Athletes with a significant neurological history, such as a seizure disorder, head injuries, concussions, stingers or burners, pinched nerves, or recurrent headaches will need a thorough history and will likely need further evaluation not possible at the PPE [2]. Preexistence of any of these conditions may indicate that the athlete is at risk for a future catastrophic neurologic injury [2]. Assessing for a history of concussions or prior head trauma allows the physician to discuss preventative strategies with the athlete as well as to counsel the athlete on the risk involved with collision sports and recurrent brain trauma.

A straightforward and easily understandable definition of concussion is “a traumatically induced transient disturbance of central neurologic function” [2]. It is important to remember that the loss of consciousness is not required to make the diagnosis of concussion, and in about 90 % of concussions, there will be no loss of consciousness [2]. Essentially, there are three main issues to consider when deciding whether it is reasonable to clear someone or return them to play after a concussion: second impact syndrome, postconcussion syndrome, and persistent neurologic deficit [2].

Stingers and burners are a common occurrence in collision sport athletes. Annually, 52 % of football athletes experience a stinger and, overall, 65 % will report at least one stinger in their career [2]. Evaluation of episodes of cervical cord neuropraxia (CCN) is also important. Athletes with CCN or recurrent stingers may benefit from a formal neurologic evaluation.

A thorough musculoskeletal history provides the examiner insight into an athlete’s prior injury history and training methods. If the athlete has a history of stress fracture, further inquiry into training methods may be indicated to prevent recurrence of such injuries. Any workup that has been done on previous injuries also gives the examiner insight into the severity of the injury.

EIA is one of the most common encountered conditions of the PPE with a prevalence of 10–50 % in adolescents. In athletes who have been diagnosed with EIA, the PPE allows the physician to discuss timing and use of short-acting inhalers, avoidance of possible triggers, use of rescue inhalers during competition, and response to treatment. The physician must also maintain a high level of suspicion when the athlete complains of subtle symptoms, such as fatigue, being “out of shape,” muscle cramps, and decreased stamina. Workup in such cases may be aided by performing spirometry in an exercise setting.

Heat edema, heat cramps, heat-related syncope, heat exhaustion, and heat stroke make up the spectrum of heat-related illnesses. Exertional hyperthermia is the leading cause of nontraumatic, noncardiac-related sports deaths [5]. Assessment of circumstances around the occurrence of heat illness in an athlete is important. Factors such as acclimatization, equipment, fluid intake, weight changes, medications and supplements, and history of heat illness are all important factors. Previous occurrence of heat illness does not prevent the athlete from being able to participate in sports. The importance of the PPE in these cases is to discuss prevention and treatment strategies.

Individuals with sickle cell disease should avoid highly strenuous activity and all contact and collision sports. Sudden death in athletes has been associated with sickle cell trait while doing strenuous activity in high environmental heat or altitude. Universal screening for sickle cell trait has been recommended [2]. Recommendations include asking the athlete if they have been screened for sickle cell trait. If positive for sickle cell trait, the athlete should acclimatize gradually and engage in year round training to maintain physical conditioning [2]. Education of the staff, coaches, and athletes concerning the condition and prevention of possible complications is the most important aspect [2]. The remainder of the PPE may focus on issues that are specific to the athlete. Questions concerning weight issues, menstrual history, and immunizations may be indicated based on concerns or observations of a specific athlete. Any affirmative responses on the history form should be an indicator to the examiner to obtain further information.