NPFL : Pre-Participation Medical Examination is compulsory

Osun footballer slumps and dies during a match on the 7th of September, 2020- This is another death too many!

The goal of sports medicine is mainly to ensure that athletes are kept in their best health to allow them deliver optimum performance in competitive and non-competitive sports. Ethically, sports medicine ensures best performance in athletes, without compromising the health and wellbeing of athletes. It is therefore accepted, that the single most important thing for a sports medicine team is the health of athletes.

Although sports activity – either in competitive or non-competitive form – has several benefits, it poses potential risks that can lead to several diseases or even death. History shows many athletes who died in action and others who died due to complications that arose from medical problems during sports action. These deaths are highly regrettable, in this context, because they were mostly avoidable, provided preventive measures were taken.

Over time, the concern of sports medicine professionals – like general medical practitioners – has shifted from management of sports related injuries and diseases to their prevention. More prevention strategy and protocol have been adopted in various competitive sports as regular routine for athletes with results that imply a positive correlation between prevention measures and health outcome of athletes.

Of all the steps involved in prevention of death of athletes, Pre-Participation Evaluation (PPE) remains the single most important approach. The PPE focuses on areas of concern in sports participation and areas identified as problems in the history, and it follows recommended baseline steps. It places importance particularly on indices of Cardiovascular risks – history of cardiovascular symptoms, general examination including anthropometry (weight, height, and BMI), cardiovascular examinations including baseline heart rate, blood pressure, presence of murmurs and investigations like chest x-ray, electrocardiogram and echocardiogram tests.

PPE has potential to protect the lives of athletes and promote their health by ensuring that they are not put at unnecessary risk. Contrary to what many people think, the target of PPE is not exactly to disqualify athletes from participating in sports, but to ensure a healthy participation that does not pose danger to the athletes. The assessment done is used to identify athletes that need medical counselling and those that may have to consider other sports or not even participate in sports, due to their health condition.

Taking the available evidences supporting the benefits of PPE into consideration, many countries have made legislations that compel athletes to undergo evaluation before they participate in competitive sports.

For example, since 1982, Italy mandated PPE for all competitive athletes, conducted by medical professionals. In Netherlands, all citizens are required to do a regular screening hence there is no special plan for athletes. In France, it is necessary that competitive athletes obtain a “Certification of Absence of Contraindications” before participation. For athletes in Finland, evaluation is required about six weeks prior to sporting activities. In the U.S., the American College of Sports Medicine (ACSM) encourages athletes to have a complete assessment before commencement of a seasonal competition. In most states however, the assessment is composed only of a questionnaire, while few other states have included ECG for athletes. The plan in the U.K. is a full PPE which is however exclusively for elite athletes.

In many countries of sub-Saharan Africa, there are no legislations, policies or regulations regarding PPE. In Nigeria for example, the preparticipation medical evaluation has been included in the medical guidelines in some of the sports leagues but ensuring compliance is still a major issue and this has led to several complications and avoidable deaths. Recently, a talented footballer in the Nigerian Premier Football League (NPFL) named Chineme Martins and aged 22 died on 9th March 2020, after collapsing during a game for his club ‘Nasarawa United’. As painful as his death is, it was certainly not the first of its kind. There are records of players in Nigeria who died on the field, with or without contact.

Although, there are less facts available about the actual causes of death in such situations, a critical assessment of circumstances around the events show patterns indicative of Sudden Cardiac Death or other cardiovascular issues that would have been detected if there were adequate medical evaluation for the athletes before commencement of the competition. This strongly suggests the need for complete medical evaluation in athletes before participation in sports.

Conclusively, it is the responsibility of every country to ensure that athletes in competitive sports undergo PPE under the regulation of the professional bodies responsible for the administration of such sports. Athletes who are at risk should have no business being involved – that is the most important step in preventing avoidable death.

For PPE to take full effect , there must be review of policies and eventual provision of enabling laws that compel administrators to complete medical assessments of athletes before competitions. It is therefore recommended that governments initiate processes for such legislations to prevent further loss of talents and lives.

Dr Ayodeji Olarinoye MON For Sports Medicine Professionals