There is a lot that goes into each season when you work in professional sports. When the season is over, the "off season" begins. In all honesty, neither the players or coaching staff have an off season. While the sport and competitive season have downtime, the off season is equally as vital as the season itself. The off seasons involve a lot of work. From roster changes to performance training and the establishment of processes and systems for the following season, everything is covered. There is something to be learned from every season. As a result, there is always space for development. Offseason preparation includes putting processes and mechanisms in place for Pre-Participation Examinations.

The Medical and Performance Readiness Evaluation(MPRE) is a pre-competitive season examination and evaluation process. In this article I will cover the fundamental objectives of a MPRE as well as Administration and Organization within professional sports. For the sake of this series, I will highlight specific scenarios involving the sport of baseball.

The development of MPRE’s starts by establishing the purpose. In other words, why are we developing these systems in the first place? What is the purpose of sports medicine team members to engage in such responsibility? From a medical stand point, the goal of this evaluation process is to determine if an athlete is medially able to participate in the upcoming competitive season. Additionally, the goal from the sports medicine team should be to ensure that the athlete can compete safely and within an acceptable risk for injury. From a performance stand point, the goal of this evaluation process is to determine the current state of athletic performance the athlete. During this process skill and performance coaches gather relevant data and metrics that serve as a baseline for each athlete.

(Specific examples of each of these will come in future articles of this series)

As you can see a MPRE is not just a set of medical test and musculoskeletal test performed by medical doctors, physiotherapist and athletic trainers. Creating these systems prior to the start of the season gives sports medicine and performance teams time to guarantee that any medical and obvious health problems are addressed before the season begins. Furthermore, It is a medical and performance team approach to viewing athletic health and performance.

In the world of sports medicine, having a clear and comprehensive understanding of an athlete's health is critical to achieving optimal performance and mitigating injuries. This is where assessments such as physical exams, imaging studies, and laboratory tests come into play. These assessments provide the healthcare team with a bird's-eye perspective of the athlete's current state, allowing them to see the bigger picture and make informed decisions about their care. This allows the team to develop a tailored plan that addresses the athlete's unique needs and maximizes their potential. However, it's important to note that these assessments provide a snapshot of the athlete's current state and may not predict future developments.

One crucial aspect of effective sports medicine is collaboration and integration. The athlete's health is influenced by many interconnected factors, such as their medical history, training regimen, and injury history. As such, it's essential for healthcare professionals to collaborate and share their expertise to ensure that the athlete receives the best possible care. By working together, the sports medicine team can develop a holistic approach to the athlete's care, which not only addresses their current health issues but also aims to mitigate future injuries and optimize their performance.

Objectives of the MPRE

There are 5 main objectives for a pre-participation evaluation:

1. Examine for potentially fatal conditions: The first objective of a pre-participation evaluation is to examine an athlete for any potentially fatal conditions that could put them at risk during participation in the sport or training.

2. Screen for injury risk: The second objective is to screen for any pre-existing injuries or potential injury risks that may affect the athlete's performance or put them at risk of further injury.

3. Determine the athlete's overall health: The third objective is to assess the athlete's overall health and fitness level to ensure that they are physically capable of participating in the sport or activity.

4. Serve as a gateway to the athlete care system: The fourth objective is to provide a means for the athlete to access the care system, which includes medical professionals and resources that can assist with any health-related concerns or issues that may arise during the season.

5. Allow for a discussion of off-season training and injury history: The final objective is to allow for a discussion of the athlete's off-season training and injury history, which can provide valuable information for the development of an individualized training plan and help prevent injuries during the season.

As previously mentioned, When assessing an athlete's health and fitness, it's important to have a team of professionals with diverse areas of expertise. These professionals may include medical doctors from different specialties (such as cardiology, neurology, or orthopedics), sports dieticians, doctors of physical therapy, athletic trainers, and performance coaches. By having a multidisciplinary team in place, the athlete can receive a thorough assessment that takes into account various aspects of their health and fitness. This can help identify any potential issues or areas for improvement, and ensure that the athlete receives the best possible care and support. It might be difficult to manage so many cooks in the kitchen. Having too many people involved in a project can create chaos or confusion. As a result, it is critical to create a point of contact (POC) who will organize all aspects of the MPRE. The lead can be someone who has extensive experience working across different disciplines, such as an athletic trainer, physiotherapist or physician.

Roles and Responsibilities

When developing roles and responsibilities for a MPRE, it's important to consider the different professionals involved and the specific tasks that each individual will be responsible for. Here are some examples:

The Point of Contact (POC) is responsible for organizing and coordinating all aspects of the MPRE. This person should have experience working across different disciplines and be able to communicate effectively with all team members. Medical Doctors from different specialties, such as cardiology, neurology, or orthopedics, may be involved in the MPRE. Their responsibilities may include conducting physical exams, reviewing medical histories, and providing medical clearance for participation. Sports Dieticians: may be responsible for assessing an athlete's nutritional status and providing recommendations for optimal performance. Physiotherapist may be responsible for conducting musculoskeletal evaluations and developing individualized rehabilitation plans for athletes with pre-existing injuries. Athletic Trainers: may be responsible for conducting baseline concussion testing, providing on-site medical care during practices and games, and communicating with other healthcare professionals regarding an athlete's care. Performance Coaches may be responsible for developing individualized training plans and monitoring an athlete's progress throughout the season.

(A general practical example emphasizing each MPRE aim as well as sample duties and responsibilities for an athlete with a history of elbow injuries is provided below.)

Practical Application Example

Objective 1: Examine for Potentially Fatal Conditions

• Medical History: No history of heart disease, stroke, or other cardiovascular conditions.

• Physical Exam: Normal heart rate, blood pressure, and breathing rate.

Objective 2: Screen for Injury Risk

• Medical History: Previous UCL sprain (right elbow) and Grade 1 strain of flexor pronator mass.

• Physical Exam: Limited elbow range of motion in right elbow and pain reported with palpation to flexor pronator mass.

Objective 3: Determine the Athlete's Overall Health

• Medical History: No history of chronic illnesses, allergies, or asthma.

• Physical Exam: Normal weight, height, and body mass index (BMI).

Objective 4: Serve as a Gateway to the Athlete Care System

• Referral to a sports medicine physician for further evaluation of the elbow exam findings.

• Information provided to the athlete about how to access medical resources, such as athletic trainers and physical therapists.

Objective 5: Allow for a Discussion of Off-Season Training and Injury History

• Discussion with the athlete about their off-season training regimen and any previous injuries.

• Recommendations provided for individualized training plan and injury prevention strategies.

Take Home Points

Off-season preparation is just as crucial as the regular season in professional sports, and it involves a lot of work, including roster changes, performance training, and the establishment of processes and systems for the following season. One such process is the Medical and Performance Readiness Evaluation (MPRE), a pre-competitive season examination and evaluation process that determines an athlete's ability to participate in the upcoming competitive season safely and within an acceptable risk for injury. Collaboration and integration among healthcare professionals with diverse areas of expertise is essential in creating a comprehensive understanding of an athlete's health and developing a tailored plan to maximize their potential while addressing their unique needs. The MPRE has five main objectives, including screening for any pre-existing injuries or potential injury risks that may affect the athlete's performance or put them at risk of further injury, allowing for a discussion of off-season training and injury history, and serving as a gateway to the athlete care system. A point of contact should be established to organize all aspects of the MPRE.

In the next article of this series, we will dive into the essential components of an MPRE. This will include a detailed examination of the medical and performance tests that are typically conducted during the evaluation process. We will also discuss how the results of these tests are analyzed and interpreted, and how they are used to inform the athlete's care plan. By understanding the essential components of an MPRE, sports medicine professionals can ensure that they are conducting a thorough evaluation that addresses all of the athlete's unique needs and helps them achieve optimal performance while minimizing the risk of injury.

I talk about the ins and outs of being part of a sports medicine team in the HPSM course.

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