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: medical tips for coaches

Dealing with Detours- Lessons Learned as a Sports Medicine Physician

I have become more comfortable dealing with detours

Detours are going to happen.

We like to live in the ideal world where performance and recovery both travel a straight line ahead without and obstacles or set-backs. After carefully evaluating a situation, we thoughtfully construct a comprehensive plan, then look to execute it with frank precision.

Then reality kicks in, and the detours begin.

When I was asked to speak on behalf of friend and colleague Benjamin Strack, PhD on his installation as 2017 President of the Orange County Psychological Association, I shared insights that have been taught as part of the team behind the team learning from our best teachers- our patients and their families.

My focus was on Dealing with Detours.

Let’s be real.

Our athletes certainly also do not like to admit that detours occur.

How many athletes when asked about the start of season are going to tell you anything other than they're going to have an awesome time, the youngsters are going to come through, the opponents aren’t that tough, and big accomplishments on the horizon.

Does anyone ever say that they're going to anticipate obstacles, team dissension, untimely injuries, more talented and prepared opponents, bad losses and maybe even firings?

Detours come in the crucible of athletics that often place unique demands on young athletes.

While some athletes can handle detours without the blink of an eye, others will suffer from anxiety, depression, and other challenging coping behaviors.

Those of us who serve as the team behind the team are charged with the task of helping build a supportive culture focus on big picture outcomes such as success in sport translating to success in life, building healthy habits, and yes, navigating those detours.

Our presence as a sports medicine team is based on reacting to detours. 

Just like no one athlete can emerge victorious to win all by him or herself, no good sports medicine effort is a solo performance. It is the ultimate function of a team that will often lead to the best possible outcomes.

Building the team behind the team and our relationships with athletes is a dynamic process.

The process starts with being available and that might be nothing more than hanging out at a practice, chasing volleyballs before gold-medal match, or helping fold towels between points. Those menial tasks are often the pathway to a higher level of engagement.

That availability also means being dealing with atypical situations at atypical times (before 9 AM and after 5 PM for certain) in atypical venues (on fields, over the phone).

No matter your level of availability to the team and athlete, you must keep your eye on the goal.

Developing trust that contributes to the ultimate short-term and long-term health of each individual patient.

This takes building a relationship.

When meeting with “the athlete” I attempt to separate the person from the the athlete identity.  I may also separate from my team physician role- first and foremost, my priority is to be the medical provider for the athlete, above any team or group commitments. 

Before asking about sports, I want to know what is going on in the life of the athlete: school, grades, outside jobs, family and friends, changes, substance use, sleep, appetite.

Once I get to know someone's goals, fears, and what truly is important in their life, then I feel I can make a greater impact with them. It often takes listening to the kid, independently from the parent, to meet these goals.

Be alert for transitions such as end of eligibility/career, injury, new team, new coaches, higher level of participation (intensive, summer camp, showcase). 

Remember to emphasize confidentiality. Teenagers especially are quick to shy away from anything that will cause embarrassment or public scrutiny. They may Instagram multiple things about their life, but then can hide behind a wall of silence when they feel necessary.

When I eventually get to the sports thing, I ask about:

  • Demands of the sport- time, intensity, and level
  • Team Dynamics
  • Multiple coaches and teams
  • Flux of rosters, positions, starting spots
  • Travel
  • Financial/time commitment
  • Perceived role
  • Perceived voice

 If you don't know exactly when an athlete does with the demands of their activity ask them. If they won't tell you then Google or YouTube it.

If there's been an injury, ask how the athlete is dealing with the new found free time away from sport demands.

Some find it liberating...don't be surprised.

Some don't  miss their sport.

This leads into one big thing I have learned- don’t assume anything. Let me repeat that. Don't assume anything.

Believe in the art of negotiation. Our job is to advise and offer suggestions not unilaterally dictate a treatment plan. Amazing how sufficient discussion leads to the best answers, and often the athlete is the one coming up with the best answer.

Be ready to be pummeled for specifics- "what exactly can I do"? This can be painstaking but is absolutely necessary.

 Allow exit strategies.

The ultimate best outcome of your professional involvement may not be wins or titles- it very well may not even be a return to sport. 

Sometime a preconceived detour is actually a path towards something more rewarding.

Offer to take the hit for the athlete- if decision not to play, put all the blame on the medical team.

Give athletes the opportunity select how they want to mourn an injury or decision to retire. Some will totally distance themselves from the sport or team, while others want to have an active role. Help them in this choice

Don't feel the need to be a hero or go solo. Feel free to share the burden of difficult cases.

Always keep common themes and consistent messaging with athletes, families and other professionals.

Respect the hard work, past efforts, goals, dreams and commitment of the athlete and their schedule, but don't make decisions strictly based on the next big event.

Even if it's the Olympics. 

Develop rapport before dropping bombs

Focus initially on performance enhancement. No kid will shy away from wanting to get better. Once you've built their trust and rapport, then you can delve into more of the sensitive emotional or behavior issues.

Learn to deal with uncertainty, with taking appropriately aggressive decisions that may work, or may run into those detours.

When confronted with setbacks or plateaus in recovery, continue to encourage the athlete. Try to limit conveying disappointment.

Finally, never wondering how to do something better, to keep learning, to keep finding more people to add to the team and help negotiate those detours.























Teenagers Not Designed as Early Birds: How to Combat Adolescent Sleep Deprivation

Are you a well-meaning coach trying to get the most out of your athletes during early morning training sessions? Somewhat frustrated that everyone seems a step slow or out of sorts during zero period? While "morning people" are a dime a dozen in the adult world, doesn't it seem that finding teenagers raring to go at 0600 is like the proverbial needle in a haystack?

According to a timely American Academy of Pediatrics (AAP) policy statement on School Start Times for Adolescents this type of behavior is not just an irritating by-product of teenage rebellion and striving for independence, but is a consequence of age-related delays in release of melatonin (hormone that influences sleep onset) and a slower drive to fall asleep compared with non-adolescents.

So yes, teenagers are biologically designed to have their own (circadian) rhythms and if they truly ran the world (instead of thinking that they do) they would select later school start times around the order of 8:30 if not later. This does often conflict with the usual norms of the adult-oriented world (such as parents having to be at work by 9 AM) and the realities of limited access to pools and court space along with trying to fit in another activity into already tight class schedules.

The ultimate goal according to the AAP and its review of the scientific literature would be to provide a consistent 8.5-9.5 hours of sleep per night and reduce the consequences of cumulative sleep deprivation:

How do we best respond to these sleep deprivation concerns?

First of all, don't think that teenagers shouldn't get off without taking some responsibility for their less than impressive sleep statistics, as they often do not do themselves any favors with poor sleep initiation behaviors such as late night caffeine use, using electronics and media right before bedtime, and having access to television in bedrooms. Modifying some of these habits definitely could should be a high priority for parents, coaches, and educators with emphasis on the importance of sleep in post-activity recovery, preparation for next day activity, and especially the impact of insufficient sleep in mood and academic focus:

While giving appropriate counsel to sleep hygiene behaviors, there are certain nutritional recommendations that may also increase the quality of sleep initiation and maintenance according to an article conveniently published just before the AAP article:

  • High Glycemic Index foods such as white rice, pasta, bread, and potatoes may promote sleep; however, they should be consumed more than 1 hour before bedtime.
  • Diets high in carbohydrate may result in shorter sleep latencies.
  • Diets high in protein may result in improved sleep quality.
  • Diets high in fat may negatively influence total sleep time.
  • When total caloric intake is decreased, sleep quality may be disturbed.
  • Small doses of tryptophan (1 gram) may improve both sleep latency and sleep quality. This can be achieved by consuming approximately 300 grams of turkey or approximately 200 grams of pumpkin seeds.
  • The hormone melatonin and foods that have a high melatonin concentration may decrease sleep onset time.

Promoting short naps (under a hour) during the day can contribute to the overall daily sleep total, and if done before an afternoon or evening exercise session may contribute to reduced sleepiness and and can be beneficial when learning new skills, strategies or techniques.

Finally, those of schedule-making adults might want to take a hard and scientific look at the utility of early-morning activities designed for adolescents. While the decision for later school starts may not be part of your pay grade, carefully weighing the risks and benefits of zero period weight training sessions or other before school activities in favor of more after school activities may actually increase athletic and academic performance in this age group. Delaying the start of afternoon training or competition sessions to allow for that brief nap (again, under an hour) may also enhance overall performance and mood of the team or group.

Do these sound like sensible and realistic recommendations to address sleep issues in adolescents?