Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Comprehensive blend of general pediatric and sport medicine care with an individualized approach that enhances the health and knowledge of patients and their families



Proud physician:
USA Volleyball Mens/Womens National Teams
CS Fullerton Intercollegiate Athletics
Chapman University Dance Department
Orange Lutheran High School

Co-Author of Acclaimed Textbook

Pediatric Sports Medicine: Essentials for Office Evaluation

Orange County Physician Of Excellence, 2015 and 2016


Getting Safety Info to Those in Need - Are We Best Protecting Young Arms?

The pediatric sports medicine community has diligently produced statements about common injuries and prevention/treatment strategies. We'd like to think that these recommendations are making their way to the playing fields to benefit coaches, parents and players. This is the first in a series of blog posts addressing the current realities of translating safety policy into actual practice. I welcome thoughts and suggestions on how to best perform this key role.

I've had the pleasure of coaching my young twin sons in baseball over the past two seasons, and like many coaches I constantly wonder about how well I am doing with teaching the basics and strategies of this great sport.

Put me in my pediatric sports medicine specialist role, and once again, I am constantly wondering about how well we in the injury prevention community are doing with teaching the basics of injury prevention and translating our knowledge to fellow coaches, parents, and ultimately, to our players.

Let's take the case of arm injuries in young pitchers as an example.

After the realization that too much throwing over the course of a single season and through an entire year both increase the risk of elbow and shoulder injuries in young pitchers, well-researched Pitch Count Recommendations in Young Pitchers were developed and promoted by many sports medicine groups and youth baseball organizations. These guidelines included not allowing young pitchers to throw with any aspect of shoulder or elbow pain.

So, with these great recommendations discussed in lecture halls, outlined on websites, and passed out on brochures and handouts, how are they actually playing out on the diamonds?

Based on the results of two recent studies, those efforts appear to be mostly striking out.

Allison Gilmore, MD and colleagues from Case Western University in Cleveland, OH presented some unique findings from a recent study indicating that pitch count recommendations are not routinely utilized by Little League coaches or parents.

  • 100% of the 61 studied coaches were aware of the pitch count recommendations and did limit pitches thrown by players in some way, and 92% of the coaches knew that arm fatigue was a risk factor for future injury
  • However, when asked about actual implementation of pitch counts to address injury concerns, 44% did not use pitch counts on a regular basis
  • Less than 10% of coaches regularly monitored and set safe limits for amount of pitching over the course of a year, and 41% reported having players who were at-risk for arm injuries due to playing on more than one baseball team during a particular season. These findings probably fall at least equally on the shoulders of parents who allow the year-round or multiple team participation.

  • The apparent acute impact of this lack of compliance? More than 1/3 of coaches had a player unable to play due to an overuse injury.

  • Reasons cited for not following the recommendations?
    • Lack of knowledge
    • Lack of staff to track pitch counts
    • Lack of desire to want to do what was viewed as a tedious task

These results echo those of 2012 study on Knowledge and Compliance With Pitch Count Recommendations: A Survey of Youth Baseball Coaches which had 228 Little League (age 9-15) coaches complete an 18 question survey testing knowledge of pitch count recommendations that indicated:

  • Only 43% of questions were correctly answered
  • 73% reported following pitch count recommendations
  • 53% of coaches felt that other coaches in same league followed the recommendations
  • 35% stated that their pitchers reported shoulder and elbow pain during the season, with 19% reporting one of their pitchers threw with a sore or fatigued arm during the season.

Significant conclusions included concerns over difficulties of coaches following unfamiliar recommendations and potential of greater enforcement efforts by leagues.

As I mull over the findings of these studies, I struggle with the apparent gap between policy and practice and how to best bridge the gap.

Perhaps we in the sports medicine field are the victims of outstanding results of our surgical and rehabilitative efforts? The growing list of pitchers returning to star on the field after potentially career-threatening arm injuries may give an elevated or almost false hope that injury prevention is less important because amazing treatment results are readily available.

Perhaps its because as parents and coaches we still hang on to the adolescent vibe of invincibility- that nothing bad will happen to our kids.

Perhaps the teachers haven't found out the optimal ways to best reach and teach. Is it social media, videos, 1:1 tutorials, high profile pleas?

For now, the wondering will go on.