National Federation of State High School Associations (NFHS)
Sports Medicine Advisory Committee (SMAC)
The NFHS Sports Medicine Advisory Committee (SMAC) investigates numerous issues, rules, and situations and considers their potential risks to student athletes. One of these issues has been inquires about invasive procedures on the day of a contest.
This position statement is intended to represent the general philosophy of the NFHS SMAC and is not intended to be used as a rule or to direct the individual practice of medicine by a physician who is highly trained and experienced in sports medicine, on his or her patient. In considering these invasive procedures, the NFHS SMAC recommends that the physician remembers that the patient is a student athlete.
The NFHS SMAC encourages a philosophy that high school athletics serve the purpose of providing young men and women the opportunity for personal growth in a reasonably and acceptably safe and controlled environment. Medical interventions can enhance athletic performance by encouraging more optimal health and fitness and providing better control of chronic disease processes. Medical intervention can also enhance athletic performance by minimizing the symptoms of injury without increasing the risk of additional injury.
Medical interventions which increase the risk of disease exacerbation or additional injury are never appropriate on the day of competition, or on any other day, for a student athlete. There are three steps of decision making for the Basis of the Return to Play1. These include evaluation of health risks, participation risks, and any factors in decision modification. If a disease process or injury is not adequately controlled by the day of competition to allow safe clearance for play with full function, then heroic invasive procedures, on the day of competition, performed with the sole purpose of enabling the athlete to participate, are philosophically inappropriate.
Finally, while the primary concern is with protecting the health of the student athlete, the NFHS SMAC believes invasive procedures are also a matter of participation equity to be addressed by member state associations.
1. Creighton DW, Shrier I, Shultz, R, et al. Return-To-Play in Sport: a Decision-based Model. Clin J Sport Med. 2010; 20:379-385.
Revised and Approved April 2013
DISCLAIMER – NFHS Position Statements and Guidelines
The NFHS regularly distributes position statements and guidelines to promote public awareness of certain health and safety-related issues. Such information is neither exhaustive nor necessarily applicable to all circumstances or individuals, and is no substitute for consultation with appropriate health-care professionals. Statutes, codes or environmental conditions may be relevant. NFHS position statements or guidelines should be considered in conjunction with other pertinent materials when taking action or planning care. The NFHS reserves the right to rescind or modify any such document at any time.