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

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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 Category: injury prevention

Boarding, Biking and Skiing- Tips to Reduce Injury Risk

Skateboarding, BMX biking, snowboarding, skiing, and mountain biking are all sports practiced by dedicated athletes who put time and attention into bettering their tricks, handling, and overall skill. These athletes deserve credit for their abilities- and also should follow some basic recommendations to prevent injury and spending unwanted time away from the skate park or trails.

Do helmets actually prevent injury? How can I tell that a helmet is properly fitted?

Personal experience backed by multiple studies proves that helmets do prevent injury. For example, helmeted cyclists are 88% less likely to suffer a brain injury during a crash.

Every time some one gets on a vehicle with wheels (skateboard, scooter, rollerblades, and bicycle) or a snowboard, there should be a helmet on the head. A helmet hanging off the handlebars or kept in the garage is doing absolutely no good. 

Helmets may not look cool, but a shaved head and scars from an accident look less cool.

Now, to be fully accurate, there are some limitations to helmets.

No helmet is 100% protective- they are designed more to reduce skull fractures than concussions.

Wearing a helmet does not give license to be more daring- make sure you read this a few times for emphasis.

A improperly fit helmet can reduce vision (which may increase, not decrease injury risk).

So, wear those helmets, understand limitations, and make sure they fit!

                                                    PROPER HELMET FITTING TIPS 

  • The helmet should sit level, covering the forehead in front with the strap adjusters fitting right under the ears and straps lying flat against the head; not hanging loose, curling out, or being twisted.
  • Test for proper tightness by being able to put only one finger between the straps and chin and if helmet can be rocked from side to side, tighten straps.
  • The helmet should rock slightly forward and backward, but tighten straps if it can be moved up off the forehead or down near the eyebrows.
  • Add-on stickers and paint can personalize the helmet, but often void helmet warranties. Buy only helmets with CPSC, ASTM, or Snell stickers certifying safety standards.
  • Multi-sport helmets should carry stickers certifying each sport- look for this sticker on the helmet, do not trust sales information or pictures on the box.

What is the scoop on wrist guards, elbow pads, knee pads and other protective pads and guards?

Many younger athletes do not like to wear pads, "they get in the way, get too hot, and they are not very attractive."

They do work, and work quite well in preventing broken bones, sprains, and road rash from falls or missed stunts. Experience has shown that wrist guards can greatly reduce the risk of forearm fractures due to falls from skateboards or snowboards.

Most people would prefer wearing protective pads and guards to wearing a plaster cast for 4-8 weeks.

A final statement: always know where you are going and be honest with your limits

  • A common recipe for disaster is to barrel down an unknown trail unaware of obstacles or drop-offs that lie ahead. Taking the time to preview the course or to ride the pipe a few times at slow speed before trying tricks at full throttle can increase confidence and lower the risk of an unanticipated fall.
  • Be aware of obstacles (rocks, trees, stairs, cars, and people) who might get in your away- always look forward 20-30 yards to anticipate any potential danger and to give time to make adjustments before an accidental impact.
  • Be aware of your own skills- your strengths and weaknesses- and take into account your limits before deciding to do a particular course or maneuver. Do not be pressured by friends or your ego, if you do not feel comfortable riding the black diamond snowboarding run, do not do it. Have fun and build your skills at a run better suited for your abilities.
  • Fatigue is also a major factor in injuries- many people decide to go out for one more run at the end of a long day, and that run ends up truly becoming the last one. Most authorities recommend stopping at the first signs of fatigue before judgment, endurance, and muscle strength become too low to prevent falls and serious injuries.

Dr. Koutures Co-Authors American Academy of Pediatrics Report on Martial Arts Safety

NEW AMERICAN ACADEMY OF PEDIATRICS REPORT ENCOURAGES SAFER PARTICIPATION IN MARTIAL ARTS 

Nation’s pediatricians offer guidance on injury risks among various forms of martial arts, including mixed martial arts

Karate, taekwondo, judo and other martial arts can boost fitness, motor skills and emotional development for the estimated 6.5 million youth participants in the United States. But these increasingly popular activities also come with injury risks, which are strikingly higher for some techniques and movements within various disciplines.

A clinical report from the American Academy of Pediatrics (AAP) in the December 2016 journal Pediatrics, “Youth Participation and Injury Risk in Martial Arts” (published online Nov. 28), promotes safer participation in martial arts by guiding families to choose non-contact forms of martial arts that provide health benefits but lower risks of serious injury.

"There are so many different types of martial arts for families to consider and enjoy, but such a difference in injury risk between the different non-contact and sparring forms,” said author Chris Koutures, MD, FAAP, a member of the AAP Executive Committee on Sports Medicine and Fitness. “We hope that this report will enable pediatricians to help families select the most appropriate options for their child and realize how strongly certain practices and rules can impact a participant’s safety.”

Most martial arts injuries, such as bruises and sprains, are not life-threatening. But more serious injuries such as neck trauma, concussions and fractures do occur, especially during free sparring in competitions. Injury rates vary from 41 to 133 injuries for every 1,000 athletic exposures, depending on the form of martial art. Protective equipment such as soft helmets and mouth and face guards are not proven to prevent concussions and may provide a false sense of safety, according to the AAP.

The AAP recommends martial arts competition and contact-based training be delayed until children and adolescents demonstrate adequate physical and emotional maturity. The AAP calls for the elimination of certain rules, such awarding extra points during tournaments for kicks to the head, a rule recently enacted in taekwando, that can have particular impact on concussion rates.

The AAP strongly discourages youth participation in practices common in mixed martial arts (MMA) such as direct blows to the head, repetitive head thrusts to the floor and choking movements, which can dramatically increase risk of concussion, suffocation, spine damage, arterial ruptures or other head and neck injury. The AAP also cautions against excessive media exposure to MMA contests, which can put children at risk of injury if they imitate what they see.

Seven Practical Observations on Dealing with Shin Pain in Athletes

After seeing plenty of shin pain in ballet Nutcracker performers , Olympic Volleyball players and various other athletic activities , here are 7 practical clinical observations to help assess and treat this common problem.

1)      Look above the shin

Landing  from a jump with inadequate hip or buttock strength can lead to an inward collapse of the knee, placing abnormal rotational forces on the shin.  Similar lack of upper leg control can lead to collapse of the foot arch in running, again causing increased stress on the shin. Any complete evaluation of shin pain should include some form of hip/buttock strength- my favorites include the single-leg squat, step-ups,or plie in 2nd position for dancers. Ideal alignment has kneecap directly under the hip and over the 2nd toe.

 Plie in second position: note kneecap directly under hip and over 2nd toe

Plie in second position: note kneecap directly under hip and over 2nd toe

2)      Look immediately below the shin

Decreased ankle dorsiflexion (ability to move shin towards the foot or foot toward the shin)is yet another contributor to increased stress of the shin bones. Common causes include tight calf muscles or restricted movements between the tibia (shin bone) and the talus (first bone of the foot).  Side-to-side dorsiflexion motion comparisons can help identify abnormalities.

3)      Try to stand on toes or walk on the outside of the foot

If the calcaenous (heel bone) doesn’t move inward when standing on the toes, or if there is an inability to walk comfortably on the outside border of the foot, start thinking about restricted midfoot subtalar joint motion. Much like limited dorsiflexion, subtalar dysfunction transmits excessive forces to the shin region.  Tarsal coalition is a fairly common and under-recognized form of subtalar restriction.

4)      Never under appreciate the importance of the big toe

Amazing how restrictions within the small 1st metatarsophalangeal joint (aka big toe joint) can lead to big problems in the shin. Limited ability to raise the big toe off the ground toward the shin leads to either increased pressure on the outside of the foot or higher forces on the front of the shin during foot impact with the ground.  Stretching of the flexor hallicus longus muscle that controls big toe motion can be life and career-saving.

5)      Stressful causes of cramping calves

While most forms of generalized tightness or cramping in the calves are usually due to muscle fatigue and relative overuse, be more suspicious of cramps that can be pointed out by a finger tip and are located right next to the upper part of the tibia bone. Have found 2 recent cases of tibial stress reactions that presented with the primary concern of localized calf cramps.

6)      How are the iron stores?

Some cases of long-standing or difficult to treat shin pain may be complicated by low ferritin (measure of iron stores in the body).  More likely in females with heavier menstrual losses or those athletes and performers with restricted dietary iron intake.  I will routinely order laboratory testing in my evaluation of challenging shin pain.

7)      What are you wearing on your feet?

 source:http://runhealthylifestyle.com/2016/08/25/careful-flip-flops-dangerous-summer-choice/

source:http://runhealthylifestyle.com/2016/08/25/careful-flip-flops-dangerous-summer-choice/

Practicing in Southern California, I often see patients who will select the best in athletic footwear, but then come into my office and routinely report wearing ill-fitting or poorly supportive shoes or sandals for non-athletic activities.  I’ve learned that if you can twist a shoe or sandal like a rolled newspaper, then there isn’t much mid-foot support. Use of relatively inexpensive over-the-counter arch supports in daily use shoes can allow one to be both fashionable and functional, while leaving sandals for the pool or beach.