the physical?

When the exam is over, the provider will complete and sign a form indicating fitness to participate in the sport, if all is well. In some cases though, the provider may recommend a follow-up exam, additional tests, or specific treatment for medical problems.

Young athletes shouldn’t worry that additional follow-up care means being benched. A sports physical’s ultimate goal is to ensure athletes are safe while playing sports – not to stop them from playing.

Additional follow-up could be as simple as rechecking blood pressure in a few weeks. A referral to a specialist could ultimately help athletic performance, such as in the case of slight knee pain during running that an orthopedic or sports medicine specialist can demystify and treat.

If my child has a sports physical, do they still need a regular physical or well check?

It’s critical that patients of all ages undergo a regular physical every year, whether or not they also have a sports physical. Depending on when your child had their last physical, it can be done at the same visit as the sports physical.

While sports physicals focus on well-being as it relates to athletics, regular physicals are more comprehensive, addressing broader physical and mental health concerns, and helping to ensure patients are up-to-date on vaccinations.

Where can my child get a sports physical?

Families usually have many options for receiving sports physicals. Your child’s physician or a sports medicine physician can provide a sports physical exam.

Remember, your pediatrician knows your child’s medical history thoroughly, can make referrals if needed, and will play a critical role in any ongoing care plans – not to mention, is one of their biggest fans.

How to teach sportsmanship to your kids

When children and teens are involved in sports, they are able to learn and put into practice values that will stay with them long after they leave the field.It’s easy to get caught up in a game and become focused on winning, but parents and coaches should remind children that there is much more to be gained from the sports experience than a winning record.

Good sportsmanship is one of the life lessons that children can learn from sports. You can help your children understand and value good sportsmanship while making sure they have a safe and fun sports experience. Here are some important principles to instill in your children:

• If you lose, don’t make up excuses.
• If you win, don’t rub it in.
• Learn from mistakes and get back in the game.
• Always do your best.
• If someone else makes a mistake, remain encouraging and avoid criticizing.

Parents are important role models, so let your children see you upholding these principles whether you play a sport yourself or root for your child’s team from the sidelines.

Good sportsmanship also includes following certain guidelines for good behavior. Share these concepts with your children:

• Avoid arguing. Stay focused on the game instead of giving in to anger with teammates, coaches or referees. Always avoid using bad language and negative words.

 Everyone should have a chance to play. In youth sports, it’s important to encourage even those players who are the least skilled to have fun playing the game. Parents, coaches and even other players have an important role in allowing less talented teammates time to participate.

• Play fair. Good sportsmen want to win because they followed the rules and played the best game they could. Never support any effort to win that attempts to go around the rules. Cheating is not acceptable.

• Follow directions. Emphasize the importance of listening to coaches and referees and following their directions while on the field and involved in team activities.

• Respect the other team. Whether your team wins or loses, it’s important to show respect for the effort of the other team. If the other team wins, accept defeat, acknowledge their abilities, and move on. If your team wins, resist bragging—that’s what it means to be a gracious winner.

• Encourage teammates. Team sports work best when each individual supports the team. Praise teammates for what they do well and encourage them when they make mistakes. Avoid criticism and unkind actions. Parents should model this behavior for children by praising them for specific things they have done well, even if they made a mistake or may not have played as well as hoped.

• Respect the decisions of referees and other officials. These people are charged with making difficult decisions about plays in the game. Good sportsmanship requires that you accept a call, even if you disagree with it. Remember that it’s only one call in a long game—get back into play and focus on the game.

• End with a handshake. Good sportsmen enjoy sports and know how to end a game on a positive note, whether or not they won. Threats, anger, criticism, and other negative expressions are not acceptable.

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Advice to Jiu Jitsu Parents: How to Prevent Cauliflower Ear in Your Child

By Dr. Nguyen Pham, Pediatric Otolaryngologist

In recent times, many parents have turned to martial arts to empower their children against the threat of bullying.  Many of these parents view Brazilian Jiu Jitsu as the ideal self-defense method, as it teaches children to use leverage and guile to protect themselves from larger attackers without the need for excessive violence such as punching or kicking.

Unfortunately, like any martial arts activity that involves physical contact, Brazilian Jiu Jitsu increases the risk of a child developing a cosmetic deformity called cauliflower ear.  However, contrary to popular belief, cauliflower ear is completely preventable.

Cauliflower ear is caused by direct impact and shear force to the outer ear. This can happen when a child is accidentally struck in the ear by an opponent’s head or elbow. A common result of this injury is damage to the perichondrium on a child’s ear. The perichondrium is a thin layer of tissue that surrounds the cartilage on the outer part of the ear. It is important because it provides the cartilage with its necessary blood supply and nutrients. Injury to the perichondrium also damages the perichondrial blood vessels, resulting in blood filling the space between the perichondrium and the cartilage. This pool of blood creates a problematic condition called an Auricular Hematoma. If this hematoma is not urgently drained, permanent damage to the cartilage will occur. The cartilage will then become thickened and scarred and start to look like the cauliflower vegetable; hence the term cauliflower ear.

Fortunately, there are two effective ways to protect your child from developing cauliflower ear. The first way is through preventive techniques, and the second way is through recognizing the signs of an auricular hematoma.

In terms of preventing cauliflower ear, parents should require their children to wear ear protection at all times during any type of Jiu Jitsu or wrestling activity. Most sporting goods stores sell grappling or wrestling ear guards that provide children with solid protection against any type of ear trauma.

Parents and martial arts instructors should also learn how to immediately recognize signs of an auricular hematoma, which looks like a soft bulge of skin on the front surface of the ear. When pressed, this soft bulge feels like a moderately filled water balloon. The overlying skin on this bulge is often red or purple in color but can also be normally colored.

If an auricular hematoma is recognized, the next step is to have it drained by a surgeon. After drainage occurs, it is important to closely monitor the ear for the re-accumulation of blood, which can happen if the perichondrium does not heal properly after the injury. It is important for the perichondrium to heal so that it can reattach to the cartilage and resume providing the cartilage with its necessary blood supply and nutrients.

To ensure that the perichondrium heals completely, a compression dressing should be applied to the injured ear for one week following the drainage of the hematoma. In addition, the child should avoid engaging in Jiu Jitsu training for at least two weeks. These steps will allow the ear to completely heal.

Carbohydrate: Premium Fuel for Sports Performance

By Shonda Brown, RD, CNSC, clinical dietitian at CHOC Children’s

Carbohydrates have received a bad rap as low carb diets gained in popularity and other fad diets advertized messages of “good” and “bad” carbs. However, carbohydrate is the preferred fuel source for exercising muscles and provides two thirds or more of the energy source during intense exercise.

CHOC Clinical Nutrition and Lactation Services

Carbohydrate rich foods include: breads, cereals, pasta, potatoes, fruit, and dairy as well as honey, jam and sweets. An athlete needs carbohydrate to store energy in preparation for exercise, to provide an exogenous fuel source during exercise and to maximize recovery after exercise. The source of carbohydrate is not as important as the amount and the time which ingestion occurs. Check out the following guidelines:


Athletes should consume 200-300 grams of carbohydrate 3-4 hours prior to exercise or competition. An example would be four pieces of French toast with berries and syrup, and 12 ounces orange juice or 1 ½ cups pasta with meat sauce, 1-2 breadsticks, 1 cup fruit salad drizzled with honey, and 16 ounces low-fat milk.


During intense exercise or activity lasting longer than 60 minutes, a sports beverage containing approximately 15 grams of carbohydrate per 8 ounces should be consumed at regular intervals. This keeps blood glucose (sugar) available for the working muscles and can delay fatigue, allowing an athlete to exercise longer and harder.


After exercise, it is important to refuel with carbohydrate within the first 30 minutes to maximize carbohydrate storage in the muscles. It can also help decrease muscle protein breakdown. Anything portable and easy will do. Some examples include chocolate milk, granola bar and fig bars.

It can be a challenge for an athlete to consume the amount of carbohydrate needed for optimum performance. Some tips to increase carbohydrate intake are drizzling honey over cereal, fruit or yogurt; spreading jam on toast or crackers; adding fruit to cereal, yogurt or pancakes; and packing dried fruit, trail mix, or pretzels as a quick snack.

Learn more about CHOC Children’s Clinical Nutrition and Lactation Services.

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Improving an Athlete’s Mental Game

With the school year and spring sports season winding down, now’s the time when young athletes mighImprove_Mental_Game_2t need an extra edge over their competition. Additional drills and practices can help, but so does increased mental motivation.

“Competition can cause some athletes to react both physically and mentally in a way that can affect their performance negatively,” says Dr. Nadia Torres-Eaton, a CHOC Children’s psychologist. “Certain techniques can help young athletes overcome these barriers and continue to improve.”

Check out six ways to increase motivation and enhance overall athletic performance:

Tolerate failure

To become a good athlete or improve at a favorite sport, children must tolerate failure and accept it as part of the process of succeeding. Without failure, no one learns, and without learning, no one improves.

Dig for motivation

An athlete must have an emotionally compelling reason to stick with an exercise program. For serious athletes who train for four to eight years at a time, the motivation might be an Olympic gold medal. Here’s a trick: On the days your child doesn’t feel like practicing or exercising, talk about how good he’ll feel afterward.

Compete against yourself

Another important component of motivation is not comparing oneself with others. For example, if a teen works out regularly at a gym, she should channel her competitiveness into the progress she’s making, not against the highly fit person on the next treadmill. The same is true when competing: A runner should tune out the other athletes in the race.

Hold mental rehearsals

An athlete trying to master a particular physical feat, such as diving off the high board or perfecting a tennis serve, should imagine himself doing it.

Stay in the present

In the midst of an activity, it’s easy to fall into the trap of concentrating on the uncontrollable factors, such as the weather, an opponent or past performance. Instead, stay in the present. While running a long race, for instance, an athlete should concentrate on his breathing rhythm or arm swing, not on the length of the race or the other runners.

Plunge through a plateau

Reaching a stagnant level of fitness or performance – a plateau – is a natural part of training. However, it can dampen enthusiasm and motivation. Talking to others who have achieved a similar goal will help an athlete improve exercise performance after reaching a plateau.

An athlete can stay positive by creating a daily victory log. It might read, “I ran five miles today, and at the four-mile mark, I pushed myself when I wanted to stop.”

Learn more about psychology at CHOC, and schedule an appointment by calling 714-509-8481.

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