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


Initial Thoughts:CA Limits Contact Practice, Mandates 7 Day Minimum Return after Concussion

California Assembly Bill 2127 authored by  Assembly Member Ken Cooley (D-Rancho Cordova) has been passed by both legislative houses and now awaits the likely signature of Governor Jerry Brown. The date of implementation is uncertain at this time, but the following changes are certain to come to high school football in the Golden State:

  • All high school football teams (public, private and charter) would be limited to no more than 2 full-contact practices per week during the pre-season and regular season.
  • The full contact portion of each practice cannot exceed 90 minutes per day
  • Full-contact practices are prohibited during the off-season
  • “Full-contact practice” means a practice where drills or live action is conducted that involves collisions at game speed, where players execute tackles and other activity that is typical of an actual tackle football game

In addition to the contact practice limitations, the bill would further provide that, if a licensed health care provider determines that the athlete sustained a concussion or a head injury, the athlete is required to complete a graduated return-to-play protocol of no less than 7 days in duration under the supervision of a licensed health care provider. This stipulation is an extension of previous California legislative mandates passed in 2011 and 2012 that require:

  • Immediate removal for the remainder of the day of any high school athlete suspected of having a concussion
  • Prohibit the return of the athlete to that activity until he or she is evaluated by, and receives written clearance from a licensed health care provider
  • Each year, a concussion and head injury information sheet must be signed and returned by athletes and parent/guardian
  • Concussion education must now be part of required first aid training of every high school coach

Upon initial review of this legislation, l commend efforts to reduce concussive injuries and rushed returns to play after concussion, and also realize that many teams at all levels of football have already made live contact limitations. I also realize that there are several unanswered questions and controversies to share:

  • The current scientific literature does not have a sufficient body of evidence to declare with certainty the precise risks and benefits of live contact limitations in football. The thought that reducing cumulative sub-concussive head impacts is indeed commendable, but the counter-result of potentially having athletes participate in game situations without adequate exposure of didactic hitting instruction has not been fully studied. Ideally, live contact football limitations would have the same injury reduction outcomes as seen with ice hockey checking limitations. Raising the age of initiating checking actually reduced injuries at all levels, thus countering the argument that early and more frequent exposure to checking was important to reduce injuries in older athletes. However, these proposed checking limitations were debated (and probably still questioned in some circles) for years until good studies were done that provided a sufficient supporting evidence base. It is sensible to think that less live contact overall reduces cumulative risk, but would be more appealing to eventually have good science to further support this contention.
  • Is this global reduction on contact practice equally beneficial for all levels of high school football? Does maybe the freshman team with several members playing tackle football for the first time need more live contact versus the varsity program with more experienced athletes? Again, I have no numbers or science to support this statement, but do have to wonder.
  • Could teams try to maximize the 90 minute sessions of live contact with more drills or hitting repetitions? Is that increased exposure better or worse than spreading it out over more days?
  • I do wonder if the tackling limits will encourage the expansion of football camps and other training programs outside the formal high school environment that will allow greater exposure to live contact tackling drills and instruction? If players, parents, and coaches are concerned about receiving sufficient instruction, will they look elsewhere and if so, will those venues have appropriate coaching along with proper medical support (especially Certified Athletic Trainers) and referral mechanisms? 
  • How do other medical professionals who routinely manage concussed patients feel about the mandatory 7 day minimum return progression? Don't think that anyone out there is ever excited to speed a player's return to play (in fact, we might actually appreciate having "the law" force us to slow down eager players), but one unintended consequence might be the challenge of even more players and families reluctant to present for medical evaluation with the knowledge that they will be required miss the next game. On the other hand, will it possibly increase demand for immediate post-concussive evaluation to "start the clock" as quickly as possible for the small subset of concussed athletes who truly become symptom free within 24-48 hours of injury? 
  • The bill urges the California Interscholastic Federation to work in consultation with the  American Academy of Pediatrics and American Medical Society for Sports Medicine to adopt rules and protocols for developing the return to play progression. I am a member of both organizations, and can state that they are populated by caring and scientifically rigorous members who strive for the best safety interests of children and adolescent athletes. I implore my colleagues in these groups to rigorously evaluation these new mandates in hopes of developing more evidence-based answers to the queries and uncertainties raised above.

What do you think about the live contact tackling limitations? Do you also have any thoughts about the minimum 7 day return progression after a concussion? Very curious to hear from football players, parents, coaches, school administrators and fellow medical professionals.