Medical Conditions that may Rule Out Sports Involvement

Source: Caring for Your Teenager (© 2003 American Academy of Pediatrics)
Condition Description Is Participation Permitted? Recommendations
Atlantoaxial Instability
Instability of the joint between the two uppermost vertebrae in the neck
Conditional yes Teen needs evaluation to asses risk of spinal cord injury during sports participation. For example, some teens with Down's syndrome may ave atlantoaxial instability and be at increased risk for neck injury.
Bleeding Disorders, including hemophilia Conditional yes Evaluation needed. As a rule, hemophiliacs are counseled not to play contact/collision sports.
Cancer Conditional yes Evaluation needed.
Cardiovascular Diseases    
Inflammation of the heart
No Exertion may result in sudden death.
Chronically high blood pressure
Conditional yes Teens with significant essential (unexplained) hypertension should avoid weight and power lifting, body building, and strength training. Secondary hypertention (caused by a previously identified disease) or severe essential hypertension warrant a medical evaluation.
Congenital Heart Disease
Structural heart defects present at birth
Conditional yes Teens with mild forms may participate fully; those with moderate or severe forms, or who have undergone surgery, need evaluation.
Irregular heart rhythm
Conditional yes Evaluation needed, because some dysrhythmias require treatment and/or make certain sports participation dangerous.
Mitral Valve Prolapse
Malfuntioning heart valve
Conditional yes Teens with symptoms (chest pain, symptoms of possible dysrhythmia) or evidence of mitral regurgitation (leaking) on physical examination need evaluation. All others may participate fully.
Heart Murmur
Conditional yes If the murmur is "innocent" -that is, does not indicate heart disease- full participation is permitted. Otherwise, evaluation needed.
Cerebral Palsy Conditional yes Evaluation needed.
Diabetes Mellitus Yes All sports can be played with proper attention to diet, hydration and insulin therepy (if necessary). Particular attention is needed for activities that last 30 minutes or more.
Diarrhea No Unless mild, the youngster is not allowed to play, because of the risk of dehydration and heat-related illness.
Eating Disorders
(anorexia nervosa, bulimia nervosa)
Conditional yes These teens need both medical and psychiatric assessments before participation
Eye Disorders
(functionally oneeyed, loss of an eye, detached retina, prior eye surgery, serious eye injury)
Conditional yes A functionally one-eyed teen has a best corrected visual acuity of 20/40 in the worse eye. These athletes would suffer significant disability if the healthier eye were seriously injured, as would those who have lost an eye. Some young people who have previously undergone eye surgery or had a serious eye injury may have an increased risk of injury because of weakened eye tissue. Availability of eye guards approved by the American Society for Testing Materials (ASTM) and other protective equipment may allow participation in most sports, but this must be judged on an individual basis.
Fever No Fever adds to the workload of the heart and lungs, and increases the chances of suffering heat exhaustion or heatstroke.
Heat Illness,
history of
Conditional yes Because of the increased likelihood of recurrence, the athlete needs individual assessment to determine the presence of predisposing conditions and to establish a prevention strategy.
Hepatitis B (HBV)
Hepatitis C (HCV)
Human Immunodeficiency Virus (HIV)
Conditional yes The risk of these viruses being transmitted through sports participation is believed to be extremely low. Therefore, all sports should be open to athletes infected with HIV or with hepatitis B or C. However, sensible precautions must be taken, such as making sure that cuts, abrasions, wounds or other areas of broken skin are covered with a protective dressing before and during events.
loss of one, due to injury or disease
Conditional yes Evaluation needed for contact/collision and limited-collision sports.
enlarged (hepatomegaly)
Conditional yes If the liver is acutely enlarged, participation should be avoided because of risk of rupture. If the liver is chronically enlarged, evaluation needed before collision/contact or limited contact sports are played.
Musculoskeletal Disorders Conditional yes Evaluation needed.
Neurologic Disorders    
History of (1) Serious Head or Spinal Trauma, (2) Severe or Repeated Concussions, (3) Brain Surgery
Conditional yes Evaluation needed for collision/contact or limitedcontact sports, and also for noncontact sports if there are deficits in judgment or cognition. Recent research supports a conservative approach to management of concussion.
Convulsive Disorder
well controlled
Yes If disorder is well controlled, the teen faces little risk of having a seizure while participating in sports.
Convulsive Disorder
poorly controlled
Conditional yes If disorder is poorly controlled, evaluation needed for collision/contact or limited contact sports. The teen should avoid the following noncontact sports: archery, riflery, swimming, weight or power lifting, strength training, sports involving heights. In these sports, a convulsion, though unlikely, could pose a risk to the patient or to others.
Obesity Conditional yes Because of the risk of heat illness, obese teens need careful acclimatization and hydration.
Organ Transplant Recipient Conditional yes Evaluation needed.

loss of one, due to disease

Yes The risk of severe injury to the remaining ovary is minimal.
Repiratory Disorders    
Acute Upper-Rerpiratory Infection
Conditional yes Upper-respiratory obstruction may affect pulmonary function. Evaluation needed for all but mild disease.
Yes With proper medication and education, only teens with severe asthma will have to modify participation.
Compromised Pulmonary Function,
including from cystic fibrosis
Conditional yes Evaluation needed, but, generally, all sports may be played if the teen’s oxygenation remains satisfactory during a graded exercise test. Youngsters with cystic fibrosis need acclimatization and proper hydration to reduce the risk of heat illness.

Sickle-Cell Anemia

Conditional yes Evaluation needed. In general, if the teen is asymptomatic, all but high-exertion, collision/contact sports may be played. Steps should be taken to prevent overheating, dehydration and chilling.
Sickle-Cell Trait Yes It is unlikely that teens with sickle-cell trait (AS) have an increased risk of sudden death or other medical problems during athletic participation except under extreme heat, humidity and possibly increased altitude. These young people, like all athletes, should be carefully conditioned, acclimatized and hydrated to reduce any possible risk.
Skin Conditions
(boils, herpes simplex, impetigo, scabies, molluscum contaglosum)
Conditional yes While the patient is contagious, participation in gymnastics with mats, martial arts, wrestling or other collision/contact or limited contact sports is not allowed. The herpes simplex virus probably is not transmitted via mats.
enlarged (splenomegaly)
Conditional yes A teen with an acutely enlarged spleen should avoid all sports because of risk of rupture. Those with chronically enlarged spleens need evaluation before playing collision/contact or limitedcontact sports.
undescended or missing
Yes Certain sports may require a protective cup.