Periodic examination

The National Institute of Sports Medicine and Rehabilitation is the leading institution that performs medical supervision of athletes participating in international competitions, members of national teams and their immediate reserve. Medical supervision is performed according to the following scheme:
Basic monitoring (screening of athletes – 2 times a year). Target: screening of life-threatening and significant factors, detection of factors that restrict sports activity.
Interim monitoring (6-7 times a year). Target: control of rehabilitation processes, prevention of over-training, dynamic control of the most important indicators that characterize rehabilitation processes and over-training.
Current monitoring (1-2 times in a micro cycle). Target: control of the processes of urgent rehabilitation, prevention of overtension, control of the orientation of the actual training process in a micro cycle.
Moreover, we examine athletes after treatment (injuries, diseases, surgeries) to assure their admittance to training, as well as before competitions. A sports physician, therapist, otorhinolaryngologist, ophthalmologist, dermatologist, cardiologist, neurologist, dentist and, if necessary, other specialists are involved in the examination.

Screening of athletes is performed in order to:
  • Determine the state of health, physical development and level of training;
  • Determine the most reasonable sanitary and hygienic conditions for favourable impact on the organism of an athlete;
  • Scientifically ground the techniques and methods of physical training and medical examinations of athletes to prevent pathological and pre-pathological states in athletes.
Screening includes:
  • Examinations by specialists (sports physician, therapist, cardiologist, neuropathologist, psychologist, dermatologist, endocrinologist, ophthalmologist, otorhinolaryngologist and others);
  • Biometry and anthropometry;
  • ECG;
  • Cardiorespiratory test.
Cortex Profound medical examination of athletes is performed to obtain comprehensive information about the physical development, state of health, functional status of the organism of an athlete and indicators of his/her physical working capacity. 1. Profound medical examination includes a basic program and additional investigations and consultations by specialists. 2. The profound medical examination program is unified according to five groups of sports: cyclic; speed-strength; combat sports; sports games; complex coordination sports. 3. Selection of examination methods depends on the individual peculiarities of the organism of an athlete, presence of diseases and a number of other risk factors, specificity of sports, preparation phases, additional indications from some specialists in the process of examination. Based on the results of profound medical examination the adequacy of the load and the correctness of the applied loading mode are estimated. Besides, the tasks of profound medical examination include:
  • Detection of diseases and pathological states that hinder sports activity or restrict sports capacities;
  • Diagnostics of the physical development of an athlete and its changes during the preparation cycle based on the orientation of the training process and sports skills;
  • Identification of risk factors for pathological states and the level of reserve capabilities of the organism according to the preparation phase;
  • Prognosis of the development of the basic physical qualities: speed, endurance, strength, coordination at the current phase of the training process;
  • Recommendations for maintaining the level of health and for correcting the training process based on the detected changes;
  • Prescription of individual rehabilitation events based on the detected peculiarities of health, functional state, organism adaptation to loads.
Profound medical examination includes a basic program: 1. Consultation by a sports medicine physician: life history taking; sports history taking; anthropometric examination; visual examination; functional tests; evaluation of the physical development; evaluation of the state of health; medical recommendations for correcting the training process; admittance to the training process and competitions; analysis of the obtained information with a unified individual conclusion for each athlete as well as for the whole team. 2. Consultations by specialists: cardiologist, therapist, surgeon, pediatrician (according to the age), traumatologist-orthopedist, neurologist, dentist, otorhinolaryngologist, ophthalmologist, gynecologist, dermatovenerologist, medical psychologist, urologist, endocrinologist (according to indications). If necessary, physicians of other specialties can be involved. 3. Functional diagnostic examinations:
  • Breast fluorography once a year;
  • Roentgen examination of different parts of the musculoskeletal apparatus (according to indications);
  • ECG at rest in standard derivations;
  • Computer spirography with investigation of volume and speed parameters of external respiration (including functional tests and diagnostic pharmacological tests);
  • USI of internal organs (liver, bile ducts, kidneys, pancreatic gland, spleen, prostate gland, pelvic organs and mammary glands, thyroid gland);
  • Ultrasound imaging of the heart (echocardiography, Doppler cardiography) at rest, after a load – according to indications;
  • USI of joints – according to indications;
  • Rheoecephalography, rheovasography, rheohepatography - according to indications;
  • Electroencephalography according to indications;
  • A set of methods for examining the neuromuscular apparatus – electrical neuromyoreflectography with magnetic stimulation (according to indications);
  • Testing of physical working capacity and tolerance to physical load with a gas analysis: cycloergometric test, treadmill test with submaximum (PWC 170) or maximum loads (until refusal);
  • Special stress tests according to the orientation of the training process and type of sports (they are determined based on preparation phases, specificity of sports).
4. Additional methods of examination for athletes of different types of sports:
  • audiometry - shooting, biathlon, modern pentathlon, boxing, high board diving, water polo, ski jumping, freestyle, bobsleigh, tobogganing;
  • vestibulometry – figure skating, gymnastics, trampoline, high board diving and ski jumping, freestyle, bobsleigh, tobogganing, yachting;
  • examination of fields of vision – team sports, clay target shooting, fencing, etc.;
  • examination of the ocular fundus and measurement of intraocular pressure – boxing, taekwondo, weightlifting, high board diving and ski jumping, athletes with heavy weight, as well as according to individual indicators of health;
  • coordination test – for athletes of team and complex coordination sports: evaluation of the ability to maintain individual strength parameters that are average for this sport in case of differently directed movement of the lower and upper extremities;
  • stress ergospirometric test: determination of the lactic acid trend with a direct method (except for the rapid assessment method and assessment of the lactate threshold according to oxygen and СО2 consumption curves) – for athletes of cyclic sports.
5. Laboratory investigations performed within profound medical examination for each athlete:
  • clinical urine analysis; complete blood count using an automatic analyzer with swab microscopy, calculation of thrombocytes and reticulocytes and determination of the erythrocyte sedimentation rate;
  • state of the immune system (lymphocyte subpopulation: CD3+ (CD4+, CD8+), CD16+, CD19+, IgM, IgA, IgG, IgE, phagocytosis); functional activity of the pituitary gland (somatotrophic hormone, prolactin, thyroid stimulating hormone, cortisol, testosterone);
  • state of the thyroid gland (free thyroxine, anti-TPO, glucose, Cross Laps); ionized calcium; magnesium; phosphorus; alkaline phosphatase;
  • iron; ALT; AST; total/direct bilirubin; urea; creatinine; total protein; albumin; myoglobin; serotonin; histamine; lactate; uric acid; lipase; GGT (gamma-glutamyl-transferase); CPK-MB (cardiac creatine phosphokinase) activity; CPK-MB (cardiac creatine phosphokinase) quantitative analysis; acid phosphatase; LDH (lactic dehydrogenase); cholesterol; HDL cholesterol ratio; LDL cholesterol ratio; VLDL cholesterol ratio; triglycerides; CPK;
  • anti-HIV 1/2; anti-chlamydia trachomatis IgA; anti-chlamydia trachomatis IgG; anti-HCV with a confirming test and further additional tests in case of a positive result of anti-HCV: HCV RNA, HCV genotype; syphilis antibodies (total antibodies); HbsAg – antigen with a confirming test and further additional tests in case of a positive result of Hbs: Hbe, anti-Hbe, anti-HBs, anti-Hbcor-IgM, HBV DNA; chlamydia trachomatis DNA (biological material: urethra/cervical canal epithelial scraping); gonorrhea DNA (biological material: urethra/cervical canal epithelial scraping); trichomoniasis DNA (biological material: urethra/cervical canal epithelial scraping);
  • blood group, Rh factor and Rh antibodies.
Profound medical examination includes additional investigations and consultations by specialists. Besides the basic program of profound medical examination, if indicated, additional instrumental, laboratory investigations and consultations by specialists are performed within profound medical examination to clarify the diagnosis and give relevant recommendations for treatment and rehabilitation measures. They include:
  • magnetic resonance imaging;
  • computer tomography;
  • gastroduodenoscopy;
  • assessment of the strength of extremity muscles, detection of hidden damage of joints, determination of the angle rate of contraction of some muscle groups during testing in the isokinetic mode and the contraction rate of 30° and 60° per minute, for any extremity;
  • determination of mobility and strength of spinal muscles including compulsory testing of different sections of the spine in three projections within 3D assessment;
  • cytochemical analysis of the activity of mitochondrial enzymes of lymphocytes to determine the “mitochondrial index”;
  • consultations by specialists including a psychiatrist, endocrinologist, etc;
  • other investigations and consultations by specialists if required.
Additional laboratory program of profound medical examination:
  • one or several investigations from the list of additional laboratory investigations of profound medical examination prescribed by physicians according to indications in addition to the basic laboratory program of profound medical examination: indicators of the functional state of the pituitary gonadal system;
  • показатели функционального состояния гипофизарной-тиреоидной системы; показатели функционального состояния поджелудочной железы (оценка диабета);
  • indicators of the functional state of the pituitary thyroid system; indicators of the functional state of the pancreatic gland (assessment of diabetes);
  • indicators of osseous tissue metabolism;
  • indicators of the functional state of the pituitary adrenic system;
  • catecholamines, precursors and derivatives;
  • growth factors; prenatal diagnostics;
  • cancer markers;
  • extended analysis of the immune status;
  • allergy testing; individual allergens;
  • ulcer disease
  • extended biochemical analysis of blood; lipid profile; special indicators of lipid metabolism; electrolytes and minerals; iron metabolism
  • hemopoiesis; red blood count; white cell count; reticulocytes
  • hemostasis;
  • androgenic status;
  • biochemical analysis of urine; urinary stone disease; clinical analysis of urine;
  • helminthic infections; infectious diseases; immune fluorescent methods (smears); immunoenzymometric and serologic methods; DNA analysis (PCR-based diagnostics); bacteriological methods.
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