Detailed Assessment Protocols For NHL Entry Draft Players

Detailed Assessment

Protocols For NHL Entry Draft Players

N. Gledhill, Ph.D. and V. Jamnik, M.Sc.

York University, Toronto 2007

2

PREFACE

In the past decade, considerable information has been accumulated regarding the physical and physiological attributes of top level hockey players. Based on this information "desirable" fitness profiles have been established for elite hockey players and these profiles can be utilized for comparisons with developing hockey players. As well as identifying a hockey player's current weaknesses, fitness testing can also provide information about his physical/physiological potential for elite hockey. Hence, fitness test information can be employed in the identification of talent, to construct training regimens for the alleviation of weaknesses and to establish performance goals.

Fitness, medical and hand-eye co-ordination assessments are conducted on NHL Entry Draft players by a nationally accredited high performance athlete testing laboratory. The fitness assessment protocols are a compilation of the core fitness tests currently employed by a number of NHL teams.

Following the draft selections, additional tests such as isokinetic/isovelocity/ strength testing may also be conducted by some teams to supplement the information from these tests.

The medical assessment protocol is comprised of a Health Questionnaire which is completed by the player plus a Physical Examination conducted by the testing centre's physician. An extensive knee examination is also conducted if the physician identifies a possible problem. In addition, players are required to sign a Release of Fitness and Medical Information form so that the assessment information can be freely utilized by Central Scouting in their Entry Draft rankings and circulated to NHL teams for use in their deliberations on NHL Entry Draft players.

Strength, Power & Muscular Endurance ... 6

Flexibility... 10

Anaerobic Fitness ... 11

Aerobic Fitness ... 13

Overall Summary of NHL Entry Draft Player=s Fitness Assessment Results ... 15

Medical Assessment Overview... 16

Consent for Exercise Testing... 17

Release of Medical & Fitness Information... 18

NHL Entry Draft Medical History... 19

NHL Entry Draft Record Medical Examination... 21

Summary of Medical Findings ... 24

Yuhasz formula) the percent body fat of all players can be compared meaningfully.

MUSCULOSKELETAL FITNESS refers to the muscular strength, power, endurance and flexibility of key areas of the body. High scores in these measurements reflect the capacity to skate powerfully, shoot hard, push people out of the way and be less injury prone. Comparisons to averages and between players are meaningful. Considerations of the physician=s assessment of the player=s present body development together with these measurements is useful in determining the potential for increases in the player=s musculoskeletal fitness due to future maturation and training.

ANAEROBIC FITNESS refers to the ability to work at a very high level for relatively short periods (5 to 30 sec). The peak power output reflects such abilities as the player=s capacity for spurts of speed or to clear opponents from in front of the net. The average power output reflects the player=s ability to maintain a relatively high level of work throughout the 30 sec shift. The fatigue index indicates the drop-off in power output from the beginning to the end of a 30 sec shift - the lower the percent drop-off the better the score.

AEROBIC FITNESS (VO2max) indicates the endurance capability of the player=s heart, lungs and muscles. This ability allows a player to offset fatigue over the course of a game or practice. The best value for comparisons between players is the VO2max expressed relative to body mass (ml⋅kg^-1⋅min^-1).

High scores could be due to effective aerobic training, genetic endowment or a combination of the two.

Therefore, if a player has not been exposed to a good aerobic conditioning program, he likely has potential for considerable improvement. The peak heart rate is useful for setting up an optimal training program for the player. The duration and final workload of the cycle test are useful for conducting future fitness tests on the player.

MEDICAL EXAMINATION The Significant Findings draw attention to medical conditions which could affect the player=s future ability to play hockey. The evaluation of body development provides insight into the player=s current physical maturation and/or training status. A lack of body development indicates a greater potential for future improvement due to maturation or training.

HAND-EYE CO-ORDINATION Hand-eye coordination is an important ability for success in skilled sports such as hockey. The basic skill of coordinating vision with hand motion to move an object requires a sophisticated level of central nervous system control. This ability depends on the speed and efficiency with which the different vision and motor areas of the brain communicate with one another. A simple way to assess the efficiency of these >neural networks=, and thereby hand-eye coordination, is to determine the time it takes to complete a specific motor-vision task. Delays in central nervous system processing while performing the task will result in a longer test completion time. The assessment of hand-eye coordination will be conducted in the room where the medical examinations are conducted. The test results (time in seconds) will be reported with the summarized fitness results.

2

OVERVIEW & ORDER IN WHICH THE TESTS ARE CONDUCTED

1. BODY COMPOSITION

2. STRENGTH, POWER AND MUSCULAR ENDURANCE

3. FLEXIBILITY

4. ANAEROBIC FITNESS

5. AEROBIC FITNESS

BODY COMPOSITION

Body weight can be viewed as having two components; a fat component and a fat free (muscle, bone and fluid) component. Overweightness is a result of an excess of fat. By measuring the fat that is stored under the skin at various sites on the body it is possible to determine the total amount of fat on the body and hence the percent of the player's body weight that is fat. In order to perform optimally a hockey player should aim for 9.5% or less body fat (determined by the Yuhasz equation).

A. Standing Height: A wall-mounted stadiometer or measuring tape and set square should be employed.

The subject must be without footwear, heels together with the backs of the feet touching the wall. The body should be fully erect, the shoulders relaxed and the arms stretched downward. To make the measurement, rest the set square on the top of the head and against the wall tape. Measure to the nearest 0.2 cm from the highest point on the top of the head. Stadiometers attached to a balance-type weigh scale are inaccurate and should not be used.

B. Wingspan: The player extends his arms straight out to the sides. Measure to the nearest 0.2 cm from the middle finger tip to middle finger tip.

C. Body Weight: Obtained on a calibrated beam-type balance and recorded to the nearest 0.1 kg. The subject should be without footwear and wearing a minimal amount of clothing.

D. Skinfold Fat Measurements: Using a skinfold caliper, all of the following measurements are made on the right side of the body with the exception of the abdominal skinfold, which is made on the left side.

a. Chest: The subject stands in a normal erect position, left arm hanging by the side and right arm resting on the appraiser's shoulder. The skinfold is raised above and slightly to the right of the right nipple at an angle of 45° to the horizontal.

b. Triceps: The caliper is applied one centimetre from the left thumb and index finger raising a vertical fold at the marked mid-acromial-radiale line on the posterior surface of the arm.

4 c. Subscapular: The caliper is applied one centimetre distally from the left thumb and index finger raising a fold beneath the inferior angle of the scapula in a direction running obliquely downward at an angle of about 45° from the horizontal.

d. Suprailiac: Measured 3 cm above the iliac crest with the fold running parallel to the crest.

The fold should be taken at the midline of the body.

e. Abdomen: The caliper is applied one centimetre inferior to the left thumb and index finger grasping a vertical fold on the left side which is raised 5 cm lateral to, and at the level of the midpoint of the navel.

f. Front Thigh: The caliper is applied one centimetre distally to the left thumb and index finger raising a fold on the anterior of the right thigh along the axis of the femur when the leg is flexed at an angle of 90 degrees at the knee by placing the foot on a box. The mid-thigh position for this measure is the estimated half-distance between the inguinal crease and anterior patella. In some subjects, when the fold is difficult to raise, the grasp must be firm and the calipers can be pushed to the muscle level and slightly retracted. The subject can also assist by supporting the underside of the leg. In particularly heavy-thighed subjects, the anthropometrist can give further support to the underside of the leg by using his own knee and thigh. A further tactic is to have an assistant use two hands to raise the fold. The anthropometrist applies the caliper from the subject's right side when the assistant on his left raises the fold with the right thumb and index finger at the prescribed site; the anthropometrist positions the caliper and a second grasp of the fold is attempted with the assistant's right thumb and index finger one centimetre distal to the caliper. The measurement is made on the double grasped hold.

Calculations:

f) + e + d + c + b + (a Skinfolds Six

∑of

3.64 + .097]

x ) skinfolds six

of [(

= (Yuhasz) fat

% ∑

6

STRENGTH, POWER AND MUSCULAR ENDURANCE

Strength is the maximal force that can be generated by a muscle or muscle group. Power is a combination of force and speed. They are important in hockey for shooting, controlling opponents, accelerating and skating speed. Muscular endurance is the ability of muscles to exert force repeatedly.

This capacity is important in hockey because of the repetitive use of key muscles.

A. Grip Strength: The subject adjusts a hand grip dynamometer to his hand size, fully extends his arm and squeezes the dynamometer as forcefully as possible. The test is conducted on both hands.

B. Upper Body Push and Pull Strength: The Strength Metre measures the upper body actions of push and pull. Three trials of each action are performed with a rest interval between each action. It is important that a maximal effort be exerted during each action without jerking.

Push: In a standing position, with the knees slightly bent and the feet shoulder width apart, maximally push both handles away from the body.

Pull: In a standing position, with the knees slightly bent and the feet shoulder width apart, maximally pull both handles straight back towards your body.

C. Bench Press Repetitions (150 lb): Conducted using a standard padded bench with 150 lb of free weights (including the barbell) in time with the metronome.

a. Repeated 150 lb bench presses are performed at a rate of 25 per minute in time with the metronome (set the metronome at 50 so that each click signals a movement either up or down).

b. The subject lies on his back on the bench and grips the barbell with thumbs approximately shoulder width apart. The buttocks must remain on the bench with the feet on the floor. The starting position of the bar is touching the chest at approximately the axillary line and the bar is pushed to full extension of the arms.

c. Record the number of consecutive repetitions completed before the player falls behind the cadence.

D. Curl-ups: Conducted on a mat in time with a metronome.

a. The subject lies in a supine position, knees bent at an angle of 90°, heels in contact with the ground, arms crossed over the chest with each hand on the opposite shoulder. Set the metronome at 50 so that each click signals a movement either up or down at a rate of 25 curl-ups a minute.

b. The initial phase of the curl-up involves a "flattening out" of the lower back region (ie. posterior pelvic tilting) by active contraction of the abdominal muscles.

c. This is followed by a slow "curling up" of the upper spine far enough so that the elbows make contact with the thighs. During the curl-up the heals must remain in contact with the floor.

Anchoring of the feet is NOT permitted. On the return, the subject's shoulder blades must contact the mat. Place one hand under the shoulders on the mat to verify this contact.

d. The movement is performed in a well-controlled manner so that the time to perform the lifting and lowering stages of the curl-up is the same.

E. Push-ups: Push-ups are performed at a rate of 25 per minute in time with the metronome (set the metronome at 50 so that each click signals a movement either up or down).

a. The subject lies on his stomach, legs together. The hands are positioned under the shoulders with the fingers pointing forward. The starting position requires that the subject fully straightens the elbows using the toes as the pivotal point. The upper body must be kept in a straight line. The subject lowers himself to the point where the elbows reach a 90^o angle then returns to the starting position. Neither the stomach nor the thighs should touch the mat.

b. Record the number of consecutive repetitions completed before falling behind the required cadence.

F. Seated Medicine Ball Throw: The seated medicine ball throw is a measure of upper-body (arm) power. It is conducted using a standard 4 kg (~ 8 lb) medicine ball.

Test Procedure:

a. The individual is seated on the floor with his legs fully extended, his feet are placed 24 inches apart and his back is against the wall.

b. The medicine ball is held with both hands against the centre of the chest. The forearms are positioned parallel to the ground.

c. The individual is instructed to throw the medicine ball as far straight forward as he can while keeping his back is maintained against the wall.

d. The distance thrown is recorded in centimetres (cm) and the best of three trials is reported.

Push-Ups

G. Standing Long Jump: The player stands with feet slightly apart with toes behind the jumping line.

Using an arm swing to assist, the player jumps as far as possible. Record to the nearest centimetre the distance from the jumping line the heel mark in the best of three trials.

H. Vertical Jump: Conducted using the Vertec Jump measurement apparatus.

8 a. The player stands flat-footed facing a wall mounted scale and with fingers outstretched on the dominant arm, reaches as high as possible over his head and this height is recorded.

b. The player takes a comfortable position beneath the Vertec apparatus.

c. Without a pre-step and with the fingers of the dominant arm outstretched, the player jumps as high as possible and hits the Vertec measurement markers causing them to move. Allow three jumps.

d. The measurement is taken to the nearest 2 inch from the tip of the fingers in the standing reach height to the bottom plastic marker that was not moved during the jump.

Calculation of Leg Power:

I. Jump Timing Mat: A timer is triggered when the jumper’s feet leave the mat and stops when the jumper lands. This “hang time” is directly related to and can be simply converted to jump height.

The test will be performed alongside the customary vertical jump test and both jump heights and the corresponding leg power will be reported in the summarized fitness results.

Upper Body Push and Pull Strength

(ft) height jump x

(lb) weight x

4

= ) lb/

- (ft

Power sec

10

Standing Long Jump

FLEXIBILITY

Good trunk flexibility decreases the risk of muscle and joint injury and in particular back injury. It is important that the player engages in an adequate warm-up prior to performing this test.

Trunk Flexion (Sit and Reach Test): The subject sits without shoes with legs fully extended with the soles of the feet placed flat against the two horizontal cross boards of the flexometer. The flexometer should be adjusted to a height at which the balls of the feet rest against the upper cross boards. The inner edge of the soles are placed 2 cm from the edge of the scale. Keeping the knees fully extended and the arms evenly stretched with palms down, the subject bends and reaches forward (without jerking), pushing the sliding marker along the scale with the fingertips as far forward as possible. The position of maximum flexion must be held for approximately two seconds. Advise the subject that lowering the head will maximize the distance reached. The measurement is recorded in centimetres. To avoid negative numbers, the bottom of the foot is set at the 25.4 (10 inch) mark. Hence, reaching short of the bottom of the foot results in scores of less than 25.4 cm, and reaching beyond the bottom of the foot results in scores greater than 25.4 cm.

Trunk Flexion

performance.

Wingate Cycle Ergometer Test (30 secs):

The computerized version of the Wingate protocol employing a photocell counter is recommended, but the use of a mechanical counter and recorder is also acceptable.

a. Have the subject sit on a cycle ergometer so that when the pedals are turned the leg that is in the

"down" position is just slightly less than fully extended. The feet should be secured to the pedals in stirrups.

b. Allow the subject to warm up by pedalling at a low resistance for two minutes.

c. Calculate the resistance that the subject will have to work against during the test. (Body weight in kg X .090 = resistance on the cycle ergometer in kg).

d. If employing a mechanical counter and recorder, start the chart recorder prior to initiating the test so that each revolution of the ergometer's sprocket is recorded. To start the test, have the subject pedal at a progressively quicker cadence so that by the time the designated workload has been reached, he is pedalling at his maximal capacity. The subject pedals at his maximal capacity against the designated workload for 30 seconds.

e. Once the test has been terminated, the subject should pedal at a slow rate against a low resistance for one to two minutes in order to facilitate cool down (no lactate sampling).

f. Revolutions are recorded for each five second period, then power output is calculated for both the peak five second period and the 30 second duration.

Calculations:

Note: The score is also expressed in Watts and Watts/kg:

) ( time

) ( 60 x (m) distance x

(kg) resistance x

s revolution

= ) (kpm

Output

Power ^-1

sec min sec

•

6.123

=kpm Watts

-¹

•min

(kg) t body weigh

Watts

= Watts/kg

12 Recorded values for Anaerobic Fitness:

M Peak Power Output (Watts plus Watts/kg) M Mean Power Output (Watts plus Watts/kg) M Minimum Power Output (Watts plus Watts/kg)

M Fatigue Index (The drop-off from Peak Power Output over 30 sec)

Wingate Cycle Ergometer Test

100 x Output )

Power Peak

Output Power

Minimum -

Output Power

(Peak

= Index Fatigue

a. Adjust the seat height of the cycle and instrument the subject with a heart rate monitoring device such as a Sport Tester.

b. Allow the subject to become accommodated to pedalling the cycle ergometer with the mouthpiece in place.

c. Set the metronome so that the subject cycles at 70 revolutions per minute for the first three workloads:

Work Level Time (min) Resistance (kp) Watts

1 0 - 2 2.0 140

2 2 - 4 3.0 210

3 4 - 6 4.0 280

After the first three workloads, set the metronome so that the subject cycles at 80 revolutions per minute:

4 6 - 7 4.5 360

5 7 - 8 5.0 400

6 8 - 9 5.5 440

7 9 - 10 6.0 480

etc

d. Record the heart rate at rest, at the end of each workload stage and at maximum. Measure the VO2 in the final 30 sec of each workload.

e. Record the time to exhaustion and the final workload achieved in Watts. The end point is determined by either i) the subject physically stops pedalling or 2) the appraiser stops the subject because the subject can no longer maintain the required rpm despite intense effort. Do not stop the subject for any other reason (even if VO2 is dropping). Subjects are allowed to stand up and pedal and should be encouraged to do so until they absolutely cannot maintain the required rpm any longer.

14

Musculoskeletal Fitness

Sit & Reach (cm) 38 38 16 54

Curl-Ups (max consecutive #) 24 25 0 82

Vertek Vertical Jump (in) 25 24 18 32

Vertek Leg Power (ft-lb/sec) 1110 1098 772 1484

Jump Mat Vertical Jump (in) 22 22 17 28

Jump Mat Leg Power (ft-lb/sec) 1045 1043 796 1466

Standing Long Jump (in) 100 97 79 110

Hand Grip - Rt (lb) 129 129 88 174

Hand Grip - Lt (lb) 125 126 92 158

Bench Press (150 lb - # of reps) 10 8 0 19

Bench Press (lb/lb body weight) 8 6 0 13

Push-Ups (max consecutive #) 24 24 3 41

Push-Ups x Body Weight (lb) 4608 4589 530 8451

Push Strength (lb) 233 229 119 315

Push Strength (lb/lb body weight) 1.2 1.2 0.7 1.7

Pull Strength (lb) 258 258 165 425

Pull Strength (lb/lb body weight) 1.4 1.4 0.9 2.1

Upper Body Power 4 kg Ball (in) 200 182 147 238

Anaerobic Fitness

Peak Power Output (Watts) * 1044 969 638 1266

Peak Power Output (Watts/kg) 12.0 11.1 7.0 14.9

Mean Power Output (Watts) * 822 796 542 991

Mean Power Output (Watts/kg) 9.4 9.1 6.0 11.7

Fatigue Index (% Drop-off from Peak) 39.6 35.7 18.0 51.5

Average Overall RPM 399 387 250 492

Aerobic Fitness

VO₂max (litresAmin^-1) * 5.03 4.66 3.44 5.90

VO₂max (mlAkg^-1Amin^-1) 57.8 53.4 41.4 65.5

Note: For all measurements except Sum of 6 Skinfolds, % Body Fat and Fatigue Index, higher scores are better.

* Because body weight is not taken into account in these values, comparisons between players are inappropriate.

16

MEDICAL ASSESSMENT OVERVIEW

The purpose of the medical evaluation of NHL Entry Draft Players is to identify any medical condition which could impact on the player's ability to perform successfully in the NHL. Examples of such conditions are a heart problem, a back problem or a recurrent history of concussions.

Particular attention is paid to limb stability, so that problems such as a repeated shoulder separations or previous injuries/surgery to the knees are identified. In addition, the examining physician provides a subjective rating of the player's current muscular development so that this information about maturational status can be considered when interpreting the player's strength and endurance scores. Only significant medical findings which could hinder a player's ability to perform successfully are noted in this summary.

The Medical Assessment consists of the three components described below:

1. Medical History; completed by the player and brought with him to the testing centre.

2. Medical Examination; conducted at the testing centre by the centre's physician. An extensive knee examination is conducted if the examining physician determines that a player has a possible problem.

3. Medical Summary; provided by the centre's examining physician to draw attention to noteworthy findings in the Medical Assessment.

anaerobic power (modified Wingate cycle test), skinfolds, bench press, hand grip, upper body strength, seated medicine ball throw, vertical jump, standing long jump, trunk flexion, push-ups, curl-ups and hand-eye co-ordination

2. my consent to the tests being conducted by a qualified Fitness Professional who has been trained to administer these fitness assessment protocols

3. my understanding that there are potential risks related to the performance of some of the tests such as strained muscles, and the possibility of certain changes occurring during and after the tests including abnormal blood pressure, fainting, transient light headedness, leg cramps, nausea, and chest discomfort.

4. my understanding that I may ask questions or request further explanations or information about the fitness tests

5. my obligation to immediately inform the Fitness Professional of any unusual pain, discomfort, fatigue or any other symptoms that I incur during or after the testing

6. my understanding that I may stop any further testing if I so desire, and also that the testing may be terminated by the Fitness Professional upon his/her observation of any symptoms of distress or abnormal response.

7. my understanding that the information will also be used for research purposes and statistical analysis, but results will only be reported in an anonymous group format.

__________________________________

Name of Participant (Please Print)

__________________________________ ________________________________

Signature of Participant Date

__________________________________ ________________________________

Signature of Witness Date If under 18 years of age:

__________________________________ ________________________________

Signature of Parent/Guardian Date

__________________________________ ________________________________

Signature of Witness Date

18

RELEASE OF MEDICAL AND FITNESS INFORMATION

(Completed by the player and brought with him to the testing centre)

I, the undersigned, have been informed and direct that the information determined during this medical and fitness assessment is to be provided to NHL Central Scouting for consideration in my ranking for the NHL Entry Draft and circulated to NHL teams to utilize in their deliberations on NHL Entry Draft player selection.

I understand that the information will also be used for research purposes and statistical analysis, but results will only be reported in an anonymous group format.

I hereby release the examining physician, the Laboratory by which the tests were conducted, the NHL, (included but not limited to the NHL Central Scouting and NHL Teams) including their officers, owners, directors, employees, affiliates, representatives, successors, assigns, associates and agents, from liability for disclosure of this information for the purposes indicated above or any related use thereof.

I hereby agree that the relationship and the resolution of any and all disputes arising there from between myself and the examining physicians (Dr. R. Brock, Dr. P. Rowan and Dr. S. Gledhill ), including any issues related to this agreement, shall be governed by and construed in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein.

I hereby acknowledge that the treatment will be performed in the Province of Ontario and that the Courts of the Province of Ontario shall have exclusive and preferential jurisdiction to entertain any complaint, demand, claim, proceeding or cause of action, whatsoever arising out of the treatment. I hereby agree that if I commence any such legal proceedings, I will do so only in the Province of Ontario, and hereby irrevocably submit to the exclusive and preferential of the Courts of the Province of Ontario.

__________________________________

Name of Participant (Please Print)

__________________________________ ________________________________

Signature of Participant Date

__________________________________ ________________________________

Signature of Witness Date

If under 18 years of age:

__________________________________ ________________________________

Signature of Parent/Guardian Date

__________________________________ ________________________________

Signature of Witness Date

Date of Birth ______________ Home Phone # ____________________ Town of Birth _________________________

Day/Month/Year Country of Birth ______________________

FOR EMERGENCY NOTIFY:

Name _____________________________________________ Relationship __________________________________

Address ____________________________________________________ Phone ______________________________

Family Doctor’s Name ________________________________ Date of Last Medical __________________________

Month/Year If you answer “Yes” to any of the following questions, provide details at the bottom of this page

Yes No 1. Have you ever been hospitalized?... ‰ ‰ 2. Have you ever had surgery?... ‰ ‰ 3. Are you presently taking any medications or pills?... ‰ ‰ 4. Are you presently taking any vitamins or supplements?... ‰ ‰ 5. Have you ever used steroids?... ‰ ‰ 6. Do you have any allergies (eg. medications, shell fish or stinging insects)?... ‰ ‰ 7. Have you ever passed out during or after exercise?... ‰ ‰ 8. Have you ever been dizzy during or after exercise?... ‰ ‰ 9. Have you ever had chest pain during or after exercise?... ‰ ‰ 10. Have you ever had high blood pressure?... ‰ ‰ 11. Have you ever been told that you have a heart murmur?... ‰ ‰ 12. Have you ever had racing of your heart or skipped heartbeats?... ‰ ‰ 13. Has anyone in your family died of heart problems or a sudden death before age 50?... ‰ ‰ 14. Do you have any skin problems (itching, rashes, acne)?... ‰ ‰ 15. Do you ever have persistent heat or muscle cramps?... ‰ ‰ 16. Have you ever been dizzy or passed out in the heat?... ‰ ‰ 17. Have you ever had trouble breathing or do you cough during or after activity?... ‰ ‰ 18. Do you use any special braces (for example, knee braces)?... ‰ ‰ 19. Have you had any problems with your eyes or vision?... ‰ ‰ 20. Do you wear glasses or contacts?... ‰ ‰ 21. Do you have or have you had any other medical problem (mononucleosis, diabetes, etc.)?... ‰ ‰ 22. Have you had a medical problem or injury since your last medical evaluation?... ‰ ‰ 23. Have you had any unexplained drastic weight change?... ‰ ‰ Explain any “Yes” answers above:

20 24. When was your last tetanus shot? _____________________________________________________________

25. When was your last measles immunization? _____________________________________________________

HEAD INJURIES OR CONCUSSIONS: Yes No

26. Have you ever had a head injury?... ‰ ‰ 27. Have you ever had a concussion or been knocked out, had your bell rung or been dinged?... ‰ ‰ 28. Have you ever had a seizure?... ‰ ‰

If you answered “YES” to any of the above, please provide: Number: _______

Date(s) Activity at the time Length of unconsciousness (minutes) Length of time before full return to activity

Did you have any persistent problems with:

Memory: YES ___NO ___ Dizziness: YES___ NO___ Headaches: YES ___ NO ___

______________________________________________________________________________________________

NECK INJURIES / BURNERS / STINGERS: Yes No

29. Have you ever had a neck injury (ie, strain, sprain, fracture, etc.)………... ‰ ‰ 30. Have you ever had a stinger, burner or pinched (a burning or numb feeling in the shoulder or arm after a hit to the, neck or shoulder – aka. brachial plexus stretch injury)?... ‰ ‰

If you answered “YES” to any of the above, please provide: Number: _______

Date(s) Activity at the time Length of time sensation/strength changes persisted

_______________________________________________________________________________________________

OTHER INJURIES:

31. Check any of the areas that you have INJURED IN THE PAST and explain the injury in the space below Hand ______ Elbow ______ Neck ______ Hip ______ Shin/CaIf ______

Wrist ______ Arm ________ Chest ______ Thigh ____ Ankle _________

Forearm ____ Shoulder ____ Back ______ Knee _____ Foot __________

Year of injury Type of Injury Side (right, left, both) Is it still a problem? (Yes/No)

32. Do you currently have any injury that is not completely healed?... Yes No If yes, which injury? _________________________________________________________

I hereby certify the above information to be correct.

Player’s Signature ____________________________________________ Date _________________________

Pupil & Conjunctiva ... ~ ~ Extraocular Movements... ~ ~ Fundiscopic Evaluation ... ~ ~ Tymapanic Membrane ... ~ ~ Nasal Septum... ~ Oropharynx... ~ Thyroid ... ~ Cervical Adenopathy ... ~

Pulmonary System Normal Notable Findings

Inspection ... ~

Auscultation... ~

Cardiovascular System Normal Notable Findings

Heart Rate bpm; Regular/Irregular ~

Blood Pressure 1) 2) ~

Heart Sounds ... ~

Murmurs ... ~

Peripheral Pulses ... ~

Abdomen Normal Notable Findings

Inspection ... ~ Palpation... ~

Percussion... ~

Hernias... ~

Cutaneous Normal Notable Findings

Skin (note identifying marks) ... ~

22

Nervous System Normal Notable Findings

Cranial Nerves II – XII... ~

Rhomberg ... ~

Cerebellar ... ~

Deep Tendon Reflexes ... ~

Upper Body º Below Average ~ Average ~ Above Average ~ Extensive ~

Body Development Lower Body º Below Average ~ Average ~ Above Average ~ Extensive ~

R.O.M. STRENGTH STABILITY

Musculoskeletal N / ABNORMAL N / ABNORMAL N / ABNORMAL

Hand/Wrist

Elbow

Shoulder

Neck/Back/Scoliosis

Hip

Knee

Ankle

Feet

Additional Comments / Notable Findings: _______________________________________________________

Examining Physician: Dr. R. Brock Signature __________________________________

Dr. S. Gledhill Signature __________________________________

Dr. P. Rowan Signature __________________________________

Current Treatments (Include orthotics, braces, taping, rehabilitation, etc)

Current Medications, Supplements

Allergies Immunizations

Dated this day of , 20 . Physician: ___________________________________________

24

SUMMARY OF MEDICAL FINDINGS

PLAYER'S NAME

1. BODY DEVELOPMENT

Upper body development: Below Average ~ Average ~ Above Average ~ Extensive ~ Lower body development: Below Average ~ Average ~ Above Average ~ Extensive ~

COMMENTS __________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

2. GENERAL COMMENTS

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

3. SIGNIFICANT FINDINGS

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

4. REQUIRES FOLLOW-UP:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

_________________________________________

Name of Examining Physician Signature