Players’ medical history is of major importance in the whole pre-participation examination. A careful and detailed medical interview should be conducted in a comfortable and calm setting ensuring the confidentiality of the exam. For children, the presence of an adult with knowledge about his personal and family medical history (usually the parents) is mandatory.

Many aspects should be assessed, and each clinician might have their own protocol. Nevertheless, three main domains should be accessed during this interview: family history, past medical history and present medical history. For each, we will highlight the fundamental parameters that should be assessed.

Normally, each doctor has his own protocol, which was built during his/her career according to guidelines and personal experience. Either you choose to follow your exam from head to toes or from system to system, the most important is to follow a sequential and systematic evaluation and to never forget the mandatory items that you can find in the UEFA and FIFA guidelines.

Next is an example of how to conduct a physical examination in a professional football player. The player should expose as much of his/her body as possible, respecting his/her personal, social and religious limitations:

FIFA and UEFA recommendations are summarized in Table 44.3.

Imaging technology can be used during the preseason screening according to clinical findings in the history and physical examination. However, a fast and easy systematic ultrasonography assessment of the Achilles tendon, patellar tendon and shoulder structures (in goalkeepers) can be performed if the sports medicine physician has the proper equipment and knowledge, giving us useful information regarding some of the most common pathologies in this population [7–9].

Very recently it has been shown that college athletes were at a 2.48 times greater risk of a lower extremity injury up to 90 days post-concussion possibly due to lingering neurocognitive and motor deficits [10]. Having baseline measures on players, prior to concussion, will help return-to-play decisions and hopefully further reduce injury risk. The tests listed below are examples of what practitioners can use to establish baselines.

The United States of America Football notes that baseline screening of players using neurocognitive tools, such as ImPACT, can be used by suitably qualified staff and recommends that the Sport Concussion Assessment Tool (SCAT3), which incorporates a modified Balance Error Scoring System (BESS), should be used pitchside following suspected concussions. Players’ baseline in balance and reaction time tests should also be recorded [11, 12].

During the pre-evaluation period, it is an ideal time to check on the player’s weight, after returning from the off-season. This is also an ideal opportunity to educate players on the risks of dehydrating to make weight.

Body composition measurements, in particular percentage body fat and fat-free mass, are routinely measured in players at the start of the season and at regular intervals in-season. The widely accepted rationale behind this is that excessive adipose tissue adds ‘useless’ weight to the player resulting in greater energy expenditure and lower power and accelerations. What is not as widely accepted is the choice of devices to measure percentage body fat. Traditional ways include callipers and underwater weighing techniques; callipers being the simplest and cost-effective but prone to large intra-tester variances.

Dual-energy X-ray absorptiometry [DEXA] scans provide very accurate body composition measurements as well as information about bone density. Other potentially useful benefits include gaining insight in distribution of adipose in different regions of the body and even asymmetrical distribution between limbs.

Gay-Escoda et al. [13] found a significant correlation between players with poor oral health and muscle injuries. SportsInjuryLab, a company screening athletes for dental and occlusal problems (i.e. periodontitis, impacted wisdom teeth, malocclusion), has linked dental and temporomandibular joint problems to negative impacts on balance and ultimately performance or increased risk of injury [13].

Including an oral health assessment in the preseason evaluation is not common practice but may be worth considering, especially for teams that have a dentist associated with the club.

A player’s ability to make the correct decision in a split second is believed to be based on three important cognitive components. These components, according to Bar-Eli [14], are perception, knowledge and decision strategies. The top decision makers use well-developed visual search strategies in both their peripheral and central vision [15] together with selective, focused and divided attention [14].

There is a significant amount of literature supporting the implication of strength imbalances as an injury risk factor for most of the injuries that occur in football [6, 16, 21].

It is important to assess the different types of strength, namely, maximum strength, power and endurance.

Maximum strength imbalances are strongly correlated with several football injuries in literature (e.g. hamstring strains, groin syndrome), making it mandatory to be assessed before season starts [16, 21, 22]. Despite the absence of evidence supporting the other strength types as injury risk factors, we still find it important to measure because it can complement player’s strength profile, by providing us with a baseline of the player or leading us to a further investigation in cases where an imbalance is unveiled.