By: Physio Karamo B. Touray
LNCT University Bhopal (M.P), India – BPT Intern 2025
Maj in Clinical Sports Medicine
Every sporting nation needs a system that protects athletes before they enter the field of play. In West Africa, especially in The Gambia, the conversation around athlete safety still receives less attention than it deserves. Yet the relevance of Pre Participation Examination (PPE) and Pre Competition Medical Assessment (PCMA) continues to grow as the number of competitive events increases across football, athletics, basketball, volleyball, and regional school sports.
The ideal time for athletes to undergo PPE and PCMA is before the beginning of every competitive season, not a few days before a tournament or when symptoms arise. Medical screening should be performed when athletes are clinically stable, when workloads are low, and when there is adequate time to manage detected abnormalities. This window allows healthcare professionals to identify life-threatening conditions—especially those linked to sudden cardiac arrest, exertional heat illness, severe asthma, sickle cell complications, and catastrophic musculoskeletal injuries.
In The Gambia and many West African countries, emergency preparedness in sports remains uneven. Some competitions begin without an operational medical team, without an emergency action plan, without automated external defibrillators (AEDs), and without designated first-responders. A structured PPE/PCMA period is therefore not only about athlete fitness; it is also a moment to examine the readiness of healthcare professionals responsible for safeguarding players throughout the season.
A proper PPE begins with a comprehensive medical history, including previous episodes of chest pain, syncope, palpitations, family history of early cardiac deaths, respiratory disorders, sickle cell traits, menstruation-related difficulties among female athletes, and previous concussion events. Sudden death in sports is most often cardiac in origin, and the majority of cases show warning signs long before collapse. Detecting these early symptoms requires time, not rushed tournament-day assessments.
Cardiac screening remains one of the pillars of athlete protection. While high-resource countries incorporate resting electrocardiograms and echocardiography when indicated, West African settings must apply affordable but clinically sound methods—auscultation, blood pressure monitoring, exertional tolerance tests, and referral systems for abnormal findings. Athletes with hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, or congenital coronary anomalies often perform normally until exertion exposes the underlying pathology. This is why PPE must occur weeks—ideally 6 to 8 weeks—before competition.
Musculoskeletal screening is another essential component. This includes joint mobility, prior fractures, ligament integrity, muscle strength balance, gait analysis, and postural assessment. Many Gambian athletes enter competition with undiagnosed chronic ankle instability, patellofemoral pain, lumbar dysfunction, or tendon overuse. Early detection allows physiotherapists, sports physicians, and athletic trainers to correct these impairments before they evolve into season-ending injuries.
Bone density evaluations are especially important for youth athletes, female athletes, and long-distance runners. Conditions such as Relative Energy Deficiency in Sport (RED-S), vitamin D deficiency, and low bone mineral density can lead to stress fractures. Identifying these risks early protects athletes from long-term disability.
The PPE/PCMA period must also involve a systemic examination—ENT, respiratory, abdominal, neurological, dermatological (for contact sports), and ophthalmological evaluation. These assessments confirm whether the athlete can safely tolerate intense training, travel, weather variation, and match pressure.
In addition to athlete screening, this period is also the proper time to evaluate the competence and preparedness of the healthcare professionals assigned for the season. In The Gambia and across West Africa, there is a growing need for trained sideline personnel—sports physiotherapists, emergency nurses, trauma-care responders, first-aid teams, and physicians familiar with sports cardiology and acute injuries. A thorough PPE/PCMA process ensures that every member of the medical team understands the emergency action plan, equipment location, evacuation routes, communication channels, and specific responsibilities during an on-field collapse.
Sports safety cannot depend on prayers alone. It depends on preparation, correct timing, trained professionals, and a functioning medical system capable of recognizing red flags before tragedy occurs. The best-performing athletes are those whose health has been protected long before they run onto the pitch.
The Gambian sports calendar must therefore institutionalize PPE and PCMA as compulsory, well-timed, and clearly regulated procedures—not optional exercises. This is how nations protect their athletes, prevent avoidable deaths, and build a culture where performance grows safely under professional medical guidance.
