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


Filtering by Tag: dancers and puberty

Three Key Questions that can Reduce Overuse Injuries in Young Dancers


1.  Am I going through a growth spurt?

Bottom Line: Longer arms and legs are harder to control without appropriate strength in the shoulder and hip areas. While many pre-teen and teenage dancers want to amp up dance commitments,  growth periods are not the best time for adding more technically demanding routines. Stick to basic movements, build central strength, and once in better control, then more ready to step up the skill requirements.

2. Am I still getting over a past injury?

Bottom Line: Trying to push through a past injury that hasn't fully healed is a recipe for future trouble. Better to take a step back, get proper medical care, and when more healthy, then push ahead with more classes and more intense routines.

3. How old am I?

Bottom Line: Absolutely the best evidence out there to reduce overuse injuries, and very easy to remember. If your age in years is lower than the number of hours of organized dance activities per week, your injury risk goes up in dramatic fashion. 

Injury Prevention Tips for Adolescent Dancers

The following Injury Prevention Guidelines summarize findings from the article The Adolescent Dancer: Common Medical Conditions and Relevant Anticipatory Guidance by Kathleen Linzmeier, MD and Dr. Koutures which is published in Adolescent Medicine State of the Art Reviews, April 2015 and is copyright from the American Academy of Pediatrics.

1)      The American Academy of Pediatrics recommends a rest period from organized physical activity that includes a minimum of 1 full day off per week and 2 to 3 months off per year.

2)      Emerging evidence suggests that the risk of injury increases when the number of hours of organized sport/dance activity per week exceeds the age of the child in number of years (eg, a 14-year-old girl should not exceed 14 hours per week of organized dance activities).

3)       Single sport or activity specialization at young ages can increase the risk of physical and emotional overuse, frequently leading to burnout and complete cessation of activity. Particular warning signs may include decreased interest in dance activities, lower school grades and attendance, less social interaction, changes in appetite or sleep, and mood alterations such as irritability, anger, or lack of fun or new activities.

4)      Incorporating recommended weekly and annual rest intervals along with varying the types of organized activities can reduce the potential for burnout.

5)      Medical practitioners may be asked for their opinion on the readiness of young dancers to begin dancing en pointe, which is an advanced ballet skill that places extreme stress on the lower leg, ankle, and foot

6)     Readiness recommendations focus not on chronologic age but on the presence of adequate whole body strength and balance (especially of the foot and ankle), lack of current restricting injuries, sufficient “pre-pointe” dance class exposure (minimum 3-4 years), and the future goals of the dancer.

6)     Screening tests that can assess appropriate proximal strength, proprioception, and placement of extremities not only for pointe but for higher-level leaping

7)      Medical professionals should maintain an open dialogue about adequate intake of calories and essential vitamins and minerals, and maintenance of healthy weight to best support ongoing dance activities.

8)      Physicians should respect the anatomic and emotional changes that occur during puberty without hesitating to modify or change focus to more basic skills to allow compensation for changes in movement patterns and coordination.

Video: Dr. Koutures Grand Rounds on Performing Arts Medical Care

August 20, 2014 - Grand Rounds - CHOC Children's Hospital

Click Here for Video: The Performing Arts Athlete: Anticipatory Guidance & Evaluation

Chris Koutures, MD, FAAP
Pediatric and Sports Medicine Specialist
Anaheim Hills, CA
Medical Team Physician, Cal State Fullerton and USA National Volleyball Teams

Outcomes - At the conclusion of this presentation, the physician leaner will be able to:
1. Provide anticipatory guidance to young dancers and performers about nutrition, rest, risk of overuse, and other key injury/illness concerns.
2. Appreciate the various forms of dance and recognize certain movements and positions that can lead to both acute and overuse injuries.


Highlights: Unique Challenges of Adolescent Performing Artist

 Thanks to the Chapman University College of Performing Arts and the Performing Arts Medicine Association for hosting the 4th annual Healthy Approaches to the Training of Performing Artists Conference last weekend.  Presented on Unique Challenges of the Adolescent Performer and will highlight key points below: