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

Please Check Our New Brand and Website:

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


When do you usually see injuries in sports?

1) When an athlete is not wearing appropriate protective equipment.

Bike helmets do no good when they are strapped to the handlebars, just like shin guards can not work if they are left in the gym bag.

Make sure the equipment is in good condition, fits well (especially with growing children), and is always properly used.

2) Within a month of a new season or activity

Good studies on Marine recruits show that foot stress fractures are most commonly seen three weeks into boot camp.

My experience with young athletes is quite similar as about three weeks into a new sport, I will start to see overuse injuries.

The body is unable to handle the stress of a new activity, and breakdown occurs.

How can this be minimized?

Have the athlete prepare for the new activity with some light conditioning.

Going straight from Sega football to double days on the field can be a recipe for disaster.

Also, start slow and increase intensity or length of workouts slowly to allow the body to adjust- and do not forget those rest days.                                                                                        

3 )When an athlete steps up to a higher level

This often includes playing with older, more mature (and bigger) athletes, attending an intense sport camp, or starting high school or college training.

No matter what success the athlete has enjoyed in the past, these situations can overtax a young body.

Limit situations where 9 year-olds play with 12 year-olds.

Prepare well for camp or a new school, and gradually increase the training.

Sports medicine physicians use the mantra TOO MUCH, TOO FAST, TOO SOON as a recipe for overuse injuries.  

4) Playing more than one sport at a time

Many athletes can handle playing club soccer and running cross country at the same time, while some cannot.

Other athletes can handle summer football, baseball, and basketball camps without missing a beat while some cannot.

I will often see athletes who are burned from too much activity and once they take a brief rest period and then focus on one sport the majority return refreshed and are more successful.

 5) Playing too much of one sport

The more is better philosophy may work for some, but is has also caused the demise of many young bodies.

Repetitive activity strengthens bones and joints, but too much repetitive activity can over stress bones and joints, leading to injury.

Thus, swimming for two club teams, or playing on three baseball teams may be detrimental in the long run.

Do not forget that private throwing lessons or personal training sessions also add to the cumulative stress placed on the body.

Factor all activities into the equation when determining limits for your young athlete.      

6) Playing through pain or discomfort

No child should ever play through any significant pain.

I use a 1-10 pain grading scale (1= no pain, 10= major pain).

Any pain rating higher than 2-3/10 is significant pain.

Schedule an appointment if there also is pain that causes a limp, changes technique, or forces a child to change position or not want to continue activity.

7) When an athlete is tired

Fatigue minimizes the ability to make quick decisions and movements that can help avoid injuries.

Tired muscles and ligaments are less able to withstand forces on the field.

Make certain the athlete is getting sufficient sleep (8-10 hours a night) and enough rest between practices and games.

Despite what many young athletes think, rest is your friend.  

As a parent, it is your responsibility to help your child take appropriately placed rest days.

Children ages 5-10 should participate in organized sports no more than 3 or 4 days a week, while children ages 11-15 should take at least two rest days off per week.

High school-aged athletes should take at least one day off per week.

Another good rule- take at least two months (preferably 2 separate months) away from a sport per year for overall rest and to enjoy alternate activities.  

Another sensible guide: keeping the number of organized activity hours/week equal to or under the age of the child (in years) can reduce risk of injury.

Thus, if an 11 year old is playing organized sports more than 11 hours a week, there is a statistically increased risk of injury.

8) Too much running in cleats

Cleats are designed for a particular sport (soccer, baseball, football, etc) and not designed for prolonged running.

In early season practices with lots of running and conditioning, have young athletes wear running shoes to run, and use cleats for the sport-specific drills.

Will make a huge impact in reducing lower leg/heel pain and limit missed time.

What happens if an injury is not treated correctly?    

Children tend to heal quickly (that is why I chose pediatrics) so most injuries are not a long-term concern.

However, in a worst-case scenario: the athlete has life-long pain or disability.

Serious growth issues can develop if a minor injury is allowed to mature into a major injury.

Injuries are a common reason why kids stop playing sports, and why athletes fail in the quest for a starting job, a varsity letter, or a scholarship.

Certain injuries label the child as damaged goods, for example once a pitcher has a shoulder or elbow injury- it is common for coaches and scouts to automatically write off that athlete.

Have no regrets- call and get a qualified opinion on any childhood injury.