When I first learned to perform sports physicals, it seemed a bit overwhelming to make sure I developed an easy flow of the physical exam.  It felt like I had my patient sit, stand, sit, stoop over, and so forth. It seemed awkward in the early days as an NP in the urgent care setting.

During one of my clinical experiences, though, a former Air Force doc shared a few pearls with ME! This one is likely my most favorite and was easily implemented into my physical exam workflow.  

Beginning with the head, I examined EENT, thyroid/neck, heart and lungs with the patient sitting, then I have the patient lie down for repeat cardiac auscultation; assess the abdomen, first listening, then palpating. 

For males, while patient is lying there, have him unzip and explain you are going to check for hernias, quickly and privately.  Have him cough while you reach inside, palpating scrotal sac and track.  Repeat on opposite side.  Have him then stand, while you quickly wash/sanitize hands, and get the patient to reach overhead with both arms. I usually demonstrate the act.  Touch shoulders, back, and then toes, asking pt to remain stooped over while you assess spine.  Then have patient squat, right where they are, and then walk towards you a few steps.  This “duck walk” is a great tool for assessing musculoskeletal AND nervous system functions and connections, without performing a lot of other mini-tests or assessments.  You can then ask them to stand/hop on one leg or any additional tests you prefer, but this particular flow is quick, easy, and covers a lot of your assessment thoroughly. 

Remember though: the BIGGEST component of a sports physical is the cardiac assessment. Assessing for murmurs is critically important as it is the highest liability component of the exam. I have heard unknown murmurs a handful of times in my career that ended up resulting in a serious life altering diagnosis once the patient was seen by cardiology. So, be sure to REALLY get a good listen of that heart.

Try this flow the next time if you are a nurse practitioner that does sports physicals as these exams should only take 7-8 minutes once you got it down!